Intensive Care Medicine

, 37:1575

Recommendations on basic requirements for intensive care units: structural and organizational aspects

  • Andreas Valentin
  • Patrick Ferdinande
  • ESICM Working Group on Quality Improvement
Special Article

Abstract

Objective

To provide guidance and recommendations for the planning or renovation of intensive care units (ICUs) with respect to the specific characteristics relevant to organizational and structural aspects of intensive care medicine.

Methodology

The Working Group on Quality Improvement (WGQI) of the European Society of Intensive Care Medicine (ESICM) identified the basic requirements for ICUs by a comprehensive literature search and an iterative process with several rounds of consensus finding with the participation of 47 intensive care physicians from 23 countries. The starting point of this process was an ESICM recommendation published in 1997 with the need for an updated version.

Results

The document consists of operational guidelines and design recommendations for ICUs. In the first part it covers the definition and objectives of an ICU, functional criteria, activity criteria, and the management of equipment. The second part deals with recommendations with respect to the planning process, floorplan and connections, accommodation, fire safety, central services, and the necessary communication systems.

Conclusion

This document provides a detailed framework for the planning or renovation of ICUs based on a multinational consensus within the ESICM.

Keywords

Intensive care medicine Organization Structural requirements Quality of care Consensus paper 

Abbreviations

AHCP

Allied health care professional

dB

Decibel

ESICM

European Society of Intensive Care Medicine

ESM

Electronic supplementary material

FTE

Full time equivalent

HDU

High dependency unit

ICU

Intensive care unit

iv

Intravenous

LOC(s)

Level(s) of care

M and F

Male and female

WQI

Working Group of Quality Improvement (ESICM)

Supplementary material

134_2011_2300_MOESM1_ESM.doc (107 kb)
Supplementary material 1 (DOC 107 kb)

References

  1. 1.
    Ferdinande P (1997) Recommendations on minimal requirements for intensive care departments. Members of the Task Force of the European Society of Intensive Care Medicine. Intensive Care Med 23:226–232PubMedCrossRefGoogle Scholar
  2. 2.
    Brilli RJ, Spevetz A, Branson RD, Campbell GM, Cohen H, Dasta JF, Harvey MA, Kelley MA, Kelly KM, Rudis MI, St Andre AC, Stone JR, Teres D, Weled BJ (2001) Critical care delivery in the intensive care unit: defining clinical roles and the best practice model. Crit Care Med 29:2007–2019PubMedCrossRefGoogle Scholar
  3. 3.
    Multz AS, Chalfin DB, Samson IM, Dantzker DR, Fein AM, Steinberg HN, Niederman MS, Scharf SM (1998) A “closed” medical intensive care unit (MICU) improves resource utilization when compared with an “open” MICU. Am J Respir Crit Care Med 157:1468–1473PubMedGoogle Scholar
  4. 4.
    [No authors listed] (1995) Guidelines for intensive care unit design. Guidelines/Practice Parameters Committee of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med 23:582–588Google Scholar
  5. 5.
    College of Intensive Care Medicine of Australia and New Zealand (2010) Minimum standards for intensive care units. http://www.cicm.org.au
  6. 6.
    Hasin Y, Danchin N, Filippatos GS, Heras M, Janssens U, Leor J, Nahir M, Parkhomenko A, Thygesen K, Tubaro M, Wallentin LC, Zakke I (2005) Recommendations for the structure, organization, and operation of intensive cardiac care units. Eur Heart J 26:1676–1682PubMedCrossRefGoogle Scholar
  7. 7.
    Ferrer R, Artigas A, Levy MM, Blanco J, Gonzalez-Diaz G, Garnacho-Montero J, Ibanez J, Palencia E, Quintana M, De la Torre-Prados MV (2008) Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 299:2294–2303PubMedCrossRefGoogle Scholar
  8. 8.
    Ramnarayan P, Thiru K, Parslow RC, Harrison DA, Draper ES, Rowan KM (2010) Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study. Lancet 376:698–704PubMedCrossRefGoogle Scholar
  9. 9.
    Minvielle E, Dervaux B, Retbi A, Aegerter P, Boumendil A, Jars-Guincestre MC, Tenaillon A, Guidet B (2005) Culture, organization, and management in intensive care: construction and validation of a multidimensional questionnaire. J Crit Care 20:126–138PubMedCrossRefGoogle Scholar
  10. 10.
    Minvielle E, Aegerter P, Dervaux B, Boumendil A, Retbi A, Jars-Guincestre MC, Guidet B (2008) Assessing organizational performance in intensive care units: a French experience. J Crit Care 23:236–244PubMedCrossRefGoogle Scholar
  11. 11.
    Shortell SM, Rousseau DM, Gillies RR, Devers KJ, Simons TL (1991) Organizational assessment in intensive care units (ICUs): construct development, reliability, and validity of the ICU nurse-physician questionnaire. Med Care 29:709–726PubMedCrossRefGoogle Scholar
  12. 12.
    Bertolini G, Rossi C, Brazzi L, Radrizzani D, Rossi G, Arrighi E, Simini B (2003) The relationship between labour cost per patient and the size of intensive care units: a multicentre prospective study. Intensive Care Med 29:2307–2311PubMedCrossRefGoogle Scholar
  13. 13.
    Jacobs R, Dawson D (2003) Hospital efficiency targets. Health Econ 12:669–684PubMedCrossRefGoogle Scholar
  14. 14.
    Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O’Brien CR, Rubenfeld GD (2006) Hospital volume and the outcomes of mechanical ventilation. N Engl J Med 355:41–50PubMedCrossRefGoogle Scholar
  15. 15.
    Lecuyer L, Chevret S, Guidet B, Aegerter P, Martel P, Schlemmer B, Azoulay E (2008) Case volume and mortality in haematological patients with acute respiratory failure. Eur Respir J 32:748–754PubMedCrossRefGoogle Scholar
  16. 16.
    Pronovost PJ, Jenckes MW, Dorman T, Garrett E, Breslow MJ, Rosenfeld BA, Lipsett PA, Bass E (1999) Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA 281:1310–1317PubMedCrossRefGoogle Scholar
  17. 17.
    [No authors listed] (1994) Guidelines for training in intensive care medicine. European Society of Intensive Care Medicine. Intensive Care Med 20:80–81Google Scholar
  18. 18.
    Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA (2004) Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med 351:1838–1848PubMedCrossRefGoogle Scholar
  19. 19.
    Arnedt JT, Owens J, Crouch M, Stahl J, Carskadon MA (2005) Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion. JAMA 294:1025–1033PubMedCrossRefGoogle Scholar
  20. 20.
    Barger LK, Cade BE, Ayas NT, Cronin JW, Rosner B, Speizer FE, Czeisler CA (2005) Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med 352:125–134PubMedCrossRefGoogle Scholar
  21. 21.
    Vagts D (2007) Ärztliche Personalbedarfsermittlung in der Intensivmedizin. Anasthesiol Intensivmed Notfallmed Schmerzther 4:306–311Google Scholar
  22. 22.
    Dimick JB, Pronovost PJ, Heitmiller RF, Lipsett PA (2001) Intensive care unit physician staffing is associated with decreased length of stay, hospital cost, and complications after esophageal resection. Crit Care Med 29:753–758PubMedCrossRefGoogle Scholar
  23. 23.
    Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL (2002) Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 288:2151–2162PubMedCrossRefGoogle Scholar
  24. 24.
    Burchardi H, Moerer O (2001) Twenty-four hour presence of physicians in the ICU. Crit Care 5:131–137PubMedCrossRefGoogle Scholar
  25. 25.
    Morales IJ, Peters SG, Afessa B (2003) Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit. Crit Care Med 31:858–863PubMedCrossRefGoogle Scholar
  26. 26.
    Finkielman JD, Morales J, Peters SG, Keegan MT, Ensminger SA, Lymp JF, Afessa B (2004) Mortality rate and length of stay of patients admitted to the intensive care unit in July. Crit Care Med 32:1161–1165PubMedCrossRefGoogle Scholar
  27. 27.
    Barry WA, Rosenthal GE (2003) Is there a July phenomenon? The effect of July admission on intensive care mortality and length of stay in teaching hospitals. J Gen Intern Med 18:639–645PubMedCrossRefGoogle Scholar
  28. 28.
    Luyt CE, Combes A, Aegerter P, Guidet B, Trouillet JL, Gibert C, Chastre J (2007) Mortality among patients admitted to intensive care units during weekday day shifts compared with “off” hours. Crit Care Med 35:3–11PubMedCrossRefGoogle Scholar
  29. 29.
    Schmalenberg C, Kramer M (2007) Types of intensive care units with the healthiest, most productive work environments. Am J Crit Care 16:458–468 quiz 469PubMedGoogle Scholar
  30. 30.
    Gurses AP, Carayon P (2007) Performance obstacles of intensive care nurses. Nurs Res 56:185–194PubMedCrossRefGoogle Scholar
  31. 31.
    Haupt MT, Bekes CE, Brilli RJ, Carl LC, Gray AW, Jastremski MS, Naylor DF, Pharm DM, Md AS, Wedel SK, Md MH (2003) Guidelines on critical care services and personnel: recommendations based on a system of categorization of three levels of care. Crit Care Med 31:2677–2683PubMedCrossRefGoogle Scholar
  32. 32.
    Goldhill D (2002) Levels of critical care for adult patients. Standards and guidelines. Intensive Care Society, LondonGoogle Scholar
  33. 33.
    Tarnow-Mordi WO, Hau C, Warden A, Shearer AJ (2000) Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit. Lancet 356:185–189PubMedCrossRefGoogle Scholar
  34. 34.
    Pronovost PJ, Dang D, Dorman T, Lipsett PA, Garrett E, Jenckes M, Bass EB (2001) Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery. Eff Clin Pract 4:199–206PubMedGoogle Scholar
  35. 35.
    Dang D, Johantgen ME, Pronovost PJ, Jenckes MW, Bass EB (2002) Postoperative complications: does intensive care unit staff nursing make a difference? Heart Lung 31:219–228PubMedCrossRefGoogle Scholar
  36. 36.
    Amaravadi RK, Dimick JB, Pronovost PJ, Lipsett PA (2000) ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy. Intensive Care Med 26:1857–1862PubMedCrossRefGoogle Scholar
  37. 37.
    Reis Miranda D, Moreno R, Iapichino G (1997) Nine equivalents of nursing manpower use score (NEMS). Intensive Care Med 23:760–765PubMedCrossRefGoogle Scholar
  38. 38.
    Iapichino G, Radrizzani D, Bertolini G, Ferla L, Pasetti G, Pezzi A, Porta F, Miranda DR (2001) Daily classification of the level of care. A method to describe clinical course of illness, use of resources and quality of intensive care assistance. Intensive Care Med 27:131–136PubMedCrossRefGoogle Scholar
  39. 39.
    Cullen DJ, Civetta JM, Briggs BA, Ferrara LC (1974) Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med 2:57–60PubMedCrossRefGoogle Scholar
  40. 40.
    Miranda DR, de Rijk A, Schaufeli W (1996) Simplified Therapeutic Intervention Scoring System: the TISS-28 items—results from a multicenter study. Crit Care Med 24:64–73PubMedCrossRefGoogle Scholar
  41. 41.
    [No authors listed] (1991) Time oriented score system (TOSS): a method for direct and quantitative assessment of nursing workload for ICU patients. Italian Multicenter Group of ICU research (GIRTI). Intensive Care Med 17:340–345Google Scholar
  42. 42.
    Miranda DR, Nap R, de Rijk A, Schaufeli W, Iapichino G (2003) Nursing activities score. Crit Care Med 31:374–382PubMedCrossRefGoogle Scholar
  43. 43.
    Iapichino G, Radrizzani D, Ferla L, Pezzi A, Porta F, Zanforlin G, Miranda DR (2002) Description of trends in the course of illness of critically ill patients. Markers of intensive care organization and performance. Intensive Care Med 28:985–989PubMedCrossRefGoogle Scholar
  44. 44.
    Iapichino G, Radrizzani D, Pezzi A, Assi E, Di Mauro P, Mistraletti G, Porta F (2005) Evaluating daily nursing use and needs in the intensive care unit: a method to assess the rate and appropriateness of ICU resource use. Health Policy 73:228–234PubMedCrossRefGoogle Scholar
  45. 45.
    National AHP and HCS Critical Care Advisory Group (UK) (2003) Allied Health Professionals (AHP) and Healthcare Scientists (HCS) critical care staffing guidance. A guideline for AHP and HCS Staffing levels. http://www.ukcpa.org/ukcpadocuments/2.pdf
  46. 46.
    Rothen HU, Stricker K, Einfalt J, Bauer P, Metnitz PG, Moreno RP, Takala J (2007) Variability in outcome and resource use in intensive care units. Intensive Care Med 33:1329–1336PubMedCrossRefGoogle Scholar
  47. 47.
    Sexton JB, Berenholtz SM, Goeschel CA, Watson SR, Holzmueller CG, Thompson DA, Hyzy RC, Marsteller JA, Schumacher K, Pronovost PJ (2011) Assessing and improving safety climate in a large cohort of intensive care units. Crit Care Med 39:934–939Google Scholar
  48. 48.
    Azoulay E, Timsit JF, Sprung CL, Soares M, Rusinova K, Lafabrie A, Abizanda R, Svantesson M, Rubulotta F, Ricou B, Benoit D, Heyland D, Joynt G, Francais A, Azeivedo-Maia P, Owczuk R, Benbenishty J, de Vita M, Valentin A, Ksomos A, Cohen S, Kompan L, Ho K, Abroug F, Kaarlola A, Gerlach H, Kyprianou T, Michalsen A, Chevret S, Schlemmer B (2009) Prevalence and factors of intensive care unit conflicts: the Conflicus Study. Am J Respir Crit Care Med 180:853–860PubMedCrossRefGoogle Scholar
  49. 49.
    [No authors listed] (1997) Fair allocation of intensive care unit resources. American Thoracic Society. Am J Respir Crit Care Med 156:1282–1301Google Scholar
  50. 50.
    Dawson S, Runk JA (2000) Right patient? Right bed? A question of appropriateness. AACN Clin Issues 11:375–385PubMedCrossRefGoogle Scholar
  51. 51.
    Pirret AM (2002) Utilizing TISS to differentiate between intensive care and high-dependency patients and to identify nursing skill requirements. Intensive Crit Care Nurs 18:19–26PubMedCrossRefGoogle Scholar
  52. 52.
    Iapichino G, Radrizzani D, Rossi C, Pezzi A, Anghileri A, Boffelli S, Giardino M, Mistraletti G, Bertolini G (2007) Proposal of a flexible structural-organizing model for the intensive care units. Minerva Anestesiol 73:501–506PubMedGoogle Scholar
  53. 53.
    Wild C, Narath M (2005) Evaluating and planning ICUs: methods and approaches to differentiate between need and demand. Health Policy 71:289–301PubMedCrossRefGoogle Scholar
  54. 54.
    Moreno R, Reis Miranda D (1998) Nursing staff in intensive care in Europe: the mismatch between planning and practice. Chest 113:752–758PubMedCrossRefGoogle Scholar
  55. 55.
    Duke GJ, Green JV (2001) Outcome of critically ill patients undergoing interhospital transfer. Med J Aust 174:122–125PubMedGoogle Scholar
  56. 56.
    Wunsch H, Angus DC, Harrison DA, Collange O, Fowler R, Hoste EA, de Keizer NF, Kersten A, Linde-Zwirble WT, Sandiumenge A, Rowan KM (2008) Variation in critical care services across North America and western Europe. Crit Care Med 36(2787–2793):e2781–e2789Google Scholar
  57. 57.
    Hutchings A, Durand MA, Grieve R, Harrison D, Rowan K, Green J, Cairns J, Black N (2009) Evaluation of modernisation of adult critical care services in England: time series and cost effectiveness analysis. BMJ 339:b4353PubMedCrossRefGoogle Scholar
  58. 58.
    Valentin A, Capuzzo M, Guidet B, Moreno R, Metnitz B, Bauer P, Metnitz P (2009) Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 338:b814PubMedCrossRefGoogle Scholar
  59. 59.
    Pizzi LT, Goldfarb NL, Nash DB (2001) Promoting a culture of safety. In: Shojania KG, Duncan BW, McDonald DM, et al. (eds) Making health care safer: a critical analysis of patient safety practices. Evidence report/technology assessment number 43. AHRQ, Washington DCGoogle Scholar
  60. 60.
    Najjar-Pellet J, Jonquet O, Jambou P, Fabry J (2008) Quality assessment in intensive care units: proposal for a scoring system in terms of structure and process. Intensive Care Med 34:278–285PubMedCrossRefGoogle Scholar
  61. 61.
    Garland A (2005) Improving the ICU: part 1. Chest 127:2151–2164PubMedCrossRefGoogle Scholar
  62. 62.
    Garland A (2005) Improving the ICU: part 2. Chest 127:2165–2179PubMedCrossRefGoogle Scholar
  63. 63.
    Donchin Y, Seagull FJ (2002) The hostile environment of the intensive care unit. Curr Opin Crit Care 8:316–320PubMedCrossRefGoogle Scholar
  64. 64.
    Bastos PG, Knaus WA, Zimmerman JE, Magalhaes A Jr, Sun X, Wagner DP (1996) The importance of technology for achieving superior outcomes from intensive care. Brazil APACHE III Study Group. Intensive Care Med 22:664–669PubMedCrossRefGoogle Scholar
  65. 65.
    Hahnel J, Friesdorf W, Schwilk B, Marx T, Blessing S (1992) Can a clinician predict the technical equipment a patient will need during intensive care unit treatment? An approach to standardize and redesign the intensive care unit workstation. J Clin Monit 8:1–6PubMedCrossRefGoogle Scholar
  66. 66.
    Quinio P, Baczynski S, Dy L, Ferrec G, Catineau J, de Tinteniac A (2003) Evaluation of a medical equipment checklist before intensive care room opening. Ann Fr Anesth Reanim 22:284–290PubMedGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Andreas Valentin
    • 1
  • Patrick Ferdinande
    • 2
  • ESICM Working Group on Quality Improvement
  1. 1.General and Medical ICURudolfstiftung HospitalViennaAustria
  2. 2.Surgical and Transplantation ICUUniversity Hospital GasthuisbergLeuvenBelgium

Personalised recommendations