Robotic surgery, where the surgeon operates sitting several feet away from the operating table by using a console with tools resembling video-game controls, is old hat. Now doctors can save lives sitting hundreds of kilometers away.
Telemedicine has taken a giant leap in India with the setting up of eICUs, where critical-care specialists monitor biological parameters realtime and treat patients battling for their lives sitting hundreds of kilometers away.
That’s how Dr Amit Varma and his team of critical-care internists saved B KS Rawat, 86, from sure death two months ago. They did their live-saving act sitting 239 km away from Rawat’s bedside at Fortis Escorts Hospital, Dehradun, where he taken when his heart almost packed up after a massive heart attack on June 5. Rawat collapsed in his Dehradun home and was moved to the nearest heart hospital, where he was immediately put on heart and lung support. His family wanted to move him to a super-specialty hospital in Delhi, but they were told he was too critically ill to survive an air or road journey to a hospital in another city.
Clutching at straws, his son Narendra Rawat jumped at the idea of his father’s health being monitored using Critinext, a newly-installed eICU-option, where his father could be monitored by critical care experts sitting in Delhi’s Escorts Fortis Heart Institute.
So Varma and his team got Rawat on one of their many audio-visual monitors, which gave them realtime information on his widely-fluctuating medical parameters, such his heart rate, blood pressure, pulse rate and urine output. While video equipment allowed doctors to zoom in on the patient to assess the physical condition and the level of consciousness, the software simultaneously transmitted treatment settings and all medical and lab reports — haemodynamic (blood flow to the brain) fluctuations, ventilator settings, sedation details, infection control information and treatment strategy — to Delhi, where they were referred to super-specialists for a second opinion. Their advice was then sent back every hour to the doctors treating him in Dehradun for the first 48 crucial hours after he was admitted to the ICU.
“We got audio-visual data on 200 health parameters, which allowed us to pull in sub-specialists for review for complications, when needed,” says Dr Varma. “The eICu is works like a team of virtual specialists at your bedside and is better than calling or emailing for a second opinion because all the data and information you need is right there before us.”
“Within one day, my father’s condition showed a marked improvement and he was stable enough to be taken off the ventilator, which means he could breathe on his own,” says his son Narendra, speaking to HT from Dehradun. A week later, Rawat senior walked home.
Unlike Rawat, eICU-enabled close monitoring also helped eight month old Dagesh Kumar recover in Fortis Hospital Raipur, which is 1,176 km away from Delhi in Chhattisgarh in central India.
The baby was brought to the hospital with complaints of breathing difficulties due to a congenital heart condition called ventricular septal defect, commonly known as a hole in the heart. Gasping for each breath, the oxygen levels in Kumar’s body fluctuated wildly despite ventricular support, on which he was kept on ventilator for 15 days.
Intervention using the eICu showed there was pulmonary hypertension, following which the baby was put on sildenafil (better known as viagra). “He improved dramatically and recovered and was discharged within a week,” says Dr Varma.
Care at your doorstep
Varma and his team of eight interns and four nurses monitor 42 ICU beds across three cities — 14 in Dehradun, 18 in Raipur and 10 in Agra. They are part of a new initiative that aims to take critical care to tier-2 and tier-3 cities, where there is a shortage of intensive care specialists.
Most hospitals outside metros do not have an ICU specialists working at night or on weekends, despite studies showing that when intensive care doctors manage or help manage ICU patients, the patients’ chances of dying in the hospital decrease by 30%.
“CritiNext eICU shows telemedicine has reached a point where specialists trust it enough to make real-time treatment decisions for the sickest patients. It allows hospitals to provide advanced consultation, care and monitoring to critically ill in-patients in remote hospitals without having to physically transfer them to a big city,” says John Dineen, CEO, GE Healthcare, which installed the first eICU in India. “It simultaneously improved health outcomes while addressing critical care staffing shortage and improving bed utilisation,” he says .
Data from the US, where the eICUs were installed in 2000, shows average length of stay in an ICU drops by 12 hours, complications drop by 30-40% and death rates by 10%.
The cherry on top is that it comes with no added cost to the patient’s final bill. “The added cost per day varies between Rs 300 and Rs 500 a day, but with reduced hospital stay, the eICU actually reduces the final cost to the patients,” says Dr Varma.