A national survey of critical care services in hospitals accredited for training in a lower-middle income country: Pakistan

Abstract

Purpose To describe the extent and variation of critical care services in Pakistan. Materials and methods A cross-sectional survey was conducted in all intensive care units (ICUs) recognised for postgraduate training to determine administration, infrastructure, equipment, staffing, and training. Results There were 151 hospitals recognised for training, providing 2166 ICU beds and 1473 ventilators. Regional distribution of ICU beds per 100,000 population ranged from 1.0 in Sindh to none in Gilgit Baltistan (median 0.7). A senior clinician trained in critical care was available in 19 (12.1%) of units. One-to-one nurse-to-bed ratio during the day was available in 84 (53.5%) of units, dropping to 75 (47.8%) at night. Availability of 1:1 nursing also varied between provinces, ranging from 56.5% in Punjab compared to 0% in Azad Jamu Kashmir. Similarly, there was disparity in the availability of ventilators between provinces. All ICUs had basic infrastructure (electricity, running water, piped oxygen) and basic equipment (electronic monitoring and infusion pumps). Conclusion Pakistan, a lower middle-income country, has an established network of critical care facilities with access to basic equipment, but inequalities in its distribution. Investment in critical care training for doctors and nurses is needed.

General surgery resident’s perspective towards general surgery residency in Pakistan and allotment of surgical cases to them: a cross sectional study

“…9 Despite many structural changes in the residency program including less duty hours and organized grid system in many hospitals for the allotment of operative procedures to all the residents, residents always complain of having less cutwork as compared to his/her fellow resident. 10 In order to assess the perceptions of general surgical residents towards general surgery residency in Pakistan, this study was carried out to identity the factors and problems faced by general surgical residents during their 4 years of general surgical residency training in the Pakistan.…”

Leveraging a Cloud-Based Critical Care Registry for COVID-19 Pandemic Surveillance and Research in Low- and Middle-Income Countries

“…PRICE provides real-time reporting on the epidemiology, severity of illness, treatment, microbiology, and outcomes of intensive care unit (ICU) patients alongside information regarding the workforce, unit activity, unit acuity, and resource utilization in the ICU. Work already undertaken by PRICE has identified wide regional disparity in the availability of critical care resources [ 11 ]. Similarly, characterization of the current pandemic in relation to available resources is an essential tool in the management of an outbreak [ 6 ].…”

Health Systems Approach to Ensure Quality and Safety Amid COVID-19 Pandemic in Pakistan

“…With no global benchmark for the number of hospital beds in relation to population, 7 the functional critical bed capacity in Pakistan is 0.71 per 100,000 population, lesser than the neighboring countries. 8 Findings from the nationwide survey, held during 2017-2018 in 157 intensive care units (ICUs) across the country, revealed that 54% of the ICUs had a one-to-one nurse-to-bed ratio for ventilated patients. 8 Concerning the availability of one-to-one nurse-to-bed ratio, this ranged from 56.5% having a 1:1 availability in Punjab, compared to 0% in Azad Jammu and Kashmir.…”

“…8 Findings from the nationwide survey, held during 2017-2018 in 157 intensive care units (ICUs) across the country, revealed that 54% of the ICUs had a one-to-one nurse-to-bed ratio for ventilated patients. 8 Concerning the availability of one-to-one nurse-to-bed ratio, this ranged from 56.5% having a 1:1 availability in Punjab, compared to 0% in Azad Jammu and Kashmir. Ventilator-to-bed ratio of 1:1 was observed in 52% of the ICUs, with variations reported across the provinces.…”

“…Ventilator-to-bed ratio of 1:1 was observed in 52% of the ICUs, with variations reported across the provinces. 8 Furthermore, gaps in the critical care trained staff have also been reported. 8 In context of the current pandemic, there is a need to identify workforce gaps with training needs and infrastructure for critical care across all hospitals in Pakistan to adequately manage COVID-19 patients.…”