Australia has almost 200 fewer ICU beds available this year than at the beginning of the pandemic, making regional areas and some states “vulnerable†to the looming surge of Covid cases, a national intensive care survey has found.
The findings of the survey completed by the Australian and New Zealand Intensive Care Society for the federal health department were provided to national cabinet last month as state and territory leaders prepare for the easing of restrictions with Covid in the community.
The updated data on the number of intensive care beds shows that a total of 2,183 staffed ICU beds were available in Australia at the end of August – 8.2% fewer than the 2,378 available in March 2020.
In regional areas, where vaccination rates are lagging, the number of available intensive care beds has dropped by 18% over the same period to just 262.
Edward Litton, lead author of the Anzics report, which was published in the Medical Journal of Australia on Wednesday, said bed numbers were down compared with 18 months ago because of the pandemic’s hit to the workforce.
“Undoubtedly beds are down, and those are staffed operational beds, and I think that’s a consequence of Covid on our workforce, on our critical care workforce,†Litton told Guardian Australia.
This included the movement of staff to vaccination clinics, the furloughing of staff, work restrictions, the cancellation of elective surgery and in some cases the redevelopment of ICU infrastructure.
Litton said the drop in the availability of beds in regional and rural areas was a concern to Anzics, and workforce issues needed to be urgently addressed to ensure the sector could meet the expected surge in demand.
“What concerns me is the rural and regional areas, and the fact that there remains substantial variation between states,†he said.
“As a community, we need to ensure that we’re able to provide equally as high quality care to those in rural and regional areas as in our metropolitan areas,†he said.
The survey of Australia’s 194 intensive care units found that in the event of surging demand arising from a Covid outbreak, hospitals were theoretically able to ramp up the number of available beds to a total of 5,623 beds – an extra 3,440 beds, or an 158% increase.
This included a total of 813 extra ICU beds within existing departments, and an extra 2,627 beds in “surge areas†outside of ICUs.
However, the survey found that because of staffing constraints, only 383 of these extra beds could be adequately staffed, based on a pre-pandemic ratio of 4.91 full-time registered nurses per available ICU bed.
“ICU capacity can be increased in response to higher demands, but is ultimately constrained by the availability of appropriate staff,†the report concluded.
The forecast surge capacity is also lower than found in the survey of March 2020, which reported the ability of ICU wards to increase bed availability by 191%.
The report highlights a vast difference between states and territories on the availability of extra resources, and calls for urgent strategies to maximise the availability of staff for areas of high demand.
NSW has the highest number of available staffed ICU beds, at the rate of 10.8 per 100,000 population, followed by South Australia (9.1), the ACT (8.6), the Northern Territory (8.1), Queensland (7.9), Victoria (7.1) and Tasmania (7).
Western Australia, which is attempting to remain Covid free by keeping its borders closed to the eastern states, has the lowest number of ICU beds in the country, at six per 100,000 population.
Litton said the differences between states in ICU bed numbers per population could see those jurisdictions with lower capacity “particularly vulnerable†to increased strain as public health restrictions eased.
“New South Wales, actually, in terms of their preparedness with their staffing, had the best number of beds per population of anywhere in Australia so they were best placed to be able to deal with this. Other states are perhaps not quite as adequately resourced.â€
The Anzics paper said efforts to address workforce shortages are needed, which Litton said could include paying nursing staff more to ensure the sector remained attractive.
The paper said the pandemic had been associated with “substantial psychological distress, including anxiety and burnout, among Australian healthcare workersâ€, which needed both a short and long term solution.
Litton said the demands of the pandemic had seen the existing workforce working more hours, but this was not a “sustainable modelâ€.
“That’s not a reasonable model just to continue to ask those on the frontline to just do more, and so I think it’s about our investment in our nursing workforce in particular, ensuring that the high standards of care that they deliver and the training that they receive is adequately recognised and that pathway remains attractive,†he said.
While staffing constraints persist in the sector, the report noted that equipment shortages identified last year have since been “more than overcomeâ€, and there are now sufficient ventilators for every ICU bed.
The release of the Anzics figures comes as NSW fast approaches the 80% double dose vaccination rate as it begins to ease restrictions, with hospital admissions for Covid lower than initially forecast.
Burnet Institute modelling released earlier in September predicted NSW hospitals would peak at about 3,900 patients, including non-Covid patients, in mid to late October, with the number of people in intensive care peaking at 947 at the beginning of November.
As at October 12, there are 565 Covid cases being treated in hospital, with an additional 148 cases in ICU. This is on top of the 6174 cases being cared for at home.
The number of cases is expected to surge when restrictions are lifted next month and Covid patients take longer to recover.
In September, the federal health minister, Greg Hunt, said he was confident that state hospital systems were prepared for the forthcoming surge in demand arising from Covid outbreaks once the country moved into the next phase of the national plan.
“We have the ventilation capacity and the ICU capacity. The thing which in particular that Professor [Brendan] Murphy has been coordinating with all of the states is to make sure that workforce is in place,†Hunt said.
“But we have strong confidence in all of the states and territories to meet the surges as they come.â€
Alison McMillan, the chief nursing and midwifery officer for Australia, said the department was looking at ways to boost workforce availability for surge demand, including training more nurses for intensive care work and encouraging some back out of retirement.
“A whole range of options about how we can surge, and if necessary, mechanisms to share staff across the country if we were needed to do that through emergency management arrangements,†McMillan said.
