4. In which ways is the initiative creative and innovative?
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The execution started by team assembly of administrative, medical and technical staff to set the rules and regulation and plan to start the Tele-ICU project.
A site survey was conducted to the selected area (Hail 600 K distance from Riyadh) to determine and afford the requirements, the choice of the site was based on the geographic location, ability to start a new project, possibly of network connect at the time , the information collected was consist of medical staff , RT and physical therapy technicians, technical information such as network connection possibility starting with 2 MB of MPLS bandwidth , availability of IT and technical staff to manage and support the project , availably of administrative staff to manage and coordinate the project with no previous experience in the region , availability of other medical services such as medical informatics system, PACS , electronic medical record system.
The team stared to design the solutions according the available resources were the main challenge was the lack of standardizing and system compatibility between our hospital and the remote area.
Prove of concept was successfully performed between our hospital and King Khalid hospital in Hail an ICU case was presented by the remote medical staff , the patient was seen by video conferencing system, the vital signs were also monitored live thru network using live stream server , the radiology studies were seen thru the video system , an IP telephone was used as back up for easy communication , the patient’s family attended the medical discussion and agreed to the treatment plan , this was a good release for the family and hospital from the stress of transferring the patient over 650 KM using ambulance or mobile medical transporter , beside the social impact that the patient is been treated in his society and family eliminating the time and cost of the travel, this was published in official and social media , and very well documented as the first Tele- ICU case in the region of EMRO.
Facing limited fund and resources we planned to expand to other hospitals and regions using the same strategy of custom solution in order to fit with the lack of standardization and multiple used system.
Next step we selected different regions considering the equal geographic distributing in order to cover the country collecting and analyzing more data to help in our future plan.
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5. Who implemented the initiative and what is the size of the population affected by this initiative?
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The Tele-ICU project was up and functioning with a collaborative unlimited efforts from vast of persons and organizations.
Public:
Taking the time and effort from the patients and their families to answer the initial questioners and surveys and speaking out loud when being asked about their specific regional medical needs / limitations, has designed the outlines picture of the project and added the first main stone in progression of this initiative.
Government:
Starting by discussing this initiative in the parliament of the kingdom and considering it as a major project. The effort from the ministry of health in facilitating the access and the resources within the different hospitals. To the wise understanding from the ministry of finance, all together has fully supported this initiative.
Privet sector:
The Saudi Telecommunication Company (STC)
The MEd unit internet company
Media:
Were several newspaper articles, the social media (FB & Twitter), TV advertisements and direct public awareness days have distributed the idea and increased the acceptance
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6. How was the strategy implemented and what resources were mobilized?
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The Tele-ICU project was fully funded by the Saudi government as part of the government plan to move towards the electronic services implementation in the healthcare and other sectors, for easy fast and secure services, the fund release was based on the prove of concept , practical utilization , media documentation and official statistics on the actual presented and treated cases.
The technical recourse used in the project mainly based on the customization strategy we followed since the beginning in fact that all Tele-ICU methods implemented globally will not apply in our area with lack of standardization and system compatibility , our IT and telemedicine technical came up with customized technical solution that consist of locally developed software to send the new cases , the software was designed and developed by a hospital medical IT staff who is very well aware of the Tele-ICU requirements and parameters to give adequate information about the case and to exchange the management plan, stand-alone portable video conferencing system was also customized by our staff used to evaluate the patient if required and to secure an encrypted communication between the 2 hospitals .
The remote hospital also contributed also by assigning medical, technical and administrative staff locally to support the project , the candidates were fairly trained in our hospital to meet the required standards , the cost of the local staff was mainly funded by their local employer ( ministry of health ) with incentive level participation of our hospital , no other external contributors were involved .
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7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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In urgent situations were treating a critically ill patient, a very stressed family and loved persons is concerned, a limited resources, and when a single medical order can make a huge difference in saving the patient life, the core of this project is illustrated, the visible and existed project can be utilized for discussing the challenges, changing the plan of care as needed 24/7, monitoring vitals, taking action and even supporting the family.
2- Intensive care unit –ICU beds utilization
The more and efficient utilization of the Tele-ICU initiative has dramatically reduces the needs of transferring patients from regional hospitals. Since they can be treated remotely with the same high quality and standards as KFSHRC patients, this has also minimize the length of stay in the regional hospitals.
3- Return of Investment (coast effectiveness)
Reducing and saving amount of money needed for travelling, tickets, ICU beds and coast of other resources, etc. considering that the same quality of care provided, has made this initiative an essential project in the growing medical and health sector in the country.
4. Education
In addition to delivery of high quality of care, the initiative has also added the access to deliver massive medical, nursing and respiratory education. This education has directly impact the standard and quality of care in the regional hospitals.
5- Psychological and cultural support
As a culturally known in the Kingdom, the whole family usually should be supporting the critically ill patient, This initiative has embower this aspect that rarely considered in the traditional way of treating patient from outside Riyadh, it usually happened that one or two members of the patient family will accompanied the patient throughout the treatment time at KFSHRC, while in this initiative the patients will be treated while with family and their loved one. As known medically: half of the treatment comes from psychological wealth.
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8. What were the most successful outputs and why was the initiative effective?
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1. Establishing a 24/7 call center:
The call center has all the features of communication available in the market (video & audio), another feature of connecting the land line, pager system and cellular phones together, when calling any of them all of them will give the notification immediately. Nevertheless using all social media application as another way of communication (WhatsApp, Facebook, twitter and emails) which can be accessed from a cell phone.
2. Notifying and organizing the care team (MD, RT and ICU nurse):
After receiving the call/notification of service need, the care team will be notified for care discussion and recommendations
3. Close monitoring of the patient condition:
Through the established monitoring software that allows the team to review vital signs and the ECG, and to contact the requesting region when needed.
4. Recommendation will be dictated and reported to the requesting MD:
Throughout a software that created by our team, a holistic initial report will be created immediately with the biographical data of the patient, the general condition, APACHE score, diagnosis, current medications and ventilator setting. A dictated professional report will be send to the requesting MD.
5. Another follow up discussion will be performed as much the patient in need:
To firmly evaluate the patient outcomes and the process, a follow up discussion will be formed frequently till patient improved, family of the patient is usually e evaluation process.
6. Documentation
The whole process of each case discussion, from the call time to the signing off is documented and recorded in a filing system.
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9. What were the main obstacles encountered and how were they overcome?
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1. Shortage of expert manpower:
As known worldwide, the shortage of ICU medical team (physician, nurses and respiratory therapist) was one of the obstacles we faced in implementing this project, while an extra assignment was made for our ICU manpower which took an extra time and effort from them covering and helping the regional hospitals in treating their patients.
The issue was solved in utilizing the time of physician more efficiently and distributing the remote coverage through the team
2. Financial obstacles:
Low amount of governmental financial support was provided initially, based on hesitancy of program successes.
Till a new concept of Tele-ICU, treating patient remotely, was proven outcomes. The governmental fund was raised considering the future expansion and the extensive geographical needs.
3. Geographical challenges:
With a very wide extended country, with varies differences in the resources availability. A huge effort was made from the implementing team to customize the project logistics based on feasible trusted resources, in the far regions were internet connectivity was not high speed, another resources were created like free call lines and downloadable software
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