Supreme Court endorses uniform ICU norms to check prolonged stay of patients

THe sublime margaret court has endorsed a go under of unvarying guidelines for intensive give care units (ICUs), proposing that stabilised patients requiring no further organ support or physiological monitoring be discharged or moved to hospital wards.The guidelines were part of a report, drafted by a three-member committee and vetted by medical experts, was endorsed by the court on April 20 as “practical, implementable, and necessary as a minimum standard for an ICU.” A bench of justices Ahsanuddin Amanullah and R Mahadevan directed states and Union territories to formulate an action plan identifying five core areas from the document and a methodology for implementation by May 18.The document highlighted the trauma experienced by patients’ relatives, who often lack knowledge about ICU care and rely solely on doctors’ advice to prolong the stay, as a key reason for the new proposals.The document, titled “Guidelines for Organisation and Delivery of Intensive Care Services,” stated: “Upon clinical stabilization, when further organ support and/or close physiological monitoring are not required, patients should be stepped down to lower levels of care like ward, high dependency unit or discharged, as deemed appropriate by the treating physician.”The court-constituted committee comprising All India Institute of Medical Sciences (AIIMS) doctor Nitish Naik, additional solicitor general (ASG) Aishwarya Bhati, and advocate Karan Bharioke, who acted as amicus curiae, clarified: “It is important to emphasise that clinical judgement should be used to determine which level of care would be the most appropriate for a critically ill patient.”Also read: As Delhi sees first heatwave day, hospitals reopen specialised clinics, gear up for emergenciesSeveral leading medical professionals vetted the guidelines, including Naresh Trehan of Medanta, Harsh Mahajan of Mahajan Imaging and Labs, Shiv Sarin of the Institute of Liver and Biliary Sciences (ILBS), Devi Prasad Shetty of Narayana Health, Pankaj Chaturvedi and Sheel Pushp Bhosale of Tata Memorial Centre, and Saumitra Rawat of Sir Ganga Ram Hospital. They attended the court hearing on Monday and were requested to be present at the next hearing.DK Gupta, chairman of Felix Hospital, Noida, welcomed the proposals. “Presently, hospitals do not have a uniform ICU guideline but have standard operating protocols. It is a welcome step if the Supreme Court is coming up with such a guideline,” he said.Regarding the stepping down of patients, Gupta said: “Longer stay in ICU exposes patients to hospital-acquired infection and it is advisable that patients are stepped down to HDU or ward if they are stable. We do not encourage discharging patients from ICU. Instead, if they are shifted to HDU, it helps prevent re-admission to ICU.”Also read: Lack of basic amenities hits patients, attendants at most govt hospitals in LucknowHe said a prolonged ICU stay can create “ICU psychosis,” affecting the patient mentally, and that family support in a regular ward aids early recovery.The report established common minimum standards for ICUs. It proposed a ratio of one nurse for every two or three ICU patients, and round-the-clock monitoring by a specialist holding a postgraduate degree recognised by the National Medical Council (NMC). The guidelines establish these requirements but leave implementation monitoring to the states and Union territories.Identifying nursing care as an essential component, the report stated a basic ICU should maintain a nurse-to-patient ratio of one to two or one to three, depending on medical acuity. In a Level 3 ICU, meant for critically ill patients requiring multiple organ support, this ratio can be one to one, as patients are unstable or on ventilators.The size and bed strength of an ICU can vary based on the total number of hospital beds and the type of services delivered, such as surgical, medical, trauma, or emergency services, as well as the number of operation theatres. To promote operational efficiency, the guidelines proposed that a basic level ICU have six to eight beds, and those requiring critical care extend to 12. The document also stressed round-the-clock monitoring by resident doctors working in shifts.The guidelines detailed infrastructural requirements for enhanced monitoring and physiological organ support. These include bedside utilities, emergency and non-emergency equipment such as wheelchairs, patient trolleys, transport ventilators, and portable oxygen cylinders. They also cover imaging and laboratory services, infection control, fire safety, allied healthcare personnel, documentation, and periodic audits.The bench directed all state health secretaries and additional secretaries to convene a meeting with involved experts. They are to draw up an action plan for implementing the draft guidelines, prioritising five issues as essential and mandatory.Also read: Treatment at private hospitals to get cheaper? Health ministry mulls cap on billing, says reportOnce completed, the action plans must be shared with the Union health secretary, who will convene a meeting with state and Union territory counterparts to finalise a commonly agreed draft. This will be placed before the court at the next hearing.The court’s order stems from a 2024 petition arising from a medical negligence case at the national consumer forum. Asit Baran Mondal filed the case seeking compensation for the death of his wife at a Kolkata hospital in 2013, citing alleged medical negligence.During these proceedings, the Centre informed the court about the Model ICU and critical care unit (CCU) guidelines prepared by the Union health ministry in 2023. These could not be implemented unless states adopted similar measures, as health is a state subject under the Constitution.