644 - Expanding Critical Care Access using a tele-ICU model in LMICs

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 644
Publication Number: 644.316

Sidney JB. Hilker, Boston Children's Hospital, Boston, MA, United States; Sitarah Mathias, Boston Children's Hospital, Boston, MA, United States; Ryan CL. Brewster, Boston Children's Hospital, Boston, MA, United States; Amundam S. Mancho, Boston Children's Hospital, Boston, MA, United States; geetanjali srivastava, cloudphysician, Hyderabad, Telangana, India; Dileep Raman, Cloudphysician Healthcare, Bangalore, Karnataka, India; Carl Britto, Boston Children's Hospital, Boston, MA, United States

Presenting Author(s)

Sidney JB Hilker, MD (she/her/hers)

Resident Physician
Boston Children's Hospital
Boston, Massachusetts, United States

Background: Intensive care unit telemedicine (tele-ICU) services have evolved significantly in the West, although most progress has been made in adult ICUs. Its adoption in Low- and Middle-Income countries (LMICs) has been slow due to operational challenges, misconceptions, and high costs. In India, every minute a neonate dies due to lack of access to critical care. There is a need for solutions to meet the demand for high quality critical care amid the shortage of qualified intensivists and resources.

Objective:
We aimed to evaluate the feasibility and effectiveness of an indigenously developed low-cost tele-NICU setup in improving access to critical care using a proof-of-concept study in the low resource setting of Uttar Pradesh, India.

Design/Methods:
A case study of a 24-bed tele-NICU in India was done using data and interviews. Operational and outcome data from Cloudphysician Healthcare between June 2020 and October 2022 were analyzed alongside interviews with key stakeholders working at the tele-NICU headquarters.

Results: A hub-and-spoke model was employed with a team of neonatal intensivists, critical care nurses and nurse-practitioners, pharmacists, dieticians and IT experts providing real time medical advice to remote ICUs (spokes) from a central location (hub), using proprietary technological solutions. NICU operations began in June 2022 with 24 beds at a rural center ~200 km away from the nearest hospital with NICU services. PICU services are offered at adult facilities by an on-call PICU team. The time from signing of a memorandum of understanding to commencement of clinical service was under 15 days with the cost of establishment and operations at less than $400 per bed. In four months, there were 200 admissions, of which 81 (41%) were discharged with an expectation of survival and 92 (46%) were transferred out for further care. Additionally, there were 4 children with snake bites who were treated during this period using tele-critical care expertise who would have otherwise succumbed.

Conclusion(s): Rapid deployment of cost-effective critical care telemedicine is possible using indigenously developed technology and operational strategies tailored to LMICs. The hub-and-spoke model enabled expertise to be more widely available providing time-sensitive life-saving resources in remote and resource lacking locations. Our tele-PICU and NICU experience suggests that technology is an enabler combined with a people-centered approach. Policies that enable growth of similar tele-ICU models could significantly decrease child and infant mortality across the globe.