What is Critical Care?
Critical care is the provision of specialised, continuous, multidisciplinary care for patients in a life-threatening, but treatable, condition, who require some or all of the following:
- constant attention from specialist nursing and therapy staff at an appropriate ratio
(in the UK, for ICU i.e. Level 3 care, this means 1 trained dedicated critical care nurse per patient, plus access to multidisciplinary therapy staff when required)
- continuous, uninterrupted physiological monitoring, supervised by staff who are able to interpret and immediately act on the information.
- continuous clinical direction and care from a specialist consultant-led medical team, who are trained and able to provide appropriate cover appropriate for each critical care unit
in the case of UK Level 3 (ICU), this should be a dedicated consultant-led team of intensive care specialists.
- artificial organ support
- advanced therapies which are only safe to administer in the above environment
As a result, critical care requires a very intensive input of resources for a small number of patients. Critical care also occupies a proportionately large fraction of a hospital's estate and infrastructure, for a small fraction of the inpatient numbers.
However, critical care provides an essential enabling and underpinning service, without which a hospital would be unable to conduct most or all of its planned and unplanned activity. The resources that go into a critical care bed, should therefore be valued against the activities and care throughout the hospital, that the availability of that bed allows to happen.
Patient selection by appropriately skilled senior staff is crucial, to ensure appropriate and ethical application of critical care. Although patient comfort is a priority, and patients are sedated when appropriate, critical care is a very active treatment process, and not simply a location. Committing a patient to receive critical care is only ethical if the patient has the potential to recover.
Critical care is not appropriate as a 'measure of last resort' in patients who stand no realistic chance of recovery, except in very specific circumstances, such as to help fulfil a patient's expressed wish to be an organ donor, which generally requires a period of critical care prior to donation.
However, it is difficult to predict which patients are suitable and may benefit, and this is a clinical judgement that can only be made by appropriately specialised and tasked senior clinicians.