Criteria for Intermediate and Critical Care

Patients entering a medical facility will, at some point, receive a level of care decision. This classification is intended to place the patient in the appropriate setting to ensure the proper level care for their injury or illness. Whether the patient is admitted, discharged, or assigned to intermediate or critical care depends on criteria established by medical boards and, even, the U.S. government.

Function

• Intermediate care is a broad term used to describe the level of treatment for patients who require care higher than basic medicine but lower than intensive or critical care. The phrase originated in the United Kingdom to classify elderly patients, especially in nursing home settings. The intermediate care classification is more about policy (insurance, placement) than actual science. In contrast, the term critical care has a solid definition. Critical care patients have life-threatening injuries or illnesses involving vital organs. These patients are receiving treatment to prevent organ failure that threatens to be fatal.

Identification

• Identifying an intermediate care patient isn't something easily done by sight---a visitor won't typically see ventilators, tubes, or other means of sustaining life. These patients are primarily in healthcare facilities rather than hospitals. Intermediate care patients do not require hospitalization but should not remain at home relying on periodic visits to a physician---they need consistent supervision. In some cases, critical care patients can be identified by ventilators, intravenous lines, and other monitors that often accompany their care. However, the true identification comes from their diagnosis and prescribed treatment: If stopping treatment would result in a quick, life-threatening decline of health, a patient belongs in critical care.

Intermediate Care Criteria

• One of the most widely used criteria for determining whether patient requires intermediate care is the federal government's guidelines for Medicaid recipients. This criteria specifies the conditions under which patients need continuous care by a licensed physician, as well as one or more other provisions including monitoring of diet, therapy, and direct assistance of another individual for tasks like eating and dressing.

Critical Care Criteria

• The criteria for critical care can vary, being that this phrase is used in hospitals and healthcare facilities, and is interchangeable with the term intensive care. The Society of Critical Care Medicine outlines their admission criteria as a lack of autonomy (the body cannot sustain itself) and supporting scientific evidence of it. If scientific evidence is not readily available, expert opinion by a critical care physician is acceptable.

Considerations

• Admitting and retaining a critical care patient, in many settings, also depends on advance directives. Patients who have signed documents indicating their end of life preferences, created living wills, or assigned a medical power of attorney can change the course of their level of care---though originally considered for critical care, they may be classified "too sick to benefit" based on their refusal of life-sustaining devices.