Establishment of a high-dependency unit in Malawi

Abstract

Adults admitted to hospital with critical illness are vulnerable and at high risk of morbidity and mortality, especially in sub-Saharan African settings where resources are severely limited. As life expectancy increases, patient demographics and healthcare needs are increasingly complex and require integrated approaches. Patient outcomes could be improved by increased critical care provision that standardises healthcare delivery, provides specialist staff and enhanced patient monitoring and facilitates some treatment modalities for organ support. In Malawi, we established a new high-dependency unit within Queen Elizabeth Central Hospital, a tertiary referral centre serving the country’s Southern region. This unit was designed in partnership with managers, clinicians, nurses and patients to address their needs. In this practice piece, we describe a participatory approach to design and implement a sustainable high-dependency unit for a low-income sub-Saharan African setting. This included: prospective agreement on remit, alignment with existing services, refurbishment of a dedicated physical space, recruitment and training of specialist nurses, development of context-sensitive clinical standard operating procedures, purchase of appropriate and durable equipment and creation of digital clinical information systems. As the global COVID-19 pandemic unfolded, we accelerated unit opening in anticipation of increased clinical requirement and describe how the high-dependency unit responded to this demand.

Distinct clinical and immunological profiles of patients with evidence of SARS-CoV-2 infection in sub-Saharan Africa

“…Most adults present directly to the hospital or are referred from community healthcare facilities. After triage and testing in dedicated areas, patients with confirmed SARS-CoV-2 were treated in a cohort ward, including a high dependency area 50 . Additionally, patients with SARI were screened for SARS-CoV-2 in two separate adult medical wards.…”

Impact of establishing a respiratory high dependency unit for SCAP patients on the therapeutic effect, prognosis, and expenditure: a retrospective case-control study

“…However, the concept of HDU is not widely developed in China, and it is mostly designed for surgical patients [19]. The development of internal medicine HDU lags behind that of surgical HDU [20][21]. Our research may provide a new idea to develop internal medicine HDU in each specialty.…”

“An increase in COVID-19 patients would be overwhelming”: A qualitative description of healthcare workers’ experiences during the first wave of COVID-19 (March 2020 to October 2020) at Malawi’s largest referral hospital.

“…Most HCWs said that the hospital (QECH) prepared to respond to COVID-19 by ensuring additional space was created such as erecting tents at the main gate for screening, sample collection, and cohorting suspected cases of COVID-19 until test results were confirmed. In addition, the ENT* 2 unit and ward 3A* 3 and High Dependency Respiratory Unit (HDRU) were turned into isolation centres for patients requiring admission. Ward 1A* 4 was reserved for pregnant women diagnosed with COVID-19.…”

“…After Malawi's first confirmed case of COVID-19 (2 nd April 2020), Blantyre became the epicenter of the national epidemic. In response, Queen Elizabeth Central Hospital (QECH), the largest referral hospital in Malawi based in Blantyre, was reorganised to respond to this need 3 . As COVID-19 cases spread throughout the country, the need for informed context-specific initial experiences of healthcare workers (HCWs) became essential.…”