Hub and spokes of critical care

Launching of Intensive Care Units (ICU) in 23 district hospitals in Assam in a hub and spoke model is a significant and laudable step in critical care services in the state. As these 10-bedded ICUs have been launched in government hospitals, it will also make critical care available at affordable cost and closer to a patient’s home. Asset maintenance, as rightly highlighted by Chief Minister Himanta Biswa Sarma in his inaugural speech, will be the key to deriving optimal benefits from critical care services to be made available in these district hospitals. Adoption of the hub and spoke model for running these ICU units will help the Health Department optimize expertise of critical care experts in the state in treatment of a patient admitted in one of these hospitals. These ICU units can be expected to play a crucial role in saving lives of trauma patients including those grievously injured in road mishap. Most of such patients are currently referred to medical colleges in the state for critical care but many succumb on the way or their condition aggravate due to long distances between local healthcare services and private and government hospitals in Guwahati, Dibrugarh, Silchar or some other towns where such treatment and care is available. The ICU units set up in some of the district hospitals during the COVID-19 pandemic have become idle for want of required human resources and lack of standardization and non-adherence to ICU protocols. As medical colleges will become the hubs of the Assam Critical Care Project and district hospitals connected with digital technology as the spokes of these hubs, critical care experts will be able to provide real time guidance in treatment of needy patients admitted to ICU wards of the district hospitals. Standardization of the protocols under the networked model will help overcome the problem of high mortality on account of high infection in ICU units of district hospitals. Costly medical equipment lying unutilized for want of required anaesthesiologist, trained technical staff has been a perennial problem. Decision to train nurses and doctors in handling critical care patients is a pragmatic step as critical care specialist for each district ICU units is not feasible. Rationalization of human resources in healthcare services will be essential to ensure engagement of trained doctors and nurse in handling critical care patients do not lead to extension of wait time of other regular patients to these hospitals for want of adequate doctors, nurse and technicians. It is heartening to know that an Asset Management Portal has also been launched to maintain a real time inventory of medical equipment and their maintenance status. Hospital authorities making best use of the dashboards to stay updated on the status of available functional equipment and being prompt in following up the maintenance work will justify the expenditures and the initiative. Most public hospitals in India suffer from lack of professional management of assets and human resources and can learn best practices from private hospitals which are better managed, being funded by individuals or group of people and accountability coming from the principle of providing service against payment. As quality service comes with higher cost heath care service provided by private hospitals are not affordable to majority of patients. The government, on the other hand, apart from funding the building and equipment costs also subsidized treatment and medication investigation in public hospitals. Utilization of medical assets, equipment by hospital staff with a sense of ownership and accountability towards public funded institutions, therefore, is a must for successful application of the hub and spoke model. Patients availing healthcare services in government hospitals need to play responsible role in keeping the hospital premises clean and hygienic, maintaining discipline to provide to help hospital authorities maintain the desired ecosystem that will motivate them to render best services. Availability of healthcare services including critical care in the nearest hospital cuts down out of expenditure of patients in taking the patients to medical colleges or a private hospital in a town or city which also includes food and accommodation for attendants apart from treatment cost. Optimal function of the ICU units in district hospitals will also reduce the burden on ICU units of medical colleges and more ICU beds will be available for needy patients. It will also reduce government expenditure in operation of ambulances for shifting critical care and trauma patients referred by district hospitals to medical college hospitals and money saved can be utilized for establishment of more primacy health care and wellness centres in the state. The hub and spoke model has the potential to bring unprecedented improvement in critical care, more particularly in respect of urgent surgical intervention which is at the same time cost effective and will ensure resource conservation. Quality training and professional management of human resources and assets will be key determinants of its sustainability.