It is remarkably quiet in the intensive care units in hospitals. But 60 percent of the beds are occupied and that has not been this low for a long time. According to ICU doctor Hans Kuijsten of the Elizabeth Hospital in Tilburg, there are three reasons for the relative peace. “Care is better, there is more discussion with patients and their families and cooperation between doctors has improved.”
The images are still fresh in our memories: nurses, doctors and even dieticians who, during corona times, are flown in with protective glasses and face masks to help in the intensive care units. Before the Covid crisis broke out in the spring of 2020, there were significant cuts in healthcare. As a result, if disaster strikes, there will be far too few staff available.
There are many more people in an ICU bed than in a bed in, for example, the orthopedics department. It is the most intensive form of care, as the name itself suggests. But that hustle and bustle has now greatly diminished. In fact, ICU occupancy only continues to decline.
“Families are increasingly choosing not to continue treatment in the ICU.”
This is due to several things, explains ICU doctor Kuijsten. “Surgeons are operating better and care in the departments is also improving. There is simply more knowledge. And if patients recover faster as a result, before an ICU admission becomes a topic of discussion, then that entire scenario can be deleted from the script.”
This has created much more room for discussion between doctors, patients and families. Because if you become ill and there is a high risk that you will no longer be able to talk, walk or breathe independently after an admission, what do you choose? “Families are increasingly choosing not to continue treatment in the ICU,” Kuijsten explains. “It’s more about the quality of life, rather than about survival. Something people thought before, but never really expressed. What is acceptable for the quality of life? And what is not?”
“It’s really too early to scale down.”
Finally, Kuijsten mentions the term ‘IC without walls’ as an explanation. This is a project within the ETZ, in which ICU staff in other departments assist to prevent an admission from having to be discussed at all. “We are increasingly working in other places in the hospital to keep people away from our own department,” says the doctor. Sometimes this is the Emergency Room, sometimes the nursing department, sometimes the operating room. “And then the intensive care unit itself is a kind of fire station. But even if there is no fire, you still have to have it.”
According to Kuijsten, this means that there is no reason to scale down. “That is really still too early,” he says. “Before corona, we knew all the disease patterns. We knew the peaks during the winter and the valleys in the summer. But since the pandemic, this has no longer been possible. So I cannot yet say how permanent or structural it is,” says the doctor.