Table 2 Interventions endorsed by Delphi study, categorized into nine sub-groups

Pandemic preparedness

(1) Optimize resource usage for pandemics

(2) Establish a multidisciplinary disaster/pandemic response team

(3) Audit compliance to best practices in a pandemic situation

ICU Organization

(4) Standardize and establish governance of ICU setups (integrated or otherwise) at regional/ national levels

(5) Availability of all the relevant experts including all laboratory services

(6) Develop an international consensus report on the Green ICU concept

(7) Counselling rooms with Hospital Information System accessibility within that room

(8) Point of care diagnostics

(9) Structural elements (Hospital level)^#

(10) Structural elements (ICU design)^#

(11) Champion-led team approach^#

(12) Multidisciplinary patient care model (Multidisciplinary team consisting of a trained intensivist, a trained ICU nurse, physiotherapist, pharmacist, speech pathologist, etc.)

(13) Early mobilization

(14) Team building and support

(15) Multidisciplinary approach to implementing end-of-life interventions focused on patient- and family-centric care

(16) Ensure institutional and ICU leadership support

(17) Provide access to cost (and charge) information for treating teams

(18) Benchmark units at the National (or regional) level

Establishing and pursuing standards of care

(19) Quality audits to identify cost-reduction opportunities

(20) Multidisciplinary Practice Evaluation Programs, involving a wide range of ICU professionals. Engagement with hospital administrators in setting quality indicators

(21) Standardize practice through protocols/ care pathways and ongoing audits

(22) Setup evidence-based standards of care, including interventions for which there is limited or no evidence

(23) Establish standard ICU audit guidelines, adapted to local circumstances

(24) Critical incident report system

(25) Regular surveillance and monitoring of the clinical practice with feedback to the ICU team

Resource optimization

(26) Dynamic staff roster to accommodate even distribution according to workload

(27) Cost-effective sterilization practices

(28) ICU equipment and devices related

(29) Audit of consumable usage

(30) Reduce frequency of laboratory tests and radiological tests through Quality Initiatives

(31) Rationalize transfusion practices

(32) Rationalize the use and having a stewardship approach towards critical resources

ICU/ HDU admission and discharge optimization

(33) Careful discharge planning

(34) Appropriate use of ICU/ HDU resources

(35) Review of failed discharges/ ICU re-admission to identify opportunities for improvement

(36) Audit of time taken for ICU admission from Emergency Department/ Wards

Expanding the scope of the ICU beyond the four walls of the ICU

(37) Develop step-down units and long-term care units

(38) Appropriate remote monitoring in step-down units

(39) Utilize tele-ICU to bring down ICU costs as well as support under-served areas

(40) ICU-team-led Outreach services on wards

(41) Establish a multidisciplinary rapid response team led by ICU

Competencies and training of staff

(42) Develop and Maintain Competency

(43) Continuous training & education

(44) Audits of staff competency, training of staff

Infection control measures

(45) Hand hygiene monitoring

(46) Setup governance of antibiotic stewardship institutionally

(47) Setup anti-microbial stewardship including Infectious diseases-ICU rounds

(48) Healthcare acquired infections prevention

Electronic health records

(49) Electronic Health Records in ICUs

(50) Electronic health records to increase accountability