Guidelines - "European Society of Intensive Care Medicine"

Introduction

The objectives of an Intensive Care Department (ICD) are the monitoring and support of failing vital functions in critically ill patients, in order to perform adequate diagnostic measures and medical and/or surgical therapies to improve outcome. Successful intensive care medicine depends on a meticulous interaction between human, technological and spatial resources. The purpose of the following recommendations is to provide a guide for those who are planning a new department or to adapt an existing one. It should, however, be clear that most of the recommendations are not based on scientifically well documented evidence but rather express the consensus of a group of opinion leaders (see Task Force members) involved in intensive care medicine. As such, the recommendations represent a European average, and adaptions on local situations may be necessary. Many existing ICDs may be unable to comply with some recommendations because of structural and other constraints. The recommendations are presented here as a condensed list of items and are described in more detail in a booklet "Minimal Requirements for Intensive Care Departments". It is a available at the ESICM secretariat.

Levels of care

Human, technological and spatial resources are dependent on the level of care (LOC). In order to solve this problem, the members of the Task Force scored the necessity of an item according to three levels of care (Table 1) depending on the nurse/patient ratio.

Table 1

Level of care Nurse/patient Approximate number of ratio fulltime equivalents to run 1 ICD bed

• III (highest) 1/1 6
• II 1/1.6 4
• I (lowest) 1/3 2

The need for nurse manpower can be calculated taking into account: the number of shifts per day, the number of beds in the unit, the number of days in the unit is operating per week, the desired occupancy rate, extra manpower for holidays, illness and level of care, and the number of days theat each professional is working per week. The reader is referred to the ESICM report on "Management of Intensive Care: guidelines for better use of resources" by D. Reis Miranda, A. Williams and Ph. Loirat, published by Kluwer Academic Publishers (1990). Different LOCs may be present in the same ICD. According to the LOC, each item is scored with either

• E = Essential
• D = Desirable
• O = Optional
• - = Not required

Intensive Care Medicine is in constant evolution. Periodic revisions of these recommendations will be necessary.