How Can India Move Towards Effective Utilization of Critical Care Facilities?
A 79-year-old woman was rushed to the hospital around midnight a few years ago (1). The family members were bewildered when doctors said that no beds were available in the hospital’s ICU.
That night, they made calls to five other hospitals; all in vain.
Though she was admitted to an Intensive Care Unit (ICU) later, she died a few hours later. That’s the story of our critical healthcare today too.
The increase in hospital beds, ICU and non-ICU, in India has not kept up with the exponential growth of population in the country, resulting in an enormous demand-supply gap. According to the Frost and Sullivan ‘Patient Monitoring Decision Support Database (http://www.frost.com/prod/servlet/cpo/23540282)’, Indian healthcare faces significant challenges of accessibility and affordability to quality healthcare (2). We repeatedly fall short of the global standards with just 0.7 hospital beds per thousand people (3).
(Source: Frost and Sullivan’s ‘Patient Monitoring Decision Support Database’ (2))
When we further take the critical care unit beds into consideration, the situation looks grim. A recent multi-centric observational study of 34 ICUs across the country found out dengue (https://www.thehindu.com/news/cities/Delhi/dengue-responsible-for-most-icu-admissions-across-india/article22467431.ece)_ was responsible for nearly a 1/5th of all ICU admissions (4*). *Imagine that! A nation crippled with heart and lung diseases faces a seasonal shortage of ICU beds due to dengue and malaria outbreaks. While a small subset of these patients will require ICU admission, most of them only need continuous monitoring to detect worsening promptly. In most cases, these patients are admitted to the ICU due to the unavailability of continuous monitoring in the general wards and rooms. This is a crucial problem that the hospitals are looking to solve, and one that is amenable to technological innovation.
Critical care beds are a cost-intensive resource
Critical or Intensive Care is the diagnosis or management of life-threatening health conditions that often require life-support systems. The facilities in these units are considered to be the best and most technologically advanced, that a hospital can offer.
The ICU in manned 24/7 by doctors, specialized nurses, respiratory therapists, physical therapists, pharmacists, nurse practitioners, dietitians, and physician assistants. Equipped with the best technology and staff, the ICU ensures the highest level of patient care.
For obvious reasons, the ICU is the most cost-intensive resource of any healthcare unit. Therefore, adding ICU beds is a fiscal challenge to both the public and the private sector.
Skill gaps also limit ICU expansion
Even if we were to overcome the fiscal challenge of implementing more ICU beds, there is an acute shortage of skilled workforce required to run and ICU. In fact, India has a dual issue of a shortage of doctors, as well as a skewed distribution of doctors, where rural areas are underserved, and is thereby unable to meet the clinical demands of the population *(5).*
The multi-centric observational study on 34 ICUs also reported that “dengue was the reason for most ICU admissions (105.23%) across the country”. Why is it that dengue patients were being admitted to ICUs and could not be managed in high dependency units (HDUs) or wards when most dengue patients recover without the need for interventional or ventilatory care?
It is because of the lack of continuous monitoring in non-ICU areas, and the inability to identify patient deterioration on time to necessitate prompt action from doctors.
There are dozens of health problems that might not be as severe as a heart stroke or kidney failure and yet need continuous vitals monitoring. Indian hospitals, facing a shortage of such monitoring systems and effective communication, often divert patients to the ICU.
Enter smart monitoring solutions and effective utilization of ICU beds
There only feasible, sustainable solution to bridging the shortage of critical care facilities lies in increasing patient monitoring in non-ICU areas with automated patient monitoring solutions – such as the creation of tech-enabled step-down wards, HDUs, general wards and private rooms. Moreover, these automated technology solutions should also be able to provide the right information to caregivers in a timely manner to ensure doctors can intervene effectively.
By ensuring continuous monitoring and remote access to data outside the ICU, doctors will rethink unnecessary ICU admissions, optimize the length of stay in the ICU and thereby increase the patient throughput in ICUs. This will ensure optimal usage of a precious resource, the ICU.
Stasis (https://www.stasislabs.com/), a leader in smart monitoring solutions, is tackling this challenge head-on. With its innovative cloud-connected patient monitoring system that measures six core vital signs, and provides timely, actionable insights to clinicians, Stasis has partnered with dozens of healthcare providers across the country to boost the utilization of critical care facilities.
In the coming years, as more and more healthcare providers opt for cloud-based monitoring solutions, Stasis believes that India will be better equipped to deal with the yawning gap in healthcare supply, all at an affordable price.