Structure and organization of intensive care units in a tertiary care hospital of north India: A comparative study against national and international guidelines

Abstract

Introduction: Organization of intensive care units (ICUs) have a bearing on the quality of care rendered and outcome of care. Hence, this study was conducted with the aim to examine various ICUs for compliance against the different structural and organizational parameters prescribed by the standard national and international guidelines. Methodology: A descriptive and observational study was conducted from June 2011 to September 2012 in neonatal surgery ICU (NSICU), pediatric ICU, and medicine ICU (MICU) at a tertiary care teaching hospital of Northern India. Structural and organizational aspects of each ICU were studied against the Indian and international guidelines prescribed by concerned scientific organizations/bodies. These guidelines were selected in consultation with the domain experts. All parameters were assigned equal weightage, and scoring was done by assigning a score of 0, 5, and 10 to noncompliance, partial compliance, and compliance, respectively. Data were collected through direct observations, perusing hospital records, and unstructured interview of key informants. Results: NSICU assessment against the two international guidelines revealed the adherence of 42.52% and 37.80% toward different structural and organizational parameters. Similarly, low compliance to organizational and structural parameters were observed in pediatric (national –52.38% and international –49.39%) and MICUs (national –50.52% and international –39.01%). All the three ICUs under study have been created by carving out space from their respective inpatient admission area owing to patient care requirements, hence, does not score well against the structural/spatial parameters. Conclusion: Overall, low compliance of all three ICUs was observed when compared against the prescribed guidelines for organizational and structural parameters.