National audit of critical care resources in South Africa: unit and bed distribution

Abstract

Objective: To determine the national distribution of ICU/HC units and beds.
Design and Setting: Descriptive, non-interventive, observational study design was used. An audit of all public and private sector ICU and high care units in South Africa was undertaken.
Results: A 100% sample was obtained. 23% of public and 84% of private hospitals have ICU/HC units. This translates to 1 783 public ands 2 385 private beds. Only 18% of all beds were high care beds. The majority of units and beds (public and private) were located in three provinces: Gauteng, Kwazulu-Natal and the Western Cape. The Eastern Cape and Free State had less than 300 beds per province; the remaining four provinces had 100 or fewer beds per province. The public sector bed: population ratio in the Free State, Gauteng and Western Cape was less than 1:20 000. In the other provinces, the ratio ranged from 1:30 000 to 1:80 000.The majorities of units are in level 3 hospitals. The ICU bed to total hospital bed ratio is 1.7% in the public sector compared to 8.9% in the private sector. The ratio is more when the comparison is made only in those hospitals that have ICU beds (3.9% versus 9.6% respectively).19.6% beds are dedicated to paediatric and neonatal patients in the public and private sector with a similar disparity across all provinces. Most hospitals admit children to mixed medical surgical units. Of all ICU beds across all provinces 2.3% are commissioned but not being utilised.
Conclusion: The most compelling conclusion from this study is the need for regionalisation of ICU services in SA.