The Critical Care Society of Southern Africa Consensus Guideline on ICU Triage and Rationing (ConICTri)

Joynt, Gavin M.; Gopalan, Dean; Argent, Andrew; Chetty, Sean; Wise, Robert; Lai, Vincent S.; Hodgson, Eric; Lee, A; Joubert, Ivan; Mokgokong, S; Tshukutsoane, S.; Richards, GA; Menezes, Colin; Mathivha, R L; Espen, B; Levy, B; Asante, K; Paruk, Fathima

doi:10.7196/samj.2019.v109i8b.13

Cited by 7 publications

(5 citation statements)

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“…Thus, the conclusion was that if ICU beds are not available, efforts should be made to provide the best care possible in settings outside of the ICU. [30]…”

Section: Discussionmentioning

confidence: 99%

Association between pre-intensive care unit (ICU) hospital length of stay and ICU outcomes in a resource- limited setting

Khan

Wise

Savarimuthu

et al. 2021

SAJCC

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Background. Previous studies demonstrated higher mortality for patients with a longer pre-intensive care unit (ICU) hospital length of stay (LOS), in well-resourced settings. Objectives. The study aimed to determine the association between pre-ICU hospital LOS and ICU outcomes in a resource-limited setting. We hypothesised that longer pre-ICU hospital LOS would be associated with higher ICU mortality. Methods. This was a retrospective cohort study measuring the association between pre-ICU hospital LOS and ICU outcomes using data extracted from a regional hospital ICU in KwaZulu-Natal, South Africa. Consecutive ICU admissions of all patients (medical and surgical) older than 18 years were included during the study period September 2014 to August 2018. A corrected sample size of 2 040 patients was identified. Multivariable logistic regression was used to assess the primary outcome of ICU mortality, and multivariable Cox proportional hazard regression was used for the secondary outcome of ICU LOS. Results. The median pre-ICU hospital LOS was 1 day (interquartile range (IQR) 0 - 2 days). The median length of ICU stay was 2.4 days (IQR 1.1 - 4.8 days) and the observed ICU mortality was 16% (n=327/2 040). Pre-ICU hospital LOS was not associated with ICU mortality in the unadjusted (odds ratio (OR) 1.00; 95% confidence interval (CI) 0.98 - 1.02; p=0.68; n=2 040) and fully adjusted logistic regression models (OR 1.00; 95% CI 0.98 - 1.03; p=0.90; n=1 981) using a complete case analysis for missing patient-level covariates. In Cox proportional hazard models, there was no association between pre-ICU hospital LOS and ICU LOS (hazard ratio 1.00; 95% CI 0.98 - 1.03; p=0.72; n=1 967), including when stratified by admission source. Conclusions. Pre-ICU hospital LOS was not associated with either ICU mortality or ICU LOS in a resource-limited setting. Future studies should aim to include multicentre data and evaluate long-term outcomes.

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“…Thus, the conclusion was that if ICU beds are not available, efforts should be made to provide the best care possible in settings outside of the ICU. [30]…”

Section: Discussionmentioning

confidence: 99%

Association between pre-intensive care unit (ICU) hospital length of stay and ICU outcomes in a resource- limited setting

Khan

Wise

Savarimuthu

et al. 2021

SAJCC

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“…High-income countries more commonly use score-based screening, such as NEWS2 17 to decide about ICU admissions. In the present study, we describe a scenario of low- and middle-income countries where the triage system should maximize the benefits obtained from ICU resources available for the community 18 .…”

Section: Discussionmentioning

confidence: 99%

Improved performance of an intensive care unit after changing the admission triage model

Larangeira,

Mezzaroba,

Morakami

et al. 2023

Sci Rep

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The aim of this study is to analyze the effect of implementing a prioritization triage model for admission to an intensive care unit on the outcome of critically ill patients. Retrospective longitudinal study of adult patients admitted to the Intensive Care Unit (ICU) carried out from January 2013 to December 2017. The primary outcome considered was vital status at hospital discharge. Patients were divided into period 1 (chronological triage) during the years 2013 and 2014 and period 2 (prioritization triage) during the years 2015–2017. A total of 1227 patients in period 1 and 2056 in period 2 were analyzed. Patients admitted in period 2 were older (59.8 years) compared to period 1 (57.3 years; p < 0.001) with less chronic diseases (13.6% vs. 19.2%; p = 0.001), and higher median APACHE II score (21.0 vs. 18.0; p < 0.001)) and TISS 28 score (28.0 vs. 27.0; p < 0.001). In period 2, patients tended to stay in the ICU for a shorter time (8.5 ± 11.8 days) compared to period 1 (9.6 ± 16.0 days; p = 0.060) and had lower mortality at ICU (32.8% vs. 36.9%; p = 0.016) and hospital discharge (44.2% vs. 47.8%; p = 0.041). The change in the triage model from a chronological model to a prioritization model resulted in improvement in the performance of the ICU and reduction in the hospital mortality rate.

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“…G M Joynt, 1 MB BCh; P D Gopalan, 2 MB ChB; A Argent, 3 MB BCh, MD; S Chetty, 4 MB ChB, PhD; R Wise, 5 MB ChB; V K W Lai, 1 PhD; E Hodgson, 6 MB BCh; A Lee , 1 PhD; I Joubert, 7 MB BCh; S Mokgokong, 8 MB BCh; S Tshukutsoane, 9 BCur; G A Richards, 10 MB BCh, PhD; C Menezes, 9,11 MD, PhD; L R Mathivha, 10 MB ChB; B Espen, 12 CCRN; B Levy, 13 MB ChB; K Asante, 14 PhD; F Paruk, 15 MB ChB, PhD GUIDELINE /SAJCC specially trained staff. [1] For the purposes of the present document, critical care refers to care provided in an ICU.…”

Section: The Critical Care Society Of Southern Africa Consensus Statement On Icu Triage and Rationing (Conictri)mentioning

confidence: 99%

“…The expert consensus group aimed to summarise current evidence and provide consensus-based recommendations addressing these questions. This statement is accompanied by a clinical practice guideline [7] that provides a framework to inform frontline triage policy and ensure the best utilisation of intensive care in SA, while maintaining the fair distribution of available resources.…”

Section: The Critical Care Society Of Southern Africa Consensus Statement On Icu Triage and Rationing (Conictri)mentioning

confidence: 99%

“…Compliance -availability of written policy, availability of designated triage personnel, number of instances of violation of triage policy and nature of violations * Reasons for refusal should allow differentiation between refusal imposed by limited resources (triage) and other reasons such as patients for whom ICU would not be of benefit (alternatively termed futility), e.g. patient is not sufficiently ill to warrant admission, or too severely ill, and highly likely to die even with ICU admission See the clinical practice guideline [7] for a detailed discussion.…”

Section: Are Patients Who Could Benefit From Intensive Care Refused Icu Admission Because Of a Lack Of Beds/ Facilities In Both The Publimentioning

confidence: 99%

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The Critical Care Society of Southern Africa Consensus Statement on ICU Triage and Rationing (ConICTri)

et al. 2019

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GUIDELINE /SAJCCBackground. In South Africa (SA), intensive care is faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low-to middle-income countries experience daily the consequences of limited resources. Critically limited resources necessitate that rationing and triage (prioritisation) decisions are frequently necessary in SA, particularly in the publicly funded health sector. Purpose. The purpose of this consensus statement is to examine key questions that arise when considering the status of ICU resources in SA, and more specifically ICU admission, rationing and triage decisions. The accompanying guideline in this issue is intended to guide frontline triage policy and ensure the best utilisation of intensive care in SA, while maintaining a fair distribution of available resources. Fair and efficient triage is important to ensure the ongoing provision of high-quality care to adult patients referred for intensive care. Recommendations. In response to 14 key questions developed using a modified Delphi technique, 29 recommendations were formulated and graded using an adapted GRADE score. The 14 key questions addressed the status of the provision of ICU services in SA, the degree of resource restriction, the efficiency of resource management, the need for triage, and how triage could be most justly implemented. Important recommendations included the need to formally recognise and accurately quantify the provision of ICU services in SA by national audit; actively seek additional resources from governmental bodies; consider methods to maximise the efficiency of ICU care; evaluate lower level of care alternatives; develop a triage guideline to assist policy-makers and frontline practitioners to implement triage decisions in an efficient and fair way; measure and audit the consequence of triage; and promote research to improve the accuracy and consistency of triage decisions. The consensus document and guideline should be reviewed and revised appropriately within 5 years. Conclusion.In recognition of the absolute need to limit patient access to ICU because of the lack of sufficient intensive care resources in public hospitals, recommendations and a guideline have been developed to guide policy-making and assist frontline triage decision-making in SA. These documents are not a complete plan for quality practice but rather the beginning of a long-term initiative to engage clinicians, the public and administrators in appropriate triage decision-making, and promote systems that will ultimately maximise the efficient and fair use of available ICU resources.

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The Critical Care Society of Southern Africa Consensus Guideline on ICU Triage and Rationing (ConICTri)

Cited by 7 publications

References 0 publications

Association between pre-intensive care unit (ICU) hospital length of stay and ICU outcomes in a resource- limited setting

Association between pre-intensive care unit (ICU) hospital length of stay and ICU outcomes in a resource- limited setting

Improved performance of an intensive care unit after changing the admission triage model

The Critical Care Society of Southern Africa Consensus Statement on ICU Triage and Rationing (ConICTri)

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