MillionICU: Government Hospitals Leverage Deep-Tech Solutions to Reduce Burden on Health Workers

Introduction

India spends 1.17 percent of its gross domestic product on public health, less than what lower-income countries spend.¹ Further, India has only one doctor per 1,457 people, lower than the World Health Organization’s recommendation of one doctor per 1,000 people.² In addition, the country lacks sufficient resources to manage an infectious pandemic, with only 2,500 registered pulmonologists and 122,000 intensive care unit (ICU) beds.^3,4

The COVID-19 pandemic has tested the limits of India’s health care infrastructure and increased the burden on its already understaffed health facilities. Experts have warned that India would need an extra 500,000 ICU beds and more trained nurses and doctors to battle another COVID-19 wave.⁵

The MillionICU initiative, by medical equipment company Dozee, stands out as a promising practice to address these challenges. MillionICU’s goal is to upgrade 1 million regular ward beds to step-down ICU beds (i.e., an intermediate level between ICU and regular ward beds) across public hospitals in India, thereby reducing the burden on health care workers.

So far, the initiative has converted 5,026 general beds⁶ into step-down ICU beds and has saved 80,000 nursing hours. Timely alerts by Dozee devices have enabled the transfer of 916 critical patients to ICUs.

Background

Dozee was founded in 2015 by Indian Institute of Technology graduates Mudit Dandwate and Gaurav Parchani, who met while working in Altair Engineering, a US-based information technology company.⁷ Dozee is headquartered in Bangalore and has a presence in more than 20 states and 200 hospitals throughout India.

Dozee launched the MillionICU initiative to address the shortage of ICU beds and lack of trained staff in India. Through this initiative, regular beds in hospitals are upgraded to step-down ICU beds with Dozee’s contactless patient monitoring and early warning system using artificial intelligence. The Dozee device silently tracks heart rate, respiration, sleep pattern, stress level, cardiac contractions, apnea, and more while patients sleep. Its artificial intelligence algorithms enable early detection of any health deterioration, helping hospitals to better care for their patients and save lives.

Intensive care unit (ICU): These wards provide care to critically ill patients with intensive and specialized nursing care, enhanced capacity for monitoring, and multiple machines to provide organ support to sustain life.
High-dependency unit (HDU): These wards are located closer to ICUs and provide more extensive care than normal wards but not to the extent of ICUs.

Through the MillionICU initiative, Dozee’s contactless sensors provide patient monitoring and early warning systems for HDUs and step-down ICUs. Dozee’s technology has helped public hospitals to cope with the current COVID-19 crisis in the short term and improve India’s public health care infrastructure in the long term.

How can you replicate or adapt this promising practice?

Ensure easy access and end-to-end integration

Because the MillionICU patient monitoring system was easy to install and required minimal training, it was integrated with the hospital workflow and easily replicable. Dozee’s services for MillionICU ranged from installing devices to training doctors and nurses. The Dozee team assessed each hospital’s infrastructure to understand whether the hospital had good internet connectivity, and it provided Wi-Fi adapters if there were network issues. The team also set up a monitoring station with a desktop computer for hospitals that did not have a dedicated nurse station.

Set up a 24/7 command center

During the second COVID-19 wave, when hospitals were overwhelmed with a high number of COVID-19 cases and a shortage of beds and staff, the team set up a patient monitoring cell in each hospital, with a dedicated resource person available 24/7 to prioritize alerts and monitor critical patients.⁸ This helped doctors to receive data on each patient’s vitals at the right time and to take action as required.

Strengthen the health care system beyond COVID-19

Many of the Dozee-powered step-down ICU beds are now being used in non-COVID-19 wards, wherever COVID-19 rates have declined. Thus, they did not become redundant and have continued to strengthen hospitals’ infrastructure, minimize burden on staff, and enable comprehensive remote monitoring.

What are the lessons learned from this bright spot?

Establish centralized remote monitoring

The MillionICU setup involved installing Dozee devices under hospital bed mattresses, which enabled health care staff to monitor multiple patients remotely rather than manually every few hours. The central monitoring cell consisted of a desktop computer with dashboards from multiple Dozee devices, saving 30 minutes of nursing time per patient per day. Establishing a centralized monitoring desktop computer for other devices can similarly save nursing time and prevent exposure to infected patients.

Extend medical staff capacity

The devices have become critical, especially during the COVID-19 pandemic, as they provided medical staff with patient data and notified them when patients required critical care. In the face of staffing shortages, the devices helped staff provide better care for more patients, ultimately saving lives and improving health outcomes. The device also allowed staff to set up custom alerts for every patient, allowing doctors to customize treatment plans, focus on deteriorating patients, and provide proactive care.

Optimize ICU capacity

The initiative increased the availability of ICU beds by enabling monitoring of less severe cases in the step-down ICUs. For example, moderate and mild COVID-19 cases were monitored in step-down ICUs. When their health status deteriorated, they were taken to ICUs.

Generate funding from corporate social responsibility programs and foundations

As a part of MillionICU, the cost of setting up one Dozee device per bed was 25,000 Indian rupees annually (approximately US$330). For direct procurement by hospitals, the costs varied with the type of setup, scale, and required infrastructure. MillionICU’s key donors sponsored the cost of running the devices in the hospitals for the first 6 to 12 months. These donors included Action COVID-19 Team (ACT), SBI Foundation, Wadhwani Foundation, Michael & Susan Dell Foundation, Centre for Cellular and Molecular Platforms, and Huawei.

Government hospitals—such as Lok Nayak Hospital in Delhi, Charaka Hospital in Bengaluru, Government Kilpauk Medical College in Chennai, and several army hospitals—have been part of the MillionICU initiative.

How was this promising practice implemented?

Create an innovative funding mechanism

Public hospitals miss out on adopting new technologies because of the time and procedures involved—such as pilot demonstrations and a long tendering process. During the pandemic, the government has given grants to private entities to help bridge the gap between demand and care. Similarly, many philanthropic funders have been willing to fund COVID-19–related initiatives.

The Dozee team started the MillionICU initiative to raise funds to convert 50,000 regular ward beds into step-down ICUs within six months and to convert 1 million beds within three years.⁹ These funds were intended to cover the entire cost of running the devices in a government hospital for 6 to 12 months. The government hospitals would receive the devices free of cost, and the Dozee team would install and train personnel. If hospitals were satisfied with their experience, hospitals could directly extend commercial contracts with Dozee.

Enable fast scale-up

Dozee had the expertise of setting up Dozee devices in approximately 250 hospitals, so they had most of the standard operating protocols in place. With these standard operating protocols, along with faster access to funding through the MillionICU initiative, the Dozee team could convert beds in entire wards into Dozee-powered monitoring beds within weeks of getting permissions. Due to the simple setup, it took only a few days of training to familiarize hospital staff with the monitoring setup.

Deploy solution based on need

An internal committee selected the hospitals that would be part of the initiative. Public hospitals and a few charitable or trust hospitals were considered based on the volume of their clients, nurse-to-patient ratio, and whether they catered to middle- to low-income groups. Additionally, COVID-19 wards were given priority.

Voices from the field

The Indira Gandhi Government Medical College & Hospital, the second largest government facility in Nagpur, has a dedicated COVID-19 center with 600 beds, including 160 ICU beds and 440 HDU beds. During the COVID-19 pandemic, the hospital has needed to continuously monitor COVID-19 patients who are transferred from ICUs to HDUs to detect patients whose conditions deteriorate suddenly. Further, the hospital faced shortages of nurses and doctors while managing a high patient load.

The Dozee team enabled the installation of 150 HDU beds with Dozee devices. Dozee’s on-the-ground team trained the medical staff to use the new technology. The setup allowed one nurse per shift to monitor 150 beds through the central monitoring platform, and doctors could categorize patients as mild, moderate, or severe based on their parameters. They were able to monitor patients using the Dozee dashboard even from their homes. After six months of free service, the Indira Gandhi Government Medical College & Hospital signed a two-year commercial contract with Dozee.

“We have saved nursing working hours as well as repeated exposure of doctors to COVID patients [with Dozee devices]. When we were in a crisis of manpower plus a crisis of beds, we utilized these devices for faster shifting of patients from ICU to HDU. About 200 patients were transferred to the ICU thanks to Dozee. At the same time, when there was a bed crunch in ICU, we treated the patients in HDU itself by monitoring them” —Dr. Vaishali Shelgaonkar, Professor and Head of the Department of Anesthesiology, Indira Gandhi Government Medical College & Hospital, Nagpur

“[The] Dozee system alerted us about a 35- to 40-year-old female COVID-19 patient from the ward whose oxygen saturation suddenly fell to 30 percent on the second day of admission. We immediately put her on a noninvasive ventilator, and because of the timely help, she recovered completely and was discharged without any complication.” — Sarita Nair, Nurse in Charge of Respiratory ICU, Indira Gandhi Government Medical College & Hospital, Nagpur

“I work in the respiratory ICU and I don't have to make repeated trips to patients’ beds to look at their parameters while doing other writing work. Now, all I have to do is glance at the LED screen [connected to the Dozee system] that shows parameters of all the ten patients at once, so I feel more confident and relaxed doing my work.” —Sarita Nair, Nurse in Charge of Respiratory ICU, Indira Gandhi Government Medical College & Hospital, Nagpur

Overall, the Dozee setup has helped hospitals to:

Extend nursing capacity through centralized remote monitoring
Preserve ICU bed capacity through effective real-time monitoring of case severity
Limit health professionals’ exposure to infected patients through remote monitoring

Supplementary material

MillionICU - Government Hospitals Leverage Deep-Tech Solutions to Reduce Burden on Health Workers.pdf

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