Dos and donts guidelines framed for ICU admissions

Hyderabad: The ministry of health and family welfare has declared that henceforth, hospitals should not force admission of patients to ICUs, especially of patients suffering diseases with treatment limitation plans, and terminally ill patients with a medical judgment of futility, among other conditions, or stipulations.

In the recently released ‘Guidelines for Intensive Care Unit Admission and Discharge Criteria’ guidelines, the MoHFW, for the first time, has laid down conditions under which doctors can admit patients to ICUs.

“So far, many hospitals had their own independent guidelines on these matters, and now there are standard guidelines,” Dr. Srinivas Samavedam, a city-based intensive care specialist, who was part of the guidelines drafting committee, said.

The guidelines, he told Deccan Chronicle, will also make “aberrant professionals” think twice before they recommend ICU care for a patient.

“Such guidelines exist all over the world. The expectation is the guidelines will be posted in hospitals, or be issued as handouts to patient attendants,” he said.

There have been many complaints about how patients were admitted to ICUs, especially Covid cases. The new guidelines are designed to ensure transparency and accountability, he said.

He, however, said doctors treating a patient will be allowed to take a final call on whether a patient requires ICU admission or not based on the patient's condition and prognosis.

“This freedom is important,” said Dr. Sreenivas Kumar, director of cardiology & clinical research at Apollo Hospitals. “Such decision-making becomes important in case of cardiac medicine as the patient may appear normal or look stable, but will require close monitoring. These guidelines are a good step forward for appropriate use of ICU facilities,” he said.

Among those who can be admitted to ICUs, as per the guidelines, are patients with altered level of consciousness of recent onset, those suffering from clinical features of shock, arrhythmias, in need of respiratory support, patients with severe acute (or acute–on–chronic) illness requiring intensive monitoring and/or organ support, and any medical condition or disease with anticipation of deterioration and those who have undergone major surgeries.

Infograph

 Should not to be admitted to ICU

Patient’s or next–of–kin 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;

Low priority criteria in case of pandemic or disaster situation where there is resource-limitation.