Policies & Procedures Document Title:

Originating Entity : Admission, Criteria – Adult

Access to Care and Continuity of Care Committee Intensive Care Unit.
Date Originated: / /2010 Document No.: POL-ACC-00
Approved By: Chairman of Access to Care and Date Revised: / /2010
Continuity of Care Committee
Date of Approval: / /2010 Rev. No.: 00

Approved By: Chairman of Steering Committee. Next Revision Date : / /2012

Date of Approval: / /2010 Page 1 of 5

1. introduction
Admission to the ICU is the process of accommodating patient with life
medical/surgical disorders needing intensive care therapy and extensive efforts of
medical /surgical and nursing management.
All admission/transfers to I.C.U will be done in co-ordination with the ICU In-
charge/co- in charge
Admission policy may be subjected to periodic review

2. Purpose:
1. To provide health care that is not possible to be rendered in the general unit.
2. To provide comprehensive monitoring of patient condition and care.
3. To provide life support.
4. To prevent deterioration before more definitive treatment can given

3. Policy:
1. All patients shall meet established criteria for admission and discharge from adult
ICU.
2.The ultimate authority for ICU admission, discharge, and triage rests with the ICU
attending physician .

4. Responsibilities:
It is the responsibility of the ICU attending to implement the procedure hereunder

5. Scope of service
This approved policy is applicable to 48M.H Medical, and Nursing Departments.
6. Definitions:
Admission to the ICU is the process of accommodating patient with life threaten medical/surgical
disorders needing intensive care therapy and extensive efforts of medical /surgical and nursing
management.

7. Procedure:
1. Indication:
Priority 1: Critically ill, unstable patients in need of intensive treatment and monitoring that
cannot be provided outside the ICU. e.g. ventilator support.
 Policies & Procedures Document Title:
Originating Entity : Admission, Criteria – Adult
Access to Care and Continuity of Care Committee Intensive Care Unit.
Date Originated: / /2010 Document No.: POL-ACC-00
Approved By: Chairman of Access to Care and Date Revised: / /2010
Continuity of Care Committee
Date of Approval: / /2010 Rev. No.: 00

Approved By: Chairman of Steering Committee. Next Revision Date : / /2012

Date of Approval: / /2010 Page 2 of 5

Priority 2: These patient required invasive monitoring and may potentially need immediate
intervention.
Priority 3: These unstable patients are critically ill but a reduced likelihood of recovery because
of underlying disease or nature of their acute illness . these patients may receive intensive
treatment to relieve acute illness but ,limits on their therapeutic affords that may set such as no
intubations or cardiopulmonary resuscitation.
Priority 4: These patients generally not appropriate for ICU admission. These admission are based
on individual discretion of the treating doctor in co-ordination with the ICU in-charge/ co-in
charge.

2. PRIORITY 1:
2.1. CARDIAC SYSTEM:
1. Acute coronary syndrome-myocardial infarction, unstable angina.
2. Cardiogenic shock.
3. Complex arrhythmias requiring close monitoring and intervention.
4. Acute congestive heart failure and /or requiring hemodynamic support.
5. Hypertensive emergencies.
6. Cardiac tamponade or constriction with hemodynamic instability.
7. Dissecting aortic aneurism.
8. Complete heart block or heart with hemodynamic instability.
9. cardiac arrest

2.2. PULMONARY SYSTEM:

1. Acute respiratory failure requiring ventilator support
2. Acute pulmonary embolism
3. Patient in intermediate care/general ward who are demonstrating respiratory deterioration or
in impending respiratory failure
4. Need for nursing / respiratory care not available in lesser care areas
5. Massive hemopatysis.
6. Respiratory failure with imminent intubations
7. Patients requiring frequent monitoring or aggressive pulmonary physiotherapy

2.3. NEUROLOGICAL DISORDERS:

 Policies & Procedures Document Title:
Originating Entity : Admission, Criteria – Adult
Access to Care and Continuity of Care Committee Intensive Care Unit.
Date Originated: / /2010 Document No.: POL-ACC-00
Approved By: Chairman of Access to Care and Date Revised: / /2010
Continuity of Care Committee
Date of Approval: / /2010 Rev. No.: 00

Approved By: Chairman of Steering Committee. Next Revision Date : / /2012

Date of Approval: / /2010 Page 3 of 5

1. Acute stroke altered mental status or Glasgow coma scale=/<8

2. Coma: metabolic, toxic or anoxic
3. Intracranial hemorrhage with potential
4. Meningitis with altered mental status or respiratory compromise (isolated )
5. Central nervous system or neuromuscular disorders with deteriorating neurological or
pulmonary function
6. Status epileptics
7. Severe head trauma

2.4. GASTROINTESTINAL DISORDERS

1. Life threatening gastrointestinal bleeding with hypotension ,continued bleeding or with co –
morbid conditions
2. Fulminante hepatic failure
3. Severe pancreatitis
4. Acute gastroenteritis with shock requiring hemodynamic support
5. Hepatic coma stage 3 and 4.

2.5. ENDOCRINE DISORDERS:

1. Diabetic Ketoacidosis complicated by hemodynamic instability, altered mental status,
respiratory insufficiency or severe acidosis
2. Hyperosmolar non-ketotic state with come and / or hemodynamic instability
3. Thyroid storm or myxedema coma with hemodynamic instability
4. Adrenal crisis with hemodynamic instability
5. Severe hypocalcaemia with altered mental status, requiring hemodynamic monitoring
6. Hyper or hypomagnesaemia with hemodynamic compromise or dysarrythemias
7. Hypo or hyperkalemia with dysarrythemias or muscular weakness

2.6. DRUG INGESTION OR DRUG OVERDOSE:

1. Hemodynamically unstable drug ingestion
2. Drug ingestion with significant altered mental status with inadequate airway protection
3. Seizures following drug ingestion

2.7. MISCELLAEOUS:
 Policies & Procedures Document Title:
Originating Entity : Admission, Criteria – Adult
Access to Care and Continuity of Care Committee Intensive Care Unit.
Date Originated: / /2010 Document No.: POL-ACC-00
Approved By: Chairman of Access to Care and Date Revised: / /2010
Continuity of Care Committee
Date of Approval: / /2010 Rev. No.: 00

Approved By: Chairman of Steering Committee. Next Revision Date : / /2012

Date of Approval: / /2010 Page 4 of 5

1. Septic shock with/without multi-organ dysfunction

2. Hemodynamic monitoring
3. Clinical condition requiring ICU level nursing care
4. Environmental injuries like lightning, near drowning, etc.
5. Delirium tremens
6. Multiorgan dysfunction syndrome
7. Poly trauma

3. PRIORITY 2
1. Chronic co-morbid conditions who developed acute severe medical illness

4. PRIORITY 3(HDU)
1. Any of above models of diagnosis who are unlikely to recover from their critical illness
2. Have a reduced likelihood of recovery because of underling disease or nature of acute
illness
3. The care can be done outside the ICU
4. Admission to ICU comes after priority 1 and 2

5. PRIORITY 4
1. TOO WELL TO BENEFIT FROM ICU CARE
 Hemodynamically stable diabetic Ketoacidosis
 Mild congestive heart failure
 Conscious drug overdose….etc..
2. TOO SICK TO BENEFIT FROM ICU
 Severe irreversible brain damage
 .Irreversible multi-organ dysfunction
 Metastatic cancer unresponsive to therapy/ not eligible for therapy
 Patients with decision making capacity who decline intensive care
 Brain dead non-organ donors
 Patients in persistent vegetative state
 Patients permanently unconscious…etc
3. SURGICAL
 Policies & Procedures Document Title:
Originating Entity : Admission, Criteria – Adult
Access to Care and Continuity of Care Committee Intensive Care Unit.
Date Originated: / /2010 Document No.: POL-ACC-00
Approved By: Chairman of Access to Care and Date Revised: / /2010
Continuity of Care Committee
Date of Approval: / /2010 Rev. No.: 00

Approved By: Chairman of Steering Committee. Next Revision Date : / /2012

Date of Approval: / /2010 Page 5 of 5

 High risk patient in the preoperative period.

 Post-operative patients requiring continuous Hemodynamically monitoring/ventilator
support, usually the following:-
 Vascular surgery
 Thoracic surgery
 Airway surgery
 Craniofacial surgery
 Major orthopedic and spine surgery
 General surgery with major blood loss/ fluid
 Neurosurgical procedures

8. Forms Required:
 Admission form

9. References:
 JCI 2008 3rd addition
 48 Model Hospital