Intensive Care Unit Registry

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 Intensive Care Unit Registry

A critical care clinical registry and bed reporting system

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Registry began: 2013

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About

There are over 100 state intensive care units in Sri Lanka with over 500 beds and approximately 3000 admissions per month. More than 750 Doctors and nearly 2000 nurses serve in these ICUs. No bed availability system or registry for critical care has existed previously in Sri Lanka.

ICU beds are a precious resource, especially for developing countries such as Sri Lanka costing well in excess of Rs 50,000 a day. It is imperative that this resource is utilised in the most efficient manner targeting those who are most likely to benefit from ICU care.

The current practice of searching for ICU beds by randomly calling ICUs is inefficient and endangers patient survival. Only 18% of the ICUs had direct telephone connections making even this search even more difficult.

National intensive care surveillance (NICS) system was established in late 2011 with the aim of implementing an ICU bed availability system and improving the quality of care provided in the intensive care units. NICS is a multi disciplinary national and international collaboration led by the Ministry of Health and including Academic Colleges and Academic Institutions.

The ICU surveillance system gathers information of ICUs, patients, staffing and available resources. The system captures information to enable benchmarking of ICUs to show how ill ICU patients are (severity scoring), their outcomes and diagnoses. This benchmarking will allow ICU outcomes to be expressed relative to other units. This process will facilitate learning from each other about methods, procedures, techniques, policies, equipment, drug profiles and training that have allowed some units to excel relative to others. NICS will improve transparency, accountability and the ability to direct scarce resources towards identified needs in a targeted manner.

Such a locally developed system based on low cost, rapid feedback, sustainable and locally integrated model is unique in a lower-middle income country and possibly in any developing country.

The bed availability system will help patients directly by reducing the time that is spent on searching a bed. This system will provide bed usage and bed pressure information to the MOH, which could be used to improve access to critical care. The system has already facilitated locally led research and audit amongst the multi disciplinary ICU staff and stimulated ICU training programmes.

Objectives

  1. Develop and operate an ICU bed availability system.
  2. Implement an audit of ICU patient outcomes – mortality and morbidity.
  3. Improve effective use of ICU resources for patient care – ICU facilities and functional status reporting.
  4. Standardization of ICUs – protocols, guidelines and standards
  5. ICU Economic analysis and cost effectiveness for planning
  6. Critical care capacity building in Sri Lanka.
  7. Improving the quality of audit and research in critical care

Benefits

  1. Planning ICU services based on needs, capacity and resources-plan and allocate new ICU beds,equipment, expensive medications, staffing
  2. Bed availability system-24/7
  3. Helps coordinate ICU resource management during any national / regional emergency or disaster
  4. Improve quality of patient care- audit of ICU patient outcomes  (morbidity and mortality), ICU feedback on compliance with national and international ICU clinical guidelines, detect clinical and resource problems of ICUs early to take corrective action – outbreak of infection, equipment malfunction etc, help ICUs understand areas for improvement and development, encourage and reinforce positive clinical or management policies of individual ICUs
  5. Improve cost effectiveness of critical care by carrying out economic analysis of staff and resource use
  6. Capacity building of critical care personnel and facilitate critical care training for ICU staff by identifying training needs of doctors, nurses & physiotherapists etc
  7. Development of critical care epidemiology – capacity building
  8. Promotion of local and national level audit by collaborations with various  specialties (anaesthetists, physicians paediatricians) and professions (nurses, physiotherapists etc)
  9. Collaborations with nurses and other allied health professionals for training and practice development
  10. Promotes local and international research
  11. Human resource development

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