Guidelines formed for pooling resources in critical care

Districts asked to seek voluntary involvement of critical care specialists in private sector

With the number of those requiring critical care for COVID-19 on the rise, the Health Department has formulated new guidelines for the efficient management of its pool of intensivists and critical care specialists, so that no COVID-19 patient requiring intensive care is denied services.

Accordingly, all districts have been asked to create its pool of available intensivists and those experienced in critical care management, irrespective of where they are working. This district pool will also include postgraduates in critical care medicine, anaesthesiology, and pulmonology.

All districts have also been asked by the government to engage with the private sector and to facilitate the voluntary involvement of critical care specialists in private hospitals.

All major hospitals managing critically ill COVID-19 patients should ensure round-the-clock services of at least one intensivist/critical care specialist.

The government has directed that in districts where the availability of such specialists are scarce, additional appointment of human resources or outsourcing of services of intensivists for a fixed fee per intervention may be done.

Tele-care services

The Health Department has proposed that hospitals devise an in-house tele-critical-care monitoring room with central monitors, closed circuit television screens, and alarm system. Acute care monitors should be connected to the tele-critical-care monitoring room so that every patient in ICU can be monitored continuously.

Hospitals should also form a crisis crash team that can physically reach patients during emergencies as soon as possible.

Districts should establish a system to assess the skill competence of its junior residents, medical officers, and nurses in basic ICU intervention skills at all hospitals. Training may be organised regularly with the help of critical care experts. Medical colleges can form teams to provide hand-holding support to the recently established ICUs in district and general hospitals.

Hub-and-Spoke model

Government Medical College, Thrissur, has proposed a tele-ICU care service model, which envisages a tele ICU command centre manned round the clock by intensivists, trained nurses, and critical care experts.

One such Command Centre would be able to provide tele-ICU services for one or two districts in a hub-and- spoke model. This means that doctors in one command centre will be able to treat patients in different hospitals.

Necessary infrastructure, including high-speed Internet facility, should be established by districts. District Medical Officers and institutional medical boards have been asked to submit proposals for establishing tele-ICU care services in districts.

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