The intensive care unit (ICU) brings to mind powerful images.
It is often seen as the part of the hospital where lives hang in balance, where patients lie unconscious, machines beep constantly, and visits are tightly restricted.
Yet, behind these images, the ICU is fundamentally a place where medical expertise, technology, teamwork and human compassion must come together seamlessly.
As we look ahead to the future of intensive care in Malaysia, we must ask how we can preserve and strengthen this vital integration.
Over the years, Malaysia’s ICUs have made great strides, growing in both size and capability to meet the needs of critically ill patients.
But the Covid-19 pandemic revealed how fragile the system can be under pressure.
It showed us where the gaps are.
Moving forward, we must learn from those hard lessons and work together to build a more resilient ICU system.
The need for nurses
It is often said that an ICU is only as good as its nurses.
Their expertise, vigilance and compassion are essential for the ICU to function, and for patients to survive and recover.
Recent statements by the Health Minister underscoring Malaysia’s critical nursing shortage are therefore deeply alarming.
ICU nurses have been especially hard hit, often having to work long “double shifts” that run from morning into the late night.
These extra hours are considered overtime and not counted in the formal working hours.
This ongoing burden puts these nurses at risk of burnout, compromises patient safety and leads to a higher likelihood of leaving the profession.
To address this, we need to take a hard look at how nurses are scheduled and supported.
In many countries, nurses work about 37 to 40 hours a week.
In Malaysia, the standard is 42 hours and that does not include overtime.
It may be time to adjust this to make the job more sustainable.
We could offer more flexible work options, such as part-time fractional arrangements, to help retain experienced staff.
Another option is to offer locum (temporary or part-time) nurse positions in ICUs.
Without real change, nursing staff will continue to leave, making it harder to improve ICU care.
If we do not urgently fix the shortage of trained ICU nurses, plans to add more ICU beds will not work.
More equipment and space will not matter without enough skilled staff to care for patients.
In the end, it is the people who make the system work, not just the infrastructure.
Shortening training time
Alongside the urgent need for more ICU nurses is the need to train more intensivists, i.e. doctors who specialise in caring for critically ill patients.
In Malaysia, the current system requires doctors to first complete training in another field of medicine, such as anaesthesiology or internal medicine, before they can begin several more years of additional training focused on intensive care.
While this approach produces well-rounded doctors, it also takes a long time.
By comparison, countries like Australia and Britain offer more direct training routes that allow doctors to enter intensive care earlier.
Malaysia may need to consider similar approaches to meet the rising demand for intensivists.
Smarter systems required
Making sure ICUs provide safe and high-quality care also depends on strong standards and regular checks.
In Malaysia, hospitals undergo formal accreditation by organisations like the Malaysian Society for Quality in Health (MSQH), which has specific intensive care standards relating to staffing, equipment and systems for improving care.
These checks not only help hospitals meet national benchmarks, but they also help build a culture where safety and quality are a priority.
Broader participation from hospitals in these initiatives should be strongly encouraged.
Technology plays a big role in today’s ICUs.
Many units in Malaysia now use Critical Care Information Systems (CCIS), i.e. special electronic systems that help doctors and nurses record, monitor and manage patient care more efficiently.
Ideally, this progress should be matched by a nationwide Electronic Medical Record (EMR) system, so that hospitals and clinics can share important patient information seamlessly.
At present, many of these systems do not “talk” to each other, which makes it hard to get a full picture of a patient’s condition or to do remote consultations.
For technology to truly support better ICU care, we need a more connected and coordinated digital health system.
Digitalisation also opens the door to using artificial intelligence (AI) in intensive care, a change that is both exciting and transformative.
AI algorithms, developed from analysis of large patient data, could pick up early and subtle warning signs in a patient that might be missed by regular monitoring, or even clinicians.
This could help doctors make quicker, more accurate decisions, and prevent complications sooner.
Malaysian ICUs need to prepare to adopt AI as a tool to complement care, while always preserving the expertise and judgement of healthcare professionals.
Humanising our ICU
No matter how advanced our systems become, technology could never replace the human side of care.
The ICU is often an emotional place, where families are anxious and patients are at their most vulnerable.
In such moments, compassion and clear communication are essential.
As Malaysia’s ICUs develop, we must make humanising intensive care a real priority and not just an ideal.
This means treating patients with dignity, supporting their emotional needs, and making sure families are kept informed with empathy and honesty, especially during difficult times.
Introducing and formalising the concept of Open Disclosure in Malaysia could represent a meaningful step forward.
Open Disclosure means that, following adverse events, patients and families should receive honest explanations, sincere apologies where warranted, and guidance on next steps.
Being transparent in this way not only helps families cope, but also builds a stronger culture of safety and responsibility in our hospitals.
Caring for ICU patients is not just about medical treatment; it is also about the environment in which they recover.
In some countries, ICUs now include special spaces known as ICU Gardens.
These are small, peaceful areas designed for recovering patients to continue their rehabilitation in a calming environment.
These spaces help reduce stress and promote healing, not only for patients, but also for families, and even ICU staff.
It is a simple, but powerful, idea that Malaysia could consider as part of future ICU design.
As Malaysia’s population grows older, ICUs must prepare for the new challenges this brings.
One key challenge is making thoughtful decisions about treatments that sustain life, like breathing machines or medications to support blood pressure.
While ICU interventions can do a lot, there are times when these interventions may not improve a person’s chances of recovery or their quality of life.
For elderly patients who are frail or have several medical problems, it is important to work closely with their families to develop a realistic care plan that respects the patient’s wishes.
Talking honestly and compassionately about end-of-life care is a vital part of this.
By supporting both families and ICU staff through these difficult conversations, we help ensure that even the most advanced intensive care continues to honour the human side of medicine.
Prof Dr Nor’azim Mohd Yunos is the president of the Malaysian Society of Intensive Care (MSIC) and Datuk Dr Mohd Ridhwan Mohd Noor is the Health Ministry Intensive Care Services head. This article is the second in a three-part series on intensive care that will be published weekly, and is courtesy of the MSIC. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
