A peer-to-peer tele-ICU consultation service launched by Aga Khan University in Pakistan was rated highly acceptable and clinically useful by the physicians who used it, according to a mixed-methods study published in BMC Anesthesiology. The service connects frontline intensive care doctors in remote areas with critical care specialists elsewhere in the country, a model that matters in low- and middle-income settings where limited infrastructure and expertise constrain critical care delivery. While tele-ICU systems have been evaluated in high-income countries, the researchers note that evidence from low- and middle-income settings has been scarce.
The study surveyed 219 physicians who had used the national consultation service and received 145 responses, a 66.2 percent response rate. Quantitative data came from a structured survey, while qualitative material was drawn from open-ended survey answers and ten in-depth interviews with users of the service. Survey responses were analyzed with descriptive statistics, and the qualitative data underwent thematic analysis by two independent reviewers to identify themes related to service use, quality, and feasibility.
Consultations took place primarily by voice, used in 77.2 percent of cases, and by text, used in 43.4 percent. Respondents reported high satisfaction across three measured domains: clinical care scored a mean of 4.50, process scored 3.82, and technical performance scored 4.18. The Net Promoter Score, a standard measure of whether users would recommend a service, came in at 40.7, which the authors describe as indicating favorable satisfaction.
When asked what they gained from the service, respondents pointed to three main benefits: knowledge enhancement, support for managing complex cases, and ease of access to specialist input. These findings suggest that even without video links or continuous remote monitoring, a relatively simple voice- and text-based consultation channel can deliver specialist expertise to bedside physicians who would otherwise lack it.
The thematic analysis of interviews and open-ended responses confirmed the high satisfaction reported in the survey but also surfaced practical obstacles. Users described administrative hurdles in accessing the service and difficulty implementing standardized recommendations within local resource constraints. In other words, the clinical advice itself was valued, but turning that advice into action at the bedside could be limited by what a given facility actually had available.
The authors conclude that the peer-to-peer model was perceived as highly acceptable and clinically useful by bedside physicians, while infrastructure, resource, and workflow limitations might affect its implementation. They frame the findings as highlighting the potential of remote critical care consultation while identifying barriers that must be addressed to support wider implementation in resource-limited settings.
The study design carries some inherent limits worth noting. It was cross-sectional, capturing perceptions at a single point in time from physicians who had already used the service, so it reflects user experience rather than measuring effects on patient outcomes such as mortality or length of stay. The response rate of 66.2 percent leaves open the possibility that non-respondents held different views. As a single-country service based at one academic center, the findings describe one implementation rather than a general test of tele-ICU across all low-resource settings.
What the study does establish is a documented pattern of use and satisfaction in a setting where such evidence had been lacking. The combination of high clinical satisfaction scores, a positive Net Promoter Score, and identified administrative and resource barriers gives health systems in Pakistan and comparable settings a concrete picture of both what works and what needs fixing. The authors position the analysis as informing scalable remote ICU models, suggesting that the barriers identified here, administrative friction and resource-constrained implementation of standardized recommendations, are the specific targets for anyone attempting to expand similar services.
For clinicians and administrators weighing whether to invest in tele-critical care infrastructure, the message from this data is that frontline users in a low- and middle-income setting found the peer-to-peer model valuable for knowledge and complex-case support, and that the main risks to success lie not in the technology’s clinical acceptance but in the surrounding systems that determine whether specialist recommendations can actually be carried out locally.
Subject of Research: Physician acceptability, feasibility, and utilization of a peer-to-peer tele-ICU consultation service in Pakistan
Article Title: Assessing acceptability, feasibility, and utilization in a peer-to-peer tele-critical care model: a mixed-methods analysis to inform scalable remote ICU models
Article References: Khan, M. A., Ali, W., Mehmood, A., Atiq, H., Ahmed, E. S., Niaz, K., Ghayas, A., Sohani, S., & Latif, A. (2026). Assessing acceptability, feasibility, and utilization in a peer-to-peer tele-critical care model: a mixed-methods analysis to inform scalable remote ICU models. BMC Anesthesiology. https://doi.org/10.1186/s12871-026-04371-0
Image Credits: AI Generated
DOI: 10.1186/s12871-026-04371-0
Keywords: tele-ICU, telemedicine, critical care, Pakistan, LMICs, Aga Khan University, mixed-methods, physician satisfaction, Net Promoter Score, remote consultation, resource-limited settings, BMC Anesthesiology
News Source: Ophelia Keating. (November 7, 2026). Tele-ICU consultations win over Pakistani physicians but face workflow barriers. Scienmag.
