Achieving Economy of Scale in Critical Care, Planning Information Necessary to Support the Choice of Bed Numbers

Aims: To investigate the need for additional critical care beds, the potential for economy of scale in larger units, including ratios to support the choice of bed numbers.

Study Design: Time trend analysis and construction of useful ratios to assist planning.

Place and Duration of Study: Operational data for English NHS hospitals (2011 to 2016) obtained from NHS agencies. Analysis of critical care data at King’s College Hospital from April 2013 to February 2016.

Methodology: Analysis of time trends and/or calculation of averages and ratios of critical care beds per total hospital beds in different categories.

Results: In England, demand for critical care beds is growing at around 2.6% per annum. In 2015/16, the ratio of critical care beds to total hospital beds ranges from an average of 1:5 in tertiary/specialist hospitals to a minimum of 1:50 in general hospitals. Ratio of neonatal beds to maternity beds is around 1:5. Critical care units with more than 35 beds (adult, pediatric or neonatal) operate at around 85% annual average occupancy. Average monthly occupancy across the whole of England correlates with total monthly cancelled urgent operations.

Conclusion: Smaller units require far higher levels of flexibility in staffing and will suffer the unavoidable consequences of higher costs and the knock-on effects of periods of 100% occupancy. Smaller units must become part of a larger network in order to compensate for the higher volatility in CCU demand as size reduces.