The document provides guidelines for planning and organizing intensive care services. It defines intensive care as highly specialized care for critically ill patients requiring close monitoring and life support. A policy should be developed by a committee including anesthesia, surgery, nursing, and administration. This committee will decide the ICU type and size, staffing, facilities, policies, and organization. Physical planning includes optimal location, layout, bed space, and auxiliary areas. Staffing guidelines, types of ICUs based on services provided, and levels of ICU care from basic to tertiary are also outlined.

1. PLANNING AND ORGANIZATION OF
INTENSIVE CARE SERVICES
BY
DR. RAVINDRA JHA PGT1ST
DR. MONIKA MONI PGT 2ND
IN GUIDANCE OF
DR. NUPUR BISWAS HOD
ANAESTHESIA MGM
COLLEGE

2. INTRODUCTION
ICU is highly specified and
sophisticated area of a hospital
which is specifically designed,
staffed, located, furnished and
equipped, dedicated to
management of critically sick
patient, injuries or complications
It is emerging as a separate
speciality.
It has to have its own
separate teams of doctor
nursing and other staffs who
are tuned to the requirement of the

3. HISTORY
In 1854, FLORENCE NIGHTINGALE left for the CRIMEAN WAR,
where triage was used to separate seriously wounded soldiers from the
less seriously wounded . Until recently, it was reported that nightingale
reduced mortality from 40% to 2% on the battlefield.

5.  Florence Nightingale was an English social
reformer & statistician.
 Conventional Nursing training and services were
not available at that time & she is known as the
FOUNDER OF MODERN NURSING.
 Awards: Royal Red Cross, Lady of Grace of the
Order Of St. John, Order of Merit.
 Her birthday (12 th May), is celebrated as
INTERNATIONAL NURSE’S DAY all around
the world.

7. In 1950, anaesthesiologist PETER SAFAR established the concept of
“ Advanced Support of Life” , keeping patients sedated and
ventilated in an intensive care environment. SAFAR is considered to
be the first practitioner of intensive care medicine as a speciality

8. In the 1960s, the importance of cardiac
arrythmias as a source of morbidity and
mortality in myocardial infarctions was
recognized. This led to the routine use of
cardiac monitoring in ICUs , especially after
heart atttacks.
In INDIA first CORONARY ICU was
started at King Edward Hospital, Mumbai.
Later on ICU services were developed in
different corners of INDIA by and by.

9. WHO NEED ICU BED ????

10. ADMISSION CRITERIA
There should be fixed admission criteria for admission. Priority
to be given to the patients, who have fair chance of reversible
condition or chances of improvement.
MAJOR OPERATION
REQUIRINGVITAL
MONITORING
CRITERIA
REQUIRINGAIRWAY
SUPPORT &
ARTIFICIAL
VENTILATION
TRAUMA/
HEAD INJURY
TRANSPLANTATION
PATIENT
TOXAEMIA
SEPTICEMIA
POISONING
HAEMORRHAGIC
SHOCK
ELECTROLYTIC
IMBALANCE

11. • PLANNING AND ORGANIZATION OF INTENSIVE CARE SERVICES
INTENSIVE CARE IS DEFINED AS THE PROVISION OF SOPHISTICATED LIFE
SUPPORT.
USED FOR A VARIETY OF ADULT AND PAEDIATRIC PATIENT
IN A SETTING OF CLOSE AND CONSTANT MONITORING.
A POLICY GUIDELINE TO BE DEVELOPED FOR PLANNING A ICU BY THE
HOSPITAL BY FRAMING A COMMITTEE.
DEPT.
ANAESTHESIA
SURGEON,
NEURO
SURGEON
PHYSICIAN /
PAEDIATRICIAN
CPWD ICU PLANNING
COMMITTEE
ARCHITECT
MEDICAL
SUPERINTENDENT
NURSING
SUPERINTENDENT

12. DECISION MAKING
THE PLANNING COMMITTEE WILLTAKE THE
FOLLOWING DECISIONS :-
o CRITICAL CARE NEED OF HOSPITAL
o TYPE AND SIZE OF ICU
o APPOINTMENT OF ICU INCHARGE
o APPOINTMENT OF ICU METRON
o PLANNING,DESIGNING AND PHYSICAL
FACILITIES
o GUIDELINES, POLICIES AND PROCEDURE IN
ICU FUNCTIONING

13. PRE-REQUISITE
TRAINING OF NURSING AND MEDICAL
STAFF
PROCUREMENT OF BEDS AND
EQUIPMENTS
DEVELOPING PROTOCOLS FOR
MONITORING AND LIFE SUPPORT
TECHNIQUES
TRAINING OF SUPPORTING STAFF

14. PHYSICAL PLANNING
PHYSICAL
PLANNING
LOCATION SIZE
DRESSING
PHYSICAL
FACILITIES
ENVIRONMENTAL
PLANNING

15. HHH
ORGANIZATION
ADMISSION
CRITERIA
POLICIES &
PROCEDURES
TYPE OF ICUSTAFFING

16. LOCATION
 SHOULD BE CENTRALLY LOCATED WITH EASY ACCESS TO
EMERGENCY, OT , HDU &WARD
 EASILY APPROACHABLE
 AWAY FROM GENERAL HOSPITAL TRAFFIC
 RESTRICTED ENTRY
SIZE
 SIZE OF ICU DEPENDSON SERVICE PROVIDED BY HOSPITAL
 IN SUPER SPECIALITY HOSPITAL 10% OFTOTAL HOSPITAL
BEDS
 IN GENERAL HOSPITAL 2% OFTOTAL HOSPITAL BEDS
 OPTIMUM SIZE OF ICU 14 BEDS MINIMUM 4 BEDS
 IF NO.OF BEDS REQUIRED MORE THAN 14 THAN 2 ICU
SHOULD BE OPENED.
 IDEAL ICU IS 10 BEDED

18. LAYOUT DESIGNING
 CIRCULAR PLACEMENT OF
BED WITH CENTRALVIEW
 NURSING STATION
 RECTANGULAR WITH
CENTRAL MONITORING
 SEMICIRCULAR WITH
MONITORING SYSTEM AT FRONT
 THE LAYOUT DESIGN DEPENDS
UPON THE AVAIBLITY OF SPACE

20. DESIGNING OF ICU
PRINCIPAL OF
DESIGNING
ALL PATIENTSCAN
BE CLOSELY
OBSERVED
ADEQUATE LIGHT &
ELECTRIC FIXTURES
PIPED GAS
SUPPLY
AMPLE SPACE
AROUND BED FOR
FREE MOVEMENT

21. TYPE OF ICU ON BASIS OF
LOCATION
INSIDE HOSPITAL OUTSIDE HOSPITAL

22. PHYSICAL FACILITIES
PHYSICAL
FACILITIES
PATIENT AREA
AUXILLARY
AREA
ENTRANCE
ANCILLARY
AREA

23. ENTRANCETO ICU
ENTRANCE
ENTRANCE DOUBLE
DOOR SWINGING 5’
TO 6’WIDTH
CHANGING ROOM,
SHOES, GOWN, MASKS
RECEPTION
COUNTER
BROAD
CORRIDOR
TOILET
SNACK BAR
TELEPHONE
VISITORS LOUNGE
2 sq ft /VISITORS

24. PATIENT CARE AREA
PATIENT
CARE
NURSING
MONITORING
STATION
CALL BELL
SYSTEM
BED SPACE
WALL
FIXERS
HAND
WASHING
EQUIPMENTS

25. BED SPACE
 Sufficient space is required for each bed for
free movement and keeping ventilator ,
monitoring system and other equipments
 Space required for each bed 100 – 120 sq ft in
open ICU & 140-180 sq ft for cubicle ICU
 Space b/w two beds 5 – 8 ft
 Head wall space 1-2 ft
 The cubicle ICU must have glass partition or
transparent curtain for clear observation from
monitoring station

26. BED HEAD FIXTURE AND CALL
BELL SYSTEM
 Wall panels and call button near the bed
 Sufficient electric socket (10-15) for plugging
 Sockets should be 120- 180 cm above
ground
 Wall suctioned tube and Piped oxygen supply
 High intensity spot light
 Small wash basin
 No extension wire to be used
 Equipment with CV stabiliser and UPS

27. NURSING STATION
 Central monitoring system
 Counter, case records and essential drug
 Complete visibility for all patients
 Two way communication or intercom system
NURSINGSTATION

28. AUXILLARY AREA
AUXILLARY
AREA
MEDICATION
& NURSING
AREA
ISOLATION
ROOM/AREA
PANTRY
CLEAN & DIRTY
UTILITY ROOM
NURSES
CHANGING
ROOM
DRESSING
ROOM
DOCTOR’S
DUTY ROOM
STORE
EQUIPMENT
MAINTENANCE

29. ISOLATION AREA
 THE WORKING AREA IS EQUALTOTOTAL BED
AREA AND IS SEPRATED BY CLEAN CORRIDOR
FROM PATIENT AREA.THIS AREA HASTHE 14 sq
YARD AREA COMPRISES OF :-
-WASHING UTILITY AREA
-SECURABLE CABINATE FOR STAFF ROOM
-CLEAN SUPPLY ROOM
-WORK ROOM WITH SEPRATE SINK
-TOILET, DIRTY UTILITY
-X RAYVIEWING , SPECIAL
EXAMINATION/PROCEDURE
- 24HR LAB,RADIOLOGY AND PHARMACY

30. ANCILLARY AREA
 OFFICE SPACE AND RECORD ROOM
 STAFF LOUNGES, TOILETS
 TELEPHONE FACILITY
 STAFF REST ROOM
 GENERATOR / UPS ROOM
 ICU MATRON’S OFFICE

31. MEDICAL ENVIRONMENT
 AIR CONDITION;
ICU must be air conditioned
Temp must be maintained at 25-27centigrade & 40-50%
humidity .
Plenty of sunlight & large window
 VENTILATION
6-8 air change /hr
Filter less than 10 micron
Positive pressure flow from patient area to outside

32. MEDICAL ENVIRONMRNT
 Lightening
varying degree of light from patient area to work
area
Intensity 1- 30 lumens as per need
Soothing and glare free
wall reflection free & light colour
 Noise
To be noise free
TV & clock in each cubicle
Noise absorbable material

33. STAFFING
STAFFING
MEDICAL
STAFF
ANCILLARY
STAFF
NURSING
STAFF
TECHNICAL
STAFF

34. STAFF REQUIRED PER SHIFT
 NURSING STAFF
 Ideally 1:1 ratio for ventilated patient & 1:2
for critically ill ( non ventilated ) patient.
 Broadly 4-5 nurses per bed including reliever.
 1 ANS for administration.
 MEDICAL STAFF
 1 Physician per 5 beds
 1 Consultant ICU
 2 Senior Residents Per Shift
 2 Junior Residents

35. STAFF REQUIRED PER SHIFT
 TECHNICAL STAFF
 1 RespiratoryTherapist
 1 Physiotherapist
 1 ICU Technician Per Shift
 1 LabTechnician
 1 OT Assistant
 1 Safety Officer
 ANCILLARY STAFF
 1 Receptionist
 4 Ward boys
 2 Stretcher Bearers Per Shift
 2 Sweepers

36. ORGANOGRAM OF ICU
HOD ( Anaesthesia )
Director ICU (Anaesthesia)
Physician
24 hours
ANS
Technical
Staff
Receptionist
Bio-Med.
Engg.
Nursing Staff 24
hours
Supporting
Staff
Respiratory
Physiotherapist
ICUTech.
Lab. tech
Safety
Officer
Bio-Med.
Techh.

37. TYPEOFICU
ICU
BY ORGAN
SYSTEM
BY CLINICAL
SYNDROME
TRADITIONAL
BY
CLENTERALLY

38. ADMISSION AND TREATMENT POLICY
ICU is a place for potentially salvageable critically ill patient in need of
constant monitoring, life support and requiring specialized treatment and
trained nursing care.
-Monitoring - Monitoring
-Observation - Observation
-Short term ventilation - Long term ventilation
(Intensive Care)
-Intensive Care
-Invasive Procedures
-Hemo-Dialysis
-Constant Support
LEVEL-I
LEVEL OF ICU CARE
LEVEL-II
LEVEL-III

39. ICU Levels - Level I
• It is recommended for small district hospital, small
private Nursing homes, Rural centres.
• Ideally 6 to 8 Beds. It should be able toVentilate a patient
for at least 24 to 48 hrs .
• Provides resuscitation and short-term Cardio respiratory
support
• ABG Desirable
• Non invasive Monitoring like - SPO2, H R and rhythm
(ECG), NIBP, Temperature etc.
• Should have basic clinical Lab (CBC, BS, Electrolyte, LFT
and RFT) and Imaging back up (X-ray and USG), ECG
• Able to have arrangements for safe transport of
the patients to secondary or tertiary centres.
• The staff should be encouraged to do short training
courses like FCCS or BASIC ICUCourse.

40. Level II (Recommendations of Level
I Plus)
• Recommended for largerGeneral Hospitals
• Bed strength 6 to 12
• Director should be a trained/qualified Intensivist
• Multisystem life support
• Invasive and Non invasive Ventilation
• Invasive Monitoring
• Long term ventilation facility
• Access toABG, Electrolytes and other routine diagnostic
support 24 hrs.
• CT must & MRI is desirable
• Should be supported ideally by other super speciality
department.
• Nurses and duty doctors trained in CriticalCare

41. Level III (All recommendations
of Level II Plus)
• Recommended for tertiary level hospitals
Bed strength 10 to 16
• Headed by Intensivist
• Have all recent methods of monitoring, invasive and non
invasive, including continuous cardiac output, SPO2
monitoring etc
• Long term acute care of highest standards and Multi system
care
• Own or outsourcedCT Scan and MRI facilities should be there
• Bedside x-ray,USG, 2D-Echo & Bronchoscopy available.
• Bedside dialysis and other forms of RRT available
• Doctors, Nurses and other support staff be continuously
updated in newer technologies and knowledge in critical
Care

42. TREATMENT POLICY
 Responsibility lies with the incharge of unit
admitting the case.
 A vacant bed is allocated in original ward for patient
return.
 No direct admission to ICU but transferred from
unit.
 Admission only on recommendation of ICU Director
subjected to availability of bed.
 20% of bed to be kept vacant for emergency
admission.
 Continuity of treatment is the perview of ICU
Incharge in consultation with Unit Incharge.

43. POLICIES & PROCEDURES
 Standard treatment protocol to be followed.
 Silence to be observed.
 All new admissions/ discharge to be informed
to ICU Incharge.
 All admission and discharge to be registered.

44. STAFF STANDING ORDER
 Joint round at the time of shift change &
proper handing / taking .
 Instruction & maintenance of input / output
chart.
 Cleaning and maintenance of equipments.
 Checking and replacement of essential drugs.
 Proper maintenance of records.
 Daily round of physician and Incharge ICU
combine to take decision for changing
treatment.

45. DISCHARGE POLICY
 Decision to discharge is taken in consultation
with in charge of parent unit.
 Patient who have recovered ,stable & does not
require artificial ventilation can be shifted to
intermediate care or high dependency area.
 Patient who are not progressing and chance of
recovery is remote to be discharged for alloting
bed to patient having fair chance of recovery
when demand is acute.
 When there is no demand, patient is kept in ICU
till death.

46. QUALITY ASSURANCE IN ICU
 To maintain high standard by hygiene and
cleanliness.
 To prevent hospital-acquired infection proper
sterilisation of ICU is mandatory.
 Proper treatment and disposal of BMW.
 Daily maintenance / checking of vital
equipments.
 Priority on patient comfort and home feeling.
 Exit interview of patients and relatives to
increase the standard and quality of care.

47. INTENSIVE CORONARY CARE UNIT
 The requirements here are as that of ICU.
 The patients here are concious/ semi-
concious.
 Require constant observation and
monitoring.
 Should have acoustic and visual privacy.
 There should be partitions/ cubicles for each
patient.

48. CONCLUSION
 EXTREME SHORTAGE OF ICU BEDS IN PUBLIC AS
WELL AS PRIVATE SECTOR PREVENTSTIMELY
ADMISSION RESULTS IN POOR OUTCOME
 HIGH INVESTMENT IN PERSONNALE
,TECHNOLOGY & MATERIAL RESOURCES
 SHORTAGEOF ICU BEDS LIMITSTHE PROTOCOL
TO BE FOLLOWED FOR BRAIN DEAD PATIENTS
FOR ORGAN HARVESTING
 URGENT NEEDTO INCREASETHE NUMBER OF
ICU BEDS TO ATLEAST 10% OF TOTAL BEDS.

49.  ICU OPERATES WITHIN DEFINED POLICIES.
 PROTOCOL AND PROCEDURES SHOULD HAVE ITS
OWN QUALITY CONTROL, EDUCATION ,TRAINING
AND RESEARCH PROGRAMMES.

53. WITHTHE HELP OF OUR RESPECTED HOD MAM &
FACULTY OF ANAESTHESIA DEPARTMENT,
IT’S AN EFFORT SOLELYTO HELP
ANAESTHESISTS,
STUDENTS AND ASPIRANTS INTHEIR ATTEMPTTO
BECOME A SUCCESSFUL ICU
ADMINISTRATOR.