ICU Admission And Discharge Criteria

Question:

Is there a requirement for intensive care units to have admission and discharge criteria?

Currently, our hospital has a “scope of service” for each nursing unit but no formal admission and discharge criteria. 

I reviewed TJC and CMS as well as our state rules with not much luck. Are you familiar with what standards this would be associated with?

Answer:

There is no regulatory requirement that gets down to that level of detail.  Really, the decision to admit to the ICU is the decision of the intensivist or attending physician.  The hospital should have criteria that guides those admission decisions.  

For example, the NIH states that the decision to admit a patient to an intensive care unit should be based on the concept of potential benefit.  Patients who are too well to benefit from the ICU should not be admitted.  There are professional associations that have drafted admission criteria.  Those resources are worth reviewing.  There is also research on who benefits most from the ICU stay.  

These are two references we have found helpful:  

1. The Society of Critical Care Medicine: ICU Admission, Discharge, and Triage Guidelines

2. American College of Physicians: ACP Hospitalist

There is one Joint Commission standard in the leadership chapter of the hospital manual, LD.01.03.01 EP 3, that simply states, “The governing body approves the hospital’s written scope of services.”  This has been a CMS requirement since the beginning of time but there is little detail on how to define your scope of services.