Introduction
In the dynamic landscape of intensive care, staying abreast of the latest recommendations is paramount. This article delves into a refined set of guidelines for intensive care units (ICUs), aiming to provide a comprehensive overview of the intricate requirements in (infra) structure, personnel, and organization. Drawing from the wealth of knowledge from the German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI), these recommendations transcend a decade of influence, meticulously adapting to the evolving public health sector, economic conditions, and medical advancements.
Methodology
To ensure the utmost accuracy, a systematic literature search was conducted in May 2021, exploring PubMed and Epistemonikos. This rigorous process unearthed 2,701 potential publications, with 243 deemed relevant and scrutinized in full text. Additional insights were gleaned from references, recommendations of major intensive care societies, and pertinent documents. The recommendations, stratified across three levels of ICU, emanate from a collaborative effort involving a core group and the engaged sections of DIVI, culminating in a meticulously crafted document finalized in November 2022.
Classification of Intensive Care Units
Basic Intensive Care (Level 1)
In a Level 1 ICU, emergency treatments and therapies requiring intensive medical monitoring are conducted regularly. These units stabilize patients with vital sign disturbances, enabling subsequent transfer to higher-level ICUs through established cooperation agreements.
Advanced Intensive Care (Level 2)
Level 2 ICUs offer comprehensive care for conservative and surgical patients. Transfer to Level 3 ICUs is recommended for patients requiring medical specialties not provided or specific organ replacement procedures.
Comprehensive Intensive Care (Level 3)
Level 3 ICUs, typically found in university hospitals, offer a spectrum of intensive care and medical specialties. They are staffed and equipped to handle highly complex patients, ensuring comprehensive care.
Physicians' Role and Qualifications
Head of the ICU
An intensivist, certified in anesthesiology, internal medicine, neurology/neurosurgery, or surgery, leads the ICU. In Levels 2 and 3, the intensivist should work full-time in the ICU, overseeing medical treatment.
Qualification and Physical Presence
Physicians with at least 3 months of structured training in intensive care should be physically present 24/7 in the ICU. Additional physicians, with 6 months of training, should be available in Level 2 and 3 ICUs.
Staffing (Physicians)
For the head of the department, a minimum of 1.3 full-time equivalents (FTE) is required during absence. Level 2 and 3 ICUs need at least 0.7 FTE of physicians per ICU bed.
Physician Assistants
Physician assistants support physicians in specific activities, enhancing the efficiency of medical care delivery (Grade of Recommendation 2C).
Nursing Staff and Patient Classification
Categorization of Intensive Care Patients
Critically ill patients are classified daily into three Levels of Care (LOC) I, II, or III using validated performance measurement instruments.
Management
Ward managers, ideally with specialist training in intensive care and anesthesia or intensive care, oversee organizational and professional management. Adequate staffing, proportional to the number of beds, is essential.
Qualification and Staffing
The number of nursing staff is determined by a validated performance measurement instrument. Staffing requirements are calculated based on the ratio of nurses to patients, varying for LOC I, II, and III.
Advanced Practice Nurses
The employment of Advanced Practice Nurses (APN) is recommended, contributing to enhanced patient care (Grade of Recommendation 2C).
Therapists
Staffing of Physiotherapists, Speech Therapists, Occupational Therapists
Daily physiotherapeutic treatments, speech therapy, and occupational therapy should be provided based on specified durations and availability.
Other Professional Groups
Hygiene and Microbiology
ICUs must be supervised by hygiene officers and specialists, adhering to established guidelines.
Antibiotic Stewardship
A program for the rational use of antibiotics, monitoring clinical results, and tracking antibiotic usage is advocated.
Ward Pharmacist
A ward pharmacist, integrated into the interprofessional treatment team, ensures optimal medication management.
Conclusion
These meticulous recommendations provide a comprehensive framework for organizing and planning the operation and construction/renovation of ICUs. From the staffing of physicians and nurses to the integration of various specialists, each facet is carefully delineated, aligning with the three-tiered structure of ICUs. These guidelines, grounded in expert opinion and international literature, are poised to set a new standard for intensive care, transcending geographical boundaries.
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