Developing consensus-based indicators for intensive care unit capacity and capability in South Korea: a modified...

Area of Science:

• Healthcare Management
• Critical Care Medicine
• Health Services Research

Background:

• South Korea currently lacks capability-based standards for classifying intensive care units (ICUs).
• Patient assignment to ICUs often relies on bed availability rather than clinical acuity, leading to potential care mismatches.
• There is a need for a standardized system to assess ICU capacity and capability.

Purpose of the Study:

• To develop a consensus-based framework of indicators for assessing ICU capacity and capability in South Korea.
• To establish a foundation for a capability-oriented ICU classification system.

Main Methods:

• A modified Delphi study involving 24 multidisciplinary experts from the Korean Society of Critical Care Medicine (SCCM) Standardization Committee.
• Systematic review of international ICU frameworks (SCCM, ESICM, ANZICS) to identify candidate indicators.
• Three rounds of expert evaluation (April-July 2025) with consensus defined by content validity ratio and ≥75% agreement.

Main Results:

• A final framework of 29 indicators across four domains: Capacity, Capability, Human Resources, and Space/Equipment Infrastructure.
• Expert consensus prioritized functional capabilities (e.g., nurse-to-bed ratios, 24/7 service) over structural metrics (e.g., physician numbers).
• Indicators related to ward support, education, and research did not achieve consensus.

Conclusions:

• This study presents the first expert consensus framework for ICU capability assessment in South Korea.
• The developed indicators can inform a new classification system focused on patient safety and efficient resource allocation.
• Future research should focus on validating these indicators against clinical outcomes and exploring real-time capacity monitoring.