The demand for ICU-services is increasing in all western countries and complaints about a lack of ICU-beds arise – independent of the actual density of ICU-services in the countries.

Method:

Systematic Review, multistep searches in Medline, EmBase, Cochrane, HTA-Database, Websearches, informal searches through planning and HTA-networks; micro-planning for an Austrian region.

Introduction:

The differences between the density of intensive care in Europe and other parts of the Western world is enormous. At a first superficial glance, Austria and Germany - in absolute figures - have many more ICU-beds than any other European country. In relative figures, taken into consideration that Austria has also many more acute care beds, the number of ICU-beds corresponds to the European average. It is therefore impossible to analyse the need for ICU-beds without taking into account the national context of delivered acute hospital services. Although ICU-services take up about 15-20% of the hospital budgets, many questions remain unanswered.

Results:

• Recent planning-documents: A review of trends in recent planning shows that all planners calculate on the basis of existing style of practice within their countries; the figures change only marginally. But while planners in countries with a relatively low ICU-bed density (GB, Australia, Canada) identify the need for an increase, planners in countries with high density (USA, Germany, Austria) state a "satisfied need" and possibly an over- provision of ICU-services.
• Innovative planners apply an "appropriateness of ICU-use" approach in analysing the scores (esp. TISS) and propose a more flexible organisation of ICUs and a higher proportion of IMCU-beds.
• Clinical and ICU-management tools, such as admission and discharge guidelines, strategies to reduce treatment-variabilitiy, certain organisational changes (leadership, horizontal hierarchy) and costing methods are of increasing importance for the provision of better, more efficient and coordinated use of ICU-resources.

Conclusion:

In countries with a high density of ICU-services such as Austria not expanding capacities, but rather making better use of existing resources is recommended. For a fair comparison participation in national databases, in registers as well as benchmarking and quality-assurance programmes should be enforced.

Applying an "appropriateness" approach, the ICU-data of an Austrian region (Tyrol) are analysed and we devise a plan for the region.