Hospital cannot admit patients without contest; Centre issues norms for ICU admissions

ICU admission: The Government of India has issued guidelines for hospitals regarding ICU admissions, stipulating that critically ill patients cannot be admitted to the ICU without the explicit consent of both the patient and their family.

Check out the recent guidelines 

• The patients in critical condition should not be placed in the ICU if they or their next-of-kin refuse admission. The directive emphasises the importance of obtaining consent before admitting such patients to the Intensive Care Unit.
• The guidelines outline the specific qualifications for ICU specialists. According to the new rules, Intensivists must hold a postgraduate qualification in Internal Medicine, Anaesthesia, Pulmonary Medicine, Emergency Medicine, or General Surgery, along with specific criteria outlined in the guidelines.

• 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.

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• The guidelines furthermore emphasised that at least one-year training in a reputed ICU abroad is must  and persons so qualified or trained must have at least two-years' experience in ICU (at least 50% time spent in the ICU). 
• The recent formulated guidelines also suggest that medical professionals specialising in critical care medicine, operating across various levels of hospitals and intensive care units (ICUs) nationwide
• The guidelines also propose the decision to admit a patient to the ICU should hinge on factors such as organ failure and the requirement for organ support. Additionally, considerations may be made in anticipation of potential deterioration in the patient's medical condition.
• The guidelines also stated that patients who have undergone major surgery, (e.g. thoracic, thoraco-abdominal, upper abdominal operations, trauma who require intensive monitoring or at a high risk of developing postoperative complications). 

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• The discharge from the Intensive Care Unit (ICU) is recommended when there is a return of physiological abnormalities to near normal or baseline status. This decision is also guided by the reasonable resolution and stability of the acute illness that initially warranted ICU admission. Furthermore, ICU discharge may be considered when the patient or their family consents to a treatment-limiting decision or palliative care. Importantly, the decision to transition from aggressive care to discharge should be a medical determination, not solely contingent on family agreement, and should ideally not be influenced by economic constraints.

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