Name of Head of Department: Prof. Dr. Subhash Prasad Acharya
Department introduction/description:
Department of Critical Care Medicine (CCM) is one of the youngest departments of Maharajgunj Medical Campus (MMC) which was established on Poush 18, 2078 B.S. The department has been striving to provide quality critical care health services to the patients of Tribhuvan University Teaching Hospital (TUTH). Currently, the department is directly taking care of 2 level III ICUs comprising 24 beds and is providing critical care services to post-operative patients in the 12 bedded post-operative ward and medical patients in the 8 bedded Medical ICU (MICU).
The department currently has six faculties with Prof Dr. Subhash Prasad Acharya as the head of the department. Being one of the very first doctors trained in critical care medicine in the entire nation, Dr. Acharya has received several awards and recognition for his outstanding contribution to the development of critical care services in Nepal. With his leadership and vision, DM in Critical Care Medicine was started at the MMC, IOM from 2013 and currently 10th batch is being graduated. Department of Critical Care Medicine is now brought to this capacity by the presence of other faculties. The department currently has two Associate professors Dr. Gentle Sunder Shrestha (Fellowship in Neuro Critical Care, the first Neuro-Intensivist of Nepal) and Dr. Pramesh Sunder Shrestha (First DM CCM of Nepal) and three Assistant professors Dr. Hem Raj Paneru, Dr Sunil Pathak and Dr Sachit Sharma.
Department vision, mission and goals:
Vision: Providing Excellence in Critical Care Medicine Service and Education
Mission:
Who we are:
The Department of Critical Care Medicine, MMC, IOM is a collaborative and multi-disciplinary academic department with national reach
What we do:
We provide:
Critical care education and training across the country
Promote Competency Based Medical Education
Quality-driven, Evidence-based clinical care in ICU
Clinical and Health Service Research in Critical Care
Develop Academic Leadership that is transparent and inclusive
Nursing Leadership in Critical Care through Masters in Critical Care Nursing (through Maharajgunj Nursing Campus)
Develop Nurse Practitioner Program in Critical Care Nursing
Subspeciality Services in Critical Care:
Neuro Critical Care (TUTH ICU B, Manmohan Annex Building, 1st Floor)
Oncology Critical Care (Suresh Wagle Cancer Center ICU C)
Liver Transplant ICU (LTICU)
Extracorporeal Therapy (ECMO)
Critical Care Outreach Services (CCOS)
Who we do it for:
We serve the diverse populations of Nepal and providing the best critical care possible to patients and communities.
Our Goals
Critical Care Service:
Provide an environment for standard delivery of critical care services
Promote a sustainable career in critical care delivery for a diverse group of healthcare practitioners
Partner with other critical care organizations like NSCCM, CCNAN, NICRF, NCCDF, ICSON who are working for the delivery of quality clinical care
Education:
Providing education in delivery of critical care medicine across the country in various professional field including medicine, nursing, physiotherapy, nutrition, pharmacy, etc.
Providing an inclusive and respectful learning environment
Research
Create an inclusive and collaborative research platform for doctors, nurses, physiotherapist, nutritionist, clinical pharmacists working in the ICU
Promote the development in leadership by providing educational and training oppurtunities in research.
Academic Leadership:
Work toward a fully National Registry based ICU database and improvement network, governed by representatives from MOHP and NSCCM that integrates research, education and clinical care
Attract and support the development of leadership in diverse team of critical care practitioners
Department faculty members:
| S.N. | Full Name | Designation | Full Academic Qualifications | Joined year |
| 1 | Dr Subhash Prasad Acharya | Professor and Head of Department | MBBS, MD, FACC, FECMO, FAMV | 2007 Anaesthesiology |
| 2 | Dr Gentle Sunder Shrestha | Assoc. Professor | MBBS, MD, FACC, EDIC, FCCP, FRCP (Edin), FSNCC (Hon), FCCU, FNCS | 2009 Anaesthesiology |
| 3 | Dr Pramesh Sunder Shrestha | Assoc. Professor | MBBS, MD, DM Critical Care Medicine | 2011 |
| 4 | Dr Hem Raj Paneru | Asst. Professor | MBBS, MD, DM Critical Care Medicine, FECMO, FAMV | 2012 – 2014 2018 |
| 5 | Dr Sunil Pathak | Asst. Professor | MBBS, MD, DM Critical Care Medicine | 2024 |
| 6 | Dr Sachit Sharma | Asst. Professor | MBBS, MD, DM Critical Care Medicine | 2024 |
Academic programs and students educated/trained each year / total
| Level | S.N. | Program name | Students | Remarks |
| Masters | 1 | MD Anaesthesiology | 12 | In Collaboration with Department of Anesthesiology Rotation in ICU: 3 months |
| 2 | MD Internal Medicine | 12 | Rotation in ICU: 1 month | |
| 3 | MS General Surgery | 12 | Rotation in ICU: 2 weeks | |
| Nursing | 4 | MNCC (Masters in Nursing Critical Care) | 6 | Three student per year Total: 6 Academic Sessions: 2 per week Hospital Based, Competency Based – Full time in ICU |
| Super-specialty | 5 | DM Critical Care Medicine | 6 | Two per year Total: 6 Academic Theory Sessions: 2 per week |
List of hospital clinical services provided
The department provides inpatient services to patients admitted in two level III ICU’s ICU A and ICU B.
The Department conducts daily clinical rounds in the post-operative ward and Medical ICU to provide critical care services to the sickest patients.
Apart from regular rounds, the department entertains consultations from other specialities within the hospital.
The department also provides outreach services to medical and surgical wards for early recognition and management of critically ill patients. A Critical Care Outreach Team (CCOT) has been created which comprises Intensivists and critical care nurses who work actively day and night to identify the sickest patients in the general wards so that they can be transferred to ICU on time with the ultimate aim to improve their outcome. Dr. Hem Raj Paneru is currently leading CCOT and has been working in collaboration with staffs from the general wards and ICU and has been conducting training activities regularly.
Research activities of the faculties/department
ICU Registry
The Department of Critical Care Medicine, with technical support from the Nepal Intensive Care Research Foundation, has diligently maintained the ICU registry. This registry captures patient data from admission to hospital discharge in real-time, securely storing it on a cloud-based server. The ICU registry proves invaluable to us in multiple aspects; briefly, the ICU registry has been helpful in the following areas:
ICU Audit and Continuous Quality Improvement
ICU registry generates monthly reports for the patients admitted to ICU A, ICU B, and MICU. The reports are being utilized for identifying gaps and rectifying them. It has also helped us to design and conduct priority-based research protocols.
Measuring compliance of standard practices
We have been enabled to extract quality indicator data from the ICU registry to look at the compliance to standard practice and thus help identify the gaps and make necessary improvements.
Registry based research
The Department of CCM is overseeing various research projects based on the ICU registry.
Of particular note is the implementation of an ICU follow-up service aimed at assessing the burden of physical, psychological, and cognitive impairment among individuals who have survived critical illness and been discharged from the ICU. This initiative seeks to lay the groundwork for future ICU rehabilitation services.
Another notable achievement facilitated by the ICU registry is our ability to enroll patients in multicenter randomized clinical trials, thereby contributing to the evidence base in clinical medicine.
Moreover, registry data is being utilized for research publications by faculties, MD and DM residents not only from CCM but also from other departments.
Notable research publications utilizing the registry data are as follows:
Sabin Bhandari, Subhash Prasad Acharya, Gentle Sunder Shrestha, Pramesh Sunder Shrestha, & Hem Raj Paneru. (2023). A comparison of clinical profile and outcomes among different age groups of critically ill elderly patients in a tertiary level hospital in Nepal: A retrospective study. Asian Journal of Medical Sciences, 14(4), 126–131. https://doi.org/10.3126/ajms.v14i4.50716
Shahi Sumit, Paneru Hem, Ojha Rajeev, Karn Ragesh, Rajbhandari Reema, Gajurel Bikram Prasad. SOFA and APACHE II scoring systems for predicting outcome of neurological patients admitted in a tertiary hospital intensive care unit. Annals of Medicine & Surgery 86(4):p 1895-1900, April 2024. | DOI: 10.1097/MS9.0000000000001734
Paudel A, Acharya SP, Shrestha GS, Shrestha PS, Paneru HR, Sharma S. Admission time and outcomes of patients admitted to intensive care units in a tertiary hospital in Nepal: an observational study. Journal of Nepalese Society of Critical Care Medicine. 2024 Jan;2(1):4-7.
Research prioritization, meetings and trainings
The department hosts biweekly research meetings and annual research prioritization sessions dedicated to addressing challenges encountered in daily clinical practice. During the biweekly meetings, we discuss all aspects of clinical research, including proposal writing, research project management, and report writing. Despite these activities not being part of a formal curriculum, participants have developed research skills such as proposal writing, ethical research conduct, and manuscript preparation.
Notable research projects emerging from these activities include the following (completed and yet to be published):
Sunita Bista, Karuna Thapa, Hem Raj Paneru et al. Knowledge on the ABCDEF bundle among Nurses of critical care unit in a Tertiary Level Hospital of Kathmandu
Karuna Thapa, Sunital Bista, Hem Raj Paneru et al. Reasons for Leave Against Medical Advice from an Intensive Care Unit of a tertiary level hospital: A mixed method study.
Samichhya Shrestha, Karuna Thapa, Hem Raj Paneru et al. Challenges in sedation and analgesia management: a survey study amongst nurses in an intensive care unit in Nepal.
Number of publications by faculties/department
| Original articles | Review articles | Case reports | Newspaper | Total |
| 15 | 10 | 2 | 1 | 28 |
Training/Workshops/Conferences conducted by department
Comprehensive Neuro Critical Care Course (CN3C): A two days Neuro workshop for doctors in collaboration with Society of Neuro Critical Care (SNCC), India
Comprehensive Neuro Nursing Course (C2NC): A two days workshop of nurses on Neuro Critical Care Nursing in collaboration with SNCC
Stroke Management Workshop: Half Day workshop on stroke management for nurses from all departments / wards of TUTH, organized two times in collaboration with Department of Neurology and Neurosurgery.
BASIC for Nurses (BFN): This is a two day workshop organized for nurses working in critical care which was developed by BASIC Collaborations from Chinese University of Hong Kong and runs in 64 countries worldwide and endorsed by Critical Care Nurses Association of Nepal (CCNAN)
VAP Workshop: Half day workshop planned for Nurses on prevention and management of VAP
Tracheostomy Care Workshop: Half day workshop for Nurses on management and care of Tracheostomy patient
Infection Prevention & Control (IPC) Workshop: One day workshop organized in collaboration with IPC Unit, TU Teaching Hospital
Achievements/Grants/Awards received by faculties/department
Presidential citation Award, Awarded to Prof. Dr. Subhash P Acharya, from Indian Society of Critical Care Medicine (ISCCM), Feb 2023
Presidential Citation Award, awarded to Dr. Gentle S Shrestha, from Society of Neurocritical Care (SNCC), September 2024
Bidhyabhusan – Dr. Pramesh Sunder Shrestha, Dr. Hem Raj Paneru
Sikshya Diwas Puraskar 2080: Prof. Dr. Subhash P Acharya
