Emergency and postoperative access to critical and enhanced care: a multicentre prospective observational study

The ability to admit patients to enhanced or critical care may be limited by bed availability. In a network with low provision of critical and enhanced care beds, we aimed to assess the proportion of patients having surgery with moderate (1%-< 5%) or high (≥ 5%) predicted risk of 30-day postoperative mortality and their postoperative care location. We also aimed to study referral and admission outcomes to critical care.

This prospective, 7-day observational study was conducted across 19 acute hospital sites within the South West Critical Care Network. All adult inpatients having a procedure under the care of an anaesthetist (excluding cardiac and obstetric procedures) had a surgical outcome risk tool score calculated retrospectively, and their postoperative destination captured. Synchronously, all critical care referrals, admissions and refusal decisions were captured, along with critical care bed capacity.

Of 2222 eligible patients, 1728 (78%) were captured. Retrospective surgical outcome risk tool score calculation revealed 1060 (61%) patients had a low, 418 (24%) a moderate and 250 (15%) a high risk of postoperative mortality. In patients with a moderate predicted risk of postoperative morbidity, 72/418 (17%) received enhanced or critical care and 64/249 (26%) patients with a high predicted risk received critical care. All critical care referral and admission activity was captured; in total, 263/680 (39%) of patients referred were admitted to critical care. Referrals to critical care exceeded the available level 3-equivalent beds on 79% of occasions.

These data describe constraints in access to postoperative and emergency enhanced/critical care in the south-west of England. There is poor compliance with national guidance regarding the postoperative care location of patients with a moderate or high risk of postoperative mortality.