TeleICU
Context
CARE is the technology backbone for the 10BedICU Project that seeks to improve the critical healthcare infrastructure specifically in remote and rural parts of India.
However, a glaring deficiency identified in this model is the fact that even when healthcare infrastructure is brought to these remote districts, without skilled manpower, such infrastructure tends to be underutilized. The entire country only has close to 5000 intensivists, almost all of whom are concentrated in Urban Areas.
The TeleICU module in CARE envisages remedying this problem by allowing ICU patients in remote areas to be connected to doctors/specialists from urban locations. The urban specialists will only be advising the local doctors at the patient's bedside, giving the local doctor all the support to treat the patient.
Such remote specialists will have access to the following details of the patient.
Basic and Clinical details including medical history
Critical Care parameters
Live Feed
Vitals
Ventilator parameters
This will allow the remote specialist to understand the clinical condition of the patient holistically. The remote doctor will then be connected to the local doctor over a video call allowing them to discuss the treatment for the patient.
Benefit to users
The TeleICU system is very beneficial not only to enhance the care given to the patient, but it also supports and enables all the caregivers to be more efficient.
Nurses
Nurses are one of the most important components in delivering critical care. Nurses give care 24/7 in the ICU. A few of the responsibilities on them are:
Monitoring the condition of the patient and documenting the same
Giving nursing care such as hygiene maintenance, dressing, etc
Administering drugs as prescribed by the doctor
Executing diagnostic tests and documenting the results
Giving prompt updates to the treating physician
The first respondent in any emergency
CARE attempts to make the above tasks easier and less time-consuming so that the nurses can devote more time to providing better-personalized care to the patient by achieving the following:
Changing shifts is made easier by allowing nurses to download a treatment summary of the last 12 hours which can be easily passed on to the incoming nurse during a change of shift. This ensures the incoming nurse is properly briefed on the condition of the patient.
The vital parameters for the patient are directly captured from the 5-para monitor. The nurses can save time by documenting the same in the patient file.
All other clinical parameters of the patient can be added to the software with ease by selecting the given options/ by moving the slider rather than typing in.
The prescription module allows for easily tracking administration of drugs by maintaining a log of all drugs to be administered.
Through smart notifications and reminders, the diagnostic procedures and tests may be performed for the patients on time. The tool also allows to digitally receive the test results without any delay.
The details of the patient may be shared digitally with the treating physician for quick feedback. This greatly aids in managing critical situations.
Doctors
The doctors perform a very crucial role in the treatment of the patient by leading it. The following features allow the doctors to fulfill their responsibilities more efficiently.
Doctors can remain connected with their patients even when they are not in the ICU. They can continue to monitor the 5 parameters (vitals) as well as watch the patient through the live feed.
Doctors can provide their service to patients admitted to ICUs in far-flung remote locations as well. The tool allows doctors to overcome geographical limitations and engage with patients worldwide.
Doctors can seek expert advice from other specialists from across the world by sharing access to the details of the particular patient. This enables the doctor to upskill himself by constantly learning through practice and gives them more confidence to treat challenging cases.
Tech Deployment
The requirements for deploying the TeleICU System in detail are available at TeleICU Tech Deployment
TeleICU Components
There are four aspects to the TeleICU feature.
| S.No. | Components | Achieved Through |
|---|---|---|
1 |
| Through forms and pages in CARE |
2 |
| Camera Integration |
3 |
| Equipment Integration |
4 | Methods of communication |
|
Data capturing and visualizations
Live Feed (Camera Integration)
The camera integration will provide a live feed from the ICU to the doctors even when they are not physically present in the ICU.
Every 10BedICU will be equipped with network cameras to enable remote viewing of patients. These camera feeds are integrated into CARE with features to identify any patient and pan or zoom to any particular area on the patient's body.
The workflow to enable this includes:
Setting up the hardware
Registering and configuring camera in CARE
Linking patient
Making live feed visible in the patient consultation
The camera integrated into the system is, HIK VISION 4MP PTZ WITH 25X ZOOM
Each ICU Unit will be fitted with 2-4 PTZ Dome cameras depending on the layout of the ICU. 4-5 ICU Beds will be linked to each camera. The camera's ability to pan and zoom will allow the user to control the camera through CARE.
To set up the cameras, the requirements are as follows:
Network Cameras
Lan wiring connecting the cameras to the server at the nursing station
Desktop/server at the nursing station
Switch
Broadband Internet Connection (with min 100 Mbps speed)
Clear legible sign boards with bed numbers
Costing to set up the infrastructure is available HERE.
Registering and Configuring the cameras in CARE
The cameras need to be identified as assets within CARE and need to be linked to the specific beds so that the users can switch between monitoring specific patients. To register and configure the cameras in CARE, the following steps need to be followed:
Registering the camera as an asset
Identifying and assigning beds and regions (for camera presets)
Patient to be assigned to the bed
Utilizing the live feed
The cameras may be utilized in the following manner
ICU Monitoring: For constant monitoring of all the patients in an ICU. (one camera can monitor 4-6 patients at the most) The first version of the TeleICU system is focused on only (b). However, additional camera views for ICU monitoring will be developed in the subsequent versions.
Patient consultation: For investigating a particular patient (TeleICU consultation). This is the focus of the first version of CARE. To add to the ease of use of the camera for patient consultation, pre-sets are added to easily zoom into the patient's face/ 5-para monitor, etc.
Emergency response: For quick response to a patient in critical condition. More advanced features like automatic alerts when any patient's vitals indicate critical conditions will be developed within CARE. When such incidents happen, all nearby cameras within the ICU must automatically zoom on such a patient and all the staff assigned to the patient, including doctors and nurses must get alerts.
5-para monitor integration
The 5-para monitors for all patients (BPL ultima monitors) within 10BedICUs are integrated into CARE. This can be utilized in the following manner
ICU Monitoring
For constant monitoring of all the patients in an ICU. The first version of the TeleICU system is focused on only (b). However, additional scenes showing waveform data from all the 5-para monitors within the ICUs will be deployed so that the Central Nursing Stations can also be powered through CARE.
Patient consultation
For investigating a particular patient (TeleICU consultation).
This is the focus of the first version of CARE. Every patient's vital parameters along with waveform will be available on the patient dashboard making it easy for the doctors to monitor it.
The system will also store the vital parameters and plot graphs so that the treating physicians can study the change in these parameters.
Emergency response
For quick response to a patient in critical condition. CARE will also have alerts for all nurses and doctors catering to a patient if the vitals of a patient goes out of the normal range. This can be achieved by integrating the pre-existing alert feature in the BPL monitors.
Plan of integration to be drafted. Supporting material: BPL Ultima Prime User Manual.pdf
Ventilator integration
Communication
CARE seeks to build strong channels of communication between
Hub and Spoke
Doctor/Nurse at the location and Remote Specialist
A detailed workflow on communication between Hub and Spoke is available at TeleICU: Hub and Spoke Workflow (JNIMS).
Equipement Integration (5-para Monitor and ventilator)
Last updated
