Professor Rory Dwyer, Clinical Lead of the Irish National ICU Audit launched the Irish National ICU Audit Annual Report 2021 at a virtual meeting on the 8th November 2023.

This Report provides data on 96% of all Intensive Care Unit (ICU) activity in 2021, accounting for 11,420 patients in 26 Units across 22 hospitals. The Audit reports on the care of patients in adult ICUs, the sickest patients in the hospital. The Report offers a deep insight into the activity in these Units and the complexity of care provided, shedding light on resource requirements and areas for improvement in ICU services.

A key insight from the Report shows that risk-adjusted mortality rates were within the acceptable range in all Units. Reassuringly, outcomes were similar whether patients were initially admitted to larger Units, serving over 200 patients annually, or smaller Units with fewer than 200 patients each year. This finding differs to experience internationally which found outcomes were less favourable in smaller compared to larger Units and it reflects well on the consistent quality of care provided across the country. The Report also attributes this finding to the large number of inter-hospital transfers (913 patients, 8% of all admission to ICU), mostly from smaller to larger Units. This practice has played a pivotal role in ensuring the uniformity of outcomes for critically ill patients throughout the ICU network.

The Report sheds light on the pressure on ICU bed availability, particularly during surges in the COVID pandemic. Seventy four percent of patients admitted to ICU survived to leave hospital alive thanks to allocation of significant resources by the healthcare system to this area. This investment needs to continue in order to meet the challenges of our evolving healthcare landscape. The equity in mortality outcomes between smaller Units and larger ICU Units demonstrates the adaptability of our national ICU network, where patients receive consistent, high-quality care regardless of the size of the Unit that patients are initially admitted to.

Professor Rory Dwyer, Clinical Lead of the Irish National ICU Audit

​KEY FINDINGS

ICU Bed Availability

• On average, 303 ICU/HDU beds were open daily in publicly funded hospitals in 2021, which corresponds to 6.0 critical care beds per 100,000 population, compared to the OECD average of 14.1/100,000.

• Fifteen hospitals met the target of 80% of patients admitted to ICU within 4 hours of a decision to admit.

• The national average bed-occupancy rate was 88.5%, slightly above the recommended level of 85%. Many of the larger hospitals had bed occupancy rates above 90%.

Impact of COVID-19

• COVID-19 patients accounted for 29% of all ICU beds occupied in 2021.

• 73 patients admitted to ICU due to COVID-19 were pregnant/recently pregnant; all survived to leave hospital alive.

• Six hundred and three patients with COVID-19 died before discharge from acute hospital, giving a crude mortality rate of 36%. This compared to a 24% mortality rate for the overall ICU population.

• Risk-adjusted 28-day in-hospital mortality rates for COVID-19 patients in Ireland were 13% lower than those in the UK.

Organ Donation

• Brain death was diagnosed in 103 patients, with only 50 becoming organ donors. The biggest factor in these patients not becoming an organ donor was families not assenting to organ donation.

• The proportion of all deceased patients who progressed to become organ donors has fallen since 2019 from 4.7% to 3%.

These key findings underscore the areas where we need to direct our efforts for improvement. These areas include addressing high bed occupancy rates ensuring timely admission to ICU, optimising the inter-hospital patient transfer process, enhancing the quality of patient care, and optimising the use of scarce resources. The Report provides many insights to guide the path towards a system which provides rapid access to high quality intensive care for all those who need it.

Professor Rory Dwyer, Clinical Lead of the Irish National ICU Audit

Presentations

Click on the presentation title below to view speaker PowerPoint presentation slides.

Speaker Presentation Title Dr Martina Healy, National Clinical Lead, Critical Care Programme Welcome Address Professor Rory Dwyer, Clinical Lead, Irish National ICU Audit Irish National ICU Audit Annual Report 2021 - Key Findings & Recommendations Fionnuala Treanor, National ICU-Bed Information System Manager, NOCA ICU Bed Information System (ICU-BIS) supporting the INICUA Dr Mike O'Connor, National Clinical Advisor and Group Lead, Acute Operations Value of ICU Audit for Acute Hospitals

[ National Report]( https://s3-eu-west-1.amazonaws.com/noca-uploads/general/Irish%5FNational%5FICU%5FAudit%5FAnnual%5FReport%5F2021%5FFINAL.pdf]

[ Summary Report]( https://s3-eu-west-1.amazonaws.com/noca-uploads/general/Irish%5FNational%5FICU%5FAudit%5FSummary%5FReport%5F2021%5FFINAL.pdf]