Apollo eaccess initiative: Tele-ICU during the COVID crisis

Introduction: The practice of Telemedicine is still in its infancy in our country Lack of awareness, as well as acceptance both on the part of patients and professionals, has been cited as the principal reason behind the delay in its full-fledged development The Apollo Hospital backed “eACCESS” tele ICU service has been functional since 2013 and has remotely managed over 4,000 ICU patients in the last 3 years in several hospitals in our country Continuous round the clock monitoring of critically ill patients has been possible with the use of remote technology The global COVID-19 pandemic has united all nations against a common enemy: the novel coronavirus In times like these where social distancing is the new norm, the timely release of the Telemedicine Practice Guidelines by the Government of India has enabled healthcare professionals to evaluate, diagnose, and triage remotely We have currently extended our monitoring services for COVID-19 patients at many remote locations in India like Dadri (UP), Bahr (Bihar), Kaniha (Odisha), Vindhyachal (MP), Korba (Chhattisgarh), and Ramagundam (Telangana) Materials and methods: Our workflow has evolved with time and we do a minimum of two interactions per remote site every day Qualified and trained intensive care physicians are monitoring patients in shifts along with specially trained critical care nurses Standard guidelines issued by The Ministry of Health and Family Welfare for COVID-19 treatment are being followed Awake proning of conscious patients is also being done at these locations under supervision We are also providing education to the medical personnel at these remote sites regarding the monitoring of ICU patients, follow-up of investigations, basic medical emergencies, and how to manage them Interestingly the minimum distance of our remote connection is 100 km and the maximum distance is 1,550 km Results: We have monitored over 1700 COVID-19 positive cases since March 2020 at various locations within the Apollo campus in Hyderabad and at remote sites Majority of the patients admitted for COVID care were males (68 7%) The patient population varied from 8 years to 84 years We have the capacity to monitor 120 COVID patients at a given point of time The average length of stay in the hospital is approximately 4 5 days Triaging and reporting of Electrocardiograms from remote sites is also done from our command center We have reported 3432 ECGs during this period We have also provided 409 sub-specialist tele consultations through the eACCESS program since March 2020 Discussions: Tele-ICUs not only provide 24∗7 monitoring of critically ill patients but stand with the bedside team as the first line of care This modality has helped decrease the frequency and need to physically enter an isolation room The direct visualization and monitoring of COVID-19 patients have also allowed for the early detection of many emergencies like a drop in oxygen saturation, disconnection from NIV, ventilator circuit issues, etc Since most of the intensivists are predominantly concentrated in the metro cities, Tele-ICU services have plugged a major gap in the existing healthcare delivery system by providing quality care to smaller rural areas Patients can have access to remote expertise from the comfort of their homes Conclusion: The ongoing COVID-19 pandemic has not only highlighted the shortage of ICUs but also the shortage of trained medical personnel and resources (like personal protective equipment, PPE) Tele-ICU solution can help bridge these barriers by conserving PPE, minimizing exposure, and avoiding infection through constant remote monitoring