White Paper on Early Critical Care Services in Low Resource Settings

Losonczy, Lia; Papali, Alfred; Kivlehan, Sean M; Hynes, Emilie J Calvello; Calderon, Georgina; Laytin, Adam D.; Moll, Vanessa; Hazmi, Ahmed Al; Alsabri, Mohammed; Aryal, Diptesh; Atua, Vincent; Becker, Torben K.; Benzoni, Nicole; Dippenaar, Enrico; Duneant, Edrist; Girma, Biruk; George, Naomi; Gupta, Preeti; Jaung, Michael; Hollong, Bonaventure; Kabongo, Diulu; Kruisselbrink, Rebecca; Lee, Dennis; Maldonado, Augusto; May, J. D.; Osei‐Ampofo, Maxwell; Osman, Yasein Omer; Owoo, Christian; Rouhani, Shada A.; Sawe, Hendry R.; Schnorr, Daniel; Shrestha, Gentle Sunder; Sohoni, Aparajita; Sultan, Menbeu; Tenner, Andrea G.; Yusuf, Hanan; Adhikari, Neill K. J.; Murthy, Srinvas; Kissoon, Niranjan; Marshall, John C.; Khoury, Abdo; Bellou, Abdelouahab; Wallis, Lynne; Reynolds, Teri

doi:10.5334/aogh.3377

Cited by 31 publications

(37 citation statements)

References 90 publications

(134 reference statements)

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“…Globally, the burden of critical illness is higher and most deaths from critical illness occur in Low- and Middle- Income Countries (LMICs) [ 1 , 2 ]. Effective treatment of the patients with the highest risk of death has the potential to save many lives.…”

Section: Introductionmentioning

confidence: 99%

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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?

Guinness

Kairu

Kuwawenaruwa

et al. 2023

Cost Eff Resour Alloc

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Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill patients, focusing on first-tier, effective, low-cost, life-saving care and designed to be feasible even in low-resourced and low-staffed settings. This is distinct from advanced critical care, usually conducted in ICUs with specialised staff, facilities and technologies. This paper estimates the incremental cost of EECC and advanced critical care for the planning of care for critically ill patients in Tanzania and Kenya.The incremental costing took a health systems perspective. A normative approach based on the ingredients defined through the recently published global consensus on EECC was used. The setting was a district hospital in which the patient is provided with the definitive care typically provided at that level for their condition. Quantification of resource use was based on COVID-19 as a tracer condition using clinical expertise. Local prices were used where available, and all costs were converted to USD2020.The costs per patient day of EECC is estimated to be 1 USD, 11 USD and 33 USD in Tanzania and 2 USD, 14 USD and 37 USD in Kenya, for moderate, severe and critical COVID-19 patients respectively. The cost per patient day of advanced critical care is estimated to be 13 USD and 294 USD in Tanzania and USD 17 USD and 345 USD in Kenya for severe and critical COVID-19 patients, respectively.EECC is a novel approach for providing the essential care to all critically ill patients. The low costs and lower tech approach inherent in delivering EECC mean that EECC could be provided to many and suggests that prioritizing EECC over ACC may be a rational approach when resources are limited. Graphical Abstract

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Section: Introductionmentioning

confidence: 99%

“…Even prior to the pandemic, mortality in hospitalised patients in Africa was significantly higher than the global average [ 18 ]. Donors and policy-makers were therefore seeking out new solutions to the improvement of care for COVID-19 patients [ 2 , 5 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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

Guinness

Kairu

Kuwawenaruwa

et al. 2023

Cost Eff Resour Alloc

View full text Add to dashboard Cite

show abstract

“…To provide guidance and recommendations for the planning or renovation of intensive care units, the committee of the health infrastructure division was composed of biomedical engineers, and critical care clinicians used various evidence-based resources with context in consideration. 15 , 16 , 17 The planned units were to be open semipartitioned general ICUs staffed by a mix of both critical care– and noncritical care–trained nurses. The highest form of organ support therapy to be provided was cardiorespiratory in terms of mechanical ventilation and use of vasopressors.…”

Section: Introductionmentioning

confidence: 99%

“…Global consensus on appropriate nurse-to-patient ratio in resource-limited ICUs has not yet been achieved. 4 , 16 Some HIC data were used to inform some of the planning for recruitment and retention, although ultimately the number of nurses who received training was decided by whichever resources were available.…”

Section: Introductionmentioning

confidence: 99%

“…One such example is one where a staffing model allows accredited critical care personnel (critical care trained anesthesiologists, emergency, and internal medicine physicians) to oversee nonaccredited staff and for outside specialists to contribute to areas in which they excel, such as nonphysician anesthesiologists and emergency care physicians managing airways; this has been alluded to in a white paper. 16 Uganda has already laid the foundation for this framework. And the next steps would be to harmonize this process.…”

Section: Introductionmentioning

confidence: 99%

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