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Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic

Care for the critically ill patients is often considered synonymous with a hospital having an intensive care unit. However, a focus on Essential Emergency and Critical Care (EECC) may obviate the need for much intensive care. Severe COVID-19 presented a specific critical care challenge while also be...

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Autores principales: English, Mike, Oliwa, Jacquie, Khalid, Karima, Onyango, Onesmus, Willows, Tamara Mulenga, Mazhar, Rosanna, Mkumbo, Elibariki, Guinness, Lorna, Schell, Carl Otto, Baker, Tim, McKnight, Jacob
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626868/
https://www.ncbi.nlm.nih.gov/pubmed/37918869
http://dx.doi.org/10.1136/bmjgh-2023-013407
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author English, Mike
Oliwa, Jacquie
Khalid, Karima
Onyango, Onesmus
Willows, Tamara Mulenga
Mazhar, Rosanna
Mkumbo, Elibariki
Guinness, Lorna
Schell, Carl Otto
Baker, Tim
McKnight, Jacob
author_facet English, Mike
Oliwa, Jacquie
Khalid, Karima
Onyango, Onesmus
Willows, Tamara Mulenga
Mazhar, Rosanna
Mkumbo, Elibariki
Guinness, Lorna
Schell, Carl Otto
Baker, Tim
McKnight, Jacob
author_sort English, Mike
collection PubMed
description Care for the critically ill patients is often considered synonymous with a hospital having an intensive care unit. However, a focus on Essential Emergency and Critical Care (EECC) may obviate the need for much intensive care. Severe COVID-19 presented a specific critical care challenge while also being an exemplar of critical illness in general. Our multidisciplinary team conducted research in Kenya and Tanzania on hospitals’ ability to provide EECC as the COVID-19 pandemic unfolded. Important basic inputs were often lacking, especially sufficient numbers of skilled health workers. However, we learnt that higher scores on resource readiness scales were often misleading, as resources were often insufficient or not functional in all the clinical areas they are needed. By following patient journeys, through interviews and group discussions, we revealed gaps in timeliness, continuity and delivery of care. Generic challenges in transitions between departments were identified in the receipt of critically ill patients, the ability to sustain monitoring and treatment and preparation for any subsequent transition. While the global response to COVID-19 focused initially on providing technologies and training, first ventilators and later oxygen, organisational and procedural challenges seemed largely ignored. Yet, they may even be exacerbated by new technologies. Efforts to improve care for the critically ill patients, which is a complex process, must include a whole system and whole facility view spanning all areas of patients’ care and their transitions and not be focused on a single location providing ‘critical care’. We propose a five-part strategy to support the system changes needed.
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spelling pubmed-106268682023-11-07 Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic English, Mike Oliwa, Jacquie Khalid, Karima Onyango, Onesmus Willows, Tamara Mulenga Mazhar, Rosanna Mkumbo, Elibariki Guinness, Lorna Schell, Carl Otto Baker, Tim McKnight, Jacob BMJ Glob Health Analysis Care for the critically ill patients is often considered synonymous with a hospital having an intensive care unit. However, a focus on Essential Emergency and Critical Care (EECC) may obviate the need for much intensive care. Severe COVID-19 presented a specific critical care challenge while also being an exemplar of critical illness in general. Our multidisciplinary team conducted research in Kenya and Tanzania on hospitals’ ability to provide EECC as the COVID-19 pandemic unfolded. Important basic inputs were often lacking, especially sufficient numbers of skilled health workers. However, we learnt that higher scores on resource readiness scales were often misleading, as resources were often insufficient or not functional in all the clinical areas they are needed. By following patient journeys, through interviews and group discussions, we revealed gaps in timeliness, continuity and delivery of care. Generic challenges in transitions between departments were identified in the receipt of critically ill patients, the ability to sustain monitoring and treatment and preparation for any subsequent transition. While the global response to COVID-19 focused initially on providing technologies and training, first ventilators and later oxygen, organisational and procedural challenges seemed largely ignored. Yet, they may even be exacerbated by new technologies. Efforts to improve care for the critically ill patients, which is a complex process, must include a whole system and whole facility view spanning all areas of patients’ care and their transitions and not be focused on a single location providing ‘critical care’. We propose a five-part strategy to support the system changes needed. BMJ Publishing Group 2023-11-02 /pmc/articles/PMC10626868/ /pubmed/37918869 http://dx.doi.org/10.1136/bmjgh-2023-013407 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Analysis
English, Mike
Oliwa, Jacquie
Khalid, Karima
Onyango, Onesmus
Willows, Tamara Mulenga
Mazhar, Rosanna
Mkumbo, Elibariki
Guinness, Lorna
Schell, Carl Otto
Baker, Tim
McKnight, Jacob
Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic
title Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic
title_full Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic
title_fullStr Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic
title_full_unstemmed Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic
title_short Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic
title_sort hospital care for critical illness in low-resource settings: lessons learned during the covid-19 pandemic
topic Analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626868/
https://www.ncbi.nlm.nih.gov/pubmed/37918869
http://dx.doi.org/10.1136/bmjgh-2023-013407
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