10BedICU Conference @ INFOSYS MYSORE on July 24th 2021

Why do we need Training?

The 10BedICU track endeavors to train doctors and nurses in the government hospitals where we have deployed 10BedICUs. There are 2 factors that make training very important in the middle of this pandemic. 

• Firstly there is an acute shortage of specialist doctors and senior nurses to handle critical care requirements of Covid and other co-morbidities. So perhaps some of the tasks of specialist can be task-shifted to our government doctors and senior nurses - in order to save lives in the ICU setting.
• Due to the dynamic and changing nature of the pandemic and its treatment protocols coupled with studies reviewing the use of new drugs and their effectiveness, there is an important need to keep our doctors and nurses informed of the various developments relevant to treat Covid cases.  
• Since the experiences in different geographies and communities are quite varied depending on various factors such as age, gender as well as urban/rural, tribal, literate/illiterate populations etc. It is important for these sessions to seek inputs from the participants and hence develop a more holistic understanding of the pandemic. 

What can we expect to achieve through this training program.?

It is very important to set the expectation as to what outcomes can be expected through this training approach. It take 10-15years of medical college, internships, specialization and practice to create a fully qualified Intensivist. We can only endeavor through online and offline courses being planned here, to up-skill our hospital doctors to a certain level, so that we can attempt to task-shift some of the duties of a specialist to the available doctor and perhaps even a senior nurse. It is important to keep in mind that this approach is being taken only to deal with the huge stress in the healthcare system being posed by the pandemic esp. as caseloads soar, it is not being suggested as a replacement of specialists at govt. hospitals.

How do we create the content and deliver this training?

1) We need a content group consisting of specialist doctors including Intensivists, Pulmonologists, Anesthetists and pediatricians perhaps to come together to create the underlying content. This base content needs to be well structured based on the course structuring and the intended outcomes.

2) We need a training partner, which can take the above base content and convert it to trainable modules based on the course cadence and schedule. This will also include creation of Videos, Graphics, Charts etc. as well as translation to local content perhaps for access. 

3) Lastly the training partner needs to deliver the course as per the requirements of the 10BedICU program in several states. While some courses in English can be offered across geographies in India, other language/geo specific courses need to be scheduled for specific states.

Courses being planned to prepare the 10BedICU doctors and nurses. 

• Basic Covid Course for Doctors, Nurses and ANMs
  1. Duration: 3weeks, 3 days/week, 1hr/day
  2. Type: Online but live/interactive
  3. Topics: Mask/social-distancing, home-isolation, Medication
  4. Certification: Basic Covid Doctor/Nurse Certification

• Basic ICU Course for Doctors and Senior Nurses
  1. Duration: 3weeks, 3 days/week, 1hr/day
  2. Type: Online but live/interactive
  3. Topics: Medication, Oxygenation, Protocols
  4. Certification: Basic Covid Doctor/Nurse Certification

• Intermediate ICU Course for Doctors
  1. Duration: 4weeks, 3 days/week, 1.5hr/day
  2. Type: Online but live/interactive
  3. Topics: Medication, Oxygenation, Protocols
  4. Certification: Intermediate Covid Course Certification

Inputs on TeleICU Track

Due to the acute shortage of specialist doctors in the rural government hospitals, we are looking at developing a TeleICU module in order to provide remote intensivists support over an online platform.

• Who calls the shots: The model proposed is that of the remote online specialist (eg intensivist/pulmonologist) will only advise the local doctor, and its the local doctor who will make the final diagnosis, prescribe medication, tests and procedures. 
• Simple Video Interface: A Simple video interface to allow for Tele ICU rounds between the specialist doctor in Bangalore/Delhi/NewYork/London and the local doctor at the govt. hospital will allow for an effective way of interaction and can help the rural hospital improve outcomes.
• Mobile First: Given the high penetration of mobile/smartphones in India, we need to ensure the TeleICU module supports a easy to use mobile interface for Android smartphones (97% of all Indian Smartphones are android).
• Keep it simple: Some doctors at the conference opined that we need to keep the interface and data captured to be very simple and minimal. "Don't make us do extra work just for technology's sake, our most important job is to take care of the patient, not fill out laborious forms". So it is important to take a minimalistic approach on online data capture. 
• Support paper forms and backend data entry: It might be very difficult to a PPE suited nurse or doctor to capture clinical data even on a well designed app running on a tablet with a stylus. So it might be necessary to continue with paper forms for clinical data capture and have a data entry person to digitize the paper forms for use by the online specialist in the TeleICU setting.
• Digital Game changer: TeleICU could transform ICU care in rural India: This technology has the potential to bring specialist doctors like intensivists and pulmonologist to rural government hospital and be able to support critical care infra in rural India, we need to be forward looking an try and embrace this new technology whoch might be a game changer and save a lot of lives. 

ICU Monitoring Using CoronaSafe. How can we monitor the 10BedICU equipment that has been deployed in government hospitals, ensure it is being maintained and used properly for high effectiveness?

• Video Camera Monitoring: The use of video cameras has been seen to be a very effective way to monitor ICU units and patient care. A single camera placed at the top corner of the 10BedICU hall could monitor the patients, the nurses and doctor rounds etc.
• Equipment Breakdown & Maintenance: One of the big challenges to deploying ICU infrastructure in rural hospitals is equipment maintenance of expensive and sophisticated ICU equipment. It is important that all assets be entered in the CoronaSafe asset register by hospital, and a QR code enabled sticker be affixed to each equipment. When any equipment breaksdown, the doctor/nurse/medical-technician need only scan the sticker of the faulty equipment and lodge a complaint with the AMC provider and the company will