1. Current Status and Future Direction of Telemedicine ICU Consultation (Tele-ICU) in Kenya
Wangari Waweru-Siika
MBChB, MMed(Anaes), FRCA(UK)
Consultant Anaesthetist and Paediatric Intensivist
April 2015

2. OBJECTIVES To define telemedicine and tele-ICU
To outline the potential benefits of tele-ICU in a resource-limited country such as Kenya
To describe the current limitations of tele-ICU efforts in Kenya and chart the way forward

3. Case Report
A young woman was admitted to MTRH ICU with septic shock and Adult Respiratory Distress Syndrome (ARDS).
After initiation of mechanical ventilation, her chest X-ray was ed to an ICU consultant in the US.
Using Skype® via a wireless internet connection (Safaricom®), the ICU consultant and the Kenyan medical officer:
reviewed the patient
optimised ventilation using ARDSnet guidelines
initiated sepsis management using the sepsis bundle.

4. The scope of the problem
Sub-Saharan Africa bears 24% of the global burden of disease.
Only 3% of the world’s healthcare workers serve Sub- Saharan Africa
Kenya has only 18 physicians/100,000 population
USA physicians/100,000
Brazil physicians/100,000
India physicians/100,000
WHO 2010 World health statistics
WHO 2006 Working together for health; the World Health Report

5. Telemedicine
“The use of electronic information and communication technology to provide health care when distance separates the participants”.
Institute of Medicine. Telemedicine: A Guide to Assessing Telecommunications in Health Care. Field MJ, ed. Washington, DC: National Academy Press; 1996.

6. Telemedicine icu consultation (Tele-ICU)
‘The use of computers and audiovisual communication systems to link an ICU patient and the ICU team with a remotely-based critical care team’.
Surveillance and support provided for a large number of ICU patients in a variety of geographical locations.
Remote monitoring of physiological variables possible in active systems.
Also referred to as “virtual ICU,” “remote ICU,” or “eICU”
First described in 1982 by Grundy et al

7. Tele-ICU equipment

8. Tele-ICU equipment

9. The case for Tele-ICU
Outcomes of critically ill patients are improved by the 24-hour presence of intensivists.
The first large scale study in 2000 demonstrated a 60% reduction in severity-adjusted ICU mortality
Tele-ICU fueled by the shortage of trained intensivists.
Rosenfeld BA, Dorman T, Breslow MJ, et al: Intensive care unit telemedicine: Alternate paradigm for providing continuous intensivist care. Crit Care Med 2000; 28:3925–3931

10. Meta-Analysis of Mortality with Tele-ICU
Crit Care Jul 18;16(4):R127. doi: /cc11429.

11. TELE-ICU AND ICU LENGTH OF STAY

12. Critical Care in Kenya
There are a limited number of adult intensivists in Kenya
There are even fewer paediatric intensivists
ICUs in Kenya are manned by anesthesiologists
Kenya has 148 anesthesiologists registered with the KMPDB
MTRH has only 7 anesthesiologists who cover both theatre and ICU.

13. Tele-ICU in Kenya
The Ministry of Health plans to have ICUs in two hospitals in each of the 47 counties by the end of May 2015, at a cost of equipment of KShs 3.3 billion.
Tele-ICU consultation between these ICUs, the two national referral hospitals and external partners could be a key component of realising this goal.
Tele-ICU in Kenya would provide consultant support in ICUs that would otherwise not be able to support this level of staffing.

14. Benefits of tele-ICU
Provides support to anesthesiologists with heavy clinical obligations.
Improves morale of ICU staff.
Allows access to specialists and sub-specialists in short supply.
Potential reduction in ICU transfers from other hospitals
Improved pre-transfer resuscitation and stabilisation.

15. Limitations of tele-ICU in Kenya
Limitations due to current internet connectivity:
Quality, stability and cost
Limitations of Skype® as a platform for tele-ICU
Time-zone differences when clinicians overseas need to be consulted
Legal issues of data protection and patient confidentiality.

16. Future directions for tele-ICU in Kenya
Improved informatics infrastructure.
Research to define optimal tele-ICU configuration for a resource limited setting
Regulatory and confidentiality issues regarding transmission of protected health information.
Development of tele-ICU consultation and triage

17. SUMMARY
The critical care setting is an important arena to develop telemedicine in Kenya
Tele-ICU in Kenya has the potential to provide remote support to ICU patients and staff, and to improve patient outcomes
There are limitations that need to be overcome for tele-ICU to be successfully adopted in Kenya.

18. Thank you