ICU Site Assessment: Understanding Neurocritical Care Needs in Tanzania

During Dr. Michael T. Lawton’s inaugural surgical camp at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania, Barrow Neurological Institute neurocritical care physician Patrick Crooks, MD, accompanied the team to conduct a site assessment of the hospital’s Intensive Care Unit (ICU), with a focus on neurosurgical and severe acute brain injury management. One key takeaway was the significant resource limitation (e.g. monitoring, medication, diagnostics), as well as knowledge and training gaps among staff.

Critical opportunity areas identified include unrecognized hemodynamic failure, alarm fatigue, infection management, limited availability of tracheostomy, EVD placement and management, perioperative neurological assessments, and access to relevant literature.

Educational sessions were held on site during Dr. Crooks’ visit to inform and educate about these topics. In follow-up, short- and longer-term solutions and recommendations are being explored and implemented, which include improving monitoring, alarm management, EVD protocols, sepsis treatment, and pre/postoperative care, as well as establishing an essential medication stockpile. Longer-term efforts include enhancing neurological assessment training and implementation, ventilation practices, infection control, patient safety, neuromonitoring, neuroimaging, and collaborative training initiatives.

Efforts during this visit were further supported and facilitated by visiting nurses with experience in neuroscience nursing care: Amanda Pegler, RN, and Rachel Miller, RN.