NOCA data central to ICU capacity expansion planning

HSE plans ICU bed capacity expansion to cover ongoing intensive care requirement by Covid-19 patients

A return to normal hospital activity means a return to normal baseline requirement for intensive care unit (ICU) beds by non-Covid-19 patients and this requires increased capacity, according to Dr Rory Dwyer, Irish National ICU Audit Clinical Lead.

The Health Service Executive (HSE) is currently planning an expansion in ICU bed capacity to cope with what is expected to be ongoing requirement for intensive care beds by Covid-19 patients. National Office of Clinical Audit (NOCA) data on Covid-19 activity and on baseline non-Covid-19 activity is central to planning this.

In early March, Dr Dwyer said that the NOCA put other projects on hold, to fast-track the development of a web-based display of ICU bed occupancy and availability across the acute hospitals. This was the NOCA Intensive Care Unit Bed Information System (ICU-BIS) that they had been working on for some time.

They recognised this could play a central role in monitoring and responding to Covid-19 pressures on ICU capacity.

In an update, Dr Dwyer underlined that the team had worked late at night and at weekends to design the configuration of the system, working with their IT partners in DMF Systems to implement and test the software design, communicate with the hospitals, the HSE and the Department of Health and to train staff in the hospitals to use the system.

On March 26, the system went live just as ICU bed occupancy with Covid-19 patients had started to increase exponentially.

The ICU-BIS provided a real-time overview of bed occupancy and bed availability nationally. This provided visibility of hospitals that were approaching the limits of their capacity, to trigger transfers of patients to other hospitals with spare capacity.

This allowed monitoring of trends and of spare capacity in ICU.

This was the most up-to-date and accurate measure of the number of critically ill patients with Covid-19.

This data was used by the Department of Health to monitor trends in Covid-19 numbers bed availability in ICU and provided the data quoted in the media.

Government decisions about restrictions on activity were based on predictions from ‘modelling’ experts on likely patterns in Covid-19 infection rates and the ability of the health system, especially ICU beds, to cope with patient numbers.

NOCA data both from the ICU-BIS and ICU Audit data had been a central part of the data they were using to make these predictions.

As part of the ICU-BIS project, NOCA had undertaken a detailed census of ICU potential bed capacity at different levels of ‘surge’ in Covid-19 patient numbers.

He added that these developments had been achieved by a small team in NOCA who put their other lives on hold to complete the ICU-BIS project in time for the surge in Covid-19 activity.

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