Unprecedentedly few patients in Dutch hospitals' intensive care units
It is currently unprecedentedly quiet in the intensive care units of Dutch hospitals. While the ICUs were flooded during the COVID-19 crisis, there are presently more staff than work for them to do, various intensive care experts told De Volkskrant.
There are no hard figures for 2023 yet. “But the trend is that we have never had it so quiet, “ said Hans van der Hoeven, professor and head of the intensive care unit at Radboud University Medical Center in Nijmegen.”
According to Iwan van der Horst, head of the ICU at the MUMC+ in Maastricht and chairman of the Dutch Association of Intensive Care (NVIC), the ideal situation is to have about 85 percent of ICU beds occupied. “Then it is not too busy, but not too quiet either. We now have an occupancy of 60 percent for a long time.”
A big reason for the currently low occupancy rate is the pandemic. “Many people died during the Covid period, and also in the first winter after corona. These were mainly patients with fragile health. Without Covid, they might now have been in the ICU,” Van der Horst said.
Another factor is that the pandemic gave doctors and patients a “much more realistic picture” of what ICU care really entails, Van der Hoeven added. It’s made patients wonder whether they really want to go to the ICU if they become so ill and potentially spend the last stage of their lives there, and made GPs and specialists more hesitant to refer patients to intensive care, he said. About 15 percent of people admitted to ICU die there. “In the end, we only caused them harm at a high social cost,” Van der Hoeven said.
But the current low patient numbers are no reason to cut capacity, Bart Berden, chairman of the Elisabeth-TweeSteden Hospital in Tilburg, stressed. According to him, health insurers are considering reducing reimbursement for ICUs in the coming years. “I would argue for some breathing space. If reimbursement is lower, hospitals are forced to reduce the number of ICU beds. But, it is unclear whether the number of patients will increase again in the coming years. And scaling up intensive care again is much more challenging than scaling it down.”
Van der Hoeven agrees. Given the aging population, the demand for ICU care will likely increase again once the post-Covid effect wears off. But he added: “We are in an environmental crisis. More money needs to be spent on prevention. Then it is logical that you critically examine the ICUs, an expensive form of care with relatively little social health gain.”