Who Can Be Admitted to the ICU? Doctors Break Down Centre’s New Guidelines

How do the new guidelines impact patients?

ICU guidelines by Ministry of Health and Family Welfare

(Photo: Vaishali Sood/FIT)

The Ministry of Health and Family Welfare has issued fresh guidelines for hospitals and intensivists on when and who should be admitted to the Intensive Care Unit (ICU).

"The guidelines have been developed by a group of intensivists, from both the private and the government sector," Dr Yatin Mehta, Chairman, Institute of Critical Care and Anaesthesiology, Medanta, Gurugram, tells FIT.

What do the new guidelines say? What does it mean for you? Here's what experts are saying.

What are the new guidelines?

The guidelines essentially provide directions on the parameters that qualify a patient for ICU admission. It also defines who can make that call. Some of the key points include:

• A critically ill patient cannot be admitted to the ICU without the patient's consent, or the consent of the family (if the patient is not in a position to give consent.)

• Those who have an illness with limited treatment plan, or have an living will (advanced directive) against ICU care should not be admitted to the ICU.

• A patient should be discharged when they gain reasonable stability of the acute illness that needed ICU care, or when the patient or their family agrees for ICU discharge.

• A specialist should be in charge of the ICU, taking these calls. An intensivist is defined as a doctor with an MBBS degree with at least three years of experience working in the intensive care department.

Why does it matter?

According to the experts FIT spoke to, the new guidelines basically empower patients and their families to know why their relatives are or aren't being admitted to the ICU.

"Now, it can be clear why they need it, and that it's not just a cash grab attempt by the hospital," says Dr Sumit Ray, Head of Critical Care at Delhi's Holy Family Hospital, and Secretary of the Indian College of Critical Care Medicine.

Dr Yatin Mehta added, "It also makes it easier for a non-intensivist to make a call on who should be put in the ICU and who may not need to be, and may be treated outside the ICU, especially in peripheral medical facilities on the ground where specialists are not available."

The new guidelines also notably integrate guidelines for those opting for a living will.

But aren't these already known?

The guidelines themselves aren't new, per say.

Dr Ray says that the Indian society of critical care has had a very similar framework of guidelines that they have been following for years now.

"But when it comes officially through the Health Ministry, it becomes a little more binding."

Dr Sumit Ray

These guidelines are not rules. "It's a misconception is that guidelines are sacrosanct," says Dr Ray.

He adds, "Guidelines are only there to guide, but the clinical judgement of the clinician who is there to see the patient also needs to be taken into consideration, and that is true of all the guidelines."

This is where the practitioner's experience and clinical knowledge comes in. "Sometimes, we might see that a patient may not fit every criteria for admission but our clinical judgement tells us that the patient may require it."

Who qualifies to take these decisions?

According to Dr Sumit Ray, something that could be potentially problematic is its definition of who qualifies as an intensivist.

"The last point says that if you do not have a specialised intensivist, even someone with an MBBS, and three years of experience in the ICU would qualify."

According to Dr Ray, "Yes, they can take care of patients in the ICU if there is no one else available, but an Intensivist cannot be defined as such."

However, according to Dr Mehta:

"In a country like India with such a vast population and a shortage of not just intensivists, but also doctors in general, I think we need to have some flexibility regarding who is an intensivist."

If anything, he adds, "This recommendation may not be ideal for tertiary care hospitals in metropolitan cities, but it becomes in smaller, tier-2 and tier-3 hospitals where due to a lack of qualified staff, completely untrained and unqualified people are put in charge."

This point, if anything, he says, will help establish a minimum bar for who can be put in charge of making decisions in the intensive care unit.