The clinical and operational consequences of prolonged occupancy strain and the use of non-intensive care beds to deliver critical care in a central london teaching hospital.

Since 2000, there has been a marked reduction in non-clinical critical care transfers in England. ICNARC have reported that this has been associated with a reduction in case-mix adjusted mortality (1). One consequence has been the need to open critical care beds in non-specified locations in hospitals such as post anaesthesia recovery and high dependency areas. Here we report the consequences of an unprecedented strain on ICU capacity sustained at a central London teaching hospital over a 12 month period in 2013 (graph 1). During this period, ICU capacity reached >150% requiring a number of different emergent solutions including the use of main theatre recovery and high dependency areas. We also describe some of the clinical and operational lessons we learnt.