RECOMMENDATIONS
The following recommendations aim to overcome the shortage of beds and to improve the performance of ICUs.
1.
Increase the number of ICU beds by expanding existing facilities or establishing new ICUs.
This can be achieved through the mid-term review of the 8
th
Malaysian Plan and Dasar Baru over the next five years. Special funding from the
government may be required for this purpose. A total of 100 beds need to be urgently created to meet current demands.
2. Ensure efficient bed management
2.1 Written admission and discharge guidelines
- For effective use of expensive intensive care resources, only patients who are going to benefit from intensive care
management are admitted. When resources are scarce, it is necessary to incorporate triage guidelines to admit
patients who will benefit the most. - There is a need to have clearly written guidelines in every
unit to ensure consistency in care.
2.2 Conduct regular in-unit audit
Regular in-unit audit should be conducted to identify the
percentage of ICU beds that are occupied by patients: - who are “too ill” and are not expected to recover from
their illness as these patients should not be admitted to the ICUs.
- who are “too well” to benefit from intensive care as these patients can be cared for in the ward or high dependency
areas.
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- whom intensive care admission are required following inadequate surgical or anaesthetic management
3. Optimise utilisation of resources and staff
3.1 Integrated ICU and HDU
There are some high risk patients who require high dependency care, not necessarily intensive care. Many
intensive care patients need to be cared for in a high dependency area before being discharged to the wards.
Having high dependency beds which are integrated into the intensive care unit area is more cost-efficient for
staffing and equipment as beds are interchangeable within the same unit or in adjacent areas and patients’
level of care can be upgraded or downgraded wherever appropriate. It improves continuity of care for patients
and reduces the anxieties among patients and relatives associated with moving from one environment to
another.
3.2 Networking of ICUs within a geographical region
ICUs within a geographical region can form a network where deserving patients who cannot be admitted to an
ICU will be transferred to another ICU where a bed is available. Hospitals in the Klang Valley and its vicinity
i.e. Hospital Kuala Lumpur, Hospital Selayang, Hospital Tengku Ampuan Rahimah, Klang, Hospital Kajang,
Hospital Putrajaya and Hospital Seremban have been identified to form a network for this purpose.
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4. Minimise the length of stay through efficient treatment
4.1 “Closed” system ICU
