Audit of critical care in NHSScotland
Reporting on 2023

About this release

This release by Public Health Scotland (PHS) and the Scottish Intensive Care Society Audit Group (SICSAG) provides a summary of the activity, quality indicators, interventions and outcomes of critical care services in NHSScotland during 2023. Critical care units are specialist hospital wards for the most severely ill or injured patients. They treat patients with a high level of complexity, and this can be in either an Intensive Care Unit (ICU), a combined unit which acts as both an ICU and High Dependency Unit (HDU) or a standalone HDU.

Main points

• During 2023, there were 17,199 admissions to ICUs and combined units. There were 20,586 admissions to standalone HDUs.
• Mortality in ICUs/combined units was 11.8% and in HDUs was 5.3%. After allowing for differences in case-mix and illness severity, no ICU/combined unit had a significantly higher standardised mortality ratio than the national average.
• Delayed discharges, where a patient remains in critical care for more than 4 hours after being declared ready for discharge continues to be challenging. In 2023 62% of discharges were delayed in ICU. This remained the same elevated level as 2022, reflecting bed pressures across hospitals. In HDUs this was similar with 63% of patients delayed for more than 4 hours in 2023, compared with 59% in 2022.
• Five out of 22 ICUs did not achieve compliance with at least one of the SICSAG Minimum Standards and Quality Indicators (MSQIs) with staffing challenges across the multi-disciplinary team contributing to the reason for non-compliance in many cases.
• 14 out of 25 HDUs did not achieve compliance with at least one of the MSQI, of which seven units did not achieve more than one. Staffing challenges were again amongst the main reason for this.
• All units not meeting MSQIs have provided a summary of how they plan to achieve these in the coming year. This information can be seen in the MSQI section of the annual report.
• SICSAG are currently reviewing the MSQIs with the intention to provide a more focused, reduced list of SICSAG standards, the final draft will be shared with wider stakeholders in the coming months.

Background

This audit includes all ICUs and the majority of HDUs in NHSScotland during 2023.

It is not possible to provide an accurate figure on the number of HDUs due to differing provisions across all specialties and NHS boards. However, it is estimated that more than 95% of all HDUs participated in this audit. The audit covers nearly 35,000 patients admitted to critical care units in NHSScotland during 2023.

SICSAG aims to improve the quality of care delivered to critical care patients by monitoring and comparing activities and outcomes. The audit of critical care is a co-ordinated quality improvement programme which provides data, analysis and feedback to raise standards and continued improvement in patient outcomes.

Critical care units have provided detailed comments where any MSQIs have not been met.

Further information

The next release of this publication will be 12 August 2025.