critical care bed
To quantify the numbers of critical care beds in Europe and to understand the differences in these numbers between countries when corrected for population size and gross domestic product.
Prospective data collection of critical care bed numbers for each country in Europe from July 2010 to July 2011. Sources were identified in each country that could provide data on numbers of critical care beds (intensive care and intermediate care). These data were then cross-referenced with data from international databases describing population size and age, gross domestic product (GDP), expenditure on healthcare and numbers of acute care beds.
We identified 2,068,892 acute care beds and 73,585 (2.8 %) critical care beds. Due to the heterogeneous descriptions of these beds in the individual countries it was not possible to discriminate between intensive care and intermediate care in most cases. On average there were 11.5 critical care beds per 100,000 head of population, with marked differences between countries (Germany 29.2, Portugal 4.2).
The numbers of critical care beds per country corrected for population size were positively correlated with GDP (r 2 = 0.16, p = 0.05), numbers of acute care beds corrected for population (r 2 = 0.12, p = 0.05) and the percentage of acute care beds designated as critical care (r 2 = 0.59, p < 0.0001). They were not correlated with the proportion of GDP expended on healthcare.
Critical care bed numbers vary considerably between countries in Europe. Better understanding of these numbers should facilitate improved planning for critical care capacity and utilization in the future.
The need for critical care capacity worldwide is increasing
. This has been described in the USA, where it is recognized that future provision of critical care is unlikely to be able to meet the estimated demands
. This potential shortfall has also been described in other countries, such as Norway, as a result of changes in population demographics
. Similar patterns are being described in many other countries, although most have been unable to accurately quantify the problem. The future increase in demand is due to a number of factors that include significant changes in the size and age of the population, together with increasing prevalence of relevant comorbidities and changing perceptions as to what critical care can offer [4, 5].
The identification of mechanisms to prevent this mismatch developing needs to take place with some urgency. Several factors have to be taken into account, all of which interact with each other at a variety of levels. Unless admission and referral practices change, the increased future demand can only be met by an increase in total capacity [
2, 6]. Without an increase in capacity there will need to be rationing or triaging of available resource to ensure that patients who are most likely to benefit can receive the care they need . Although part of this change may be met by increased provision of outreach and intermediate care , there will also need to be an increase in the number of critical care beds and hence also an increase in the numbers of appropriately skilled healthcare professionals to care for the increased number of patients.
To plan for these changes there is a need to better understand the current situation of critical care bed availability [4, 9–11]. Although several countries publish the numbers of beds provided, little is known about how this varies between countries even within a confined geographical region such as Europe.
This study therefore aims to identify the total numbers of critical care beds for each country in Europe and to adjust the bed numbers to the population in order to illustrate the differences in resource provided for this group of patients.
Materials and methods
This was an observational study assessing the numbers of adult critical care beds in each country in Europe between July 2010 and July 2011. For the purposes of this study critical care includes intensive care (ICU) and intermediate care beds (IMCU).
To be included in this study, the bed had to be open, staffed and fulfil any relevant national criteria, where available. The following were excluded from the data collection: private healthcare providers, neonatal and paediatric intensive care beds, coronary care, stroke and pure renal units. The numbers of beds in each country were obtained by assessing data from reliable governmental sources (websites and contacts), national societies with a declared interest in intensive care medicine, national training boards, faculties or colleges and national registries where appropriate.
Data obtained were then cross-referenced with the national council representative for the European Society of Intensive Care Medicine (ESICM) and other personal contacts with knowledge of their country, in order to provide face validity for the numbers obtained. In countries where, following this approach, data were still not forthcoming, personal contacts were used and numbers were estimated according to a local sample assessment.
Data describing the total population of each country were identified from a series of publicly available databases. These included the European Commission database (Eurostat) (ec.europa.eu/Eurostat), the World Health Organization (WHO) regional office for Europe, the Central Intelligence Agency (CIA) World Factbook (https://www.cia.gov/library/publications/the-world-factbook/) and the Organisation for Economic Co-operation and Development (OECD). Data were analysed using Graphpad Prism (version 5.1a) and are presented as numbers with a percentage. Linear regression analysis was performed in order to assess likely associations. A p value of less than 0.05 was taken to be significant.
In many countries, readily accessible data with regards to the provision of critical care bed numbers were not available. In some countries, for instance the UK, there were governmental census data. In other countries, data were available through national societies (for instance, Germany).
In others no data were found, and local clinicians had to count the beds themselves (Portugal). There were marked differences in how critical care services were set up between countries, with some having separate intermediate and intensive care (Table ESM 1), whilst others manage both flexibly within single services. Some countries also included higher levels of care in acute general wards, for instance the Czech Republic.
We identified a total of 2,068,892 acute care hospital beds in Europe, with marked differences in total numbers of beds and also in the numbers of beds corrected per 100,000 of population between countries (Table 1). On average there were 409 acute care beds per 100,000 head of population. A total of 73,585 critical care beds were identified in Europe.
This equates to an average of 11.5 beds per 100,000 head of population for Europe as a whole. The country with the highest number of beds was Germany (23,890), and the country with the least number of beds was Andorra (6). When the total numbers of beds per country were corrected for the size of the population, the differences were less marked although still present (Table 2). Germany still remained the country with the highest number of beds (29.2/100,000), whereas Portugal had the lowest (4.2/100,000) (Fig. 1).