Implementation of an Intensive care registry in India (IRIS): Barriers and Opportunities
CCCF ePoster library. Tirupakuzhi Vijayaraghavan B. 11/12/19; 283349; EP79 Disclosure(s): None
Dr. Bharath Kumar Tirupakuzhi Vijayaraghavan
Dr. Bharath Kumar Tirupakuzhi Vijayaraghavan
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Abstract
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ePoster
Topic: Quality Assurance & Improvement

Presenting author: Bharath Kumar Tirupakuzhi Vijayaraghavan

Co-authors: 

Ashraf, Niyaz: Director, Critical Care Medicine, Iqraa Hospital, Calicut, Kerala
Venkataraman, Ramesh: Senior Consultant, Institute of Critical Care Medicine, Apollo Hospitals, Greams Road, Chennai
Ramakrishnan, Nagarajan: Director and Senior Consultant, Institute of Critical Care Medicine, Apollo Hospitals, Greams Road, Chennai
Adhikari KJ, Neill: Assistant Professor, Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada
Gamage, Dilanthi: Network for Improving Critical Systems and Training, Colombo, Sri Lanka 
Beane, Abi: Research Fellow, Network for Improving Critical Systems and Training, Colombo, Sri Lanka and Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
Haniffa, Rashan: Clinical Lecturer, Network for Improving Critical Systems and Training, Colombo, Sri Lanka and Mahidol Oxford Tropical Research Unit, Bangkok, Thailand


Introduction:
In India, data on the geographical location of ICUs, ICU resource availability, and case mix and outcomes from critical illness are sparse. ICU-based patient registries offer opportunities for quality improvement and research. We describe the initial development of an Indian critical care registry.

Objectives:

  1. To implement an electronic national intensive care registry in India (IRIS)
  2. To describe the barriers and potential opportunities

Methods:
In partnership with clinicians and administrative stakeholders, we started by recruiting ICUs from private hospitals in Chennai, Tamil Nadu. Admission characteristics, diagnosis, and daily physiology are captured for each patient admitted to the ICU, adapted from the Sri Lanka Network for Improving Critical Systems Training (NICST) registry. De-identified information is displayed in dashboards, enabling administrators to evaluate trends in their ICU activity and bed occupancy.  Anonymised aggregate data allows for comparisons across institutions.

ICU directors completed a survey of organisational factors. Data collectors (nurses, physician assistants, research assistants) were trained in data collection. The NICST team provided remote support during implementation and data are stored in servers in India. Anonymised aggregate data are backed up to a cloud-based repository and visualised to provide the user dashboards.

ICUs contributed data through a secure desktop portal. Daily telephone follow-up through nominated local coordinators was used to extract admission numbers from existing records within each ICU and to facilitate validation. Technical support was provided remotely by the NICST team. Information on completeness of reporting was displayed monthly through each participating ICU's own dashboard, guiding the participating ICUs towards greater data completeness.

Results:
The structure of IRIS helped overcome barriers related to data privacy and security; data collection started in January 2019 with 6 adult (115 beds) and 1 paediatric (9 beds) ICU. Results of the landscaping survey are described in Table 1. Data collectors were recruited from each ICU. The ICUs have reported 1367 ICU admissions with 23.19% planned (e.g. post op) and 76.81% unplanned admissions. The commonest admission diagnostic category is cardiovascular (393, 28.75%). Aggregate ICU mortality is 10.83% (148) and median LOS 2days (IQR=3 days)
Opportunities for database development and research include development of a mobile bedside application to facilitate clinician data entry; investigation of the prevalence of frailty at ICU admission and association with outcomes; and development and validation of severity of illness scoring systems.
 
Conclusion:
We describe the implementation of an Indian critical care registry. We have demonstrated feasibility of the model and we see enormous potential for the registry in evaluation of critical care delivery and in improving outcomes from critical illness.
 


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ePoster
Topic: Quality Assurance & Improvement

Presenting author: Bharath Kumar Tirupakuzhi Vijayaraghavan

Co-authors: 

Ashraf, Niyaz: Director, Critical Care Medicine, Iqraa Hospital, Calicut, Kerala
Venkataraman, Ramesh: Senior Consultant, Institute of Critical Care Medicine, Apollo Hospitals, Greams Road, Chennai
Ramakrishnan, Nagarajan: Director and Senior Consultant, Institute of Critical Care Medicine, Apollo Hospitals, Greams Road, Chennai
Adhikari KJ, Neill: Assistant Professor, Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada
Gamage, Dilanthi: Network for Improving Critical Systems and Training, Colombo, Sri Lanka 
Beane, Abi: Research Fellow, Network for Improving Critical Systems and Training, Colombo, Sri Lanka and Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
Haniffa, Rashan: Clinical Lecturer, Network for Improving Critical Systems and Training, Colombo, Sri Lanka and Mahidol Oxford Tropical Research Unit, Bangkok, Thailand


Introduction:
In India, data on the geographical location of ICUs, ICU resource availability, and case mix and outcomes from critical illness are sparse. ICU-based patient registries offer opportunities for quality improvement and research. We describe the initial development of an Indian critical care registry.

Objectives:

  1. To implement an electronic national intensive care registry in India (IRIS)
  2. To describe the barriers and potential opportunities

Methods:
In partnership with clinicians and administrative stakeholders, we started by recruiting ICUs from private hospitals in Chennai, Tamil Nadu. Admission characteristics, diagnosis, and daily physiology are captured for each patient admitted to the ICU, adapted from the Sri Lanka Network for Improving Critical Systems Training (NICST) registry. De-identified information is displayed in dashboards, enabling administrators to evaluate trends in their ICU activity and bed occupancy.  Anonymised aggregate data allows for comparisons across institutions.

ICU directors completed a survey of organisational factors. Data collectors (nurses, physician assistants, research assistants) were trained in data collection. The NICST team provided remote support during implementation and data are stored in servers in India. Anonymised aggregate data are backed up to a cloud-based repository and visualised to provide the user dashboards.

ICUs contributed data through a secure desktop portal. Daily telephone follow-up through nominated local coordinators was used to extract admission numbers from existing records within each ICU and to facilitate validation. Technical support was provided remotely by the NICST team. Information on completeness of reporting was displayed monthly through each participating ICU's own dashboard, guiding the participating ICUs towards greater data completeness.

Results:
The structure of IRIS helped overcome barriers related to data privacy and security; data collection started in January 2019 with 6 adult (115 beds) and 1 paediatric (9 beds) ICU. Results of the landscaping survey are described in Table 1. Data collectors were recruited from each ICU. The ICUs have reported 1367 ICU admissions with 23.19% planned (e.g. post op) and 76.81% unplanned admissions. The commonest admission diagnostic category is cardiovascular (393, 28.75%). Aggregate ICU mortality is 10.83% (148) and median LOS 2days (IQR=3 days)
Opportunities for database development and research include development of a mobile bedside application to facilitate clinician data entry; investigation of the prevalence of frailty at ICU admission and association with outcomes; and development and validation of severity of illness scoring systems.
 
Conclusion:
We describe the implementation of an Indian critical care registry. We have demonstrated feasibility of the model and we see enormous potential for the registry in evaluation of critical care delivery and in improving outcomes from critical illness.
 


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