ICU Admission and Discharge Criteria Guidelines

New Delhi: Releasing the guidelines for Intensive Care Unit Admission and Discharge Criteria, the Ministry of Health and Family Welfare has given a clear-cut definition on who is an "Intensivist" or Critical Care Specialist.

These guidelines, compiled by a total number of 24 experts and released by the Directorate General of Health Services (DGHS) operative under the Union Health Ministry, specified that to be called an "Intensivist", a specialist needs to have specific training, certification, and experience in managing critically ill patients in an ICU.

As per the guidelines, the Intensivist should have a postgraduate qualification in Internal Medicine, Anaesthesia, Pulmonary Medicine, Emergency Medicine, or General Surgery with either of the following:

• An additional qualification in Intensive Care such as DM Critical Care/Pulmonary Critical Care, DNB/FNB Critical Care (National Board of Examinations), Certificate Courses in Critical Care of the ISCCM (IDCCM and IFCCM), Post-Doctoral Fellowship in Critical Care (PDCC/Fellowship) from an NMC recognised University, or equivalent qualifications from abroad such as the American Board Certification, Australian or New Zealand Fellowship (FANZCA or FFICANZCA), UK (CCT dual recognition), or equivalent from Canada
• At least one-year training in a reputed ICU abroad.

Also Read: Why was respiratory medicine department removed from medical college requirements? Health minister responds in Parliament

Apart from this, the guidelines clarified that a few candidates of the ISCCM Certificate Course (CTCCM) who have been certified with a 3-year training programme in Intensive Care after MBBS are also recognised as Intensivists. "In addition, persons so qualified or trained must have at least two-years’ experience in ICU (at least 50% time spent in the ICU)," stated the Guidelines.

If a doctor does not have either of the above-mentioned qualifications or training, they are required to have extensive experience in Intensive Care in India after MBBS, quantified as at least three years' experience in the ICU (at least 50% time spent in the ICU).

Defining what is an ICU, the guidelines mentioned that "The terms Critical Care /Intensive Care/Intensive Therapy Unit are synonymous. It is a designated, specialized area for multidisciplinary, focused management of patients who have life-threatening, partially, or completely reversible organ(s) dysfunction."

"Such treatment requires continuous and intensive observation and interventions by a multi-professional team of appropriately trained healthcare workers including doctors, nurses, and other support staff with equipment and paraphernalia necessary for sustaining life until recovery," it added.

Apart from laying down the definition of the Intensivist or Critical Care Specialist, the new guidelines also framed an Expert Consensus Statement especially defining ICU admission criteria and who should not be admitted to the ICU, ICU discharge criteria. It also defined the minimum patients monitoring required while awaiting an ICU bed, the minimum stabilisation required before transferring a patient to the ICU, and the minimum monitoring required for transferring a critically ill patient (inter-facility transfer to hospital/ICU).

The Government guidelines for admission of patients to ICU comes more than 7 years after the Supreme Court directions in this regard. It was reported back in 2016 that taking into account the stream of medical negligence cases being filed against the medical professionals and hospital, the Supreme Court bench had asked the Central Government, and the erstwhile Medical Council of India (MCI), which has now been replaced by the National Medical Commission (NMC), to answer whether any guidelines are prescribed for private hospitals on providing care to patients in the Intensive Care Unit (ICU) and Critical Care Unit (CCU).

Also Read: Give guidelines on admission to ICU, CCU: SC to MCI, Centre