Fewer people in Dutch ICs, but scaling down capacity ‘not wise’ 11:54 in Binnenland Excess mortality during corona is one of the causes. In addition, operations have improved, as a result of which people do not spend a shorter time in the ICUs.

It is quiet in the intensive care units in Dutch hospitals. The occupancy in the ICUs was lower last spring and summer than in the last summers before the corona pandemic.

It concerns an occupancy of about 60 percent, so four of the ten beds are empty. De Volkskrant writes about that today.

“We think it’s because people died in corona time, who would otherwise be in ICU now,” says Iwan van der Horst, head of the IC at MUMC+ in Maastricht and chairman of the Dutch Association for Intensive Care, in NOS. Radio 1 Journal. By this he refers to people with weaker health who have died during the pandemic.

Operations are also said to have improved so that people do not end up in ICU or for less time. Added to the fact that there is currently no virus that causes a lot of admissions, this means that things are quiet now, says Van der Horst.

Images of ICs during corona

The corona pandemic also has an effect in another way. With the collective memory of overcrowded ICUs during the pandemic in mind, the conversation patients have with doctors about their treatment has changed. “There is more talk with patients about what they find desirable or not,” says Van der Horst. For example, it can happen that someone chooses not to be treated in the ICU.

According to Hans van der Hoeven, professor and head of intensive care at Radboudumc in Nijmegen, people have “a much more realistic picture” of what IC care actually entails during the corona crisis, he tells de Volkskrant. As a result, patients wonder whether they would even want to be admitted to intensive care if that were the case.

In addition to the fact that an ICU admission is drastic for the patient, it is also expensive for society. Van der Hoeven therefore thinks it is right that the new IC guideline gives a prominent place to the cost-benefit assessment. “15 percent of patients die in our intensive care unit. In the end, we only caused them a disadvantage, at a high social cost”.

Snapshot

The fact that it is now quiet in the ICUs does not mean that it will stay that way. “This is a snapshot,” emphasizes Van der Horst. In the summer it is always quieter in the ICUs and due to the aging of the population, many more people may need a place in the intensive care units in one or two years’ time.

“Of course we have not forgotten what it was like in a time of pandemic.” That is why he wants Dutch ICs to be well prepared to handle the capacity if demand were to increase again. According to him, the aim of intensive care is to have capacity available when it is needed. “It is much less interesting if it happens to be quiet for once. Because that is not annoying for anyone, except that staff cannot be deployed optimally.”

Health insurers

Bart Berden, chairman of the board of the Elisabeth-TweeSteden Hospital in Tilburg, says in de Volkskrant that he sees that health insurers want to reduce the reimbursement for IC care in the coming years due to the low occupancy rate. Then hospitals are forced to reduce the number of IC beds. He argues for some breathing space instead of scaling down. “Scaling up IC care again is a lot more difficult than scaling it down.”

Van der Horst says in the NPO Radio 1 Journaal that he does not yet have any concrete indications that health insurers want the capacity in ICs to be scaled down. He thinks scaling down is not a good choice.

“I think it is very unwise to see a trend in the current occupation that will continue in the coming years. From the point of view of the quality of IC care, I can only say that having sufficient capacity is the best choice to prevent the scenario when it gets busier, you want to have that capacity when you need it.”