Strong outcomes despite sustained pressure on capacity – NOCA ICU audit

The National Office of Clinical Audit (NOCA) has today published the Irish National ICU Audit (INICUA) National Report for 2024, providing a comprehensive overview of activity, capacity and outcomes across adult intensive care units (ICUs) and high dependency units (HDUs) in Ireland.

The report analyses care delivered to 16,394 patients in 29 ICUs and HDUs, capturing virtually all critical care activity in adult public hospitals. Despite ongoing pressure on bed capacity, ICU services continue to deliver safe and effective care once patients are admitted to ICU, with outcomes in line with international benchmarks. The report also suggests, however, that some critically ill patients who could benefit from care in ICU continue to be cared for in hospital wards because of lack of ICU capacity.

KEY FINDINGS

• Average ICU/HDU bed occupancy was 94 per cent, significantly above the recommended safe level of 85 per cent, with some units operating at or above 100 per cent occupancy, reflecting sustained pressure on critical care capacity.
• Patients in Ireland were more severely ill by the time of ICU admission, with a median predicted risk of death of 7.7 per cent compared with 5.0 per cent in the UK. In addition, 31 per cent of patients admitted from wards or emergency departments had very high early warning scores (INEWS ≥10), suggesting delayed recognition or escalation of care. Thus, patients had to be sicker in Ireland to get admitted to ICU.
• Delays in access to ICU remain evident, with 35 per cent of patients admitted within one hour of the decision to admit and 90 per cent within four hours; these figures have improved over recent years. Ideally, critically ill patients would be admitted to ICU immediately as delays lead to worsened outcomes and reflect limited bed availability.
• Patient flow through ICU continues to be impacted by system pressures, with 9.4 per cent of ICU bed days occupied by patients who were clinically ready for discharge but were awaiting transfer to a ward. Unplanned night-time discharges accounted for 3.5 per cent of all discharges, almost double the rate reported in the UK.
• Organ donation activity decreased in 2024. There was a small decrease in donors after brain death (62 versus 64 in 2023) but the decrease in the proportion of brain death patients progressing to organ donation (59 per cent in 2023 to 50 per cent in 2024) is a concern for the future. This decrease was due to a decline in consent rates by families from 75 per cent in 2023 to 59 per cent in 2024. Numbers of donors after circulatory death decreased from 24 to 17.
• 81 per cent of patients admitted to ICU survived to hospital discharge, with an ICU mortality rate of 13 per cent and a further 6 per cent of patients dying after ICU discharge, before leaving hospital. Risk-adjusted mortality remained better than predicted (SMR 0.93), with all units performing within expected ranges, indicating consistently safe care nationally.

The report highlights that ICU capacity remains low by international standards, with 5.8 public critical care beds per 100,000 population in 2024, compared with 7.0 in the UK. As of March 2026, the average number of open ICU beds in Ireland had increased to 332, equivalent to 6.1 public beds per 100,000 population, representing a significant increase in national capacity. However, demand for critical care continues to exceed available capacity, and occupancy levels remain above recommended thresholds.

A national programme of further expansion of critical care bed capacity is underway through the Strategic Plan for Critical Care, which aims to bring capacity to 458 beds over two phases*. Separately, NOCA is providing data to inform the Department of Health, HSE, and the Economic and Social Research Institute to define future ICU capacity requirements out to 2040, taking account of population ageing and increasing clinical demand.

Prof Rory Dwyer, Clinical Lead for the Irish National ICU Audit, said: “This report shows that ICU care in Ireland continues to deliver strong outcomes for patients, with all units performing within expected ranges for risk-adjusted mortality. This reflects the expertise and commitment of multidisciplinary teams working across the country. At the same time, the findings highlight ongoing challenges in access to ICU care. High occupancy levels and delays in admission mean that patients are often sicker by the time they reach ICU. Continued expansion of both ICU and HDU capacity will be important to support timely access to care and maintain safe patient flow.”

The report includes a patient perspective from Ms Chloe Greene, who describes her experience of critical illness and recovery following multiple ICU admissions in her 20s. Her account highlights the complexity of ICU care and the importance of clinical expertise, clear communication and support for patients and families during and after a critical illness.

HSE response

The HSE said it welcomed the publication of the report and will work to implement its recommendations.

“We are pleased that the report finds that ICU services continue to deliver safe and effective care once patients are admitted to ICU, despite ongoing pressure on bed capacity, and that our ICU staff provide a high quality of care for patients in ICU.”

According to the HSE, there is a plan in place to bring the total number of ICU beds to 358 in 2026 through the delivery of six level 3 ICU beds in the Mater Misericordiae University Hospital and six level 3 ICU beds in St Vincent’s University Hospital. Phase 1 of the Critical Care Strategic Plan will also see the following developments to improve the provision of adult critical care nationally:

• development of the critical care workforce by increasing the numbers of onsite critical care nurse educators and by increasing access to critical care nurse education at foundation and postgraduate levels
• increase in the number of hospitals with critical care outreach teams to improve patient care and reduce re-admissions to critical care units
• increase in the capacity of the National Ambulance Service’s critical care retrieval services.

Regarding organ donation, HSE Organ Donation and Transplant Ireland (ODTI) is “actively engaging” with every ICU in the country to ensure that key staff are trained and equipped to support organ donation following both brainstem death (DBD) and circulatory death (DCD).  ODTI is currently piloting a programme that will make possible increased use of DCD organs.

“We are also working closely with ICUs to strengthen education on the consent process as there is clear international evidence that involvement of specialist organ donation nurses results in higher levels of positive consent being obtained.  The ODTI also continues to raise public awareness about the long-term benefits and success of organ donation, and that organ donation saves lives.”

* Under Phase 1 of the Strategic Plan for Critical Care, there has been an additional 88 beds delivered to date, with the final six beds under Phase 1 included in the HSE 2026 Service Plan. Additional capacity of 106 critical care beds is envisaged under Phase 2 at five key hospital sites.