As per the most recent standards, critically sick patients who refuse to give their consent should not be admitted to an intensive care unit. “Critically ill patients should not be admitted to the ICU; if Patient’s or next-of-kin is informed of the refusal to be admitted in the ICU.”
Standards for ICU
New Delhi: The Indian government has developed standards for ICU admissions and mandated that hospitals obtain the patient’s and family’s permission before admitting critically ill patients to the ICU.
As per the most recent standards, critically sick patients who refuse to give their consent should not be admitted to an intensive care unit. “Critically ill patients should not be admitted to the ICU; if Patient’s or next-of-kin is informed of the refusal to be admitted in the ICU.”
The standards also state that the ICU expert needs to meet certain requirements. An advanced degree in Internal Medicine, Anaesthesia, Pulmonary Medicine, Emergency Medicine, or General Surgery with one or more of the following certifications is required of the Intensivist.
“An additional qualification in Intensive Care such as DM Critical Care/Pulmonary Critical Care, DNB/FNB Critical Care (National Board of Examinations), Certificate Courses in Critical Care of the ISCCM (IDCCM and IFCCM), Post-Doctoral Fellowship in Critical Care (PDCC/Fellowship) from an NMC recognised University, or equivalent qualifications from abroad such as the American Board Certification, Australian or New Zealand Fellowship (FANZCA or FFICANZCA), UK (CCT dual recognition), or equivalent from Canada.”
A minimum of one year of training at a reputable ICU overseas. A small number of ISCCM Certificate Course (CTCCM) students who completed a 3-year intensive care training program after earning their M.B.B.S. are also acknowledged as intensivists. It further said that those who meet the requirements must also have at least two years of ICU experience, with at least 50% of the time spent in the ICU.
“In case of doctors not having either of the mentioned qualifications or training, they should have extensive experience in Intensive Care in India after M.B.B.S., quantified as at least three years’ experience in ICU (at least 50% time spent in the ICU).” declared the rules
Physicians with specialisation in critical care medicine who operate in various hospital levels and intensive care units (ICUs) around the nation have established the new recommendations.
ICU admission criteria
The requirement for organ support and organ failure, or the expectation of a worsening of the patient’s state, should be the basis for admitting a patient to the intensive care unit.
“Altered level of consciousness of recent onset, Hemodynamic instability (e.g., clinical features of shock, arrhythmias), Need for respiratory support (e.g., escalating oxygen requirement, de-novo respiratory failure requiring non-invasive ventilation, invasive mechanical ventilation, etc.)” should be the basis for ICU admission criteria if a patient needs respiratory support.
Patients in need of close observation, organ support, or both who have severe acute illnesses (or acute-on-chronic conditions). Any illness or medical condition that is expected to worsen Individuals who have encountered any significant postoperative complications, such as unstable breathing or cardiovascular conditions.Individuals who have experienced significant surgery (such as thoracic, thoraco-abdominal, or upper abdominal procedures), trauma, or who are at a high risk of developing problems following surgery, according to the guidelines, should be closely monitored.
ICU discharge criteria
The ICU discharge criteria guidelines states, “return of physiological aberrations to near normal or baseline status. Reasonable resolution and stability of the acute illness that necessitated ICU admission.
Patient/family agrees for ICU discharge for a treatment-limiting decision or palliative care. Based on lack of benefit from aggressive care (should be a medical decision, not obligating family agreement and as far as possible should not be based on economic constraint.”
“For the purpose of maintaining infection control while making sure the patient receiving the proper treatment in a non-ICU setting. Rationing (i.e., setting priorities when resources are scarce). A clear, open, and acceptable written rationing policy that is fair, consistent, and appropriate should be in place in this situation.”
