You have been asked by your director to assist in the planning and development of a new level Ⅱ intensive care unit.
a) Define what is meant by level Ⅰ, level Ⅱ and level Ⅲ ICUs
b) Briefly outline the principal considerations you should cover during the planning phase with specific attention to physical design of the unit and staffing
This information is covered in the college document IC-1 and candidates should be familiar with at least the broad areas that are covered when a new unit is planned.
A Level I ICU should be capable of providing immediate resuscitation and short-term cardio-respiratory support for critically ill patients. It will also have a major role in monitoring and prevention of complications in “at risk” medical and surgical patients. It must be capable of providing mechanical ventilation and simple invasive cardiovascular monitoring for a period of at least several hours.
A Level II ICU should be capable of providing a high standard of general intensive care, including complex multi-system life support, which supports the hospital’s delineated responsibilities.
A Level III ICU is a tertiary referral unit for intensive care patients and should be capable of providing comprehensive critical care including complex multi-system life support for an indefinite period. Level III units should have a demonstrated commitment to academic education and research. All patients admitted to the unit must be referred for management to the attending intensive care specialist.
b) Design and staffing
A Level II ICU should have at least 6 beds. The unit needs to provide a suitable environment with adequate space for patient care delivery, storage, staff accommodation (including office space), education and research. (CICM IC-1 2011)
There should be adequate space around each bed to allow easy access to the patient from all sides
– with at least one hand basin for every 2 beds. Adequate lighting and service outlets need to be provided for each bed space and there should be provision for adequate privacy.
At least one isolation room should be available.
The unit should have appropriate air conditioning which allows control of temperature, humidity and air change.
Equipment storage area.
Dirty utility – area for cleaning appliances, urine testing, emptying and cleaning bed pans and urine bottles.
Including offices, tea room and education areas.
Including a waiting room with basic facilities and separate room for interviewing or seeing distressed relatives.
A dedicated director (should be a Fellow of the College) and team of specialists with junior medical cover. One specialist exclusively rostered to the unit at all times, structured bedside ward round.
A minimum of 1:1 for ventilated and other critically ill patients, and 1:2 nursing staff for lower acuity
Consideration should also be given to ancillary staff: Clerical, Wardsmen, Physiotherapists, social workers and cleaning staff
This question distinguishes which candidates have been ferreting around in the morass of college policy documents.
What is this document IC-1, from 2011? Why, its Appendix 15: "Minimum Standards for Intensive Care Units" , of course. It outlines the minimum standards for ICUs in Australia. American guidelines are also available, and they are equally verbose, laying out rules about each minute detail of the ICU.
The following basic equipment should be available:
Patient monitoring equipment should be
Levels of intensive care units
CICM Policy Document IC-01: Minimum Standards for Intensive Care Units.
Leaf, David E., Peter Homel, and Phillip H. Factor. "Relationship between ICU design and mortality." CHEST Journal 137.5 (2010): 1022-1027.
Frankel, Stephen K., and Marc Moss. "The Effect of Organizational Structure and Processes of Care on ICU Mortality as Revealed by the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study*." Critical care medicine 42.2 (2014): 463-464.
Stoddart, J. C. "Design, staffing, and equipment requirements for an intensive care unit." International anesthesiology clinics 19.2 (1981): 77-96.