Hospital readiness for the provision of care to critically ill patients in Tanzania - an indepth cross-sectional study

Abstract

Background: Critical illness is a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and potential for reversibility. The burden of critical illness is high, especially in low- and middle-income countries. Critical care can be provided as Essential Emergency and Critical Care (EECC) – the effective, low-cost, basic care that all critically ill patients should receive in all parts of all hospitals in the world– and advanced critical care – complex, resource-intensive care usually provided in an intensive care unit. The required resources may be available in the hospital and yet not be ready in the wards for immediate use for critically ill patients. The ward readiness of these resources, although harder to evaluate, is likely more important than their availability in the hospital. This study aimed to assess the ward readiness for EECC and the hospital availability of resources for EECC and for advanced critical care in hospitals in Tanzania. Methods: An in-depth, cross-sectional study was conducted in five purposively selected hospitals by visiting all wards to collect data on all the required 66 EECC and 161 advanced critical care resources. We defined hospital-availability as a resource present in the hospital and ward-readinessas a resource available, functioning, and present in the right place, time and amounts for critically ill patient care in the wards. Data were analyzed to calculate availability and readiness scores as proportions of the resources that were available at hospital level, and ready at ward level respectively. Results: Availability of EECC resources in hospitals was 84% and readiness in the wards was 56%. Availability of advanced critical care resources was 31%. Conclusion: Hospitals in Tanzania lack readiness for the provision of EECC – the low-cost, life-saving care for critically ill patients. The resources for EECC were available in hospitals, but were not ready for the immediate needs of critically ill patients in the wards. To provide effective EECC to all patients, improvements are needed around the essential, low-cost resources in hospital wards that are essential for decreasing preventable deaths.

Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic

“…Worryingly, even in the midst of the COVID-19 pandemic, infection prevention and control measures remained weak. For example, in Kenya only two out of five facilities had protective face masks and aprons widely available, compounding wider problems of overcrowded, poorly maintained hospital buildings often with limited water provision 9 10. Our findings in Kenya and Tanzania are consistent with those from other low-resource settings 11…”

“…Our studies in Kenya and Tanzania conducted in late 2020 and in 2021 found that hospitals were generally poorly prepared to cater to the basic needs of those with critical illness 9 10. Evaluations of equipment and the human and material resources for dealing with acute, severe illness highlighted considerable variability between hospitals in such inputs and were generally lacking in Tanzania.…”

“…Evaluations of equipment and the human and material resources for dealing with acute, severe illness highlighted considerable variability between hospitals in such inputs and were generally lacking in Tanzania. Even in better-resourced settings, there were major deficiencies in local organisational arrangements and clinical processes 10. For example, national referral hospitals described uniform triage processes within their emergency departments, but triaging systems in all hospitals’ wards and in the emergency departments of general hospitals were largely absent 9 10.…”

“…Even in better-resourced settings, there were major deficiencies in local organisational arrangements and clinical processes 10. For example, national referral hospitals described uniform triage processes within their emergency departments, but triaging systems in all hospitals’ wards and in the emergency departments of general hospitals were largely absent 9 10. Importantly, in both countries, even if hospitals had equipment and materials required to institute EECC, they typically lacked the management systems and routines for the proper deployment and use of these resources.…”

“…EECC requires that all staff are able to identify critical illness and provide the most basic immediate care that a critically ill patient would need. In Tanzania, personnel with any relevant training were available in the facilities on average less than 50% of the time 10. Skills deficits exacerbated substantial human resource shortages across both countries, particularly in more rural or smaller hospitals; they are a fundamental limitation to the proper treatment of the critically ill patients.…”