Same label, different patients: Health-workers’ understanding of the label ‘critical illness’

Mkumbo, Elibariki; Willows, Tamara Mulenga; Onyango, Onesmus; Khalid, Karima; Maiba, John; Schell, Carl Otto; Oliwa, Jacquie; McKnight, Jacob; Baker, Tim

doi:10.3389/frhs.2023.1105078

Cited by 4 publications

(5 citation statements)

References 27 publications

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“…It could lead to long periods within a facility where critically ill patients could deteriorate while waiting to move to the next stage of care 16. In fact, issues as fundamental as a lack of any unified understanding of what comprises ‘critical illness’ among health workers also contribute to communication failures and suboptimal organisational processes 17. In sum, the absence of structured organisational systems means in many hospitals, the provision of EECC becomes contingent on the awareness, capacity and motivation of individuals to do what they consider best in very difficult circumstances.…”

Section: Lessons Learnedmentioning

confidence: 99%

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

English,

Oliwa,

Khalid

et al. 2023

BMJ Glob Health

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Care for the critically ill patients is often considered synonymous with a hospital having an intensive care unit. However, a focus on Essential Emergency and Critical Care (EECC) may obviate the need for much intensive care. Severe COVID-19 presented a specific critical care challenge while also being an exemplar of critical illness in general. Our multidisciplinary team conducted research in Kenya and Tanzania on hospitals’ ability to provide EECC as the COVID-19 pandemic unfolded. Important basic inputs were often lacking, especially sufficient numbers of skilled health workers. However, we learnt that higher scores on resource readiness scales were often misleading, as resources were often insufficient or not functional in all the clinical areas they are needed. By following patient journeys, through interviews and group discussions, we revealed gaps in timeliness, continuity and delivery of care. Generic challenges in transitions between departments were identified in the receipt of critically ill patients, the ability to sustain monitoring and treatment and preparation for any subsequent transition. While the global response to COVID-19 focused initially on providing technologies and training, first ventilators and later oxygen, organisational and procedural challenges seemed largely ignored. Yet, they may even be exacerbated by new technologies. Efforts to improve care for the critically ill patients, which is a complex process, must include a whole system and whole facility view spanning all areas of patients’ care and their transitions and not be focused on a single location providing ‘critical care’. We propose a five-part strategy to support the system changes needed.

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Section: Lessons Learnedmentioning

confidence: 99%

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

English,

Oliwa,

Khalid

et al. 2023

BMJ Glob Health

Self Cite

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“…This process of acceptance was made easier because of the results produced through this process such as the rich analysis of qualitative data led by Kenyan and Tanzanian junior researchers. A further area of positive change was in ensuring that all of the team participated in academic writing including junior Kenyan and Tanzanian researchers leading on papers as first authors 28. This practice was adopted by other studies within our institutions before the pandemic but is not commonplace in all research institutions 27 29…”

Section: Decentralising Powermentioning

confidence: 99%

“…A further area of positive change was in ensuring that all of the team participated in academic writing including junior Kenyan and Tanzanian researchers leading on papers as first authors. 28 This practice was adopted by other studies within our institutions before the pandemic but is not commonplace in all research institutions. 27 29 …”

Section: Decentralising Powermentioning

confidence: 99%

COVID-19 and unintended steps towards further equity in global health research

et al. 2023

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There was, and possibly still is, potential for COVID-19 to disrupt power inequities and contribute to positive transformation in global health research that increases equity. While there is consensus about the need to decolonise by transforming global health, and a roadmap outlining how we could approach it, there are few examples of steps that could be taken to transform the mechanics of global health research. This paper contributes lessons learnt from experiences and reflections of our diverse multinational team of researchers involved in a multicountry research project. We demonstrate the positive impact on our research project of making further steps towards improving equity within our research practices. Some of the approaches adopted include redistributing power to researchers from the countries of interest at various stages in their career, by involving the whole team in decisions about the research; meaningfully involving the whole team in research data analysis; and providing opportunities for all researchers from the countries of interest to voice their perspectives as first authors in publications. Although this approach is consistent with how research guidance suggests research should be run, in reality it does not often happen in this way. The authors of this paper hope that by sharing our experience, we can contribute towards discussions about the processes required to continue developing a global health sector that is equitable and inclusive.

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“… 20 In low-resource settings, effective triage and flow of care are, however, difficult to accomplish. Healthcare facilities are frequently characterised by overcrowding, insufficient drugs, limited equipment and staff shortages 13 21 22 as well us a lack of understanding of critical illness, 23 contributing directly to delay in essential care. To use the limited human and material resources effectively, different forms of triage are used to classify patients according to the severity of their condition and determine the priority for further treatment.…”

Section: Introductionmentioning

confidence: 99%

Third delay in care of critically ill patients: a qualitative investigation of public hospitals in Kenya

Onyango,

Willows,

McKnight

et al. 2024

BMJ Open

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ObjectivesThird delay refers to delays in delivering requisite care to patients after they arrive at a health facility. In low-resource care settings, effective triage and flow of care are difficult to guarantee. In this study, we aimed to identify delays in the delivery of care to critically ill patients and possible ways to address these delays.DesignThis was an exploratory qualitative study using in-depth interviews and patient journeys. The qualitative data were transcribed and aggregated into themes in NVivo V.12 Plus using inductive and deductive approaches.SettingThis study was conducted in four secondary-level public Kenyan hospitals across four counties between March and December 2021. The selected hospitals were part of the Clinical Information Network.ParticipantsPurposive sampling method was used to identify administrative and front-line healthcare providers and patients. We conducted 12 in-depth interviews with 11 healthcare workers and patient journeys of 7 patients. Informed consent was sought from the participants and maintained throughout the study.ResultsWe identified a cycle of suboptimal systems for care with adaptive mechanisms that prevent quality care to critically ill patients. We identified suboptimal systems for identification of critical illness, inadequate resources for continuity care and disruption of the flow of care, as the major causes of delays in identification and the initiation of essential care to critically ill patients. Our study also illuminated the contribution of inflexible bureaucratic non-clinical business-related organisational processes to third delay.ConclusionEliminating or reducing delays after patients arrive at the hospital is a time-sensitive measure that could improve the care outcomes of critically ill patients. This is achievable through an essential emergency and critical care package within the hospitals. Our findings can help emphasise the need for standardised effective and reliable care priorities to maintain of care of critically ill patients.

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Same label, different patients: Health-workers’ understanding of the label ‘critical illness’

Cited by 4 publications

References 27 publications

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

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

COVID-19 and unintended steps towards further equity in global health research

Third delay in care of critically ill patients: a qualitative investigation of public hospitals in Kenya

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