CRITICALLY ill patients are being discharged too early from Tayside’s main intensive care unit because the number of beds available is “inadequate”, a report has warned.

An annual review found that patients treated in the Intensive Care Unit at Ninewells Hospital in Dundee were three times more likely than the Scottish average to be moved to a bed in another department before it was clinically ideal, because the facility does not have enough beds to meet demand.

It comes amid a reorganisation of surgical care by NHS Tayside which will see all emergency patients who require an operation admitted to Ninewells.

The annual Scottish Intensive Care Audit found that, overall, the critical care available nationally is “of a very high standard”, but added: “There is, however, increasing evidence that some areas of the country really do lack sufficient numbers of intensive care beds.”

Chairman of the audit group, Dr Stephen Cole, said: "I would urge those boards that appear to have lower levels of critical care provision to scrutinise this report in detail and to consider their local investment decisions."

A spokeswoman for the Faculty of Intensive Care Medicine added: "Discharge from ICU should only be considered if it is safe to do so and early discharge highlights a lack of resource that will be put under more pressure if demand increases, which may result in patient safety concerns."

It is the first report on intensive care since the definition of early discharge was refined to take into account only those patients who were moved from ICU to a ward where they would receive a lower level of care.

At Ninewells ICU, auditors found that 7% of patients were being discharged too early.

In the "vast majority" of cases they were transferred to a bed in the High Dependency Unit (HDU), or to another ward in the hospital.

The report states: "This figure suggests that the number of physical ICU beds available at Ninewells hospital is inadequate to meet the demands of the service.

"At times of peak occupancy, ICU bed demand appears to exceed the supply and patients were discharged early to a lower level of care.

"The frequency of documented early discharges is more than three times the Scottish average."

The warnings come amid controversy over the decision to centralise the most serious A&E admissions at Ninewells.

The plan, signed off by the Scottish Government in July, means that all emergency patients in Tayside who require surgery will be sent to Dundee, while Perth Royal Infirmary - which has its own A&E and ICU - is upgraded to a centre of excellence for planned operations.

NHS Tayside said work is underway to try to increase ICU capacity at Ninewells.

Professor Peter Stonebridge, NHS Tayside Medical Director for the Operational Unit, said: “Patients and their families should be reassured that any decision to transfer a patient from the ICU at Ninewells Hospital into another specialist area would only be made by the ICU consultant following a full clinical assessment.

“In the vast majority of cases, patients are transferred from ICU to an HDU in Ninewells which is a specialist area for patients who require more intensive observation and treatment than is provided in a general ward.

"In 2017, 28 patients were transferred from ICU in this way, none of whom required to be readmitted to the ICU within a 48-hour period."

He added that the unit's mortality rate was also in line with the Scottish average.

Meanwhile, the auditors said a Scotland-wide spike in intensive care admissions among the elderly over the past decade was "worthy of further investigation".

Between 2011 and 2016, the rate of admissions among patients aged over 70 has increased from 485 per 100,000 to 681 per 100,000.

A spokeswoman for the Faculty of Intensive Care Medicine added: "The ageing population is increasing due to improved health and longevity amongst other things.

"They undergo more complex procedures than would have previously been offered and are more likely to develop medical conditions that require hospitalisation.

"Therefore, there is an increased likelihood of them being admitted to an ICU.

"The ability to discharge this group of patients from ICU to free beds for more admissions necessitates the availability of adequate rehabilitation resources on the ward and in the community."

The report covered some 46,000 intensive care admissions in 2017.

In total, 19% of all patients admitted to intensive care in 2017 died before being discharged from hospital - a similar figure to 2016 - and no unit was found to have a significantly higher mortality rate compared to the rest of Scotland.

Forth Valley Royal Hospital in Larbert was found to have the highest rate of patients waiting too long in ICU once they were fit to move to another ward, mainly due to a lack of available beds elsewhere in the hospital.

More than half (52%) of its ICU patients waited more than four hours at least to be transferred. This compared to an average of 25% across all Scottish ICUs.