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- Basic Science and Research
- Developing consensus-based indicators for intensive care unit capacity and capability in South Korea: a modified Delphi study
- Jeehye Lee, Ho Kyung Sung, Min-hwan Oh, Jin Young Kim, KyoungHo Kim, Jae Young Moon
- Acute Crit Care. 2026;41(2):282-294. Published online May 28, 2026
- DOI: https://doi.org/10.4266/acc.000676
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Abstract
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Supplementary Material - Background
Intensive care units (ICUs) are essential components of modern healthcare systems, but South Korea lacks capability-based standards for ICU classification. Critically ill patients are frequently assigned based on bed availability rather than clinical need, creating mismatches between patient acuity and ICU capability. The aim of this study was to develop consensus-based indicators for assessing ICU capacity and capability in South Korea. Methods: A modified Delphi study was conducted with 24 multidisciplinary experts, including members of the Korean Society of Critical Care Medicine (SCCM) Standardization Committee. Based on a systematic review of international ICU frameworks (SCCM, European Society of Intensive Care Medicine, Australian and New Zealand Intensive Care Society), 42 candidate indicators across six domains were evaluated over three rounds (April–July 2025). Consensus was defined as a content validity ratio ≥ a preset critical threshold and ≥75% expert agreement. Results: The response rates were 79.2%–91.7% across rounds. The final framework comprises 29 indicators across four domains: Capacity (staffing, facilities, bed management), Capability (life support, specialized care), Human resources (physician and allied health coverage), and Space and equipment infrastructure (monitoring and safety systems). The experts prioritized functional capabilities over structural metrics: nurse-to-bed ratios were rated more important than physician numbers, and 24/7 service availability was prioritized over personnel counts. Ward support, education, and research indicators did not reach consensus. Conclusions: This study establishes the first expert consensus framework for ICU capability assessment in South Korea. The 29 indicators provide a foundation for a capability-oriented classification system that prioritizes patient safety and efficient resource allocation. Future research should validate these indicators against clinical outcomes and explore real-time ICU capacity monitoring strategies.
- Epidemiology
- The functional landscape of critical care: a nationwide study of volume, capability, and institutional variation in South Korea
- Ho Kyung Sung, Jeehye Lee, Min-hwan Oh, Jin Young Kim, Young Kyun Choi, Jae Young Moon
- Acute Crit Care. 2026;41(2):270-281. Published online April 15, 2026
- DOI: https://doi.org/10.4266/acc.004225
- 1,508 View
- 55 Download
- 1 Web of Science
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Abstract
PDFSupplementary Material
- Background
In Korea, intensive care units (ICUs) are defined mainly by administrative categories, which do not reflect functional capability. This study examined the relationship between hospital capacity and functional performance by analyzing nationwide patterns of volume, capability, and institutional variation. Methods: We analyzed adult emergency department-to-ICU admissions in 378 hospitals from 2016 to 2023. Admission and life-support intervention (LSI) volumes were measured; organ-supportive therapies such as mechanical ventilation and renal replacement therapy were considered LSIs, and the LSI rate (LSI admissions/total admissions) was used as a proxy for functional capability. Generalized additive models assessed non-linear relationships with bed capacity, and residual-based analysis was used to classify hospitals into functional phenotypes. Results: Critical care delivery was highly concentrated; the top 8% of hospitals provided 50% of LSIs. Admission and LSI volumes increased with hospital size but plateaued beyond approximately 1,300 beds, while the LSI rate continued to rise until approximately 1,700 beds. Hospitals of similar size showed wide variation in both volume and capability. Based on residuals, 42.4% of hospitals formed a central reference group, while others were classified as high-volume/high-capability (13.7%), low-volume/high-capability (15.0%), low-volume/low-capability (12.0%), or high-volume/low-capability (16.9%). Conclusions: The relationship between structural capacity and functional performance in Korean ICUs is complex and non-linear. Hospital size alone is insufficient to predict emergency critical care delivery, underscoring the importance of operational models alongside structural resources. These findings provide a foundation for capability-based ICU stratification to guide resource allocation and strengthen system resilience.
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