A Survey of Perioperative Monitoring Capacity of Major Referral Hospitals in Kenya

Abstract

Background: Monitoring in anaesthesia entails checking the physiologic progress and status of patients over time. This is important in predicting, preventing, and mitigating adverse perioperative events, hence a certain level of minimum standard of monitoring is recommended by various professional medical organizations. Main Objective: To determine the capacity for recommended minimum monitoring of patients in anaesthesia in major referral hospitals in Kenya. Methodology: This was a descriptive, cross-sectional, observational study carried out in surgical operating suites, procedural sedation areas, and post-anaesthesia care unit beds in 16 major referral hospitals in Kenya. The availability of recommended monitoring devices was evaluated using an in-person audit checklist adapted from the 2015 Association of Anaesthetists of Great Britain and Ireland (AAGBI) monitoring guidelines. Results: We evaluated 103 operating suites, 96 post anaesthesia care unit beds, and 16 areas where procedural sedation was administered in 16 major referral hospitals in Kenya. The average availability of intraoperative minimum monitoring devices as recommended by the AAGBI was 70.2%. Only one hospital (6.25%) had all of the recommended devices. Capnography was available in 62.5% of hospitals. All the recommended monitoring devices were present in 12.5% of the procedural sedation areas and 2.1% of the post anaesthesia care unit beds. Advanced monitoring devices such as invasive arterial blood pressure were available in only 25% of the institutions audited. Portable multi-parameter devices for monitoring patients during transfer were present in 5 (31.25%) of the hospitals. Conclusions: The majority of referral hospitals in Kenya do not meet the minimum requirements for intraoperative and peri-procedural monitoring. We recommend that these data be used to effect advocated policy change and safety profile