Essential emergency and critical care as a health system response to critical illness and the COVID19 pandemic: what does it cost?

Guinness, Lorna; Kairu, Angela; Kuwawenaruwa, August; Khalid, Karima; Awadh, Khamis; Were, Vincent; Barasa, Edwine; Shah, Hiral; Baker, Peter J.; Schell, Carl Otto; Baker, Tim

doi:10.1186/s12962-023-00425-z

Cited by 8 publications

(16 citation statements)

References 44 publications

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“…Scaling up advanced critical care is costly(34) and complex and might not be effective (35) or cost-effective in the short term for countries with scarce resources such as Tanzania(36). A study done in Tanzania and Kenya during the COVID-19 pandemic, showed the cost of advanced critical care to be 7 to 9 times higher than that of EECC (11). Focusing on improving readiness for EECC before scaling up advanced critical care is likely to yield greater bene ts and reduce the need for advanced critical care, thus allowing it to be available for the patients where EECC is not enough.…”

Section: Discussionmentioning

confidence: 99%

“…Resource requirement lists for EECC (66 items -Supplementary Table 1, Additional File 1) and advanced critical care (161 items -Supplementary Table 2, Additional File 1) developed in previous studies were used for de ning hospital-availability and ward-readiness (10,11). The lists group resources in the eight categories of infrastructure, human resources, equipment, consumables, drugs, training, guidelines, routines with an additional ninth category of support systems for advanced critical care, (care beyond the critical care location such as laboratory tests and imaging).…”

Section: De Nitionsmentioning

confidence: 99%

“…Advanced critical care, including mechanical ventilation and advanced organ support, is more complex and resource-intensive and is typically provided in intensive care units (9). The resources required for a hospital to be ready to provide EECC have recently been speci ed in a global consensus study (10) and those for advanced critical care by a group of global experts (11) Critical care, and in particular EECC, has not been extensively researched in LMICs. The little that is known about availability and quality of care shows large gaps.…”

Section: Introductionmentioning

confidence: 99%

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Hospital readiness for the provision of care to critically ill patients in Tanzania - an indepth cross-sectional study

Khalid

Schell

Oliwa

et al. 2023

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Background: Critical illness is a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and potential for reversibility. The burden of critical illness is high, especially in low- and middle-income countries. Critical care can be provided as Essential Emergency and Critical Care (EECC) – the effective, low-cost, basic care that all critically ill patients should receive in all parts of all hospitals in the world– and advanced critical care – complex, resource-intensive care usually provided in an intensive care unit. The required resources may be available in the hospital and yet not be ready in the wards for immediate use for critically ill patients. The ward readiness of these resources, although harder to evaluate, is likely more important than their availability in the hospital. This study aimed to assess the ward readiness for EECC and the hospital availability of resources for EECC and for advanced critical care in hospitals in Tanzania. Methods: An in-depth, cross-sectional study was conducted in five purposively selected hospitals by visiting all wards to collect data on all the required 66 EECC and 161 advanced critical care resources. We defined hospital-availability as a resource present in the hospital and ward-readinessas a resource available, functioning, and present in the right place, time and amounts for critically ill patient care in the wards. Data were analyzed to calculate availability and readiness scores as proportions of the resources that were available at hospital level, and ready at ward level respectively. Results: Availability of EECC resources in hospitals was 84% and readiness in the wards was 56%. Availability of advanced critical care resources was 31%. Conclusion: Hospitals in Tanzania lack readiness for the provision of EECC – the low-cost, life-saving care for critically ill patients. The resources for EECC were available in hospitals, but were not ready for the immediate needs of critically ill patients in the wards. To provide effective EECC to all patients, improvements are needed around the essential, low-cost resources in hospital wards that are essential for decreasing preventable deaths.

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Section: Discussionmentioning

confidence: 99%

Section: De Nitionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hospital readiness for the provision of care to critically ill patients in Tanzania - an indepth cross-sectional study

Khalid

Schell

Oliwa

et al. 2023

Preprint

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“…In fact the unmet needs of care for most critically ill patients [5][6][7][8][9] can be provided outside ICUs. 4,11,13,38 The recently defined Essential Emergency and Critical Care (EECC) includes 40 foundational interventions selected for clinical effectiveness and feasibility in all hospital settings, such as triage, airway protection and oxygen therapy. 3,12 EECC aligns with the WHO's Fair Priorities framework to maximize the population impact of care interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Such critical care interventions are needed wherever a critically ill patient is located. 1,2 Although many effective critical care interventions are low-cost and feasible throughout hospitals 3,4 there is alarming evidence from different settings that they are frequently not provided. [5][6][7][8][9] Improving critical care has the potential to increase survival across medical disciplines.…”

Section: Introductionmentioning

confidence: 99%

The hospital burden of critical illness across global settings: a point-prevalence and cohort study in Malawi, Sri Lanka and Sweden

Schell,

Kayambankadzanja,

Beane

et al. 2024

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Key PointsQuestion:What is the burden of critical illness in hospitals in different global settings, and where are critically ill patients being cared for?Findings:Among 3652 hospitalized patients in countries of different socio-economic levels (Malawi, Sri Lanka, and Sweden) we found a point-prevalence of critical illness of 12.0% (95% CI, 11.0-13.1), with a hospital mortality of 18.7% (95% CI, 15.3-22.6). The odds ratio of death of critically ill compared to non-critically ill patients was 7.5 (95% CI, 5.4-10.2). Of the critically ill patients 3.9 % (95% CI, 2.4-6.1) were cared for in Intensive Care Units (ICUs).Meaning:Critical illness is common in hospitals and has a high mortality. Ensuring that feasible critical care interventions are implemented throughout hospitals including in general wards where more than nine in ten critically ill patients are cared for, has potential to improve outcomes across all medical specialties.AbstractImportance:Large unmet needs of critical care have been identified globally, but evidence to guide policy priorities is scarce. Available studies into the burden of critical illness have important limitations.Objective:To assess the adult burden of critical illness in hospitals across global settings.Design, Setting, and Participants:This was a prospective, observational, international, hospital-based, point-prevalence and cohort study in Malawi, Sri Lanka, and Sweden. On specific days, all adult in-patients in the eight study hospitals were examined for the presence of critical illness and followed up for hospital mortality.Exposure:Patients with one or more severely deranged vital sign were classified as critically ill.Main Outcomes and Measures:The primary study outcomes were the point-prevalence of critical illness and 30-day in-hospital mortality. In addition, we assessed the proportion of critically ill patients who were cared for in Intensive Care Units (ICU)s, and the association between critical illness and 30-day in-hospital mortality.Results:Among 3652 hospitalized patients in countries of different socio-economic levels we found a point-prevalence of critical illness of 12.0% (95% CI, 11.0-13.1), with a hospital mortality of 18.7% (95% CI, 15.3-22.6). The odds ratio of death of critically ill compared to non-critically ill patients was 7.5 (95% CI, 5.4-10.2). Of the critically ill patients 3.9 % (95% CI, 2.4-6.1) were cared for in ICUs.Conclusions and Relevance:The study has revealed a substantial burden of critical illness in hospitals from different global settings. One in eight hospital in-patients were critically ill, 19% of them died in hospital, and 96% of the critically ill patients were cared for outside ICUs. Implementing feasible, low-cost, critical care in general wards and units throughout hospitals would impact all critically ill patients and has potential to improve outcomes across all acute care specialties.

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A health systems approach to critical care delivery in low-resource settings: a narrative review

et al. 2023

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There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to “ensure the timely and effective delivery of life-saving health care services to those in need”. In this narrative review, we examine critical care capacity building in LICs from a health systems perspective. We conducted a systematic literature search, using the World Heath Organisation (WHO) health systems framework to structure findings within six core components or “building blocks”: (1) service delivery; (2) health workforce; (3) health information systems; (4) access to essential medicines and equipment; (5) financing; and (6) leadership and governance. We provide recommendations using this framework, derived from the literature identified in our review. These recommendations are useful for policy makers, health service researchers and healthcare workers to inform critical care capacity building in low-resource settings. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07136-2.

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Essential emergency and critical care as a health system response to critical illness and the COVID19 pandemic: what does it cost?

Cited by 8 publications

References 44 publications

Hospital readiness for the provision of care to critically ill patients in Tanzania - an indepth cross-sectional study

Hospital readiness for the provision of care to critically ill patients in Tanzania - an indepth cross-sectional study

The hospital burden of critical illness across global settings: a point-prevalence and cohort study in Malawi, Sri Lanka and Sweden

A health systems approach to critical care delivery in low-resource settings: a narrative review

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