Hospital can’t force for ICU admission, Center releases new guidelines

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The criteria for admitting a patient to Intensive Care Unit (ICU) should be based on organ failure and need for organ support or in anticipation of deterioration in the medical condition, said the new guidelines for ICU Admission and Discharge Criteria released by Center on Tuesday. The hospitals cannot admit critically ill patients in the intensive care unit in case of refusal by them and their relatives.

The guidelines has been compiled by 24 doctors with expertise in Critical Care Medicine working in different levels of Hospital and Intensive Care Units (ICU) across the country. It  has recommended that when no further treatment is possible or available in a disease or in terminally ill patients, if the continuation of therapy is not going to make an impact on the outcome, especially survival, then keeping in ICU is futile care.

Further, anyone with a living will or advanced directive against ICU care should not be admitted to ICU. Besides, low priority criteria in case of pandemic or disaster situation, where there is resource limitation, should be taken into account for keeping a patient in the ICU. The guidelines has underlined that blood pressure, pulse rate, respiratory rate, breathing pattern, heart rate, oxygen saturation, urine output and neurological status among other parameters should be monitored in a patient awaiting an ICU bed.

Altered levels of consciousness of recent onset, hemodynamic instability, need for respiratory support, patients with acute illness requiring intensive monitoring and/or organ support or any medical condition or disease with anticipation of deterioration have been listed as criteria for ICU admission. Patients who have experienced any major intraoperative complication like cardiovascular or respiratory instability or have undergone major surgery also feature among the criteria.

“The following critically ill patients should not be admitted to ICU — patient’s or next of kin’s informed refusal to be admitted in ICU, any disease with a treatment limitation plan, anyone with a living will or advanced directive against ICU care, terminally ill patients with a medical judgement of futility and low priority criteria in case of pandemic or disaster situation where there is resource limitation (e.G. Bed, workforce, equipment),”the guidelines stated.