Critical care is a vital but relatively costly resource. Harnessing the power of data analytics can ensure services are delivered more effectively, saving both lives and cost.
The National Intensive Care Surveillance (NICS) is an ICU bed availability system and a critical care clinical registry for Sri Lanka. The registry collects vital information about patient care that can be used by both the Ministry of Health and frontline healthcare professionals to understand and improve critical care systems. Island wide the registry provides live information regarding bed availability, patient flow, staffing and critical care patient outcomes in Sri Lanka. Using this information it is able to provide 24 hr online and telephone support for all clinicians looking for critical care beds for the sickest patients in their care. This data also helps individual intensive care and their teams to evaluate their current critical care service provision for patients and their families. We have achieved a continuous increase in ICU recruitment to the registry since the project started in late 2012 with over 100 centres now networked and participating.
NICS is one of the first such systems in a developing country and is an international collaboration led by the Ministry of Health of Sri Lanka with NICST as the core partner responsible for delivery of the project. The NICS mission is to contribute to the improvement of critical care services in Sri Lanka. We collaborate with the Ministry of Health and the relevant academic professional colleges in Sri Lanka, to provide expertise in healthcare data acquisition, analysis, clinical training and networking to improve acute and critical care in Sri Lanka. This was our first programme of work and forms the foundation on which all our subsequent developments are built.
Patients admitted to hospital are at risk of becoming more unwell and potentially developing critical illness. In Low and Middle Income Countries (LMICs) critical illness carries a high risk of death and so early recognition and effective treatment is vital to save lives.
This innovative project is harnessing our data gathering, data analytics and quality improvement expertise to improve acute care provision for the patients at District hospital Moneragala, rural South East Sri Lanka. The project uses both real time vital signs data display and clinical skills training to enable staff at the hospital to recognise and respond to patients who are becoming sicker and are at risk of becoming critically ill. The project has seen the appointment of a team of locally developed and empowered Rapid Response Nurses who work across wards with the multidisciplinary team to help provide hands-on clinical support for the sickest patients. NICST is collaborating directly with the hospital leadership and frontline staff at the hospital, providing expert input, facilitation and training to enable the local team to drive improvement in their acute care wards.
Once assessed their observations are immediately displayed so that their progress can be seen by all the team both on the ward and remotely. The learning from this pilot project in Sri Lanka has potentially far reaching implications both across the Sri Lankan health system and globally. For instance, whilst the Rapid Response Nurse model is common in the United Kingdom currently only a handful of hospitals combine this with data analytics systems. The ability to use such systems to assist healthcare teams in the earlier recognition of the acutely ill patient may offer real potential to improve the quality and safety of care.
Our quality improvement and training project is part of a wider research study to evaluate the effects of our activities.
Professional development and clinical skills training is an essential element of developing high quality healthcare. Building the sustainable capabilities in LMICs to provide effective training and development is key to improving care for the sickest patients.
For Doctors and Nurses
All our courses focus on building practical skills to enable healthcare professionals to recognise and manage acute and critically unwell patients. Essential to the provision of appropriate care is the ability to rapidly assess and competently treat patients during common medical and surgical ward emergencies. Alongside the framework of critical care, acute and emergency medicine is an emerging speciality in LMIC settings and there is a growing need for training in this arena. Commencing with our intensive care skills for nurses programme, we now have an active, internationally published and prize winning programme of courses developed to provide essential skills in safe, effective clinical care for nurses and doctors working with the sickest patients.
These courses are delivered in collaboration with the Government Medical Officers Association, Post Basic College Colombo, Nursing Council of Sri Lanka, the Faculty of Medicine, University of Colombo and Asiri Health (pvt) Ltd.
Medical simulation is a safe and effective method of delivering context-relevant learning to health care professionals. It is especially suited to developing the procedural and team skills required for high quality acute and critical care delivery. Prior to 2013 there had been no easily accessible medical simulation training in Sri Lanka.
Our training is delivered by a team of junior doctors and experienced nurses. This team is supported by a small international team of critical care specialists who have experience in capacity building and health care training in both High Income Country (HIC) and LMIC settings.
Since starting training in 2013 we have delivered 140 short courses in practical skills training to 2,132 Sri Lankan Nurses, Doctors and members of the Public. We have run 48 simulation sessions for Nurses working in critical care and emergency admission departments.
Building sustainability into our projects is at the heart of everything we do. Each of our course has an associated ‘Train the Trainer’ programme to develop the local capabilities to deliver these courses independently and sustainably. Typically the process of building the faculty capability takes around 12 months, including training and coaching in vivo.
All of our courses for nurses and doctors are now run independently by Sri Lankan faculty that we have trained. Our training and capacity building model for nurses in a LMIC was endorsed and recognised by the European Society of Intensive Care Medicine.
For the Public, Public Sector Workers and Community Health Care Providers.
Building individual capacity to create sustainable community first aid networks is an essential next step to increasing community access to basic acute and emergency healthcare. This project aims create a robust network of trained, experienced individuals who can rapidly mobilise and co-ordinate local community based teams skilled in pre-hospital first aid, emergency transportation & logistics in the event of a local, regional or national disaster. Training is cyclical ensuring quality and sustainability by working with communities, utilising the expertise of
NICST and community collaborators to create effective communication in the event of local, regional or national disaster. Practical training is delivered island wide in regional dialects using locally trained faculty who have come together to improve the pre hospital care availability in their community. Volunteers are encouraged to use their existing networks and roles within the community, opening up first aid training for students, school children and women through schools, community centres and local hospitals. Since commencing the programme in January 2016 we have helped train 164 community members in first and basic life support skills in locations across the island. All training and community faculty give their time, resources and expertise on a completely voluntary basis. Focus groups and feedback is now being utilised to identify the specific healthcare gaps within each community.
In collaboration with experienced health care volunteers from traditional and western medicine we are developing programmes to expand the programme scope and target remote communities in the North, North Western and Eastern provinces of Sri Lanka.