The quality of Intensive Care Units (ICUs) is an essential healthcare need. Due to continual technological advancements, there has been a sharp increase in the knowledge, technology, and skills that are required to treat critically ill patients.
In the US, the Leapfrog Group, which comprises more than 170 companies and organisations that work together to reduce preventable medical mistakes and improve the quality and affordability of healthcare, states that only those hospitals fulfilling the ICU physician staffing standard can operate adult and paediatric ICUs that are managed or co-managed by intensivists.
The Indian critical care sector has also witnessed an emergence of aspiring intensivists or critical care specialists training and practising critical care in tertiary hospitals. However, according to a survey by National Center for Biotechnology Information (NCBI), “In India, ICUs are mostly semi-open and mixed in nature. They are mostly 10–30 bedded. Trained staffs in the form of intensivists and nurses are less than required. Twenty-four hours intensivist coverage has been shown to improve outcome of patients admitted to ICUs. Twenty-four hours presence of trained intensivists has been only 37% in the survey, which can be attributed to scarcity of qualified intensivists and resource limitations in the country.” The survey also stated that the maximum response was seen to nurse patient ratio of 1:2 (47%) for ventilated and 1:3 (46%) for non-ventilated patients.
Critical care is to be provided when life is threatened due to an accident, in an ambulance, in a hospital emergency room, or in an operating room. Most critical care today is delivered in specialised ICUs. Terms like Critical Care Unit (CCU), Intensive Therapy Unit (ITU), and Coronary Care Unit (CCU) are used to describe such services.
Critical care is provided by multi-professional teams of highly experienced and professional physicians, nurses, respiratory care technicians, pharmacists, and other allied health professionals who use their unique expertise, ability to interpret important therapeutic information, access to highly sophisticated equipment to provide care. Patients are rarely admitted directly to the critical care unit. The continuum of critical care begins at the moment of illness or injury and continues throughout the patient’s hospitalisation, treatment and subsequent recovery.
Evolution of critical care needs
Critical care evolved from a historical recognition that the needs of patients with acute, life-threatening illness or injury could be better treated if they were grouped into specific areas of the hospital. Nurses have long recognised that very sick patients receive more attention. Florence Nightingale wrote about the advantages of establishing a separate area in a hospital for patients recovering from surgery.
Intensive care began in the United States when Dr. W.E. Dandy opened a three-bed unit for postoperative neurosurgical patients at the Johns Hopkins Hospital in Baltimore. In 1927, the first premature-born infant care centre was established at the Sarah Morris Hospital in Chicago.
The development of new and complicated surgical procedures, such as transplantation of the liver, lung, small intestine, and pancreas, created a new and important role for critical care. Widespread utilisation of pharmacologic therapy for critical care patients with specific organ system failures reduced time spent in both critical care units and in the health care facility. Typical illnesses like heart attacks, poisoning, pneumonia, surgical complications, premature birth, and stroke often needs critical intervention. Critical care also includes trauma care.
The CK Birla Group of Hospitals maintains a highly advanced set of critical care units and speciality clinics. According to doctors in CMRI, everyone in six persons will have a stroke (paralysis) in his/her lifetime. Symptoms like face drooping at one side, weakness or numbness in the arm and slurred speech can be indicate critical emergencies like stroke. The CMRI stroke centre is a 24x7 centre and is operated by a team of expert doctors, stroke specialists and neurosurgeons.
Pain in the heart is a symptom that may lead to a heart attack because one of the arteries supplying blood to some parts of heart could be getting blocked. For someone undergoing a heart attack, it is important to restore the flow of blood through the blocked artery either by dissolving the clot partially or totally with thrombolysis. Another alternative is to open up the blocked artery by balloon angioplasty with or without stenting immediately within 90 minutes of arrival. According to BM Birla sources, their chest pain centre takes immediate action during such critical moments.
The critical care team
A critical care team comprises of intensivists, who are doctors with subspecialty training, or equivalent qualifications, in critical care. An intensivist directs the care of critically ill and injured patients and works in collaboration with other health care professionals. The team includes highly trained professionals who provide specialised care. All members of the team may be asked to teach patients and their families various strategies to improve health, healing, coping, and well-being specific to their area of expertise. Critical care nurses are also equipped to provide a high level of skilled nursing. Their expertise and continuous presence allows early recognition of subtle, but significant, changes in patient conditions, thereby preventing worsening of conditions and minimising complications.
Infectious diseases (ID) are disorders caused by organisms such as bacteria, viruses, fungi or parasites. Many diseases are contagious and can be passed from person to person. Some are transmitted by bites from insects or animals. Others are acquired by ingesting contaminated food or water or being exposed to organisms in the environment. Signs and symptoms of these types of diseases vary depending on the organism causing the infection but often include fever and fatigue. Mild infections may respond to rest and home remedies while some life-threatening infections may require hospitalisation. Infectious diseases, such as measles and chickenpox can be prevented by vaccines. Frequent and thorough hand-washing also helps protect you from most infectious diseases. In case of infectious diseases, antiviral medications help in some cases. They can either prevent the virus from reproducing or boost the host’s immune system. Antibiotics are not effective against viruses. Using antibiotics against a virus will not stop the virus and it increases the risk of antibiotic resistance. Most treatment aims to relieve symptoms while the immune system combats the virus without assistance from medicine.
ID is a sub-speciality of general or internal medicine. However, ID specialists are relatively few in India at this point. For this, good and appropriate laboratory back-up is crucial. Although, each infectious disease has its own specific signs and symptoms, general signs and symptoms common to a number of infectious diseases are fever, diarrhoea, fatigue and muscle aches.
Isolation of infected patients is done as a preventive strategy in containing spread of diseases in the general wards as well as in the ICU. Infection control plays a prominent role in determining outcomes of any ICU. Implementation of infection control practices seems to be on par with international standards in our country. Nonetheless, standard setting organisations such as the National Accreditation Board for Hospitals and Healthcare Providers and the Joint Commission International have made an impact in developing structured quality protocol implementation in Indian hospitals and their ICUs.