Sweden’s declining critical care beds worry ICU personnel [Advocacy Lab Content]

7 months ago 30

The number of intensive care beds in Sweden continues to fall, raising concern among dedicated doctors and nurses. It is estimated that an additional 60 to 80 critical care beds will be needed soon.

Healthcare personnel’s hopes for better-staffed Swedish intensive care services after the pandemic have been dashed. The Swedish Intensive Care Registry, SIR, recently reported a 5% loss in Swedish intensive care unit (ICU) beds from 2019 to 2024, with the number of available beds falling from 523 to 499

A major reason for this is the lack of intensive care specialists, and in particular, a large shortage of intensive care nurses. Working 12-hour shifts and seeing an extraordinary number of patients die during the pandemic caused many specialist nurses to quit and turn to new careers.

“As a result of the pandemic – our hospital was one of the hardest hit Swedish hospitals – many nurses decided to leave their jobs. When it was at its worst during the pandemic, we lost 25% of our intensive care nurses,” David Konrad, Managing Director of Perioperative Medicine and Intensive Care at the Karolinska University Hospital in Solna, near Stockholm, told Euractiv.

Working at full capacity

Even though the Karolinska Hospital has one of the most advanced intensive care units in Sweden (EU category 3), it still struggles with high bed occupancy.

“Today, it is close to 100%”, David Konrad said. At the same time, due to a lack of ICU nurses, 20 ICU beds are empty.

“We have become much better at getting our nurses to stay, but we still need more intensive care capacity,” Konrad continued. He would like to open six to eight ICU beds as early as tomorrow, if possible.

“But I can assure the patients that if anybody needs an ICU bed, he or she will get one”, he said decisively.

More ICU beds will be needed

David Konrad estimates that by 2030, the Stockholm region will need 30 more intensive care beds. To accomplish this goal, an extra 150 ICU nurses are needed, as five nurses are needed for each ICU bed.

In the latest reported national figures from 2021, Sweden had 4,9 ICU beds per 100,000 inhabitants, the second lowest OECD rate after Iceland. But in 2021, COVID-19 was in full swing.

Since then, there has been a continued decline in the number of beds in Sweden.

Speaking with Euractiv, Johnny Hillgren, the head of the SIR registry and an intensive care specialist in the region of Gävleborg, said that Sweden cannot reduce its ICU bed numbers any further.

“We must reverse the trend. Everyone is working to cover the need for more beds. The rate at which we succeed will depend on how well we manage the supply of skills,” he said. Hillgren estimates that Sweden will need 70-80 more critical beds going forward.

Intermediate care beds

However, Swedish regions have been compensating for the lack of critical care beds, by installing intermediate care beds at hospitals. These beds may provide, among others, breathing support such as CPAP (Continuous Positive Airway Pressure), and High-flow Oxygen Therapy. The Swedish Intensive Care Registry is now inventorying the number of these intermediate care units.

According to Swedish doctors, intermediate beds are sometimes included in the OECD figures for ICU beds. For example, Germany ranks high among OECD countries with 29,3 intensive care beds per 100,000 people (2021).

How to increase ICU nurses

Lotta Johansson has been an ICU nurse for more than 30 years. Between 2018 and 2021, she was the head of 150 specialist nurses and assistant nurses at Sweden’s largest hospital, the Sahlgrenska University Hospital in Gothenburg, where she still works. At the same time, she leads the Aniva, the national association for nurses working with anaesthesia and in intensive care.

“Well, I don’t think that hospital management really understands how resource-sensitive intensive care is and that ICU nurses have multiple and advanced work tasks at hand,” she said. To make a change, she believes that nurses, as experts on nursing care, need to be offered seats in hospital management groups.

“Nurses care for patients and train other nurses to become specialists, and they participate in or conduct research activities, and they also work to make the care up to date with new knowledge.”

Military hospitals’ need for nurses

Swedish military rearmament is also affecting health care as the Swedish defence forces are planning to set up three extra mobile field hospitals on top of the two existing ones. They are, therefore, looking for about 1,500 doctors and nurses ahead. Many of them are specialised in trauma care and are today working at civilian hospitals, according to Swedish Radio.

Sweden’s new membership in NATO might also suggest that more ICU beds will be needed in the future.

“Intensive care is a demanding form of care for all personnel. We have to design the posts in a sustainable way so that our ICU personnel wants to stay but also to attract new colleagues to the profession,” said Sten Rubertsson, Professor at the Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala Univerity.

[By Monica Kleja, edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy Lab]