So what exactly makes an ICU bed different from the rest of the beds in the hospital?

So as COVID rates spike and hospitals are getting full people are looking at the number of ICU beds in their local area and state as a metric. But what exactly makes an ICU bed well an ICU bed.

ICU beds are, first and foremost, a legal definition in the state they reside in. For example, in the state of California, Title 22

"§70909. Intensive Care Service SpaceSection 70499 shall apply as written with the following exceptions: an intensive care unit may consist of less than four (4) but shall not consist of less than two (2) patient beds; an isolation room is not required.§70911. Perinatal Unit StaffSection 70549 shall be replaced by the following

a) A physician shall have overall responsibility of the unit. This physician shall be certified or eligible for certification by the American Board of Obstetrics and Gynecologists or the American Board of Pediatrics. If a physician with one of the above qualifications is not available, a physician with training and experience inobstetrics and gynecology or pediatrics may administer the service. In this circumstance, a physician with the above qualifications shall provide consultation at a frequency which will assure high quality service. The physician responsible for the unit shall be responsible for

1) Providing continuous obstetric, pediatric, anesthesia, laboratory, and radiologic coverage.(2) Maintaining working relationships with intensive care newborn nursery.(3) Providing for joint staff conferences and continuing education of respective medical specialties.(b) A physician who has training and experience in newborn care shall be responsible for the nursery.(c) There shall be one registered nurse trained in infant resuscitation on duty on each shift assigned to the labor and delivery suite. In addition, there shall be sufficient trained personnel to assist the family, provide family education, monitor and evaluate labor, assist with the delivery and assist the patient during the postpartumperiod.(d) If the hospital has a nursery, a registered nurse who has had training and experience in neonatal nursing shall be responsible for the nursing care in the nursery.(1) A registered nurse trained in infant resuscitation shall be on duty on each shift.(2) A ratio of one licensed nurse to eight or fewer infants shall be maintained for normal infants.(e) There shall be evidence of continuing education and training programs for the nursing staff in perinatal nursing and infection control.
www.nurseallianceca.org...

The whole title is pretty long and delves into staffing ratios, minutia, etc. Each hospital has designated beds that have state approval to be considered ICU beds. For example, my children's hospital has about 350 total beds. Of these, about 100 are 'ICU" designated spread between the NICU/PICU/CVICU. Those beds can only be used for ICU care. A few are designated 'Flex" and can go back and forth, but most hospitals do not bother as it costs more to certify them that way.

What makes an ICU different? (Each state, hospital system will have some variation)
1) More outlets and most modern ones have towers surrounding the bed to plug in and rack all of the gear. Kids can have as many as 12-15 continuous IV infusions running simultaneously depending on how sick they so it takes up a lot of space.
2) The staffing is different. In California, the staffing ratios mandate a MAX of one nurse to 2 patients IF the workload is appropriate. But one nurse to one patient or 2-3 nurses per patient if they are really sick and at our hospital, you have 3-4 ventilators Per respiratory therapist
3) The unit layout is different and geared less towards the patients' privacy and more towards safety
4) The monitoring systems are linked and have a central station

That being said, ANY hospital bed can become an ICU bed, and the regulations allow for a suspension of the "designated" bed system in the event of an emergency.

But and there always is a but: It's not about the space. Any bedspace can be turned into an ICU, etc., by merely moving in the equipment. Heck when I am in the air, be it rotor or fixed-wing or on the ground, we are a mobile ICU not only because of the license but because we have the training…….

The issue is one of staffing. A serviceable ICU nurse needs at least five years to be competent. Nor can you take a nurse with 20 years' experience and put them into an ICU room and expect no harm to come to the patient. ICU care is hyper-specialized, and it's a rare individual that can stand the emotional and physical stressors for an extended period of time. Those of us that that do are a bit freaky in that way. You also need trained respiratory therapists, and you need Intensivists who are MD's specifically board certified in providing ICU care. Anesthesiologists can fill in in a pinch, but you cannot expect a urologist to run an ICU.

The gear is important as well but secondary to the staffing. If we run out of vents, relays can be set up to manually breathe for you using a bag, and a mask hooked up to oxygen. Families with no experience can be taught rapidly to do this. But without the staff, it's all meaningless.

So a bed is a bed; it comes down to the staffing as always….

Good info, thank you!

You can't see me in the regular beds.

Sorry...

originally posted by: vonclod

Good info, thank you!

Thanks Ive gotten a few inquires about the whats and whys of ICU beds so I thought I would post this up because people are appropriately worried. There is no quick intervention for the staffing issue

originally posted by: incoserv
You can't see me in the regular beds.

Sorry...

??? like actual bed? Most ICU beds have a few more features like a easily removable head board if we have to intubate and built in scale

originally posted by: FredT

originally posted by: incoserv
You can't see me in the regular beds.

Sorry...

??? like actual bed? Most ICU beds have a few more features like a easily removable head board if we have to intubate and built in scale

ICU / You can't see me ... Say it out loud ...

a reply to: FredT

Well put!

a reply to: FredT

I never worked ICU , but in my view the main difference at my hospital was the staffing .

On a regular floor a Nurse would be assigned several beds / patients .

On the ICU floor each Bed / Patient had it's own individual Nurse assigned , each patient was considered so critical they required the full attention of an RN.

What people do not know is ICU beds are always 80%+ in use no matter what....I think it is something like 2% of people in hospitals actually there because of COVID.

a reply to: FredT

Also,
For sedated or possible Coma patients, the matress is capable of vibrating which helps prevent possible bed sores.

The ICU I am ashamed to say I worked in for a decade was one of the better in this area (I genuinely hate to admit that). That hospital's had all of the previously listed requirements but also had 16 rooms per floor (2, one general purpose, one mostly cardiac) that had reinforced glass front walls, decontamination rooms in the entryways, positive/negative pressurization and were completely separated from each other by concrete walls.

I was surprised when my aunt was put into the ICU of another local hospital that is MUCH more respected for internal bleeding that couldn't be located. When I went to visit it was very much like walking down a normal wing's corridor in my hospital and endi g up in what just appeared to be a 2 patient room in an older wing of the hospital that had just been cleared out to hold more equipment for a single patient.

I won't even begin to discuss the joke that was the "ICU" my cousin was in for her final days in a local Catholic hospital. Filthy joke, that hellhole.

They get to charge more.

a reply to: FredT

This is good info. In Des Moines we had a news article come out last week saying the metro is almost at capacity dur to covid. When you go to the iowa covid dashboard you could see there are plenty of beds. Turns out the hospitals had laid off tons of staff months back and the real problem was the one they created, not the virus.

Been in ICU once, they also have clear doors, walls, and are directly across from the nurses station so they can physically see you, they can also monitor your vitals from the nurses station.

originally posted by: Xtrozero
What people do not know is ICU beds are always 80%+ in use no matter what....I think it is something like 2% of people in hospitals actually there because of COVID.

You are spot on. Most hospital systems run from 76-85 percent capacity. their internal systems, supply chains, etc. AT any given time our almost 40 bed picu hovers around 90% full because we are large children's hospital with too many specialties to count.

COVID has changed some things. While we are not seeing as much trauma, kid (and adults) still get sick COVID or not and need the same care which takes up beds as well.

originally posted by: FredT

You are spot on. Most hospital systems run from 76-85 percent capacity. their internal systems, supply chains, etc. AT any given time our almost 40 bed picu hovers around 90% full because we are large children's hospital with too many specialties to count.

COVID has changed some things. While we are not seeing as much trauma, kid (and adults) still get sick COVID or not and need the same care which takes up beds as well.

We need to remember that a hospital is a for profit business and to have lets say only 10% of their ICU being used then that is a lot of space not making money for them. I'm not saying this as a bad thing...we saw what happens when hospitals shut down a large amount of their departments to get "ready" for the pandemic. They ended up laying off 10,000s of medical personal right in the middle of a pandemic...lol as their beds stayed empty.

I spent some time in a ICU this summer because of a diabetes drug i was taking.
i had fourniers gangrene.

First I have bradycardia with a heart rate that drops into the high 40s when I sleep.
They set the alarm for heart rate at 50 so every time i went to sleep the alarm went off and woke me up.
plus there was another ICU bed in the room and there alarms also kept me awake.

Then every time an alarm went off they would turn the room lights up bright.

After about 3 days of no sleep they had to sedate me so i could sleep then it was another 3 days without sleep.

You would think a hospital would have foam earplugs, so i could sleep.

I was lucky that one of the male nurses was also navy veteran a knew a maintenance man and got a couple from him, so i could sleep after a week and half.

I spent almost 4 months in the hospital, and it almost drove me NUTS.