Intensive Care Units: Progressive Patient Care Concept

Intensive care units
Progressive patient care concept

Progressive patient care
Proposed by Florence Nightingale
Developed by Llewelyn Davis
• Intensive medical care
• Intensive nursing care
• Medium nursing care
• Low nursing care
• Self care
Trend in per capita health care costs
Adhikari, N. et al. Anesth Analg 2003;96:311-314
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Health care costs as a percentage of gross national product (GNP) for Canada, the United
States, and the average of countries in the Organization for Economic Cooperation and
Development (OECD)
Adhikari, N. et al. Anesth Analg 2003;96:311-314
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Intensive care units
• A unit that is staffed and equipped to look
after critically ill patients with potentially
reversible lesions and unable to
communicate their needs or require
intensive medical and nursing care.
Among the various types of services and
interventions offered in the hospital
setting, none have a greater drain on
overall resources than those provided to
the critically ill patient. Data
demonstrate that between 1986 and 1992,
approximately 1% of the total US gross
domestic product was spent on critical
care.
ICU
• Patients requiring advanced respiratory
support alone.
• Patients requiring support of two or more
organ systems
• Patients with chronic impairment of one or
more organ systems sufficient to restrict
normal activity and who require support for an
acute reversible failure of another organ
system.
HDU
• Patients requiring support for a single
failing organ system,
• but excluding those needing advanced
respiratory support.
• Patients requiring a level of observation
or monitoring not possible on a general
ward.
Types of ICUs
• Single specialty ICU

• Multispeciality ICU
• Closed unit or open unit
• 'Open Unit': Clinical management remains
responsibility of admitting consultant
• 'Closed Unit': Intensive care consultant
completely responsible for clinical
management
Factors to be considered in estimating
size of an ICU
• · Number of acute beds in hospital or catchment area

• · Type of acute bed (adult, paediatric)
• · Previously calculated occupancies of wards, HDU(s) and ICU(s)
• · History of refusals
• · Location of other 'high care' areas (other ICUs or HDUs in
hospital, other
• hospitals)
• · Number of operating theatres
• · Surgical specialties serviced and case mix (e.g. vascular,
cardiac, thoracic,
• emergency, urgent, elective)
• · Medical specialties (e.g. respiratory, cardiology)
• · A & E department
Factors to be considered in estimating
size of an ICU
• Subregional or regional services (e.g. neurosurgery,
maxillo-facial surgery,
• complex orthopaedic, renal services, oncology etc.)
• Ability to transfer patient to an off-site ICU (staff,
equipment, transport)
• Paediatric care
• Location motorways, holiday resort, mainline
transport terminal (rail, coach,air)
Physical facilities
• Location
• Number of beds –5% in general hospital, 10-15% in
specialty hospital
• Size of unit – 8 - 12 is ideal
• Areas- clinical, support, admn, public
• design considerations
area, floor, walls, roof, partitions,beds, electrical
installations,lighting, medical equipment,
nursing station, special procedure room
Patient module
• Ward-type ICUs should allow at least 225 square
feet of clear floor area per bed.
• individual patient modules should allow at least
250 square feet per room (assuming one patient
per room),
• provide a minimum width of 15 feet, excluding
ancillary space.
• A utility column (freestanding, ceiling mounted,
or floor mounted) is the preferred source of
electrical power, oxygen, compressed air and
vacuum, and should contain the controls for
temperature and lighting
ICU bed
• • Electric/Hydraulic Hospitals Beds
• • 2 to 4 pcs Bed Sections
• • Options
• • Side Rails
• Flexible head end
• Head pannel – 2 O2 out lets 2 suction inlets,2
compressed air out let,B P monitor
• • IV Pole
• •Trendelnberg and Reverse Trendelnberg
• • X-ray Cassette
• • Mattress
• • Side Tables etc.
Clinical area Patient module
• Cubicle/ non cubicle module
• Bed space – 2-3 times the normal ward bed – ward type
225sft, module type 250sft minimum width 15 ft
• Nursing station- location direct/indirect visualization
• Noise - <45dB day time, <40 evenings, <20 nights(intl
noise control)
• Electrical – separate feeder, 16 –24 out lets at each bed,36
inches from floor,
• Lighting – general-30fc,procedure- 150fc, night – 10-15fc
with dimmers
• Temp- 22-25 centigrade
• Air – 10-15 air changes/hr with positive pressure
• O2- 2outlets/bed, compressed air – 1-2 outlets/bed,
vacuum- 3 outlets/bed
Support services
• Work Areas and Storage.
• Toilet – entry for wheel chair,grab bar
panic button
• Clean and Dirty Utility Rooms.
• Equipment Storage.
• Nourishment Preparation Area.
• Supply and Service Corridors.
• Patient Transportation Routes.
Admn area
• Receptionist Area.
• Staff Lounge and rest rooms
• Conference Room.
Public area
• Visitors' Lounge/Waiting Room.
Staffing
• Medical
• Nursing
• auxiliary
Importance
• 3 times more nursing hours than general
ward
• Cost is 3-20 times more in establishing and
maintaining
• Lab expenditure may be about 30% of ICU
cost
• ALS varies from 2-12 days with average of
5days
Policies
• Admission
• Triage
• Treatment
• Discharge
• Infection control
• Teaching and research
• Quality
• Ideal occupancy –60-70%
Admission criteria
Rating System
• Level 1: Convincingly justifiable on scientific
evidence alone
• Level 2: Reasonably justifiable by available
scientific evidence and strongly supported by
expert critical care opinion
• Level 3: Adequate scientific evidence is lacking
but widely supported by available data and critical
care expert opinion
Discharge criteria
• A. When a patient's physiologic status has stabilized and
the need for ICU monitoring and care is no longer
necessary
• B. When a patient's physiological status has deteriorated
and active interventions are no longer planned, discharge
to a lower level of care is appropriate
Discharge criteria from Critical Care Units should be
similar to the admitting criteria for the next level of
care such as intermediate care where available.
Establishment of NICU
• Land – 20%
• Equipment – 67%
• Building – 12%
• Furniture – 1%

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Intensive care units

Progressive patient care concept

Adhikari, N. et al. Anesth Analg 2003;96:311-314

Copyright restrictions apply.

Adhikari, N. et al. Anesth Analg 2003;96:311-314

Copyright restrictions apply.

• Single specialty ICU

• · Number of acute beds in hospital or catchment area

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