ICU Bed Information System
Background
The National Office of Clinical Audit (NOCA) in its first Irish National Intensive Care Unit Audit (INICUA) Annual report in 2017 included among its recommendations that-
“The HSE should take measures to facilitate transfers of critically ill patients between hospitals in order to make optimum use of scarce critical care beds and to facilitate transfers for specialist care. The INICUA can support a live ICU Bed Information System in order to provide data on bed capacity in participating units, and this ICU-BIS could also be used to improve communication for referrals”
Project Deliverables
With funding provided by the HSE, a project to implement the ICU- BIS was launched within the scope of the NOCA National ICU Audit project. DMF Systems were tasked with developing a solution to deliver the following aims.
- Provide direct access to ‘live’ information on ICU bed availability for clinicians who need to transfer a patient to another ICU or Critical care unit Nationally.
- Provide contact details for ICU’s and a pathway for electronic referrals of patients to streamline the communication process between hospitals.
- Provide information to the HSE regarding availability of ICU beds nationally, particularly for Surge/ Major disaster situations.
- Provide information and an electronic referral pathway for Transport Medicine/ National Ambulance Service to facilitate integration with ICU’s
- Provide an overview of patients managed by the Critical Care team outside the ICU.
Provide reports on ICU bed availability and utilisation Nationally and in real time.
The ICU – Bed Information System implementation was separated into three phases-
Phase 1 – National ICU Bed occupancy
Phase 2 – National provision of key Clinical Information on ICU patients
Phase 3 – National Referral pathways for ICU and Transport Medicine
Clinical View of Critical Care Utilisation and Capacity
The ICU-BIS supports both a National view and an Internal Hospital view of ICU Bed status. Typically, National information is available to all system users while Hospital Views are available to clinical teams within the hospital.
The National view provides the HSE & Hospital intensivists with a live information dashboard detailing of the breakdown of Critical Care beds. This includes the number of open/staffed beds, the number of occupied beds, the number of reserved beds, beds that are cleared for discharge and unoccupied beds. The dashboard also provides the time of the most recent update of the system for each Critical Care unit.
The real-time contact information for the Consultant on Call in each Critical Care unit is also accessible directly from the dashboard.
The internal hospital provides a breakdown of Clinical and Patient information for Clinicians within the participating hospital for each of its critical care units and ICU beds. This view provides details including the total number of beds, the number of open/ staffed beds, the number of occupied beds, the number of patients receiving invasive ventilation, the number of patients cleared for discharge and the number of available beds in each critical care unit within the hospital and is summarised and presented nationally.
Covid-19 Pandemic
As of February 2020, a live view of Bed Occupancy in the Dublin area hospitals was available. At the same time HSE planning for the emerging Covid-19 pandemic and the expected surge in ICU Admissions not only put a greater urgency on implementing the National ICU Bed Information System but it also called for an expanded solution to encompass all of the newly created and expanded ICU capacity in the system. The ICU Bed Information System ‘off-unit’ component was also adopted to include the expansion of ICU’s and to measure the overall burden of Covid-19 on Critical Care capacity. In total there are 33 hospitals now live on the system which encompasses 77 critical care units (Public Hospitals, Private Hospitals and Paediatric Hospitals). The ICU-BIS solution is live since the 26th of March. In practice each ICU team confirm their data twice daily which automatically updates the real-time Information dashboard.
Covid-19 specific data is also recorded and available to view on both a National view and an expanded detailed level on the hospital view.
Covid-19 specific fields include the number of admissions of confirmed Covid-19 patients in the last 24 hours, the total number of confirmed Covid-19 cases in each unit, the confirmed number of Covid-19 cases that are invasively ventilated, the confirmed number of deaths of Covid-19 patients over the past 24 hours and the confirmed number of Covid-19 patients discharged to the ward over the past 24 hours.
