Guidelines Restrict ICU Admissions: Hospitals Cannot Admit Critically Ill Patients Against Refusal, says Union Health Ministry

In a recent set of guidelines, the Union Health Ministry has outlined stringent criteria for Intensive Care Unit (ICU) admissions, stating that hospitals cannot admit critically ill patients in the ICU if both the patient and their relatives refuse admission. Compiled by 24 experts, these guidelines emphasize the importance of ensuring that ICU care is not futile, especially when no further treatment is available or impactful on the outcome, particularly in terminally ill patients.

The guidelines underscore that individuals with a living will or advanced directive against ICU care should not be admitted to the ICU. Additionally, in situations of resource limitations, low priority criteria during pandemics or disasters should be considered when making decisions about ICU admissions.

The criteria for ICU admission are outlined based on organ failure, the need for organ support, or the anticipation of deterioration in the patient’s medical condition. Parameters such as altered consciousness, hemodynamic instability, the need for respiratory support, acute illness requiring intensive monitoring, and major intraoperative complications are taken into account.

The guidelines explicitly state that critically ill patients refusing ICU admission, those with treatment limitation plans, individuals with living wills or advanced directives against ICU care, terminally ill patients judged as futile, and low priority cases during pandemics or disasters should not be admitted to the ICU. Discharge criteria from the ICU include the return of physiological parameters to near-normal or baseline status, stability of the acute illness, and agreement from the patient or family for ICU discharge based on treatment-limiting decisions or palliative care.

The document also outlines the parameters to be monitored in patients awaiting an ICU bed, including blood pressure, pulse rate, respiratory rate, breathing pattern, heart rate, oxygen saturation, urine output, and neurological status. These guidelines aim to provide a standardized and ethical framework for ICU admissions and discharges in healthcare settings.