ICU Design and Staffing
OVERVIEW
- This page is based on the CICM Policy IC-01 Minimum Standards for Intensive Care Units
- This document outlines the minimum standards relating to work practice, caseload, staffing and operational requirements, design, equipment and monitoring for Level III, II, I and Paediatric Intensive Care Units (PICUs)
DEFINITION
- An Intensive Care Unit (ICU) is a specially staffed and equipped, separate and self-contained area of a hospital dedicated to the management of patients with life-threatening illnesses, injuries and complications, and monitoring of potentially life-threatening conditions.
- It provides special expertise and facilities for support of vital functions and uses the skills of medical, nursing and other personnel experienced in the management of these problems.
- In many units, ICU staff are required to provide services outside of the ICU such as emergency response (eg rapid response teams) and outreach services. Where applicable the hospital must provide adequate resources for these activities.
GENERIC REQUIREMENTS
Staffing
- Medical staffing, including a director, with sufficient experience to provide for patient care, administration, teaching, research, audit, outreach….
- Nursing staff: Australian College of Critical Care Nurses requires 1:1 for ventilated patients and 1:2 for lower acuity patients. Nurse in charge with post registration ICU qualification
- allied health and ancillary staff
Operational
- Documented educational programme
- agreed policies
- team approach
- surge capacity for emergencies
- documented procedures for audit
- peer review
- quality assurance
Site
- separate unit
- appropriate access to ED, theatre, radiology
Design
- Patient cubicles (> 20 m2), wash basin, service outlets, appropriate electrical standards, privacy
- Work areas, equipment and storage areas, staff facilities, seminar room, offices, relatives area
- Equipment: appropriate equipment and regular system for checking safety
- Monitoring equipment: for each patient, for unit (eg. gas supply alarms), and for patient transport
- Criteria for a level I, II and III ICU and a PICU
LEVELS OF INTENSIVE CARE UNITS
LEVEL 1
- should be capable of providing immediate resuscitation and short-term cardiorespiratory support for critically ill patients
- will also have a major role in monitoring and prevention of complications in “at risk” medical and surgical patients
- must be capable of providing mechanical ventilation and simple invasive cardiovascular monitoring for a period of at least several hours
LEVEL II
- 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
- minimum of 6 beds
LEVEL III
- a tertiary referral unit for intensive care patients
- should be capable of providing comprehensive critical care including complex multi-system life support for an indefinite period
- 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
- all consultants are FCICMs
- may have over 50 beds, should include pods of 8-15 beds
PICU
- as for a Level III unit, but dedicated to the care of patients under the age of 16 years
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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