Standards for Intensive Care Units

An ICU is an area of the hospital that is:

This covers the prescribed CICM standards for an ICU. Standards for a HDU are covered under Standards for High Dependency Units.

• Specially staffed
• Specially equipped
• Separate
• Self-contained
• Dedicated to the management and monitoring of patients with life-threatening disease

Requirements

Staffing:

• Medical director
  • Full time
  • FCICM
• Sufficient staff specialist cover
  • Clinical work
    1 per 8-15 beds.
  • Teaching
  • Research
  • Audit
  • Other administration
  • Must meet CICM CPD requirements
• Sufficient junior medical cover
  • At least one in the ICU at all times
  • Any outreach staff must be in additional to internal staff, and not compromise care of ICU patients
• Nursing
  • 1:1 for ventilated and other critically ill patients
  • 1:2 for other acuity patients
  • Nurse in charge with additional ICU qualification
  • Majority of staff must have an additional ICU qualification
  • Supernumerary team leader each shift
  • 1 educator per 50 rostered nurses
  • All division 1 nurses
• Other
  • Appropriate clinical and non-clinical support staff

Operational

Structure:

• Separate geographical unit within the hospital
• Access to ED, OT, radiology, and interventional secretions
• Total area 2.5-3× the total patient care area
• Patient care areas:
  • Shared rooms: 20m² per bedspace
  • Single rooms: 25m² per bedspace
  • Adequate outlets:
    • 4 oxygen
    • 3 air
    • 3 suction
    • 4 data
    • 16 power
  • Cardiac protected electrical status
  • Adequate lighting
• Working area
  • Space for staff in visual contact with patient
  • Radiology viewing
  • Equipment storage:
    • Resuscitation
    • Blood
    • Mobile x-ray
  • Dirty utility
• Staff area
  • Breaks
• Education
  • Seminar room
• Offices
  • Adequate office space for each senior clinician
  • Available space for junior staff

Monitoring

Clinical monitoring should include:

• A vigilant bedside nurse
• Electronic monitoring with:
  • Visible and audible alarms
  • Trending capability
  • Unobstructed views
• Circulatory monitoring
  • Regular blood pressure measurement
  • ECG display
• Respiratory monitoring
  • SpO₂
  • Capnography when appropriate
  • Blood gas analysis
• Equipment monitoring
  e.g. Alarms for equipment in use, e.g. circuit humidifiers.

Levels

Intensive care units are divided into three levels:

• Level III
  Tertiary referral unit capable of providing comprehensive critical care, including complex multi-system life support for an indefinite period. Should:
  • Have demonstrated commitment to education and research
  • >8 functioning ICU beds
  • Sufficient clinical workload to maintain high level of clinical expertise
    >400 mechanically ventilated patients per annum.
  • Divided into pods for clinical management
  • Staffing requirements
    • FCICM medical director
    • >4 FTE of ICU specialists
      • Expected that all are FCICM
    • All patients should be seen at least twice per day by the FCICM
    • >50% of nurses per shift have additional ICU qualification
    • Equipment officer
  • Operational requirements
    • Defined protocols
    • Formal auditing processes
      • Participation in ANZICS CORE
    • Orientation program
    • Research program
    • 24 hour access to pharmacy, pathology, OR, radiology, and other specialists
• Level II
  Capable of providing high standard of general intensive care, including multi-system life support for an indefinite period provided appropriate specialty support is available.
  • Arrangement with designated level III ICU so that patients can be accepted for specialty management
  • >6 functioning ICU beds
  • Staffing requirements
    • FCICM medical directory
    • >4 FTE of ICU specialists
      • >50% should be FCICM
      • ⩾2 should be at least 0.5
    • Otherwise as level III
  • Operational requirements as level III
• Level I
  Capable of providing immediate resuscitation and short term cardio-respiratory support, and monitor ‘at risk’ patients.
  • Arrangement with level II or III ICU for:
    • Transfer of patients
    • Joint review process
  • Provision of mechanical ventilation for >24 hours is only acceptable when the patient is managed by an FCICM
  • Staffing requirements
    • Medical director who is an FCICM
    • Adequate staffing to provide a 1:3 call roster with specialists with sufficient experience in ICU
    • ⩾2 nurses in the unit at all times, if a patient is admitted
    • Nursing qualifications as level III ICU
    • Support staff as required
  • Operational requirements
    • Auditing process is mandatory, though ANZICS CORE participation is not
    • Research program desirable
    • Access to other resources commensurate with the role of the unit
    • Otherwise as level III ICU

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References

1. CICM. IC-1 Minimum Standards for Intensive Care Units. 2016.