Overview

The Department of Critical Care of Nepal Mediciti comprises skilled and experienced intensivists, doctors, nurses, and allied staff competent to deliver state-of-the-art critical care services in Nepal. The department has a vision to lead performance management in critical care medicine in Nepal. We will pursue translating innovative and quality approaches to critical care delivery in Nepal. Fostering best practices will be a priority and we will also benchmark internationally with other critical care systems. There will be constant efforts to monitor and measure performance which ultimately will strengthen critical care services. Besides regular services, the department will be prepared for disaster events through surge management planning and regular surge exercises. The department is backed by high-end ECMO which is used in cardiac surgery and in patients recovering from heart failure or lung failure. NMC is proud to have Sorin’s fifth-generation modular heart-lung machine which sets new standards for functionality, flexibility, and quality.

 The working culture of the department will revolve around the following values:

• Patient Focus
• Patient Safety
• Credibility and Accountability
• Collaboration
• Performance Improvement
• Outcome Oriented
• Evidence-Based Practice
• Innovation
• Training
• Family Support 
   

Key Components
 The key components of the department are highlighted as follows:

• Skilled doctors and teams in intensive care will provide comprehensive critical care services round the clock.
• Implementation of specific Admission, Discharge, and Triage (ADT) policies.
•  Integration of Protocolized Care with Precision Medicine in the care of individual patients.
• A multidisciplinary approach to patient management.
• Management of severe infections, sepsis, trauma, brain injury, shock with multi-organ failure, ARDS.
• Advanced mechanical ventilator support and respiratory care.
• 1:1 patient-to-nurse ratio services for ICU patients.
• Availability of Early Warning System (EWS) and Rapid Response Team (RRT) services round the clock.
• Infection Control and Antibiotic Stewardship Program.
• Advanced and extracorporeal life support, ECMO, Intra-aortic Balloon Pump (IABP), Renal Replacement Therapy (RRT), Advanced Hemodynamic Monitoring, and Targeted Temperature Management.
•  Point of Care diagnostic and therapeutic facilities like Critical Care Ultrasound and Echocardiography.
•  Dedicated physiotherapy and rehabilitation care.
• The dedicated supporting team of nurses, physiotherapists, nutritionists, pharmacists, occupational therapists.
• Seamless continuum of care to High Dependency Unit (HDU) and post-acute care in collaboration with different clinical and non-clinical departments.
• Timely and efficient In-hospital and Out-of-hospital transfer of critically ill patients in collaboration with the EMS team.
• Post-critical care follow-up clinic.
• End-of-Life Care.
• Organ donation and Transplant critical care services.
• Family-centered critical care services to enhance patient and family experience and satisfaction

Facilities

Training and Education Initiatives:

• Expand the skill and capacity of existing critical care health professionals, enhancing pre- and post-ICU care, and supporting surge capacity response plans during disasters.
• Organize Continuous Medical Education (CME)/Continuous Professional Development (CPD) programs.
• Standardize critical care nurse training and education through Continuous Nursing Education (CNE).

Critical Care Information System:

• Enable evidence-based decision-making to support system-wide capacity planning and targeted performance improvement initiatives through data collection, analysis, and reporting.
• Improve data quality in Critical Care Information System
• Collaborate and integrate with international critical care databases/ registries. The outcome analysis will be used for performance and quality improvement.

Performance Improvement Initiatives:

Implement innovative approaches to achieve quality benchmarks and develop a culture of ongoing accountability and performance improvement in critical care service delivery. The reiterative process of the Plan, Do, Study, Act (PDSA) approach for quality improvement will be followed. We will choose the right metric that will gauge the quality of care in the ICU.

The following initiatives and performance management tools will be implemented.

 Initiatives and Performance Management Tools:

• Admission, Discharge, and Triage (ADT) Scores
• Trauma Performance Improvement Tools
• ICU Protocol Toolkit
• Critical Care Scorecards
• Sepsis Management Toolkit
• Neurosurgery Performance Improvement Tools
• Enhanced Recovery After Surgery (ERAS) Toolkit
• Infection Control Toolkit
• Ventilator-Associated Pneumonia and Central Line Infection Toolkit
• Rapid Response Team Toolkit
• Surge Capacity Management Toolkit
• Antimicrobial Resistance (AMR) Toolkit
• Critical Care Nurse Training Toolkit
• ICU Quality Measures Toolkit Conclusion Improving care in ICU will be the ultimate goal of the department. The services provided by the department will be safe, timely, effective, efficient, equitable, and patient-centered. The Department of Critical Care will lead the change in critical care service delivery in Nepal.