This document is a consensus statement which sets out to re-define ‘Levels of Adult Critical Care’ to reflect the modern delivery of critical care and the changing demands upon it.

Levels of Adult Critical Care Second Edition, as in the original guidance, describes the care a patient requires, not where they are receiving it, nor does it measure the actual care being delivered.

It does not recommend any changes in staffing ratios, until such time that appropriate critical care staffing tools and evidence base are available, and we support the continued research in this area.

It merges the pre-existing level 0 and level 1 into ward care. This frees up ‘level 1’ of critical care to represent the emerging Enhanced Care, with Level 2 and 3 remaining. Level 2 and 3 have subtle changes to reflect the current picture of critical care, in particular the addition of delirium.

Many of these changes may seem subtle, but they reflect current practice. These changes also signal a move towards a changing landscape with Intensive Care 2020 and Beyond¹ which considers our shared vision of the future of critical care, the development of Enhanced Care2 and the ongoing staffing ratio research.