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.