Factors influencing decisions to admit or refuse patients entry to a South African tertiary intensive care unit

Gopalan, P D; Vasconcellos, Kim de

doi:10.7196/samj.2019.v109i9.13678

Cited by 14 publications

(20 citation statements)

References 19 publications

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“…In contrast to other published South African data, the refusal rate of 17.9% in this study is low [26] . It is comparable to studies from developed countries which had refusal rates between 17 and 38% 9.…”

Section: Discussioncontrasting

confidence: 99%

“…An early study from a large tertiary centre in Johannesburg also showed a high ICU admission rate from trauma-related conditions [25] . The high admission rate for medical conditions is in contrast to recently published data from KZN, where patients from internal medicine were twice as likely to be refused in comparison to surgical patients [26] . This may be due to a bias in accepting surgical patients in primarily surgical ICUs compared to the ICU in this study, which caters for a mix of surgical and medical patients.…”

Section: Discussioncontrasting

confidence: 77%

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Profile of referrals to an intensive care unit from a regional hospital emergency centre in KwaZulu-Natal

Singh

Maharaj

Allorto

et al. 2021

African Journal of Emergency Medicine

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 77%

Profile of referrals to an intensive care unit from a regional hospital emergency centre in KwaZulu-Natal

Singh

Maharaj

Allorto

et al. 2021

African Journal of Emergency Medicine

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“…Furthermore, none of the studies above have been performed in sub-Saharan Africa. With our combined burden of sepsis, trauma, HIV, tuberculosis and malnutrition, there are many unknowns with respect to serum albumin in the critically ill. [12][13][14][15][16] It is unclear what the prevalence is of hypoalbuminaemia, what the kinetics are of albumin in our setting, and what association (if any) exists between serum albumin levels and ICU outcome. In a setting with endemic malnutrition and chronic diseases such as HIV and tuberculosis, does serum albumin have the same association with outcome as in other settings, and even if so, are our thresholds potentially different?…”

mentioning

confidence: 96%

Low albumin levels are associated with mortality in the critically ill: A retrospective observational study in a multidisciplinary intensive care unit

Atrash

Vasconcellos

2020

S Afr J Crit Care

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Albumin is the major component of plasma proteins.. [1,2] It modulates microvascular permeability, maintains oncotic pressure, acts as a buffer, transports cations, prevents platelet aggregation and assists with binding toxins. [2] Albumin binds to drugs and has a significant effect on the half-life and action of these drugs. [2] In addition, serum albumin is used in assessment of the nutritional status of both acute and chronically ill patients. [3] Total body albumin measures about 3.5-5.0 g/kg of body weight. [2] The plasma compartment contains 42% of the total body albumin, the rest being in the extravascular components. [2] The liver controls the synthesis of albumin, and the rate of synthesis is controlled by nutritional intake more than other hepatic proteins. [2] Therefore, fasting reduces albumin synthesis, but omitting protein from the diet causes a greater decrease in albumin synthesis. [2] The degradation of albumin is about 14 g/day, or 5% of daily whole-body protein turnover in a 70 kg adult. [2] The rate of synthesis and degradation and the distribution of albumin between the intravascular and extravascular compartments is altered in the critically ill. [2] There is often a dramatic decrease in serum albumin concentration during critical illness. [2] Serum albumin levels increase as recovery from illness progresses. [2] The alteration of albumin distribution in critical illness is related, at least in part, to an increase in capillary leakage due to a dysfunction of the endothelial barrier. [2] This occurs after major surgical stress and during sepsis, and results in leakage of, and loss of proteins into the interstitial space. [2] A number of studies have attempted to describe the incidence of hypoalbuminaemia and determine if there is an association between hypoalbuminaemia and outcome. [4-11] These studies have varied in their populations, definitions of hypoalbuminaemia and outcomes of interest. [4-11] The frequency of hypoalbuminaemia in adult hospitalised patients (serum albumin levels <35 g/L) has been reported to be 21% at the time of admission. Herrmann et al. [4] reported an association between low serum albumin within 48 hours of admission and increased length of stay (LOS) and in-hospital mortality. Similar findings were reported in surgical populations. [5,6] A preoperative albumin level of <40 g/L

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“…17 However, evidence from the UK and South Africa suggests that although these scores are used, other contextual factors also affect decisions for ICU referral and admission, and this is probably the case everywhere. [18][19][20] The ICU model that is supported by expensive equipment, high-quality laboratory support and highly trained staff in high-income countries may not apply to lowincome countries where there are not enough human and material resources. 21 Nonetheless, the high burden of critical illness and demand for ICU beds in lowincome countries demands evidence-based, ethical and transparent decision-making tools for selecting which patients are admitted to ICU.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Doctors’ experiences of referring and admitting patients to the intensive care unit: a qualitative study of doctors’ practices at two tertiary hospitals in Malawi

et al. 2023

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ObjectiveTo explore doctors’ experiences of referring and admitting patients to the intensive care unit (ICU) at two tertiary hospitals in Malawi.DesignThis was a qualitative study that used face-to-face interviews. The interviews were audiotaped and transcribed verbatim into English. The data were analysed manually through conventional content analysis.SettingTwo public tertiary hospitals in the central and southern regions of Malawi. Interviews were conducted from January to June 2021.ParticipantsSixteen doctors who were involved in the referral and admission of patients to the ICU.ResultsFour themes were identified namely, lack of clear admission criteria, ICU admission requires a complex chain of consultations, shortage of ICU resources, and lack of an ethical and legal framework for discontinuing treatment of critically ill patients who were too sick to benefit from ICU.ConclusionDespite the acute disease burden and increased demand for ICU care, the two hospitals lack clear processes for referring and admitting patients to the ICU. Given the limited bed space in ICUs, hospitals in low-income countries, including Malawi, need to improve or develop admission criteria, severity scoring systems, ongoing professional development activities, and legislation for discontinuing intensive care treatments and end-of-life care.

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Factors influencing decisions to admit or refuse patients entry to a South African tertiary intensive care unit

Cited by 14 publications

References 19 publications

Profile of referrals to an intensive care unit from a regional hospital emergency centre in KwaZulu-Natal

Profile of referrals to an intensive care unit from a regional hospital emergency centre in KwaZulu-Natal

Low albumin levels are associated with mortality in the critically ill: A retrospective observational study in a multidisciplinary intensive care unit

Doctors’ experiences of referring and admitting patients to the intensive care unit: a qualitative study of doctors’ practices at two tertiary hospitals in Malawi

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