It’s a typical day in an intensive care unit (ICU) of a busy hospital in mufassil India. Interventionists Dr Kanthi Raj sits at his workstation peering intently at 10 screens displaying blood pressure readings, heart rate, pulse oximetry (blood oxygen saturation) and respiratory rate of three critically-ill ICU patients at Gitanjali Medical Centre in Puthur, Trichy.
He switches the display on some monitors several times to refer to scans, blood work, prescriptions and other data. The mechanical hum is suddenly broken by his urgent command. “Nurse, what’s the dark spotting in the endotracheal tube (breathing tube) in Bed number 3? It looks like blood.”
The nurse immediately examines the stroke survivor in bed number 3 and confirms the staining in the tube is blood. She calls a doctor, who examines the patient and announces that the patient has accidentally bitten his tongue and the blood has found its way into the endotrachealtube going through his mouth into the trachea (windpipe) to help him breathe.
The bite is treated and the doctor leaves the ICU to examine other patients, leaving the three battling for their lives in the very competent hands of Dr Raj and an attending nurse. Once again, the only sounds in the room are electrical hums and beeps.
The day may be typical, but the ICU is anything but. Dr Raj is a “virtual” super-specialist who spotted blood in a small tube sitting 317 km away in a small office in Anna Nagar, Chennai. He could do it before the nurse less than 3 feet away from the patient because Gitanjali Medical Centre is one of four hospitals getting 24x7 critical care using Philip’s InteleICU solution, which allows specialists at a command centre to closely monitor and treat people in multiple ICUs across several states.
“Realtime clinical date is transmitted from the monitors, ventilators and infusion pumps connected to the patient and directly streamed to a single workstation, which allows specialists to continuously monitor vital health parameters, such as heart rate, blood pressure, pulse rate and urine output, ” says Dr Ashwin K. Mani, director, clinical informatics, InteleICU.
The cameras over the ICU beds are controlled at the command centre, which allows the interventionist to zoom in, pan out and focus to examine the patient closely while advising on treatment management, as done by Dr Raj. While the specialist is assessing physical symptoms and level of consciousness, the software simultaneously transmits treatment settings and medical and lab reports, including haemodynamic (blood flow to the brain) fluctuations, ventilator settings, sedation details, infection control information and treatment strategy.
Tele-ICU intervention lowers death and hospital length of stay, as well as increases best practice adherence and lowers rates of preventable complications, reported the Journal of American Medical Association in June 2011, after comparing data before and after tele-ICU re-engineering of critical-care processes in US hospitals. The results for medical, surgical, and heart ICUs were similar.
While pan-India numbers are not available, tele-ICUs are increasingly become the lifeline for many small hospitals with a specialists crunch, with groups like Fortis Healthcareplanning to connect to 20 small towns and cities within a year.
Almost 50% hospital deaths occur in ICUs. “In India, there are barely 500 critical-care interventionists to provide care for its more than 1.2 billion people. Remote-monitoring helps to meet this shortfall by allowing critical-care specialists to monitor and direct treatment of patients in suburban hospitals that typically do not have the same expertise available,” says Krishna Kumar, CEO, Philips India, which is focusing on expanding its tele-ICU solution in India.
InteleICu’s tiny command centre in Chennai, for example, provides critical care to four hospitals – Gitanjali Medical Centre in 317 km away, Sri Renga Hospital in Chengalpattu 60 km away, Aditya Hsopital in Warangal 653 km away, ad Surya Nursing Home in Karimnagar, 757 km away.
Despite close to four years of monitoring ICUs for 18 hospitals in the US, InteleICU needed to innovate to meet India’s infrastructure deficits. “Many hospitals in India, for example, don’t have electronic medical records, so they fax us the data. Many more have mechanical ventilators to help patients breathe, so instead of remotely changing ventilator settings, our experts guide ICU staff how to do it,” says Dr Mani.
But these problems have not affected medical outcomes. “Our target is crisis prevention, not management, and the fact that it reduces ICU cost by a third shows we’re doing it right,” says Dr Mani.