Critical care service delivery across healthcare systems in low-income and low-middle-income countries: protocol for a systematic review

Lim, Andrew; Kivlehan, Sean M; Losonczy, Lia; Murthy, Srinivas; Dippenaar, Enrico; Lowsby, Richard; Yang, Marc Li Chuan; Jaung, Michael; Stephens, P Andrew; Benzoni, Nicole; Sefa, Nana; Bartlett, Emily S.; Chaffay, Brandon; Haridasa, Naeha; Velasco, Bernadett; Yi, Sojung; Contag, Caitlin A; Rashed, Amir Lotfy; McCarville, Patrick; Sonenthal, Paul D.; Shukur, Nebiyu; Bellou, Abdelouahab; Mickman, Carl; Ghatak-Roy, Adhiti; Ferreira, Allison; Adhikari, Neill K. J.; Reynolds, Teri

doi:10.1136/bmjopen-2020-048423

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…A containment of LOS times and an improvement in the outcome of some categories of patients was observed as well [81][82][83][84][85][86][87][88]. These findings were in line with data from several other European and American research groups [89][90][91][92][93][94].…”

Section: Microlevel Strategiessupporting

confidence: 82%

Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions

Savioli

Ceresa²,

Gri

et al. 2022

JPM

133

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It is certain and established that overcrowding represents one of the main problems that has been affecting global health and the functioning of the healthcare system in the last decades, and this is especially true for the emergency department (ED). Since 1980, overcrowding has been identified as one of the main factors limiting correct, timely, and efficient hospital care. The more recent COVID-19 pandemic contributed to the accentuation of this phenomenon, which was already well known and of international interest. Considering what would appear to be a trivial definition of overcrowding, it may seem simple for the reader to hypothesize solutions for what seems to be one of the most avoidable problems affecting the hospital system. However, proposing solutions to overcrowding, as well as their implementation, cannot be separated from a correct and precise definition of the issue, which must consider the main causes and aggravating factors. In light of the need of finding solutions that can put an end to hospital overcrowding, this review aims, through a review of the literature, to summarize the triggering factors, as well as the possible solutions that can be proposed.

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Section: Microlevel Strategiessupporting

confidence: 82%

Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions

Savioli

Ceresa²,

Gri

et al. 2022

JPM

133

View full text Add to dashboard Cite

show abstract

“…An Italian research group showed that over the years of operation of an OBI team, a stabilization of the phenomena of “boarding” and “exit block” was observed, despite an increase in the number of ED admissions and the need for hospitalization of the patients themselves. A containment of the length of stay and improvement in the outcomes of some categories of patients was also observed [ 10 ]; these results are in line with data from other European and American research groups [ 10 , 60 , 61 ].…”

Section: Resultssupporting

confidence: 82%

Overcrowding in Emergency Department: Causes, Consequences, and Solutions—A Narrative Review

et al. 2022

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Overcrowding in Emergency Departments (EDs) is a phenomenon that is now widespread globally and causes a significant negative impact that goes on to affect the entire hospital. This contributes to a number of consequences that can affect both the number of resources available and the quality of care. Overcrowding is due to a number of factors that in most cases lead to an increase in the number of people within the ED, an increase in mortality and morbidity, and a decrease in the ability to provide critical services in a timely manner to patients suffering from medical emergencies. This phenomenon results in the Emergency Department reaching, and in some cases exceeding, its optimal capacity. In this review, the main causes and consequences involving this phenomenon were collected, including the effect caused by the SARS-CoV-2 virus in recent years. Finally, special attention was paid to the main operational strategies that have been developed over the years, strategies that can be applied both at the ED level (microlevel strategies) and at the hospital level (macrolevel strategies).

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“…The methods for this review have been published previously [14]. In summary, controlled vocabulary terms and text words related to critical care in LLMICs were developed.…”

Section: Methodsmentioning

confidence: 99%

Critical care delivery across health care systems in low-income and low-middle-income country settings: A systematic review

Bartlett,

Lim,

Kivlehan

et al. 2023

J Glob Health

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Background Prior research has demonstrated that low-and low-middle-income countries (LLMICs) bear a higher burden of critical illness and have a higher rate of mortality from critical illness than high-income countries (HICs). There is a pressing need for improved critical care delivery in LLMICs to reduce this inequity. This systematic review aimed to characterise the range of critical care interventions and services delivered within LLMIC health care systems as reported in the literature.Methods A search strategy using terms related to critical care in LLMICs was implemented in multiple databases. We included English language articles with human subjects describing at least one critical care intervention or service in an LLMIC setting published between 1 January 2008 and 1 January 2020. ResultsA total of 1620 studies met the inclusion criteria. Among the included studies, 45% of studies reported on pediatric patients, 43% on adults, 23% on infants, 8.9% on geriatric patients and 4.2% on maternal patients. Most of the care described (94%) was delivered in-hospital, with the remainder (6.2%) taking place in out-of-hospital care settings. Overall, 49% of critical care described was delivered outside of a designated intensive care unit. Specialist physicians delivered critical care in 60% of the included studies. Additional critical care was delivered by general physicians (40%), as well as specialist physician trainees (22%), pharmacists (16%), advanced nursing or midlevel practitioners (8.9%), ambulance providers (3.3%) and respiratory therapists (3.1%).Conclusions This review represents a comprehensive synthesis of critical care delivery in LLMIC settings. Approximately 50% of critical care interventions and services were delivered outside of a designated intensive care unit. Specialist physicians were the most common health care professionals involved in care delivery in the included studies, however generalist physicians were commonly reported to provide critical care interventions and services. This study additionally characterised the quality of the published evidence guiding critical care practice in LLMICs, demonstrating a paucity of interventional and cost-effectiveness studies. Future research is needed to understand better how to optimise critical care interventions, services, care delivery and costs in these settings.

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Critical care service delivery across healthcare systems in low-income and low-middle-income countries: protocol for a systematic review

Cited by 3 publications

References 16 publications

Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions

Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions

Overcrowding in Emergency Department: Causes, Consequences, and Solutions—A Narrative Review

Critical care delivery across health care systems in low-income and low-middle-income country settings: A systematic review

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