Monitoring of critically ill patients in the client hospital ICU.

Coordination with the primary treating physicians and the hospital- We believe that critical care is multidisciplinary team work and will coordinate all treatment plans with the primary treating physicians

Implementation of evidence based guidelines and protocols- Our team strongly believes that care should be standardized in order for all patients to receive treatments based on strong scientific principles and international and national guidelines. We can help in implementing these protocols and guidelines in the client hospital. We can also track the data to ensure that our team and the hospital comply with evidence based guidelines to provide the best possible care to the patient.

Collection of data - Although several simple measures like head of the bed elevation and low tidal volume ventilation have been shown to reduce mortality over the years, they are still not followed routinely by physicians in clinical practice. Our team will ensure that these protocols are not only implemented but are followed and audited periodically.

We can also obtain data for the hospital which will be useful for the management in resource utilization - such as ICU bed occupancy, number of ventilator days etc

Clinical Vignettes

Here we share details of patients in whom our team promptly identified an event, intervened immediately and successfully abated adverse outcomes.

Clinical Vignette 1:

The first patient was a victim of road-traffic accident, who presented to the ICU with hemodynamic instability late in the evening. The Intele-Physician who was monitoring the patient in the night evaluated this patient and noticed a drop in his haemoglobin and immediately requested an ultrasound of the abdomen. The ultrasound was done, interpreted and the surgeon on call notified without any delay. The Surgeon saw the patient at 2 AM and performed an emergent exploratory laparotomy and found a hepatic laceration for which appropriate haemostasis was done and patient stabilized.

Clinical Vignette 2:

Another patient was an elderly gentleman who was admitted with hypotension, severe azotemia, oliguria and hyperkalemia. After evaluation by our team, arterial blood gas was done which revealed combined severe metabolic & respiratory acidosis. Primary physician was informed by our staff about patient’s acute condition and the need for immediate dialysis and further work up. Dialysis was initiated emergently and metabolic parameters normalized. Both these patients were discharged from the ICU successfully within the next few days.

Clinical Vignette 3:

An elderly gentleman with diabetes, hypertension and coronary artery disease and moderate LV dysfunction was admitted with complaints of acute onset breathlessness and oliguria. On routine monitoring, the Intele-Physician noticed on the monitor that this patient was hypoxic, tachypneic and tachycardic with extremely high blood pressure. Immediate video assessment confirmed that the patient was in frank pulmonary edema from the accelerated hypertension. The bedside physician and the InteleICU™ physician collaborated and devised the appropriate treatment strategy. Non-invasive ventilation, intravenous nitroglycerin, diuretics and antihypertensive measures were promptly initiated. Bladder outlet obstruction was thought to be the precipitating event for this episode of pulmonary edema and hence urinary catheter placement suggested immediately by the InteleICU™ team. With the above interventions, the patient improved and intubation was avoided. After stabilization and medical optimization, patient was transferred to an outside facility for a coronary angiogram. This Clinical vignette clearly underlines the value of constant monitoring by trained eyes, early identification of problems, collaboration with bedside team and timely and appropriate interventions.

Clinical Vignette 4:

In another instance, on video monitoring it was noticed that the ICU patient was extremely dyssynchronous with the ventilator and was very uncomfortable. The Intele-Physician quickly zoomed into the ventilator settings, identified the problem, and walked the ICU staff at the Client Hospital through the proper ventilator and alarm settings. The Patient’s breathing became synchronous and comfortable within minutes of these changes. Patient-ventilator dyssynchrony is a very common problem and most times manifests as patient agitation in the ICU. Suboptimal ventilator settings are often overlooked and the patient is sedated and or paralyzed to counter agitation. This practice however prolongs number of patient days on the ventilator and increases complications associated with the use of mechanical ventilation. By swiftly identifying the problem and helping the bedside nurses to trouble shoot common ventilator alarms, the InteleICU™ team was able to avoid unnecessary sedation of the patient and at the same time were able to educate the bedside staff. These Clinical Vignettes point to the easy availability of timely intervention from an expert Intensivist through the InteleICU™ program which leads to improved patient outcomes at a place and time where expert clinical work force was otherwise limited. In the coming months, we aim to expand the InteleICU™ program to many more hospitals and will continue to augment bedside care by 24X7 remote monitoring and constant titration of care. We are excited with this new venture and sincerely believe we can make a positive impact to the quality of ICU care provided across the country.