INTENSIVE CARE UNIT
[2022-2023]
[IIHMAHS]
[RUPAM BISWAS]
Submitted to department of BHA The West Bengal University of
Health Science for the 2nd semester.
By
RUPAM BISWAS
NAME: –
ROLL NO: -
RESGISTRATION NO: -
SESSION: -
COLLAGE: -
UNIVERCITY: -
Under the prof. of the Department of BHA.
Prof. Tanmay Majumder
The West Bengal University of Health Science
ACKNOWLEDGEMENT
It is a great honour to express my heartful gratitude to my highly esteemed
teacher and guide Prof. Tanmay Majumder.
I express my sincerest thanks for my teacher’s suggestions and guide that were so
valuable for me in writing this paper.
I would also like top express my respect to all my teachers of The West Bengal
University of Health Science Department for their encouragement and support
that helped me to carry on my study.
I’m also thankful to my friends, parents and well wishers for their support, guide
and assistance in the preparation of this paper.
…………………………………………………
Student ( signature )
DECLARATION
I Rupam Biswas, hereby declare that this study entitled ‘ICU’ has been
prepared by me towards the partial fulfilment of the requirement for the
award of the Bachelor of Hospital Administration (BHA) degree under
the guidance of Prof. Tanmay Majumder.
I also declare that this study is my original work and has not been
previously submitted.
Exclusive Summary
The pressure on our ICUs is severe, and Academy Health Science (AHS) is doing
all it can to increase capacity so that all patients needing critical care will receive
it. It is important to be ready and Academy Health Science (AHS) is taking steps to
ensure we are prepared today and for the future. Given the significant pressure on
our ICUs, we are providing education and training on the application of the
protocol.
The triage protocol would only be activated when all available resources for
critical care have been utilized and all other mitigations have been exhausted and
ability to provide for all who might potentially benefit.
Led and operationalized by highly-trained critical care physicians and stuff, the
protocols ensure a fair and equitable process is applied to all. The process of
development included extensive consultation with Academy Health Science (AHS)
clinical ethics to embed ethical guiding principles, review of literature and existing
protocols in other jurisdictions, and consultation with medical specialist groups,
patient and family advisory, and patient advocacy groups.
In a pandemic situation, critical care resources will not be available to everyone
who may need it thus withholding or withdrawing life sustaining therapies may not
be in the best interests of individual patients but is focused on saving the greatest
number of lives.
As per Academy Health Science (AHS) standards for health care, we provide non-
judgmental health care but treatment to all who are in need and all patients
considered for ICU admission.
INTRODUCTION: -
ICU
The Intensive Care Unit (ICU) is a separate, self-contained area within a
medical facility, equipped with high-tech specialized facilities designed
for close monitoring, rapid intervention and often extended treatment of
patients with acute organ dysfunction.
Intensive care represents the highest level of patient care and treatment
designated for critically ill patients with potentially recoverable life-
threatening conditions.
The Centers for Medicare & Medicaid Services defines critical illness or
injury as “acutely impairing one or more vital organ systems such that
there is a high probability of imminent or life-threatening deterioration
in the patient’s condition”.
The aim of intensive care is to maintain vital functions in order to
prevent further physiological deterioration, reduce mortality and
prevent morbidity in critically ill patients.
TYPES OF ICU :
Healthcare professionals who are responsible for assigning patients to
the department that's best for them may choose to admit a patient to
a certain intensive care unit.
MEDICAL (MICU) : Patients who require close observation and
specialized treatment may be candidates for the medical ICU.
Common conditions that patients present with include respiratory
failure, cancer, overdose and sepsis.
LONG-TERM : Individuals who are in need of long-term care
because of their critical diagnosis may become patients of the
long-term ICU.
CARDIAC (CCU OR CTU) : Individuals who have had a cardiac
emergency, like a heart attack or sudden stoppage of their heart,
may become a patient in the cardiac ICU. Healthcare
professionals, like cardiologists and surgeons who specialize in
the heart, may care for these patients.
GERIATRIC : The geriatric ICU is dedicated to providing care to
critically ill or injured elderly patients. These patients may
experience severe infections or require more advanced
monitoring after surgery.
ISOLATION : The isolation ICU is for patients who have a
contagious disease and should receive care away from other
hospital patients so their disease doesn't spread. Healthcare
professionals working in this ICU typically wear personal
protective equipment (PPE) so they can also stay protected from
contagion.
NEONATAL (NICU) : The neonatal ICU is for premature newborns
and infants, usually up to a year of age, who are in acute distress
and require constant care.
NEUROLOGIC(NEURO-ICU) : Patients in the neurologic ICU may
admit with a stroke, aneurysm or brain tumor. Patients may also
enter this type of ICU following a neurological surgery so
neurosurgeons and other specialized staff can provide more care
and closer monitoring.
PEDIATRIC (PICU) : Children who are experiencing severe and life-
threatening conditions such as asthma, infections, accidents,
near-drowning incidences and heart conditions are usually in the
pediatric ICU. Some children get admitted to the PICU following a
complicated surgery that can affect the respiratory system.
PHYCHIATRIC (PICU) : The psychiatric ICU is typically for patients
who are experiencing an intense psychological episode that
makes them a danger to themselves or others. Healthcare
professionals in this ICU closely monitor their patients to make
sure they remain safe.
SERGICAL (SICU) : Patients who need surgery or who are
recovering from surgery may be in the surgical ICU. The surgeons
who will care for the patient population are usually the ones who
manage this ICU so they can use their critical care experience if
need be.
TRAUMA (TICU) : The trauma ICU is for patients who have
experienced an accident, like one involving an automobile,
gunshot wound or fall at work although patients who have
undergone a complicated surgery may also qualify for the trauma
ICU. Healthcare professionals in this ICU often need to stabilize
the patients and be able to respond to any changes in status that
require emergency intervention.
WHO WORKS IN AN ICU :
MEDICAL TECHNICIAN : Medical technicians have an important role
in any ICU environment. They're responsible for maintaining the
equipment that other healthcare professionals use to treat
patients during their stay. Because patients may experience a
status change that requires rapid intervention, having working
equipment that's available is imperative. Depending on their
education and skill level, medical technicians may also draw labs,
clean rooms or assist nurses with patient care.
NURSE : An ICU nurse typically has critical care experience or
training so they can provide for patients in the intensive care unit
following an injury or illness. They often have to monitor patients,
respond to emergency situations, make quick decisions for the
benefit of the patient's health and communicate with the ICU
physician for any major changes to a patient's status. ICU nurses
also work with specialized equipment and administer and adjust
medications.
NUTRITIONIST : While a nutritionist or dietitian may have a
primary office setting outside of the ICU, healthcare professionals
who are treating ICU patients may consult with the nutrition team
to ensure their patients receive specific foods. The nutritionist
helps create menus for patients based on their condition and any
nutrients they may be lacking that can aid in their recovery.
Dietitians and nutritionists may also speak with the patient or
their family about a diet that can help them manage the onset of
symptoms for their disease.
OCCUPATIONAL THERAPIST : Occupational therapists are
particularly helpful to those patients who are able to continue
their daily living following an ICU stay. These healthcare
professionals visit the patient prior to discharge to help them
learn how to dress themselves, eat on their own and perform
other daily tasks following an injury or illness.
PHARMACIST : A pharmacist may visit the ICU to understand more
about a patient's status and medication needs. They often
recommend medications based on a patient's condition, disease
progression and any allergies they may have. Physicians and
nurses may consult with a pharmacist if a patient is experiencing
an adverse drug reaction.
PHYSICAL THERAPIST : In most ICUs, we are likely to find patients
who aren't able to move or who have limited abilities and remain
in bed throughout the duration of their stay. A physical therapist
may visit patients and increase their mobility by stretching their
arms and legs, rolling them from one side to the other and
helping them complete breathing treatments or walk around their
room. The help of physical therapists can often prevent bedsores,
pneumonia and blood clots.
PHYSICIAN : An ICU physician, who is commonly referred to as an
intensivist, is a doctor who typically has more advanced training
and experience in critical care, anesthesia practices or surgery,
among other specialties. Upon a patient's arrival in the ICU, the
attending physician may complete an assessment and various
exams, including pulmonary, cardiovascular and bowel, to
determine the severity of the patient's condition and develop a
treatment plan.
SOCIAL-WORKER : A social worker is an important part of ICU
operations for patients. Their primary duty is to provide resources
and care options to patients and their families that can help them
cope with the emotional and financial toll that being in the ICU
may bring. Many social workers also manage communication
between the healthcare team and a patient, ensuring that
patients understand their condition and treatment plan.
SPEECH-THERAPIST : Because it's common to find ICU patients
on a ventilator, which can affect their ability to speak, speech
therapists are an important part of an ICU setting. They provide
equipment, such as speech boards, that help a patient
communicate with doctors, nurses and their family members.
Speech therapists often assess a patient's swallowing capability
and help patients speak and swallow after a healthcare
professional has removed their breathing tube.
Duties and Responsibilities :
. Specific responsibilities include:
1. Examine their patients at least daily
2. Review the laboratory, x-ray, and other new studies at least daily.
3. Enter an admission note (history and physical) in One Chart at the time of
admission. In the case of CCM consultations, a formal consultation note must be
entered after the patient has been staffed.
4. Write daily progress notes. When a student is helping the resident, the student
may write the progress note. However, the resident must review and edit this
note to make sure it is correct prior to rounds each morning. The note must
include the overall assessment and plan for the day.
5. Enter all orders for their patients in One Chart. The fellow and staff will also be
able to write orders in the absence of the resident. Students may write orders on
patients they are following but the orders must be co-signed by the appropriate
resident or fellow. Each resident must review their patients’ orders daily and sign
all verbal orders within 24 hours of placement.
6. Enter either discharge summaries or death summaries in One Chart when any
patient leaves the Intensive Care Unit. This must be done within 24 hours of
discharge or death. In the case of transfers to the floor, a transfer note,
appropriate orders, and checkout to the receiving team is sufficient. When a
complicated patient has been in the Intensive Care Unit for a long period of time,
the resident should enter an interim hospitalization summary at the end of the
month so that the next resident who is on this service will have this available and
will make the final discharge or death summary much simpler.
7. Perform all procedures on their patients (with the exception of bronchoscopy)
after they have discussed this with the CCM fellow and/or the attending staff. The
resident should not perform any invasive procedures until they have been
adequately supervised by the fellow and /or attending physician. It will remain
the option of the fellow to do the procedure. However, it is expected that the
residents will perform the majority of the invasive procedures at the discretion of
the fellow.
8. Remain in or near the intensive Care Unit to help with other ICU
responsibilities, attend all lectures, and help teach the medical students on days
when they are not post-call or on-call. The exception to this is the day after
overnight call. Each resident is only allowed to work 24 hours continuously with
an additional 6 hours to complete patient care responsibilities and attend
required conferences as provided by the ACGME Common Program
Requirements. Prior to leaving the hospital, the post-call resident must check out
their patients in detail to both the on-call resident and the CCM fellow. If the
patient load for a particular resident 35 becomes unwieldy, patients can be
reassigned to another resident on the team at the discretion of the fellow or
attending. In this way, the numbers of patients can be distributed in an equitable
way.
9. Carefully check out their patients to the resident on call prior to leaving the
hospital on non-call days. The resident taking call is responsible for all the patients
on the CCM team after check-out has occurred. This is also true for coverage after
checkout on weekends.
10. Attend all Critical Care lectures. All efforts must be made to attend these
teaching sessions. With the exception of a true medical emergency or a standing
outpatient clinic obligation, attendance at these lectures is required.
Evaluation:
1) At the conclusion of each resident’s service period, a performance evaluation
must be prepared by the responsible attending physician. The assessment should
be reviewed personally by the internal medicine resident in the presence of the
attending physician.
2) At the conclusion of the resident’s service period, he/she should complete an
evaluation form assessing the quality of the rotation; he/she should also address
the teaching undertaken by the attending physician.
REVIEW AND LITERATURE :
The recent literature regarding intensive care unit (ICU) updated clinical
practice guidelines are reviewed. The incentive care unit (ICU) is a crucial
and expensive resource largely affected by uncertainly and variability.
Insufficient ICU capacity causes many negative effects not only in the ICU
itself, but also in order connect departments along the patient care path.
Operations research/management science (OR/MS) plays an important role
in identifying ways to manage ICU capacities efficiently and in ensuring
desired levels of service quality.
We start our review by illustrating the important role the ICU plays in the
hospital patient flow. Then we focus on the ICU management problem
(single department management problem) and classify the literature from
multiple angle’s including decision horizons, problem setting, and modeling
and solution techniques.
METHODOLOGY :
clinical parameters analysis : The clinical parameters should converge to
normality values as the patients’ day of discharge approaches.
Simultaneously, the variability of the observed values should decrease as
the discharge day is closer. Heterogeneity here corresponds to how
much the average value of the parameters in a group deviates from the
normality values or normality range and, alternatively, how much the
variability of these values for patients within a group decreases
as approaches to one (i.e, the day before discharge).
severity scales analysis : Several clinical scales or scores, such as SOFA,
NAS, or EMINA, are frequently used in ICU to measure different
dimensions of the patient complexity, condition severity, or care
requirements. These scales simplify medical interpretation of
diagnostic, therapeutic, and prognostic aspects, such as the degree of
patient’s organ failure (SOFA), the percentage of nursing activity
required (NAS), or the risk of developing pressure ulcers as a combined
assessment of mental state, mobility, incontinence, nutrition and
activity (EMINA).
cluster analysis : In statistical classification, cluster analysis is based on
the premise that elements in the same cluster are similar and elements
in different clusters are dissimilar. Combining these intra-cluster
similarity and inter-cluster dissimilarity concepts, there are several
indices to assess the quality of a given clustering. Among them, Davies-
Bouldin, and average silhouette are some of the most used. Converting
these distance-based indices into ICU patient similarity indices is
accomplished.
UCI patient heterogeneity analysis : All the adult patients admitted in the
ICU of the University Hospital Joan XXIII, Spain, in the years 2016–
2019 were taken to quantify the patient heterogeneity within that
service. Only patients discharged alive were considered. All discharges
correspond to patients who were transferred to other non-critical units
of the hospital to continue their treatment. None of them were
discharged from the hospital. While in the ICU, the daily information of
these patients in the 21 days previous to discharge was used in the
analysis.
DATA COLLECTION ANALYSIS :
The condition of the critically ill patient can change rapidly and often
unpredictably. This implies that the assessments of cardiovascular, respiratory
and metabolic variables must be extremely frequent, if not continuous, to
allow early identification of adverse trends and prompt therapeutic
intervention. The vast amount of data thus generated necessitates its
presentation in an informative manner with emphasis on significant change.
Manual recording and charting often prove inefficient both in terms of nursing
time and the quality of patient record produced.
Computer-assisted monitoring and data documentation are ideally suited to
the requirements of patient management in the intensive care unit. When
suitably programmed, tasks can be performed more efficiently than with
nursing staff; for example, automatic documentation of cardiovascular
variables can be obtained direct from the monitors more frequently than
would be possible with nursing staff. Similarly, computers can perform tasks
which personnel cannot, or do not, perform accurately such as complex
calculations to assess the degree of intrapulmonary shunting or calculation of
drug doses and infusion rates.
Rapid advances in microprocessor development have brought powerful
microcomputers within the financial reach of individuals and small intensive
care units. However, adequate planning of the microcomputer system must
precede its implementation to identify the tasks which can be improved. In
addition, it is essential that the system is easy to use by the frequently
changing personnel, and adaptable to their suggestions for improvement and
modification. Otherwise, it will prove unacceptable, and the project will fail.
Microcomputer-assisted recording and documentation offers an efficient and
developing tool for the management of patient data in the intensive care unit.
