Caring Critically Ill Patients in the General Wards in Tanzania: Experience of Nurses and Physicians

T, Mselle Lilian; Halima, M. Abdul

doi:10.23937/2474-3674/1510047

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…Another reason for delaying tracheostomy in patients is to prevent the use of the procedure in patients with lesser injuries, who may be able to extubate successfully, and in those who have a rapidly progressive course of the disease and die early from their injuries. [13][14][15][16][17] In this study, there were differences in the length of stay in the intensive care unit for critically ill patients with mechanical ventilation who underwent early and late tracheostomy, where the length of stay was longer in the late tracheostomy group. This is consistent with studies that state that early tracheostomy is associated with a shorter average hospital stay (27 days) compared to standard tracheostomy (36 days) and late tracheostomy (48 days).…”

Section: Resultsmentioning

confidence: 89%

Comparison of Outcomes in Critically Ill Patients Installed with Mechanical Ventilation Performed Early and Late Tracheostomy at Dr. M. Djamil General Hospital Padang

2022

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Background: Tracheostomy is an alternative that is widely used as airway access after the use of a ventilator in the care of critically ill patients. Several factors are known to influence the outcome in patients undergoing tracheostomy. This study aimed to compare the outcomes of critically ill patients installed with mechanical ventilation performed early and late tracheostomy in Dr. M Djamil General Hospital, Padang, Indonesia. Methods: This study was an analytical observational study with a cross-sectional approach. A total of 97 research subjects participated in this study. Data analysis was carried out with the help of SPSS software in a univariate and bivariate manner between tracheostomy time (early and late) with patient outcomes in the form of death and length of stay. Results: There was a statistical difference in the mortality rate in critically ill patients with mechanical ventilation performed early and late tracheostomy, p = 0.014. There is a statistical difference in the length of stay in the intensive care unit in critically ill patients with mechanical ventilation performed early and late tracheostomy with p = 0.000. Conclusion: There are differences in outcomes in the form of mortality and length of stay in critically ill patients who have tracheostomy installed at Dr. M. Djamil General Hospital Padang, Indonesia.

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Section: Resultsmentioning

confidence: 89%

Comparison of Outcomes in Critically Ill Patients Installed with Mechanical Ventilation Performed Early and Late Tracheostomy at Dr. M. Djamil General Hospital Padang

2022

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“…The lack of human resource is fundamental and the consequences of the lack of skilled personnel was exposed during the various waves of the pandemic. As a result of shortages in trained specialists, there has been a strong reliance on generalist (non-specialist) and junior doctors, non-physician clinical officers and nurses to manage critically ill patients, under the supervision of the very few on call-specialists, as is the case in many other resource-limited setting [ 54 ]. We suggest that planning for the treatment of the critically ill in Kenya should prioritise the human resources required to provide the most effective forms of support to the widest group of patients.…”

Section: Discussionmentioning

confidence: 99%

Policies and resources for strengthening of emergency and critical care services in the context of the global COVID-19 pandemic in Kenya

Oliwa,

Mazhar,

Serem

et al. 2023

PLOS Glob Public Health

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Critical illnesses cause several million deaths annually, with many of these occurring in low-resource settings like Kenya. Great efforts have been made worldwide to scale up critical care to reduce deaths from COVID-19. Lower income countries with fragile health systems may not have had sufficient resources to upscale their critical care. We aimed to review how efforts to strengthen emergency and critical care were operationalised during the pandemic in Kenya to point towards how future emergencies should be approached. This was an exploratory study that involved document reviews, and discussions with key stakeholders (donors, international agencies, professional associations, government actors), during the first year of the pandemic in Kenya. Our findings suggest that pre-pandemic health services for the critically ill in Kenya were sparse and unable to meet rising demand, with major limitations noted in human resources and infrastructure. The pandemic response saw galvanised action by the Government of Kenya and other agencies to mobilise resources (approximately USD 218 million). Earlier efforts were largely directed towards advanced critical care but since the human resource gap could not be reduced immediately, a lot of equipment remained unused. We also note that despite strong policies on what resources should be available, the reality on the ground was that there were often critical shortages. While emergency response mechanisms are not conducive to addressing long-term health system issues, the pandemic increased global recognition of the need to fund care for the critically ill. Limited resources may be best prioritised towards a public health approach with focus on provision of relatively basic, lower cost essential emergency and critical care (EECC) that can potentially save the most lives amongst critically ill patients.

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“…Clinicians may also refer these patients to the intensive care unit (ICU) if they believe it will provide better monitoring and clinical management than the general ward. Staff issues such as nurse-to-patient ratios, skill, adequate training, and knowledge were identified by Mselle and Msengi as challenges in managing critically ill patients in the ward [ 21 ]. It was also reported that the general wards lacked specialised equipment to monitor and manage these patients, such as ventilators, infusion pumps, and basic oxygen delivery systems.…”

Section: Discussionmentioning

confidence: 99%

“…Infectious diseases such as human immunodeficiency virus (HIV) and tuberculosis were more likely to be found in admitted patients compared to those rejected (21). Cardiovascular diseases such as hypertension and congestive cardiac failure (15), together with endocrine pathologies such as diabetes mellitus (8), were more common among the refused group.…”

Section: Secondary Outcomesmentioning

confidence: 99%

Causes and Outcomes of Intensive Care Admission Refusals: A Retrospective Audit from a Rural Teaching Hospital in Eastern Cape, South Africa

Ninise

Mrara

Oladimeji

2023

Clinics and Practice

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(1) Background: Patients who deserve intensive care unit (ICU) admission may be denied due to a lack of resources, complicating ICU triage decisions for intensive care unit (ICU) clinicians. Among the resources that may be unavailable are trained personnel and monitored beds. In South Africa, the distribution of healthcare resources is reflected in the availability of ICU beds, with more ICU beds available in more affluent areas. Data on ICU refusal rates, reasons for refusal, patient characteristics, and outcomes are scarce in resource-constrained rural settings. Hence, this study sheds light on the ICU refusal rates, reasons for refusal, characteristics, and outcomes of refused patients at NMAH. (2) Methods: This was a three-month retrospective cross-sectional record review of refused and admitted patients from January to March 2022. COVID-19 patients and those younger than 13 years old were excluded. Refusal rates, reasons for refusal, characteristics, and outcomes of refused patients were analysed quantitatively using SPSS VS 20 software. Reasons for refusal were categorised as “too well”, “too sick”, and “suitable for admission but no resources”. (3) Results: A total of 135 patients were discussed for ICU admission at NMAH during the study period; 73 (54.07%) were refused admission, and 62 (45.92%) were admitted. Being considered too sick to benefit from ICU was the most common reason for refusal (53.23%). Too well and no resources contributed 27.42% and 19.35%, respectively. Patients with poor functional status, comorbidities, medical diagnoses, and those referred from the ward or accident and emergency unit rather than the operating room were more likely to be refused ICU admission. Refused patients had a seven-day mortality rate of 47%. (4) Conclusions and recommendations: The study found an unmet need for critical care services at our institution, as well as a need for tools to help clinicians make objective triage decisions for critically ill patients. Therefore, the study suggests a need to improve the quality of services provided outside of the ICU, particularly for patients who were refused ICU admission, to improve their outcomes.

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Caring Critically Ill Patients in the General Wards in Tanzania: Experience of Nurses and Physicians

Cited by 5 publications

References 22 publications

Comparison of Outcomes in Critically Ill Patients Installed with Mechanical Ventilation Performed Early and Late Tracheostomy at Dr. M. Djamil General Hospital Padang

Comparison of Outcomes in Critically Ill Patients Installed with Mechanical Ventilation Performed Early and Late Tracheostomy at Dr. M. Djamil General Hospital Padang

Policies and resources for strengthening of emergency and critical care services in the context of the global COVID-19 pandemic in Kenya

Causes and Outcomes of Intensive Care Admission Refusals: A Retrospective Audit from a Rural Teaching Hospital in Eastern Cape, South Africa

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