New ICU guideline aims to bridge trust deficit between doctors and patient families

New Delhi: A new intensive care unit guidelines, released by the Union Health Ministry, may help bridge some of the trust deficit between doctors and patient families by clearly spelling out the admission and discharge criteria.

The guideline advises the doctors to weigh in a risk-benefit analysis before admitting a patient in an ICU. For instance “terminally ill patients with a medical judgement of futility” and patients having “diseases with a treatment limitation plan” should not be admitted in an ICU with the reason being explained clearly to the family.

“Economic criteria alone should not be the deciding factor in keeping a patient in the ICU or to discharge him/her. Both are wrong. ICU resources are scarce and need to be used judiciously,” RK Mani from Yashoda Super-speciality Hospital Ghaziabad and a member of the panel that drafted the guideline told DH.

Other patients who should not be admitted in an ICU are pandemic and disaster victims when there is a resource limitation.

Mani, one of India’s foremost specialists on critical care, said since ICU treatments were expensive, admission in a critical care unit often turned out to be a key factor contributing towards the trust deficit between doctors and patients and their families.

On the discharge criteria, the new guideline says that among other things doctors will have to evaluate if an aggressive line of treatment is benefiting a patient at all and such a decision “should be a medical decision, not obligating family agreement and as far as possible should not be based on economic constraints.”

“There is no point in having someone with advanced malignancy in the ICU. It is better to shift the patient to a palliative care unit. An ICU should not be used to prolong the process of dying as there are limitations to treatment,” said Dhruva Chaudhary, Post Graduate Institute of Medical Sciences (PGIMS), University of Health Sciences Rohtak and one of the members of the expert team that prepared the report.

Altered level of consciousness of recent onset, hemodynamic instability, need for respiratory support, patients with acute illness requiring intensive monitoring and/or organ support or any medical condition or disease with anticipation of deterioration have been listed as criteria for ICU admission.

Patients who have experienced any major intraoperative complication like cardiovascular or respiratory instability or have undergone major surgery also feature among the criteria.

Weighing in the pros and cons from a medical standpoint and communicating the reasons clearly to the next of kin can curb arbitrary decisions leading to the admission and discharge of patients from hospital ICUs, the doctors said.