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The Changing Face of Critical Care

In last few years healthcare sector in India has witnessed a paradigm shift, with earlier, the major focus of the industry being the disease care. The practice was primarily citizen funded, with PHCs, secondary care and tertiary care facilities fulfilling the need, in severe medical conditions.

But today, with an overkill of super-processed foods to timeless Critical-Carework-shifts; lifestyle upgrades come with an inbuilt compromise on general health, demanding better awareness as well as high specialty care. In addition, the overall increase in the buying power of public morphed healthcare into a service oriented industry, holding the patient at the center of its universe.

The Ultimate Game-Changer

Throughout this time, the single-most element that revolutionized the healthcare industry in India was technology. Corporate houses ventured into the medical care landscape, modernized the concept of wellness, and turned it into a data-driven, efficiency oriented system. The industry necessitated newer methodologies that ensured first-rate service delivery, while still keeping the costs minimum.

Among many areas, where technology is revolutionizing the way healthcare is being used, Critical care is one. For some time, critical care is starting to face some tough obstacles, and the ICU of the future will be shaped by these problems—namely an aging population and a shrinking field of expert critical care practitioners. And so now,it is believed that with the help of technology ICU must look different and work differently in order to handle a steady influx of critically ill patients. Prospects for critical care may look questionable now, but solutions are available. And the future just might be brighter than expected. The demand for personalized patient attention encouraged ideas such as second opinion, customized care-plans, and doctor-patient interaction and connectivity. Patients’ priorities and expectations have reformed drastically too. Patients today want to know their options, receive excellent service – both medical and non-medical, stay updated and understand how they’re improving by the day.

As said Dr Yatin Mehta, Chairman, Institute of Critical Care & Anesthesiology, Medanta, The Medicity Mehta, “Critical Care is something where lot of revenue is involved; it is a very expensive settlement. If the patient is sick then there is lot of devices and experts being used in the care of patients. Now these small nursing homes they called themselves specialise in Critical Care with the set-up of few beds and ventilator and they think they are in business. That’s where things go wrong because they know that they could not handle the serious patients well and other than making them better they sometime end up giving them infections and making them sicker. And then they try to move them in tertiary care or better intensive care for better facilities by the time the patient’s conditions become more deteriorated. So the problem in India is that we don’t have quality care. There is no certification unless you really have a Journal of Clinical Investigation (JCI) or National Accreditation Board for Hospitals and Healthcare (NABH) accreditation which many of these set-ups don’t have. I think Medical Council should get tougher plus we need to improve the facilities through education and improve the level of doctors.”

Obstacles in the way

According to Dr Omender Singh,MD, FCCM, Head – Department of Critical Care Medicine, “Critical Care today is the requirement of the day. In India the basic problem with the Critical Care is inadequate number of beds. We have more sick patients and less number of beds. Second problem we are facing is now from the human resources. As Intensive Care Units (ICU) are manned by critical care physicians and they are trained specifically to treat critically ill patients. The programmes which are running in critical care in India have just begun in the last few years only. So, critical care infact is a new specialty which is evolving and we have huge demand of these kinds of services. Other then this we are lacking good intra-hospital transport.

Advising on the challenges,  Dr Yatin Mehta, said “ One of the major challenge that tertiary care hospitals like us faces is that patients come very late, and when they reach us they already been loaded with all antibiotic, have multi drug resistant organism, they are already very sick with multi-organ dysfunctions. Second problem is the cost, Intensive Care is very expensive because antibiotics and anti fungus are very costly. The average cost of the tertiary care hospital is around `40,000 to `50,000 per day. Now how the people will afford it unless the insurance goes up, like a middle class family cannot afford that, they sell their homes and property, that’s all they are doing that. Obviously the private hospitals are not running the charity, even if you try to help them by reducing your professional fees but the cost of the stuff which is being used in the patients and salaries of the staff have to come out. We have one to one nursing in our ICU’s; centralised AC; the filters to reduce the infections all that cost. I think government or semi government or private agencies should work towards this otherwise it will be very difficult to bear the cost.”

Giving example Dr Singh explains, “the patients who have some trauma or illness, we do not have facilities like West that even if the patient get sick anywhere in the country, he will get treatment right there. We as the critical care physicians are ready to transport such kind of patients but the challenge is we don’t have dedicated aircraft. There is no dedicated space to land such aircrafts in most of the areas. At last I think we need more training centers like Max Healthcare that can produce more certified and trained critical care doctors to take care of critical ill patients. Likely we also need trained doctors in tier II cities and peripheral hospitals. I think India should have more training centers. Unfortunately there is no government hospital which is running any critical care training programme.”

Agreeing on the fact says, President of ISCCM, Dr Narendra Rungta, “Cost, compensation, security to doctors and nurses, massive load during post monsoon, staff shortages, and very poor state security despite laws are the major concerns and challenges. Politicians are happy to be taking populist approach and corporate invasion of medical services. Nursing homes, booming now days but somewhere they will not be able to give all the facilities.”

How Technology Fits In

The technology backed healthcare industry, sees immense scope for innovation, making it a great time for investors as well as innovators. We strongly opine that the next decade will see some of the most brilliant medical game-changers of all time.

There are more sophisticated and efficient ventilators which can pump oxygen up to the rate of 200 per minute in patients with adult Acute Respiratory Distress Syndrome (ARDS), while we breathe at the rate of 12-15 per minute. Then there is an Extracorporeal Membrane Oxygenation (ECMO), which is not used too much in India but it is increasing. Now we have ECMO conferences in which you do function of the heart and lung outside. This has been shown to improve the mortality. Dialysis technique has been improved now you can continue the dialysis even if the patient’s blood pressure is low. Then the patients whose brain has been affected because his heart is stopped, we cool these patients to improve the survival of the brain to reduce the oxygen consumption of the heart. Then transfusion inde cision has been improved, to treat the infections newer antibiotics are available , then there are many therapies like Early Goal Directed Therapy (EGDT), if patient comes with severe infection within six hours you start there group read therapy their survival is much better ,which is also improving in India, speaks Dr Mehta.

Further, agreeing on the fact that technology driven critical care is actually bringing the change Dr Singh added, “Technology helps in improving the quality care especially during hospital stay. With the help of good monitoring devices you can optimize a critically ill patient and improve the patient’s condition in lesser period of time. Also with computerized prescriptions, drug errors become less. So in nutshell, hospital related complications and healthcare associate events become less”.

The Critical Care Team of the Future

Today’s most highly developed ICUs are utilizing trained critical care teams to ensure the best possible care. In the future, all ICUs will follow this model in order to improve patient safety and efficiency of care.

As predicted Dr Singh from Max Hospital, “Critical Care is a field which is going to grow leaps and bounds in coming years. With the existing healthcare, now we have more aging population who survive beyond the age of 60-70. India is the world capital of Diabetes. We have now more cancer patients and these kinds of patients at some point of time need Critical Care services. If you really want to deliver these high-end services then you need to focus more on Critical Care otherwise you may not succeed in giving quality care or good outcome.”Critical-Care-in-india

Having a complete team of ICU providers address each patient’s needs will vastly improve quality of care, but these teams must have some guidelines to follow in order to ensure that they work at maximum efficiency.

Hospitalists and Critical Care

In concert with technologic advancement and improved guidelines, one major solution to the staffing shortage is hospitalists. According to Dr Sai  Praveen Haranath, Consultant Intensivist and Pulmonologist, Apollo Hospitals, “The cost of doing excellent critical care with safety and competent management is high and a big barrier. At the same time lack of evidence based protocols and the irrational use of various treatments is a big challenge. In the future the role of initiatives by groups like the Indian Society of Critical Care Medicine, Apollo Hospitals Center of Excellence in Critical Care and ventures like remote monitoring will help overcome the barriers. In the future, we will face a lack of critical care beds and doctors as well as trained nurses to a greater magnitude. This needs urgent attention.

Looking Ahead

In the upcoming years, the sector would see a steep rise in the awareness of non-communicable conditions that result because of lifestyle changes. The focus of treatment will continue to change from disease-care to patient-care, empowering individuals with options of disease prevention, pain-free treatment and coordinated recovery.

Critical Care is a vastly and rapidly growing specialty. So, I will say that the future is bright. We just need to do ethical practices; trained the doctors and practice good medicine, and then everyone will be happy including the patients, speaks Dr Mehta

Emphasis would be laid on overall wellbeing and quality of life. In case of an illness, complete recovery and rehabilitation designed and implemented by a multi-disciplinary team, would help patients return to the highest levels of functionality and independence. Transition care would play an important role in reversing the effects of illness and help individuals lead a stress-free, healthy life after treatment.

The area of critical care may be moving more quickly toward the future than other hospital functions because it must do so in order to continue to work at all. The success of achieving a future of quality care, patient safety, and adequate staffing rests on a different approach with providers and technology.

“Modern hospitals are now spending a lot of effort in Critical Care since the volume of patients has gone up. More importantly we are now able to rescue patients who would not have survived in the past. This is due to a successful interaction between technology and the critical care team” Dr Praveen Haranath.


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