Health and Me

Rachel V Thomas

ICU Rules In India Set For Overhaul: SC-Backed Staff, Discharge Norms Likely from Mid-May

India's Supreme Court has revamped guidelines for <span>intensive care units</span> (ICUs) across the country, and the top court has also asked all the states and Union Territories to prepare a “realistic and practical” action plan to implement the guidelines necessary as a minimum standard for intensive care units. 

As per the new draft guidelines, set to be implemented from mid-May, patients who are stable and no longer need critical support will be shifted out of ICUs to wards or other care units.

The guidelines, prepared by a three-member court-appointed committee and reviewed by leading medical experts, were endorsed by the apex court as “practical, implementable, and necessary as a minimum standard for an ICU,” The Hindustan Times reported.

A bench of Justices Ahsanuddin Amanullah and R Mahadevan said copies of the guidelines should be shared with all the states and UTs.

“Moving further, as an immediate measure, let all the additional chief secretaries/secretaries … heading the department of health and medical education in the states and the UTs, convene a meeting of all experts involved in this exercise to prepare an action plan for implementation of the guidelines. Such a plan shall be realistic and practical,” the bench said in its order.

<ul><li>The guidelines prepared by experts, including AIIMS doctor Nitish Naik, Additional Solicitor General Aishwarya Bhati, and advocate Karan Bharioke as amicus curiae, stressed that doctors’ clinical judgment should guide decisions on the level of care for each patient. </li></ul> 

<ul><li>The guidelines set minimum standards for how ICUs should function. They recommend having one nurse for every two to three patients in basic ICUs, and one nurse per patient in advanced ICUs where patients need multiple organ support, <em>The Times of India</em> reported.</li></ul> 

They also call for round-the-clock monitoring by resident doctors working in shifts, under the supervision of specialists with postgraduate qualifications recognized by the National Medical Council. 

<ul><li>The document lists requirements for equipment such as ventilators, oxygen supply systems, patient transport facilities, and bedside utilities. It also lays down norms for infection control, fire safety, record-keeping, and regular audits, the media reports said.</li></ul> 

<ul><li>For capacity, the guidelines suggest that a basic ICU should have six to eight beds, which can be expanded to about 12 beds in hospitals handling more critical cases, depending on the services offered.</li></ul>

The SC bench had urged for a meeting of all concerned to discuss and prepare a final common guideline, which shall then be circulated to all states and UTs.

“A final report/blueprint/recommendation shall be prepared, which shall be placed before this court on the next date,” it said, adding that the entire exercise should be completed within three weeks. 

“Let the Ministry of Health, Government of India, formally issue the guidelines placed before us today, to the states and UTs concerned by way of an advisory. A copy of it shall also be uploaded on the website of the Ministry of Health, Government of India,” the bench said, while posting the matter for further hearing on May 18.

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India's Supreme Court has revamped guidelines for intensive care units (ICUs) across the country, and the top court has also asked all the states and Union Territories to prepare a “realistic and practical” action plan to implement the guidelines necessary as a minimum standard for intensive care units. As per the new draft guidelines, set to be implemented from mid-May, patients who are stable and no longer need critical support will be shifted out of ICUs to wards or other care units. The guidelines, prepared by a three-member court-appointed committee and reviewed by leading medical experts, were endorsed by the apex court as “practical, implementable, and necessary as a minimum standard for an ICU,” The Hindustan Times reported. A bench of Justices Ahsanuddin Amanullah and R Mahadevan said copies of the guidelines should be shared with all the states and UTs. “Moving further, as an immediate measure, let all the additional chief secretaries/secretaries … heading the department of health and medical education in the states and the UTs, convene a meeting of all experts involved in this exercise to prepare an action plan for implementation of the guidelines. Such a plan shall be realistic and practical,” the bench said in its order. What Are The Draft Guidelines? The guidelines prepared by experts, including AIIMS doctor Nitish Naik, Additional Solicitor General Aishwarya Bhati, and advocate Karan Bharioke as amicus curiae, stressed that doctors’ clinical judgment should guide decisions on the level of care for each patient.  The guidelines set minimum standards for how ICUs should function. They recommend having one nurse for every two to three patients in basic ICUs, and one nurse per patient in advanced ICUs where patients need multiple organ support, The Times of India reported. They also call for round-the-clock monitoring by resident doctors working in shifts, under the supervision of specialists with postgraduate qualifications recognized by the National Medical Council.  The document lists requirements for equipment such as ventilators, oxygen supply systems, patient transport facilities, and bedside utilities. It also lays down norms for infection control, fire safety, record-keeping, and regular audits, the media reports said. For capacity, the guidelines suggest that a basic ICU should have six to eight beds, which can be expanded to about 12 beds in hospitals handling more critical cases, depending on the services offered.The SC bench had urged for a meeting of all concerned to discuss and prepare a final common guideline, which shall then be circulated to all states and UTs. “A final report/blueprint/recommendation shall be prepared, which shall be placed before this court on the next date,” it said, adding that the entire exercise should be completed within three weeks.  “Let the Ministry of Health, Government of India, formally issue the guidelines placed before us today, to the states and UTs concerned by way of an advisory. A copy of it shall also be uploaded on the website of the Ministry of Health, Government of India,” the bench said, while posting the matter for further hearing on May 18.