Developing consensus-based indicators for intensive care unit capacity and capability in South Korea: a modified Delphi study.

Abstract

Background: Intensive care units (ICUs) are essential components of modern healthcare systems, but South Korea lacks capability-based standards for ICU classification. Critically ill patients are frequently assigned based on bed availability rather than clinical need, creating mismatches between patient acuity and ICU capability. The aim of this study was to develop consensus-based indicators for assessing ICU capacity and capability in South Korea.

Methods: A modified Delphi study was conducted with 24 multidisciplinary experts, including members of the Korean Society of Critical Care Medicine (SCCM) Standardization Committee. Based on a systematic review of international ICU frameworks (SCCM, European Society of Intensive Care Medicine, Australian and New Zealand Intensive Care Society), 42 candidate indicators across six domains were evaluated over three rounds (April-July 2025). Consensus was defined as a content validity ratio ≥ a preset critical threshold and ≥75% expert agreement.

Results: The response rates were 79.2%-91.7% across rounds. The final framework comprises 29 indicators across four domains: Capacity (staffing, facilities, bed management), Capability (life support, specialized care), Human resources (physician and allied health coverage), and Space and equipment infrastructure (monitoring and safety systems). The experts prioritized functional capabilities over structural metrics: nurse-to-bed ratios were rated more important than physician numbers, and 24/7 service availability was prioritized over personnel counts. Ward support, education, and research indicators did not reach consensus.

Conclusions: This study establishes the first expert consensus framework for ICU capability assessment in South Korea. The 29 indicators provide a foundation for a capability-oriented classification system that prioritizes patient safety and efficient resource allocation. Future research should validate these indicators against clinical outcomes and explore real-time ICU capacity monitoring strategies.