In 2012, 70000 ICU beds were available to people who needed critical care in and around the country. With over 5 million needing these services annually, the need for more and better facilities is one that will not go away. With between 20-30% of a hospital’s budget going into its critical care facilities and limited government resources, the onus is on charitable trusts and for-profit organizations to create, and run the infrastructure needed to support our burgeoning population and its needs.
The challenges of hospitalization in India – a patient’s perspective
The need for affordable healthcare in India is critical. Over 40% of the people admitted in ICUs at hospitals around the country have borrowed money or sold assets to facilitate treatment. Even in the growing middle class of the country, one hospitalization in the ICU could account for up to 58% of the per capita expenditure and can even push 2.2% of the people below the poverty line. In for-profit hospitals capital budgets may be rearranged, if perceived financial goals aren’t met. This, in turn, affects service delivery, and ultimately, patient outcomes. In poorly-funded government hospitals, the story is different, where due to a lack of resources, infrastructure, support staff and intensivists, patients and their families end up sharing costs formally or informally, adding to their burden. For clinicians, the long-term feasibility of projects becomes a challenge.
In a study of 50 patients conducted in Mumbai, India in 2014, at a tertiary care hospital in Mumbai, with a 20-bedded well-equipped and fully-functional MICU, specialists on call, and experienced support staff trained to handle medical emergencies, the average expenditure per patient amounted to Rs. 27,213. The average cost per day per patient worked out to Rs. 6637.3, and total expenditure of these 50 patients over 205 days amounted to Rs. 13,60,650.
How important is nutrition for patients admitted in ICUs?
Patients admitted in the ICU are at nutritional risk within 48 hours. Observational studies conducted over the years have shown that low caloric and protein intake can negatively alter outcomes. If patients are unable to consume food, then additional micronutrients are necessary. Vitamin D supplements are also recommended in cases of severe deficiency.
The need for nutritional management
Efforts need to be made to ensure that at least 55-60% of the target calorie requirement is met within the first week of ICU stay for a clinical benefit. Abdominal distension, pain, bloating, and passage of stools should be tracked to check tolerance of enteral feeding. For patients receiving parenteral nutrition, bedside glucose monitoring needs to be done several times a day. Creatinine, BUN, electrolytes, and bicarbonate should also be monitored daily for the first few days.
The final word
For most health care providers in critical care, a switch in focus to better nutrition can help reduce the length of stay for patients. The use of technology to map nutritional intake will be critical and game-changing, as through it the proper nutrition and medicine dosages can be provided. Currently, patient nutrition is also dependent on individual experience, rather than scientific evidence. For India’s healthcare system to evolve and meet future needs, changes will need to begin today, for a better tomorrow.
