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Dr. Dhruv Joshi, Co-founder & CEO, of Cloudphysician.
The airline industry is an interesting comparator industry for ICU care. Both deal with mission critical situations but are widely divergent in their safety profiles. In today’s routine airline travel experience, no passenger ever enters a flight questioning the competency of the pilot or fearing that the chances of landing safely may be compromised by the training of the staff or the lack of standard safety processes.
Unfortunately, that is not the case for most patients who are entering an ICU today.
Patients are at their most vulnerable state and critically ill, and yet most of them and their families are worried about whether they will receive the quality care they need. The reasons for this are multifold, and among them is the fact that in most places, there are no mandated prerequisites to qualifications or processes to run an ICU. This is largely due to a huge shortage of round the clock trained expertise in most ICUs, of both doctors and nurses.
Furthermore, every pilot and his or her crew in an aircraft has the support of technology and a team at the air traffic control that help guide them, help them see things they can’t see, or if they are busy with something else, help provide them with the information they need so that every passenger can be assured of a safe flight.
Contrastingly, in ICUs today, even though patients are critically ill and there is a lot of data available that could help improve the management of the patient, technology is not used to the extent possible to monitor and prevent critical events from happening.
In an aircraft, the senior most pilot has to be present in the flight at all times of the flight. In an ICU, that is not possible, since it is impossible for a senior trained ICU specialist, in this case, a trained intensivist, to be at the bedside of every patient 24/7.
As a result of this, today less than 1 out of 10 patients in ICUs receive the quality critical care that they need. This leads to the unnecessary loss of hundreds of lives every day. This is unacceptable!
The solution to this massive problem lies in the use of tailor made technology and new systems to run ICUs. With the advent of technology, every ICU bed can today be converted into a Smart-ICU bed and connected to Care Centers. Telemedicine in critical care is a component of Smart-ICUs and it is similar to every cockpit of an airline being technology enabled and connected to an air traffic control centre. This allows for better monitoring of patients, better coordination of care where the team at the bedside can rely on those in the Care Center to assist them when they are busy or when they need an extra set of eyes. The patient’s data is digitized and, similar to the role of radar in aerospace, Smart-ICU technology platforms can be used to predict and monitor the progress of the ICU patient—thereby responding to and preventing medical errors or emergencies. Similarly, the Care Center can have highly trained ICU specialist doctors 24/7 who can ensure that there is always an expert available to help troubleshoot critical issues.
Such a system will ensure that ICU patients located anywhere can get the care that they need. This system also provides the doctors and nurses the respite and support that they need, since working unassisted in a high stress environment like an ICU can be overwhelming and certain studies have shown those working in ICUs have the highest likelihood of burnout.
Such a system is not a farfetched reality. Technology is present today and is ever improving. Hospitals in the west have been adopting and using such solutions for the last two decades, and even in India, there are hospitals that have adopted such systems and shown significant reductions in the mortality of their patients, better compliance with standard of care protocols, and improvement in the support systems for their doctors and nurses. These solutions are much more cost effective, scalable, and a foolproof means to ensure that an ICU patient, irrespective of their location, irrespective of the time of day or night, can be assured of quality critical care.
In the last few years, hospitals as far apart as Leh in the North, Cachar in Assam, Nadiad in Gujarat and Warangal in Telangana have adopted such Smart-ICU technology, ensuring that the communities they serve receive world class critical care.
In the last 2 years, during the COVID period, many of the fault lines in our critical care delivery system were exposed. Technology and innovative means to address these problems have proven that they can work, and it is imperative that we don’t just stop at COVID but use this opportunity to foundationally improve our healthcare delivery system. Therefore, it would be anachronistic to assume that telemedicine and Smart-ICUs are just another technological innovation in passing. Any hospital today can easily transition to a digital setup, and the ICU can be converted into a Smart-ICU which is then linked to a central hub with tele-intensivists, nurses, and other healthcare professionals who can monitor patients around-the-clock and offer help as necessary. With the help of this solution, patients who previously lacked access to crucial care can now receive it, and it is imperative for us to move this paradigm of Smart-ICUs from a few hospitals that are providing world class care to the masses. Through technology and smart systems, hospitals everywhere in India should be providing the best critical care quality to their community members.
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Views expressed above are the author's own.
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