ICU monitoring tool saved COVID-19 patients, shows huge potential

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+.

“We also had it tell us how many staff were missing, because we thought that might become a rate-limiting step.”

CHRIS has the potential to be used beyond the context of COVID-19, he says.

“CHRIS allowed us to respond to the clinical problem. It allowed us to move patients from those ICUs that were really busy, and shift them to ICUs that had greater capacity.

“What we’ve seen since then is it provides visibility on the whole system of what’s happening on a day-to-day practice.

“For instance, right at the moment, the bigger tertiary hospitals in Melbourne are really busy. You can see that in the system, so it allows us a response to normal levels of activity.

“We’re seeing that retrieval agencies around the rest of the country and hospitals find it useful.”

Bushfires, flooding, thunderstorm asthma events are just some of the disaster scenarios for which CHRIS may prove useful.

“You can use it for emergency departments or in theory for other parts of the health care sector or even outside the health care sector, potentially. It’s very adaptable and can be lifted into a whole different environment.”

Did CHRIS save lives during the COVID-19 pandemic?

“CHRIS provided a bit of glue for people to see what was going on. It was that collaboration that really made the difference,” said Dr Pilcher.

“When I was talking [later] to the CHRIS developers, I said, I think that the thing you created genuinely saved lives because we can see where to move people. That meant we could respond in a way that allowed people to turn up in ICUs that weren’t under strain.”

Also online first at the MJA

Perspective: Patient‐reported outcomes and personalised cancer care
Koczwara et al; doi: 10.5694/mja2.50893 … FREE ACCESS for 1 week.

Perspective: A pathway for acute chest imaging in suspected or confirmed COVID‐19
Ngan et al; doi: 10.5694/mja2.50990 … OPEN ACCESS.