Delivering critical care in remote and resource-limited settings through a neoteric tele-ICU service: A COVID-19 experience from Pakistan

Syeda Asfia Hussain, Huba Atiq, Mareeha Zaki, Fahham Asghar, Kiran Sami, Ali Azim Daudpota, Ammarah Ghayyas, Muhammad Sohaib, Ali Asghar ashraf, Muhammad Faisal Khan, Amber Sabeen, Muhammad Haroon Khan, Naveed Haroon Rashid, Hameed Ullah, Syed Kashif Amin, Adil H. Haider, Zainab Samad, Asad Latif

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Background: Since February 2020, there have been 825,519 confirmed COVID-19 cases and 17,957 fatalities across Pakistan. The number of ICU beds in Pakistan is approximately 2166, a ratio of 0.7 beds per 100,000 population. Critical care resources are concentrated in metropolitan cities with limited availability in rural areas. These gross shortages have escalated during the COVID-19 pan[1]demic, leaving large parts of the country without access to skilled personnel or ICU beds. The Aga Khan University established a free 24/7 teleICU consultation service to rapidly increase access to trained personnel during the COVID-19 pandemic.Methods: The tele-ICU service adheres to a Scheduled and Responsive Care Model delivered through a centralized and decentralized structure. Using two-way audio-visual technology, the tele-ICU lever[1]ages critical care expertise and connects to clinical teams in rural and remote hospital settings. End[1]to-end encrypted Zoom and WhatsApp applications or telephone calls are utilized. Initially, only COVID-19 patients were consulted; however, coverage was broadened to include surgical and medical patients requiring intensive care.Results: Between June 2020 and April 2021, 1709 teleconsultations have been conducted on 404 patients. These include 339 COVID-19 patients, 231 of which were severe and critically ill. An esti[1]mated 20,394 minutes of consultative services have been provided covering 26 hospitals across 4 provinces. The mean call duration of each teleconsultation was 13.29 (1-60) minutes. The major mode of communication was Zoom (45.58%) followed by Telephone (43.30%) and WhatsApp (11.12%). The overall hospital discharge outcome for the teleICU is 58.27% with a mortality rate of 29.13%. The remaining patients (12.60%) were transferred or left against medical advice.Conclusion: To combat the insufficient critical care capacity, Aga Khan University implemented a novel tele-ICU service to provide an innovative solution for coordination of care and increase avail[1]ability of intensivists in remote settings across Pakistan.

Original languageUndefined/Unknown
JournalMedical College Documents
Publication statusPublished - 1 Sept 2021

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