The Supreme Court has approved a set of common guidelines for intensive care units (ICUs) across the country, saying patients who are stable and no longer need critical support should be shifted out of ICUs to wards or other care units.
The guidelines, prepared by a three-member court-appointed committee and reviewed by leading medical experts, were endorsed by the court on April 20 as “practical, implementable, and necessary as a minimum standard for an ICU,” Hindustan Times reported.
A bench of Justices Ahsanuddin Amanullah and R Mahadevan has asked states and Union territories to prepare a plan to implement them by May 18.
The report pointed out that ICU stays are often prolonged because families may not fully understand critical care and rely entirely on doctors’ advice, which can lead to extended admissions.
According to the document, titled Guidelines for Organisation and Delivery of Intensive Care Services, once a patient is stable and no longer needs close monitoring or organ support, they should be moved to a ward, high-dependency unit (HDU), or discharged, depending on the doctor’s assessment.
Who prepared the guidelines
The committee that prepared the report included AIIMS doctor Nitish Naik, Additional Solicitor General Aishwarya Bhati, and advocate Karan Bharioke as amicus curiae. It also stressed that doctors’ clinical judgment should guide decisions on the level of care for each patient.
Staffing and monitoring norms
The guidelines set minimum standards for how ICUs should function.
They recommend having one nurse for every two to three patients in basic ICUs, and one nurse per patient in advanced ICUs where patients need multiple organ support, The Times of India reported.
They also call for round-the-clock monitoring by resident doctors working in shifts, under the supervision of specialists with postgraduate qualifications recognised by the National Medical Council.
Infrastructure and equipment requirements
The document lists requirements for equipment such as ventilators, oxygen supply systems, patient transport facilities, and bedside utilities. It also lays down norms for infection control, fire safety, record-keeping, and regular audits, according to The Times of India.
For capacity, the guidelines suggest that a basic ICU should have six to eight beds, which can be expanded to about 12 beds in hospitals handling more critical cases, depending on the services offered.
Risks of prolonged ICU stay
Medical experts cited in the report said longer ICU stays can increase the risk of hospital-acquired infections and lead to “ICU psychosis,” which can affect a patient’s mental health. Moving stable patients to HDUs or wards can help recovery and also free up ICU beds.
What happens next
The court has asked state health secretaries to meet experts and identify five priority areas from the guidelines, and prepare a roadmap for implementation. These plans will be reviewed at the national level and placed before the court at the next hearing.
The matter stems from a 2024 petition linked to alleged medical negligence, during which the Centre informed the court that model ICU and critical care guidelines had already been prepared in 2023. However, these could not be uniformly implemented across the country as health is a state subject under the Constitution, requiring individual states to adopt and operationalise them. It was in this backdrop that the court stepped in to examine the issue more closely and push for a standardised framework.