Design and Organisation

CICM classifies intensive care units into three levels:

• Level I
  Provide resuscitation and short-term cardiorespiratory support. Role in small district hospitals. Should have:
  • FCICM as director
  • Relationship with level II/III unit for transfer

2. Level II
   Provide general intensive care including multisystem life support. Large general hospital. Should have:
   • FCICM for director and majority of intensivists
   • Referral policy with level III unit for escalation
3. Level III
   All aspects of intensive care for indefinite periods. Major tertiary centre. Should have:
   
   • Commitment to education and research
   • Pods of 8-15 patients

Design Considerations

Layout:

• Rapid access to other key parts of the hospital
• Avenues for transport
• Public reception
• Storage rooms
  • 10m² per bed space
  • No further than 30m from patient area
• Sluice rooms
• Family meeting rooms
• Family support areas/waiting rooms
  10m² per 8 beds.
  • Tea/coffee
  • Toilets

Patient rooms:

• Should have three areas
  • Patient zone
  • Family zone
  • Caregiver zone
• Minimum 20m²
  Larger for single rooms.
• Adequate service outlets
  For a level III ICU:
  • 4 O₂
  • 3 air
  • 3 suction
  • 16-20 power
  • 4 data
  • Lighting
• Natural light
• Noise dampening design
  • Baffles
• Orientation aids
• Isolation rooms
  Additional requirements:
  • Air quality
    • HEPA filters in isolation rooms
    • 15 air changes per hour
  • 25m²

Policy

Key elements:

• Fire and evacuation plan
• Sensible rostering
• Adequate supervision for junior staff
• Closed intensive care
  Admission, discharge, management, and referral policies are under the control of the intensivist (rather than other unit clinicians having admitting rights). Associated with ↓ mortality.

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1. Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.