Implementing an intensive care registry in India: Preliminary results of the case-mix program and an opportunity for quality improvement and research

Bharath Kumar Tirupakuzhi Vijayaraghavan, Neill K. J. Adhikari, Rajeshwari Arali, Udara Attanayake, Sampath Balasundaram, Abi Beane, Vijay Chakravarthy, Niyaz Channanath Ashraf, Sri Darshana, Dedeepiya Devaprasad, Arjen M. Dondorp, Robert Fowler, Rashan Haniffa, Pramodya Ishani, Augustian James, Issrah Jawad, Devachandran Jayakumar, Chamira Kodipilly, Rakesh Laxmappa, Kishore MangalAshwin Mani, Meghena Mathew, Sristi Patodia, Rajyabardhan Pattnaik, Dilanthi Priyadarshini, Mathew Pulicken, Ebenezer Rabindrarajan, Pratheema Ramachandran, Kavita Ramesh, Usha Rani, Suchitra Ranjit, Ananth Ramaiyan, Nagarajan Ramakrishnan, Lakshmi Ranganathan, Thalha Rashan, Raymond Dominic Savio, Jaganathan Selva, Swagata Tripathy, Timo Tolppa, Ishara Udayanga, Ramesh Venkataraman, Deepak Vijayan

Research output: Contribution to JournalArticleAcademicpeer-review

7 Citations (Scopus)

Abstract

Background: The epidemiology of critical illness in India is distinct from high-income countries. However, limited data exist on resource availability, staffing patterns, case-mix and outcomes from critical illness. Critical care registries, by enabling a continual evaluation of service provision, epidemiology, resource availability and quality, can bridge these gaps in information. In January 2019, we established the Indian Registry of IntenSive care to map capacity and describe case-mix and outcomes. In this report, we describe the implementation process, preliminary results, opportunities for improvement, challenges and future directions. Methods: All adult and paediatric ICUs in India were eligible to join if they committed to entering data for ICU admissions. Data are collected by a designated representative through the electronic data collection platform of the registry. IRIS hosts data on a secure cloud-based server and access to the data is restricted to designated personnel and is protected with standard firewall and a valid secure socket layer (SSL) certificate. Each participating ICU owns and has access to its own data. All participating units have access to de-identified network-wide aggregate data which enables benchmarking and comparison. Results: The registry currently includes 14 adult and 1 paediatric ICU in the network (232 adult ICU beds and 9 paediatric ICU beds). There have been 8721 patient encounters with a mean age of 56.9 (SD 18.9); 61.4% of patients were male and admissions to participating ICUs were predominantly unplanned (87.5%). At admission, most patients (61.5%) received antibiotics, 17.3% needed vasopressors, and 23.7% were mechanically ventilated. Mortality for the entire cohort was 9%. Data availability for demographics, clinical parameters, and indicators of admission severity was greater than 95%. Conclusions: IRIS represents a successful model for the continual evaluation of critical illness epidemiology in India and provides a framework for the deployment of multi-centre quality improvement and context-relevant clinical research.
Original languageEnglish
Article number182
JournalWellcome Open Research
Volume5
DOIs
Publication statusPublished - 2020

Keywords

  • Critical care
  • India
  • Registries

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