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Levels of Critical Care within the NHS

• December 20, 2021

Critical Care units and departments within the NHS are usually graded dependent on the level of Care the patients within them require. Most ICU wards in hospitals will have smaller units within them designated to each level of Adult Critical Care.

Any Doctor considering a career in Intensive Care Medicine, should be aware of the different NHS levels of critical care and what to expect from each. 

Whilst the levels of adult critical care will often combine with one another, a very broad explanation of each can be found below. These levels have been defined and written about by the UK Intensive Care Society. The full Guidance can be found here.

Level 1 - Ward Care

• Patients whose needs can be met through normal ward care in an acute hospital.
• Patients who have recently been relocated from a higher level of care, but their needs can be met on an acute ward with additional advice and support from the critical care outreach team.
• Patients who can be managed on a ward but remain at risk of clinical deterioration.

Level 2 – Enhanced Care

• Patients requiring more detailed observations or interventions, including basic support for a single organ system and those ‘stepping down’ from higher levels of care.
• Patients requiring interventions to prevent further deterioration or rehabilitation needs which cannot be met on a normal ward.
• Patients who require on going interventions (other than routine follow up) from critical care outreach teams to intervene in deterioration or to support escalation of care.
• Patients needing a greater degree of observation and monitoring that cannot be safely provided on a ward, judged on the basis of clinical circumstances and ward resources.
• Patients who would benefit from Enhanced Perioperative Care.

Level 3 – Critical Care

• Patients needing advanced respiratory monitoring and support alone.
• Patients requiring monitoring and support for two or more organ systems at an advanced level.
• Patients with chronic impairment of one or more organ systems sufficient to restrict daily activities (co-morbidity) and who require support for an acute reversible failure of another organ system.
• Patients who experience delirium and agitation in addition to requiring level 2 care.
• Complex patients requiring support for multiple organ failures, this may not necessarily include advanced respiratory support.
   

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References

Intensive Care Society (2021) Intensive Care 2020 and Beyond: Co-developing the future. https://www.ics.ac.uk/ICS/Guidelines/PDFs/Intensive_Care_2020_and_Beyond.aspx

The Faculty of Intensive Care Medicine (FICM, 2020). Guidance on service development in the hospital setting. https://www.ficm.ac.uk/sites/default/files/enhanced_care_guidance_final_-_may_2020-.pdf

Intensive Care Society (ICS, 2009). Levels of Critical Care for Adult Patients http://icmwk.com/wp-content/uploads/2014/02/Revised-Levels-of-Care-21-12-09.pdf

Intensive Care Society/The Faculty of Intensive Care Medicine (ICS/FICM, 2019). Guidelines for the provision of intensive care services. Edition 2. https://www.ics.ac.uk/ICS/ICS/GuidelinesAndStandards/GPICS_2nd_Edition.aspx