How tele-ICUs can help bridge the gap between demand & supply for intensivists

As hospitals struggle to provide quality critical care to patients owing to the COVID-19 surge, tele-ICUs are emerging as the optimal solution to provide affordable, accessible and quality critical care.
An ICU bed in an Indian hospital with a patient sleeping on his side
An ICU bed in an Indian hospital with a patient sleeping on his side

Intensive Care Units hold the most vulnerable patients, those who require the best of what any healthcare system can provide. These patients should ideally be taken care of by intensivists, who are doctors with specialized training in critical care after their post graduation. However, India has less than 5,000 intensivists to manage more than 3,00,000 ICU beds across the country, majority of whom are concentrated in urban cities and that too in large tertiary care centres. This shortage has been aggravated with the advent of the COVID-19 pandemic. 

Given the rate at which our medical education system is training intensivists, this staggering demand-supply gap is far away from getting closed anytime soon. While there have been several attempts at addressing this gap, all the traditional solutions have run into the iron triangle of healthcare which consists of access, quality and cost at its three vertices. Nobody has been able to solve all the three at the same time; attempts at solving any two of them invariably leads to a decline in the third one. 

To solve this seemingly insurmountable challenge, it is necessary to deploy technology. Traditionally, technology in healthcare has been associated with expensive medical equipment that invariably leads to increased costs; technology has not been viewed as an enabler for providing quality, access and affordability in healthcare. However, tele-ICUs are a stark contrast to this notion- they are the perfect amalgamation of healthcare and technology, breaking the iron triangle of healthcare. 

In a first of its kind initiative in Kerala, Meitra Hospital, a private quaternary hospital in Kozhikode, partnered with Government General Hospital (Beach Hospital), Kozhikode to introduce the first tele-ICU system in the state on November 1, 2020. As a part of this program, all the ICU beds in Beach Hospital were connected to a Critical Care Hub in Meitra Hospital which is manned 24/7 by a team of expert intensivists and ICU nurses. The team at the Meitra Critical Care Hubs has been monitoring the patients’ real time video feed, vitals and data from the monitors and all equipment, and works alongside the bedside team of nurses and doctors at Beach Hospital to ensure evidence-based care of ICU patients. Tele-ICUs enable an intensivist to take care of around 50-60 patients in multiple locations as opposed to only 10-15 patients when the intensivist is at the bedside thereby scaling their scarce expertise. 

As hospitals across the country struggle to provide quality critical care to patients owing to the surge in COVID-19 cases, tele-ICUs are emerging as the optimal solution that can be replicated across the country to provide affordable, accessible and quality critical care for every citizen. What makes initiatives like the Meitra Tele-ICU Program laudable is the fact that the underlying technology solution used has been completely made-in-India. One of the reasons why technology adoption in healthcare has not been successful in our country is because we have always tried to forcefit expensive solutions made for the West to our settings which are completely different. In a sharp contrast to this, the Tele-ICU program at Beach Hospital, which has now completed six months, is a testament of how a made-in-India technology solution can make a difference in providing quality care. 

With the tele-ICU program expanding across both private and government hospitals, this initiative will mark the beginning of many technological innovations that transform how healthcare is delivered. As we look towards the future, it is inevitable that we embrace technology as the enabler that democratizes healthcare and makes quality care accessible and affordable for every individual.

Dr Naveen A is District Program Manager at National Health Mission and Adhnan Rasheed is Head of Strategy at Meitra Hospital.  

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