This release appeared a few days ago:
National ICU dashboard critical during Vic second wave
Tuesday, 30 March, 2021
The Critical Health Resources Information System (CHRIS) — a national tool for monitoring and sharing intensive care unit (ICU) capacity — has been described as a vital component of Victoria’s COVID-19 response, with potential to augment existing healthcare monitoring systems, according to its developers.
Dr David Pilcher — an intensivist at the Alfred Hospital in Melbourne, and Chair of the Centre for Outcome and Resource Evaluation with the Australian and New Zealand Intensive Care Society (ANZICS) — and colleagues detailed the development and success of CHRIS in the Medical Journal of Australia.
“In late March 2020, rising numbers of COVID-19-related admissions to ICUs were observed throughout Australia,” Dr Pilcher and colleagues wrote.
“ANZICS and the Australian Government Department of Health [DoH] recognised that ICU demand was unlikely to be uniform, that capacity might be exceeded in one region but not in another, and that matching ICU resources to areas of greatest need might be required.
“A single sentence encapsulated the approach: ‘Why would we let a patient die in Western Australia if we can see a spare ventilator in Sydney?’”
In a collaboration between ANZICS, the DoH, Telstra Purple and Ambulance Victoria, a national dashboard of ICU activity (CHRIS) was created.
The authors explained that public and private adult and paediatric ICUs throughout Australia were instructed to enter data twice daily, with each ICU able to see patient numbers and resources available within every ICU in their region and an aggregate summary of all ICUs in Australia. CHRIS was available to all state and territory health departments, to all patient transport and retrieval agencies, and also to ICUs in New Zealand. Three weeks after the system went live on 1 May 2020, 184 out of 188 eligible ICUs (98%) in Australia were contributing data, meaning that the system was ready for the second wave of COVID-19 that hit Melbourne and Victoria at the end of June.
“From the beginning of July to the end of September 2020, there were 237 ICU admissions with COVID-19 pneumonitis, of which 210 (88%) occurred in July and August,” Dr Pilcher and colleagues wrote.
“Admissions were predominantly to public hospitals in north-western Melbourne. The rapid and localised nature of presentations meant that it was faster to transfer patients to ICUs with vacant capacity than to open and staff additional beds, despite physical ICU bed spaces being available.
“Transfers from the emergency department or ICU at the four north-western metropolitan hospitals alone accounted for 35% (46/133) of all critical care transfers in Victoria during July and August.”
CHRIS provided real-time data on ICU activity and capacity, as well as facilitating the transfer of critically ill patients. The system also enabled early diversion of ambulance presentations to emergency departments at hospitals where ICUs had capacity.
“These approaches were integral to ensuring standards of care were maintained by clinicians, retrieval agencies and the Victorian health department. At the same time, there was visibility to the Australian Government Department of Health, which would, if required, coordinate a national response to overwhelmed ICU services,” the authors wrote.
Dr Pilcher and colleagues believe CHRIS has the potential to be used beyond intensive care settings, assisting in the response to local and national public health emergencies such as mass casualty events, bushfires or thunderstorm asthma. They noted that automated linkage of CHRIS to existing state-based and national systems should be investigated, as well as potential use in monitoring health policy impacts more broadly.
More here:
There is a slightly more in-depth article here:
ICU monitoring tool saved COVID-19 patients, shows huge potential
Authored by Cate Swannell
A MONITORING tool designed to help Victorian and other intensive care units (ICUs) nationwide save lives during the COVID-19 pandemic in 2020 may prove useful to other medical specialties, including emergency departments and mental health services.
The Critical Health Resources Information System (CHRIS), which went live on 1 May 2020, was developed by a collaboration between Telstra Purple, Ambulance Victoria, the Australian and New Zealand Intensive Care Society (ANZICS) and the Australian Government Department of Health.
Speaking with InSight+ in an exclusive podcast, Dr David Pilcher, an intensivist at the Alfred Hospital in Melbourne and Chair of ANZICS’ Centre for Outcome and Resource Evaluation, said the collaboration on and development of CHRIS came out of “a mixture of absolute desire to try and do something, a little bit of panic, and a bit of not knowing what was going to happen”.
“By this time last year, we realised that [the COVID-19 pandemic] was actually going to affect us,” said Dr Pilcher, who is the lead author of a Perspective on CHRIS, published in the MJA.
“We were looking at what was going on in China. And then Italy started happening, and then Italy became Germany, and the UK, and New York. And then patients with COVID-19 were coming in off the cruise liners and being put into ICU.
“Even though it was one or two, we knew that could become a handful and that could become something that crushes the resources that we’ve got.”
That was the kernel of the thing that became CHRIS.
In the MJA article, Pilcher and colleagues described CHRIS as:
A nationwide dashboard of ICU activity … All adult and paediatric ICUs (public and private) in Australia were instructed to enter data twice daily. This manual data entry typically took 5 minutes. Each ICU was immediately able to see patient numbers and resources available within every ICU in their region and also see an aggregate summary of all ICUs in Australia. CHRIS was available to all state and territory health departments, to all patient transport and retrieval agencies, and also to ICUs in New Zealand. The system went live on 1 May 2020, after 26 days of development. Three weeks later, 184 out of 188 eligible ICUs (98%) in Australia were contributing data. A single sentence encapsulated the approach: ‘Why would we let a patient die in Western Australia if we can see a spare ventilator in Sydney?’
As the pandemic escalated in Victoria, CHRIS was deployed.
“From the beginning of July to the end of September 2020, there were 237 ICU admissions with COVID-19 pneumonitis, of which 210 (88%) occurred in July and August,” Pilcher and colleagues wrote.
“Admissions were predominantly to public hospitals in north-western Melbourne. The rapid and localised nature of presentations meant that it was faster to transfer patients to ICUs with vacant capacity than to open and staff additional beds, despite physical ICU bed spaces being available.
“Transfers from the emergency department or ICU at the four north-western metropolitan hospitals alone accounted for 35% (46/133) of all critical care transfers in Victoria during July and August.
“Spare ventilators were available at all sites on all days. On six occasions in August, there were more than 140 ventilated patients (with or without COVID-19) in Victoria. On each of these days, there were more than 500 spare ICU ventilators available.
“Despite individual hospitals indicating transient increases in ICU bed numbers, there was no overall increase in open staffed ICU beds.”
In the podcast, Dr Pilcher said CHRIS had enabled intensivists to have immediate access to the situation in their region.
“What we needed was have visibility of where all the services were, and who had what capacity, because we knew it was not going to hit everywhere uniformly.
The developers of CHRIS took existing local systems and turn it into one which could “see” the whole country.
“CHRIS allows you to look at all the hospitals in your region. You can see how many patients are in your ICU, how many are on a ventilator, how many spare ventilators you’ve got, how many of your patients have COVID-19, how many need dialysis or other important ICU therapies,” Dr Pilcher told InSight+.
More here:
This is a great example of relatively simple technology, some fast foot work and a clear need getting a really useful outcome.
What is probably less well known is that this national level of co-operation has been the hallmark of the Australian Intensive Care community for many years and that we have leveraged this co-operation, over time, to answer many key clinical questions by the conduct of a range of very important clinical trials.
The community these days still seems to have preserved the collegiality and co-operation that existed when fewer than 100 specialists in a few of the major capital-city teaching hospitals got together to form the Intensive Care Society and formed a small interest group within the much larger College of Anaesthetists. At that stage there was no speciality recognition and even if trained in the area you did not get any separate recognition. Over the 40 years I have been involved that has now evolved into a separate College of Intensive Care Medicine but we still see an organisation that is small enough to work together to make a difference nationally!
Our Intensive Care community is seen world wide as real pioneers and innovators. I hope that ethos and spirit is never lost.
You can read about the evolution of the specialty here:
https://www.cicm.org.au/About/History
I will note that I qualified in Intensive Care in 1982 so was really in at the start and was busy then using down time to program our ICU’s PDP-11/30 to make and record clinical calculations….
Great to see that spirit of collaboration and co-operation for a good clinical outcome!
David. FANZCA, FCICM.
David,
ReplyDeleteWhat was the involvement of the Federal Department of Health in these ICU initiatives?
None I am aware of but I am a long way from the action these days! They are mentioned in the release so may have helped at some point but this seems to me to be a College / ANZICS initiative by and large!
ReplyDeleteDavid.
I would have thought that the Department of Health and/or ADHA would be shouting it from the roof tops if they have any involvement, however small.
ReplyDeleteTheir silence speaks volumes.
ADHA is unable to coordinate a large portfolio they have no real programme planning or delivery skills required. Updating a few specifications no one uses and paying vendors to talk to them is all they ever do. The only clinically useful thing just ticks over in the shadows, mostly forgotten by the executives and certainly not really understood.
ReplyDelete