Khyber Teaching Hospital Peshawar
Department of Health
Government of Khyber Pakhtunkhwa
PC-1
Improvement of ICUs in KTH
ADP NO.141 Code: 130657(2013-14)
Estimated Cost: Rs. 54.642Million
PC-1
1.
Name of Project:
Improvement of ICUs in KTH, ADP No. 141 Code: 130657
2.
Location:
Khyber Teaching Hospital, Peshawar.
3.
Authority Responsible for:
i.
Sponsoring:
Department of Health, Government of Khyber Pakhtunkhwa.
ii.
Execution:
Communication & Works department
iii.
Operation and maintenance:
Departments of Surgery, Medicine & Pediatrics KTH
iv.
Concerned Ministry:
Ministry of National Health Services, Regulations and Coordination
4.
Plan Provision:
The project is reflected in the ADP 2013-14 at serial No. 141/ 130657 at a total
cost of Rs. 54.642 million with full allocation during the CFY.
5.
Project Objectives& its relationship with sectoral objectives:
Improvement of ICUs (Intensive Care Units) in KTH
1. To improve infrastructure of existing intensive care units in KTH, including
Medical ICU, Surgical ICU, Pediatric ICU and Neonatal ICU.
2. To
improve
satellite
intensive
care
components
of
ICUs (High
Dependency Beds) in Department of medicine & Surgery.
3. Training of Nurses and doctors in Intensive care medicine in specialized
centers of Pakistan.
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6. Description/Justification and technical parameters of the Project
o Intensive care units (ICUs) are specialist hospital wards. They provide intensive
care (treatment and monitoring) for people in a critically ill or unstable condition.
o ICUs are also sometimes known as critical care units or intensive therapy
departments.
o A person in an ICU needs constant medical attention and support to keep their
body functioning. They may be unable to breathe on their own and have multiple
organ failure. Medical equipment will take the place of these functions while the
person recovers.
When intensive care is needed
There are several circumstances where a person may be admitted to an ICU. These
include after surgery, or following an accident or severe illness.
ICU beds are a very expensive and limited resource because they provide:
• Specialized monitoring equipment
• A high degree of medical expertise
• Constant access to highly trained nurses (usually one nurse for each bed)
Some ICUs are attached to areas that treat specific conditions. Others specialize in the
care of certain groups of people. For example, an ICU can specialize in:
• Nerve disorders
• Heart conditions
• Babies (neonatal intensive care, NIC) – for example, for babies born with serious
conditions, such as heart defects, or if there is a complication during birth
• Children (pediatric intensive care, PIC) – for children under 16 years of age
Pediatric Critical Care Medicine (PCCM) is a relatively a new subspecialty of pediatrics
in Pakistan. PICUs in Pakistan are scarce, under- staffed, have limited equipment, and
have limited formal training structure. PICU in KTH is no different. PICU was created
keeping in view the needs of patients and special interests of Pediatricians in KTH. Due
to limited space and financial resources, Neonatal ICU and Pediatric ICU were
established within Pediatric wards. They are not properly equipped and the overall
infrastructures are now worn out due to lack of interest and maintenance in the past.
This situation is affecting care of the critically ill. Availability of advance equipment and
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appropriate technical staff positively affects the outcome of critically ill patients.
Evidence from literature suggests that Pediatric intensive care is recognized as a
mature and established discipline in developed countries. Pediatric intensive care
services are likely responsible for nearly fivefold reduction in infant and child mortality in
the United States.
High Dependency Unit (HDUs)
Khyber Teaching Hospital has 10 beds in Medical ICU, 8 Beds in Surgical ICU. These
are insufficient for current workload, leading to stress and dissatisfaction among staff
and patients. KTH had established four bed High Dependency Units (HDU) in
department of surgery and medicine to function as satellite Intensive care facilities for
patients who cannot be looked after in general medicine and surgery wards but can be
rigorously monitored outside ICUs in case there are no beds available. High
Dependency Units (HDUs) also called step-down, progressive and intermediate care
units are for people who need more intensive observation, treatment and nursing care
than is possible in a general ward but slightly less than that given in intensive care. The
ratio of nurses to patients may be slightly lower than in intensive care but higher than in
most general wards. Some hospitals have a combined ICU and HDU or a certain
number of beds in ICU given to HDU patients. In these cases, although a person is not
moved to another ward, the level of care is slightly reduced, as s/he is no longer in such
a critical state. People spend varying lengths of time in HDU, depending on the nature
of their illness and the demands on the unit.
7.
Capital Cost Estimates:
Rs. 54.642 Million
8. Annual Operating and Maintenance Cost after completion of the project:
KTH will operate and maintain ICUs within its own resources.
9.
Demand and Supply Analysis:
The equipment demanded and the renovation work planned will address some of the
basic requirements of Khyber Teaching Hospital. At present KTH within its meager
resources, cannot carry out this work all at once, due to which one of the vital functions
of the tertiary care i.e. critical care is suffering heavily. With completion of this project,
both capacity and quality of critical care will be enhanced.
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10.
Financial Plan and Mode of Financing:
The Scheme will be funded from the ADP 2013-14
(Rupees in million)
Item
Component
2013-14
Total
A.
Capital work (Renovation work)
20.660
20.660
B.
Revenue
33.982
33.982
Total
11.
54.642
Project Benefits and Analysis
a) Financial: It is extremely difficult to put a money value on each life saved in
ICUs. Critically ill patients with reversible conditions can go back to their work
and earn living for their families. In case of non-availability of space or lack of
complete critical care facilities; some relatives might take their patients to private
facilities, with price tag of Rs. 30,000- 50,000/day.
The training component
included in the project will lead to HR development and will lead to training of
more staff and efficient utilization of equipment. Current experience suggests that
use of High tech expensive equipment by inexperienced staff lead to frequent
breakdowns and interruption in healthcare services.
b) Social Benefits with Indicators:
The project will increase the capacity of the department and will lead to both
quantitative and qualitative improvement in services offered to general public. This
will expand care of the critically ill patients and will help families while saving
precious live of patients with reversible causes. The number of patients treated
and the number of various diseases treated will serve as some of the indicators
for performance evaluation.
c) Employment generation:
Provision of training to Nurses and Doctors will increase the capacity of the
existing staff and will enable KTH to train more staff.
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d) Environmental Impact: This project has no adverse environmental impacts.
e) Impact of delay on Project cost and viability: Delays in the project would
result in increase in the total cost by approximately 10%. Also delay in the project
would lead to continuation of existing problems of care in ICUs and shortage of
beds in ICUs.
12) Implementation schedule: 2013-14
13) Additional Project/Decision Required:
Re-appropriation of funds among
various heads in the revenue component on the recommendation of technical
evaluation committee to be approved by purchase committee. The hospital
technical and purchase committee will also look into the matters of this scheme.
14) Management Structure & man power requirement including specialized
skills during execution and operational phases:
The C&W department will carry out the Capital work while the revenue
component will be executed by KTH. ICU staff (Nurses and Doctors) will be
trained in specialized centers inside Pakistan during the implementation phase
so that when work is about to be completed on improvement of infrastructure, the
staff is back to resume work in ICUs of KTH.
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15) Certified that the project proposal has been prepared on the basis of instructions
provided
by the planning commission for preparation of PC-1 for Social Sector
Projects.
Prepared by___________________________
Dr. Shahzad Faisal
DMS Planning & Development
Phone: 0300 5922 768
Checked by
________________________
Prof Dr. Inayat Shah Roghani
Chief Executive,
KTH, KMC & KCD, Peshawar.
Phone: 091-9216362
Recommended by _____________________
Dr. Aftab Akbar Durrani
Secretary to Govt. of Khyber Pakhtunkhwa,
Health Department
Phone: 091-92103420
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