Critical care capacity may vary according to:
- physical capacity and equipment
- management decisions (i.e. number of funded beds at a particular period)
- short term staffing fluctuations (staffing levels, vacancies, sickness, Agency availability)
- patient flow (delayed discharges, step-down capacity)
Capacity determines access for patients: failure of access may include:
- inability to admit an unplanned emergency patient, causing delayed admission, care in an inappropriate area, or transfer
- cancellation of elective procedure due to lack of appropriate bed
- inability to admit a tertiary referral admission needing critical care.
Lack of capacity
Failure of access to critical care can be life-threatening. Local capacity decisions (e.g. planned change in staffed bed numbers) will have knock-on effects on other units and hospitals in the Network and in London, and on wider patient flows and commissioning.
- For example, a local unit which is temporarily one bed down due to sickness or other absence on one shift, or a temporarily closed bed, may result in a patient being transferred to another part of London for a potentially long stay, at a cost which exceeds that of the single bed-day/shift that was saved locally.
- In addition this is an avoidable clinical risk for that patient, and potentially a greatly increased travel burden for relatives.
For these reasons, the Network monitors capacity-related issues particularly at times of high pressure (e.g. winter).
- Questionnaires and guidelines on maximising capacity are issued according to circumstances, and findings may be shared back with units, Trust critical care delivery groups, and commissioners.
- Units and Trusts can help to maintain communications and Sector-wide planning by making early notification of planned or unplanned changes in bed numbers and activity.