The number of beds in a ICU is variable from hospital-to-hospital. In the early eighties, it was observed that 3 to 6 per cent of all cases being admitted in any hospital needed intensive care.
The 1968 report of the Study Group on Hospitals had recommended that 10 per cent of beds in teaching hospitals in cities with population over 10 lakhs and 5 per cent of beds in district hospitals should be kept apart for emergency cases.
In 1978 the Hospital Review Committee for Delhi Hospitals suggested 2 per cent as ICU beds. Due to increase in the number of accident cases, advancements in surgery and increased awareness among people as well as medical professionals the percentage of intensive care beds has gradually raised.
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In UK one ICU bed for every 100 acute beds is recommended. In USA up to four times this proportion is followed and in Germany 5 per cent of total hospital beds are for ICU.
Although there are varying opinions regarding number of beds an ICU should have, an ICU of less than 4 beds, with less than 200 admissions annually, is uneconomical. On average, an 8-bedded ICU should admit about 600 cases in a year.
Very small units have not been found to be viable in terms of economy of facilities and manpower. Large units have the danger of turning unwieldy and chaotic.
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For larger units the beds can be grouped as pods or clusters of about 7-8, grouped together to form a larger department under a single roof.
In Paediatrics, 8 per cent of paediatric beds should be earmarked for paediatric ICU. In Thoracic and Neurosurgery units the ICU beds to clinical beds ratio is about 15 per cent.
An important factor in utilisation of beds is the unpredictability of demand and occupancy. Underutilization cannot always be avoided entirely but it can be minimised by careful planning.
It is estimated that a 10 bed multidisciplinary ICU should meet the requirement of up to 300 bed district hospital. It may not be practicable to maintain a separate ICU for a small hospital, of say 50 beds or so. However, every hospital above 100 beds should have a fully equipped and staffed ICU.
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Efficiently functioning critical care units in the foreseeable future will largely be confined to the big cities in our country.
Promoting a modicum of better care for critical illnesses in the huge population of our country that reside outside the big cities can, for the present, only be achieved by providing a better staffed and better equipped high-dependency ward in every District Hospital.
These wards would not qualify by western standards as critical care units, but could offer better care, with improved results, at a smaller cost.
Because ICU beds are expensive to maintain no hospital can afford to create or maintain excess of beds. Some decision will have to be made to distribute resources so that no patient is deprived of necessary care.
It is inappropriately to devote limited ICU resources to a patient whose prognosis has resolved to one of a vegetative state. A separate facility, adjoining the ICU, with better focus on care of dying patients resulting in reduction of unnecessary activities, can be a possible way out.