Although the medical fraternity across the country have welcomed the Centre's new guidelines on intensive care unit (ICU) admissions, there are mixed opinions on specific aspects of the directives. As per the government, hospitals will need to take consent of kin of patients before admitting them to an ICU.
Opinion divided on ICU care guidelines
While some said that the move will ease public woes as some hospitals try to fleece people in the name of ICU admissions, others said that the medical institutions should not be held liable for further outcomes if relatives refuse ICU care. The general mood is that more clarity is needed for better understanding and implementation of guidelines.
“These directives are need of the hour, given that the ICU facilities are unique and the role of an intensivist is paramount,” said a health official, while highlighting the clause which states that an intensivist should have a postgraduate qualification in internal medicine, anaesthesia, pulmonary and emergency medicine, or general surgery with either of them. However, a senior intensivist from a private hospital had a different viewpoint. Pointing out that sometimes patients are brought in critical condition and ICU is the only option to stabilise them. “There are policies in this regard, which are adhered to by hospitals. The decision of ICU admissions are based upon the patient’s clinical condition,” he said.
Dr Kapil Zirpe, Indian Society of Critical Care Medicine ex-president, said that the Centre “referred” to a report prepared by experts, including him, on ICU planning and designing. It was published in the Indian Journal of Critical Care Medicine in 2020. “The guidelines prioritise the appropriate use of ICU resources, such as avoiding admission of end-stage or terminally ill patients.” Redirecting such cases to high dependency or palliative care wards ensures that ICU facilities can focus on patients who benefit most from intensive care interventions, he added.
Health activists welcome the guidelines
Health activists welcomed the guidelines, reasoning that many required ICU care or oxygen beds during Covid. However, the facilities were occupied by those who didn't even require hospitalisation. A senior doctor from a private hospital association said, “It was a sensible move on the part of the government to come up with a set of guidelines on ICU admissions. Moreover, it will help in determining the appropriate level of care for critical patients.”
Dr Nitin Bhagali, former president of the Pune Orthopaedic Society and the ex-chief of the Association of Small Hospitals in Pune, pointed out that doctors and hospitals should be exempted from legal liabilities if patients or their kin refuse ICU care when advised. He even went to the extent of holding the health ministry accountable in any eventuality. “Patients not ready for ICU admission when recommended by the treating doctor should be discharged from that hospital and shifted to a convenient/government hospital,” said Dr Bhagali.
ICU admission criteria
- Patient suffering from altered consciousness
- Need for respiratory support
- Anticipation of deterioration
- Intra-operative complications
- Cardiovascular/respiratory instability
Instances for not providing ICU care
- If patient or next of kin refuse consent
- Those suffering disease having treatment limitation plan
- Anyone with a living will
- Advanced directive against ICU care
