Ramping up Critical Care Infra in Hinterland India
By Sandhya Mishra
An aim to take affordable home health beyond Tier I & II cities can be life-saving in these tough times, and Critical Care Unified is stepping into these very shoes.
The COVID-19 outbreak is certainly serving as a radical stimulus to innovation in healthcare industry and pervasive home healthcare is one such example of the many disruptions today.
The need for critical care, outside the hospital has always existed; but it has become more compelling during the pandemic, needless to mention the haunting episodes of shortage of ICU beds. The increased demand of home healthcare with technology enablers providing critical care at home is not only bridging the shortage of healthcare infrastructure, it is making healthcare affordable and conveniently accessible to most.
The father of disruptive innovation, Dr. Clayton Christensen in his remarkable work “will disruptive innovations cure healthcare?” claims that healthcare industry is ripe for disruptive innovation and believes will happen in the form of decentralization. The medical technologies will become simpler and care to begin to move out of the hospitals to a more convenient, less expensive settings like clinics, retail clinics, and, eventually, the home.
Mr. Rajiv Mathur, the Founder & Executive Chairman of Critical Care Unified Pvt. Ltd is a respected global leader who has operated extensively in the US, Europe and Asia for nearly 40 years. Passionate about leveraging technology for disruptive business solutions, Rajiv launched Critical Care Unified Pvt. Ltd. (CCU), a home healthcare company with special emphasis on Critical Care at home.
In an exclusive interview, he says, “for ailments ranging from post-stroke rehab to chronic COPD, late stage cancer management and post cardiac intervention care, facilities and expertise exist to provide care in comfort of the home.” Pointing out at an inequitable picture, he says, “whilst appropriate ICU and critical care facilities exist in hospitals of metropolitan locations and Tier 1 cities, both the quantity and quality take a severe drop in Tier 2 and Tier 3 cities or when going deeper into the rest of Tier 1. The patients who require critical care have to travel to cities incurring not only the treatment cost at tertiary care centres but also significant expense on travel along with inconvenience to the family. Not having access to standard treatment care or well-equipped hospitals often deteriorates the medical condition of a patient to a point beyond which either further treatment is rendered ineffective or, debilitating effects remain even if the patient overcomes the primary ailment.”
Critical Care Unified Pvt. Ltd. (CCU), in its fifth year of operation, has treated over 6000 patients with critical ailments in their homes. Once the surgery, trauma and acute phase is over, for medium to long term, comprehensive ICU facilities are setup in the homes of patients; comprising of medical equipment, expertise ranging from doctors, nurses and paramedic staff, physiotherapists and psycho-counsellors, as well as, providing a one stop solution for consumables, lab tests, delivery of medicines and a range of infusions including blood and platelet transfusions.
Mr. Mathur on emphasizing the difference of care offered at home & hospital says, “since the environment, infrastructure, constraints and challenges are different in the home as compared to the hospital, CCU has developed SOPs for implementation of critical care outside the hospital. For the entire chain of management processes that allow a caregiver by the bedside deliver consistently standard level of services, CCU has planned a roll-out of technology based solutions for remote monitoring and support.”
He points out some features of home healthcare;
While Point of Care (POC) setup can be arranged, the management and monitoring processes need to be robust and responsive. By definition, home care is remote and disparate. While in a hospital, standard facilities exist which then are utilized by patients admitted, in the case of home care, each setup is unique with its nuances and needs close monitoring and support.
The role of technology gains significance to implement 24*7 ICU type care in each home. Not only regular monitoring, but support to staff on duty as well as emergency responses need to be catered for.
For these services to be viable, it is important that they are available at costs affordable in these geographies. Economies of scale need to be considered on a cluster basis rather than a single city or town.
Staff cost is a significant element in the service packages for critical care at home. It is imperative that trained and competent staff is made available in these towns/cities through extensive training. It also makes sense for locally trained staff to continue in and around their home towns rather than move to big cities with associated costs and other inconveniences.
National data suggests that there exist between 75,000 to 90,000 ICU beds in the country. Both the first and second waves of COVID-19 have exposed the dire shortage of ICU beds.
Figures reported by the 15th Finance Commission also highlighted the shortage of doctors, nurses and hospital beds. According to the report, every allopathic doctor in India caters to at least 1,511 people, much higher than the World Health Organization’s norm of one doctor for every 1,000 people. The shortage of trained nurses is even more dire, with a nurse-to-population ratio of 1:670 against the WHO norm of 1:1300.
The same report highlights the poor ratio of hospital beds. India has 1.4 beds per 1000 of population— significantly lower than comparator countries like China, Sri Lanka, United Kingdom and the United States.
It is evident that a parallel infrastructure that provides ICU type facilities outside the hospital, will alleviate the situation as well as provide healthcare services conveniently.
During the COVID-19 pandemic, CCU provided isolation services and support at home to infected patients, following rigid norms as laid out by the Government, ICMR and WHO. Not only were the infected patients treated with isolation norms, implementation of robust protocols mitigated spread of the infection within the micro community of the family.
CCU is now embarking on a plan to take critical care services deeper into the country via the Hub-n-Spoke model. The target is to cover 25 cities in 2 years with critical care services that would include, but not limited to, mechanical ventilator support, TPN and RT feed, mechanical suctioning, IV infusions, physiotherapy, nutrition management, dialysis at home, chemotherapy at home and various medical examinations like X-ray at Home, ABG at home, ECG at home and others to be added soon.