Critical care is of vital, life-saving importance, but services are fragmented, expensive and under pressure. And, while there is a strong database about the illnesses of patients, there has been a dearth of useful management information about critical care resources, the treatments given and their effectiveness.
Mismanagement can have adverse effects on trust-wide performance and quality - for example, major surgery may be cancelled when critical care units are full. The report makes explicit the links between organisation, efficiency and quality. Key improvements will require the involvement of those at the highest level of the trust - a good test-bed of the new proposals on clinical governance. To help fill the information gap, the Audit Commission's study included a national survey of bed numbers and staffing resources in England and Wales that secured a 100 per cent response from trusts and 85 per cent response from general adult units.
This report is not a blueprint for the reconfiguration of the country's network of services. It does not consider the number of beds needed nationally, the workings of the National Intensive Care Bed Register, whether current patterns of transfer between hospitals are appropriate, or how to transfer patients safely. This is because the NHS Executive has just carried out regional reviews, based on the survey information reported here. Instead, the Audit Commission's recommendations are aimed at helping individual trusts to improve their services.
Included in this report:
- reviewing the service
- improving survival and quality of life
- reducing costs through flexibility
- managing a complex network