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Glob Heart. 2014 Sep;9(3):337-42.e1-5. doi: 10.1016/j.gheart.2014.08.002. Epub 2014 Oct 31.

A survey on critical care resources and practices in low- and middle-income countries.

Author information

1
Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia. Electronic address: kojicic.marija@gmail.com.
2
Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
3
Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
4
Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada.
5
Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC), Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
6
Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
7
Department of Anesthesiology and Reanimation, Gulhane Military Medical Faculty, Ankara, Turkey.

Abstract

BACKGROUND:

Timely and appropriate care is the key to achieving good outcomes in acutely ill patients, but the effectiveness of critical care may be limited in resource-limited settings.

OBJECTIVES:

This study sought to understand how to implement best practices in intensive care units (ICU) in low- and middle-income countries (LMIC) and to develop a point-of-care training and decision-support tool.

METHODS:

An internationally representative group of clinicians performed a 22-item capacity-and-needs assessment survey in a convenience sample of 13 ICU in Eastern Europe (4), Asia (4), Latin America (3), and Africa (2), between April and July 2012. Two ICU were from low-income, 2 from low-middle-income, and 9 from upper-middle-income countries. Clinician respondents were asked about bed capacity, patient characteristics, human resources, available medications and equipment, access to education, and processes of care.

RESULTS:

Thirteen clinicians from each of 13 hospitals (1 per ICU) responded. Surveyed hospitals had median of 560 (interquartile range [IQR]: 232, 1,200) beds. ICU had a median of 9 (IQR: 7, 12) beds and treated 40 (IQR: 20, 67) patients per month. Many ICU had ≥ 1 staff member with some formal critical care training (n = 9, 69%) or who completed Fundamental Critical Care Support (n = 7, 54%) or Advanced Cardiac Life Support (n = 9, 69%) courses. Only 2 ICU (15%) used any kind of checklists for acute resuscitation. Ten (77%) ICU listed lack of trained staff as the most important barrier to improving the care and outcomes of critically ill patients.

CONCLUSIONS:

In a convenience sample of 13 ICU from LMIC, specialty-trained staff and standardized processes of care such as checklists are frequently lacking. ICU needs-assessment evaluations should be expanded in LMIC as a global priority, with the goal of creating and evaluating context-appropriate checklists for ICU best practices.

PMID:
25667185
DOI:
10.1016/j.gheart.2014.08.002
[Indexed for MEDLINE]

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