Children’s critical care units often exceed recommended occupancy levels

Children’s critical care units regularly exceed recommended occupancy levels and much-needed beds remain closed due to staff shortages, according to a new report.

Occupancy levels at the Republic’s two paediatric critical care units in Dublin are rising year on year and often exceed 100 per cent, the report by the National Office of Clinical Audit finds.

In the month of November 2019 bed occupancy at Crumlin hit a high of 114 per cent. The recommended occupancy rate is 85 per cent.

“Such high occupancy levels contribute to the sudden, unexpected cancellation of semi-elective surgeries, leading to anxiety and upset for families,” the report states.

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Nonetheless, the units are providing safe care, based on a benchmarking of outcomes with 30 other units in Britain and Northern Ireland, according to the Irish Paediatric Critical Care Audit.

The survival rate for children entering critical care is 96 per cent and just 1.5 per cent require emergency readmission within 48 hours.

There are 32 children’s critical care beds available over two sites, Crumlin and Temple Street hospitals, but the report found that only 27 were consistently open and staffed 24/7 over a three-year period.

It called for improvements in staff retention and recruitment so that optimal bed capacity can be prioritised by Children’s Health Ireland.

Respiratory viruses

Capacity in children’s hospitals has come under scrutiny in recent weeks due to a surge in respiratory viruses, notably RSV.

On Sunday night, there was just one available paediatric critical care bed, according to the daily HSE update. Of 30 children’s critical care beds that were open and staffed, 29 were occupied. One child with Covid-19 was in critical care.

Almost 1,500 children a year require treatment in paediatric critical care. Another 111 children aged 16 and under were admitted to adult critical care units in 2019; the report says such patients should be transferred to paediatric services.

More than half of children admitted to paediatric critical care units were aged less than one year; almost three-quarters were aged less than five years. Over 60 per cent required ventilation.

A paediatric high dependency unit at University Hospital Limerick cared for 126 children in 2019. The report says this model of treating sick children locally should be extended to Cork and Galway.

"This report highlights the excellent care provided to sick children in Irish paediatric critical care units, which are safe and compare favourably with units across the UK, despite staff shortages and the continuing high occupancy levels," said Dr Martina Healy, clinical lead for the audit.

Crumlin hospital had the third busiest paediatric critical care unit in Britain or Ireland, while admissions to Temple Street’s critical care unit rose 20 per cent from 2018 to 2019.

Cardiovascular issues accounted for 42 per cent of admission in Crumlin, which is an all-Ireland centre for this specialty. At Temple Street, respiratory conditions was the single biggest cause of admission, at 35 per cent.

Crumlin recorded a bed occupancy of 96 per cent over 2017-2019, and 100 per cent in 2019. At Temple Street, bed occupancy was 88 per cent in 2019.