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Tele-ICU: A new paradigm in critical care

New Delhi: Necessity is the mother of invention. Well, quite true. But when invention is in the area of healthcare and medicine, it can be interpreted more than just an invention. In a country like India, where healthcare access and facilities to all is still abysmally low, a new technology known as Tele-ICU can give an all new dimension to the critical healthcare system.

Setting a new paradigm in telemedicine technology, Tele-ICU is a kind of virtual ICU (intensive care unit) that remotely monitors a patient’s status via state-of-the-art audio-visual communication and computer systems with the help of a good networking with the bedside ICU team.

Chennai-based InTeleICU is one such firm providing “second set of eyes” with the help of Tele-ICU technology to give additional clinical surveillance and support to ICU patients in disparate geographical locations for multiple hospitals.

Dr N Ramakrishnan

“InTeleICU uses state-of-the-art equipment to connect patients to intensivists 24 hours a day, seven days a week, from anywhere in the country. Doctors and nurses, at a centralized location, use remote-control cameras, video conferencing and continuous monitoring technology to access real-time patient information,” Dr N Ramakrishnan, director, Critical Care Services and the man behind starting the first Tele-ICU service in the world outside USA, told AalaTimes.

“This service continues to provide care to ICUs in the United States of America from Chennai. The team has now innovated to suit this to the requirements in India and is now offering services to any hospital that is committed to improving care to their critically ill patients,” he said.

Presently, InTeleICU is offering its services to two hospitals in Tamil Nadu — Geetanjali Medical Centre, Tiruchirapalli and Sree Renga Hospital, Chengalpattu — besides proposals to extend coverage in two hospitals in Andhra Pradesh and few other hospitals.

Critical care, which has been a major area of concern in hospitals, uses typically 10 per cent of the hospital bed strength but accounts for more than 80 per cent of the resource utilization. Further, over the years there has been a surge in volume and severity of cases treated in ICUs. Yet training in critical care lags behind and there is a shortage of fully trained critical care physicians or intensivists.

Today, most hospitals are not equipped with state-of-the-art intensive care units and supportive staff to efficiently handle the ever-growing demand of intensive care. The lack of human resources and suboptimal staffing of ICU nurses could adversely affect patients’ outcomes and may lead to medication errors.

Patients can now avail extra medical care with the help of new technology without a significant addition to their hospital bill. “The cost would be similar to having a specialist consultation and would be marginal amount considering the fact that the service will improve the care and reduce the length of stay and complications in the ICU thereby reducing the overall hospital costs,” said Dr Ramakrishnan.

Further, absence of critical healthcare facility in the remote corners of the country is another area, which needs attention and action. Lack of critical care facility and personnel in the remote areas of the country claims many lives every year. The answer to solving this crisis has emerged from the world of telemedicine.

In collaboration with Philips Healthcare, the technology provider, InTeleICU has introduced a completely new model of bringing the highest standard of ICU care to hospitals that otherwise would not be able to either recruit the appropriate number of intensivists, establish an ICU management programme, or afford the technology on their own due to financial constraints.

“The intensivist and nurse are located in a central remote monitoring centre (also known as Command Centre) and view the patient records electronically through a Clinical Decision Support software provided by Philips which includes transmission of live waveforms from the patient bedside. The intensivist and nurse can also remotely enter the ICU by using the InTeleEye Mobile Cart and review the patient’s physical condition,” said Dr Ramakrishnan.

“Providing expert opinion to physicians, bedside staff and patients when needed, InTeleICU monitors patients in the ICU and provides expert advice for the management of critically ill patients including initiation of mechanical ventilation or non-invasive ventilation, haemodynamic monitoring support, management of difficult to ventilate patients like ARDS (acute respiratory distress syndrome) and obstructive lung disease,” he added.

Cutting edge technology being an integral part of the programme, technology provider Philips Healthcare is playing a key role in assisting Tele-ICU programmes in India and other countries.

Krishna Kumar

“There are currently 12 hospitals in India that are using the IntelliSpace Consultative Critical Care (ICCC) solution, which is based on Philips’ global eICU programme. The most recent hospitals to be added to this network are Aditya Hospital (Warangal, Andhra Pradesh), Sree Renga Hospital (Chengalpattu, Tamil Nadu) and Geetanjali Hospital (Tiruchirapalli, Tamil Nadu), which are connected to the Chennai-based InTeleICU acting as the command centre, monitoring their ICUs. Philips Healthcare plans to keep extending this network in the coming months,” A Krishna Kumar, president, Philips Healthcare India, told AalaTimes.

Globally, Philips eICU Programme customers monitor more than 350,000 ICU patients every year. Philips eICU customers have oversight for nearly 7,000 ICU beds, with approximately 150 patients being monitored in an average Tele-ICU simultaneously, with larger sites caring for over 400 patients on any given day.

The technology can prove a boon for smaller hospitals to provide round-the-clock access to intensivists to needy patients and prevent them from going to distant medical centres for treatment through the decentralized approach of intensive care.

Highlighting the importance of the Tele-ICU technology specifically for India, Krishna Kumar said, “Although bedside care providers are present in the ICUs, monitoring all the patients all the time, including multiple high-acuity patients, is a big challenge. This is where a solution like IntelliSpace CCC can be extremely helpful. This solution enables the ICUs of several remote hospitals to be connected to a big specialist ICU care where best-in-class critical care specialists monitor and review the patient remotely through online data from connected patient monitors and real-time video images of patient conditions.”

IntelliSpace CCC is a solution where connectivity is absolutely essential. Therefore the biggest challenge that needs to be overcome especially in the case of rural areas is lack of electricity and low broadband internet penetration.

In big hospitals, the role of Tele-ICU can be of prime importance in an environment where a busy nurse or a physician, while monitoring one patient may be unaware of a second patient’s change in status that requires immediate attention. Here the technology takes centre stage by providing personal attention to every bed in the intensive care unit.

“Tele-ICU technology can reduce LOS (length of stay) in the ICU thereby reducing the probability of the patient acquiring hospital diseases. It may help in lowering mortality rate of the patients because of continuous and focused care delivered by the InTeleICU solution, hence, increasing the availability of ICU beds for the sickest of the sick patients,” said Dr Ramakrishnan.

Philips Healthcare terms the Tele-ICU technology as a breakthrough in the Indian perspective as it addresses two of the biggest issues in healthcare – Accessibility and Affordability.

As the modern critical care is highly dependent on technology and has become an essential pre-requisite, Krishna Kumar said, “Intensive care units worldwide (irrespective of the country) account for an increasing percentage of hospital admissions and resource consumption. Typically 10 to 15 per cent of all hospitals beds are ICU beds. However, nearly 50 per cent of all hospital deaths happen in ICUs and nearly 33 per cent of the hospital cost is accounted for in the ICU. Given these factors, it is easy to estimate the kind of impact that this solution can have on the overall state of healthcare in a country.”

“Although evidence demonstrates reduced complications and mortality when intensivists (physicians trained in intensive care) manage ICU patients, a dramatic national shortage of these specialists precludes most hospitals from implementing a round-the-clock, on-site intensivist care model. Philips IntelliSpace CCC solution can help bring this expertise and proactive, continuous care to the critically ill, thereby achieving 24-hour intensivist oversight and improved clinical outcomes,” he added.

The success of the programme also depends heavily on the networking between the bedside critical care team and the remotely based critical care team.

“The InTeleICU solution complements and greatly values the existing ICU bedside nurses and doctors rather than eliminating them. The concept promotes teamwork and collaboration and provides an extra pair of eyes watching and monitoring the patient through effective communication, collaboration, and collegiality to ensure optimal quality outcomes,” said Dr Ramakrishnan.

Addressing the concern over the competency of remote monitoring team, Dr Ramakrishnan clarified that a minimum of three years of bedside experience in ICU is desired for doctors and nurses. InTeleICU ensures appropriate training and etiquette by providing regular in-service training for its staff.

Given the overall benefits and experiences around the world, Tele-ICUs should – and most likely will – be an integral part of India’s critical care future.

The fact that the revolution in critical care services today has enabled doctors to use mobile apps and iPads to help detect sepsis in the ICU, the day is not far when telemedicine will bring expert medical services at the doorsteps of patients offering unparalleled levels of care to patients throughout the world.

by Vidhi Rathee

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