What Is Preparedness and Capacity of Intensive Care Service in Indonesia to Response to COVID-19? A Mixed-method Study

Abstract

BACKGROUND: Pandemics can increase disease spread, as well as unpredictable and highly in patient demand, which can have a negative impact on hospital capacity and the overall functioning of the health-care system. The preparedness and capacity of intensive care services to respond to COVID-19 in Indonesia are remain unknown. AIM: This study aimed to investigate the preparedness and capacity of intensive care services in Indonesia to respond to the initial stage of the COVID-19 pandemic. METHODS: A mixed-method research design was used in this study using in-depth interviews and an online survey. An in-depth interview was conducted with the medical team (intensive care consultant and an anesthesiologist) who is actively involved in the provision of COVID-19 services in 15 national referral hospitals. The online survey was conducted to all medical teams that provide direct care to the COVID-19 patients. A total of 459 (response rate was 95.2%) agreed to join the survey. The content analysis technique was used to analyze qualitative data and a descriptive analysis was used to describe issues encountered in providing health services to COVID-19 patients. RESULTS: The analysis preparedness and capacity of intensive care service in Indonesia to respond to the initial stage of the COVID-19 pandemic resulting in 4 themes with 12 sub-themes. The four themes were limited quality and quantity of standardized intensive care unit (ICU) isolation room (inadequate zoning systems, adequacy of the standardized ICU isolation room, the readiness of the hospital infrastructure, and telemedicine facilities are not yet widely used, including in the COVID-19 isolation room), limited medical service support (lack of personal protective equipment (personal protective equipment [PPE], re-used PPE, lack of availability of medical devices), limitations in the medical team’s quality and quantity management (lack of number and distribution of expert doctors and medical team screening for ICU), and command systems (task shifting, effective communication, and leadership). CONCLUSION: Medical team encounters several difficulties, particularly related to the quality of facilities, staff preparedness, and systems for the provision of services to COVID-19 patients with critical conditions. There is a critical need for well-defined pathways, legal protection, and occupational health for medical teams providing services in the aftermath of a pandemic.

Task shifting healthcare services in the post-COVID world: A scoping review

“…Hospitals recognised the need for TS intensive care. Helmi et al [58] evaluated capacities of intensive care units (ICU) in Indonesia and reported inadequacies in rooms, equipment and specialists distribution. Given these limitations, leaderships directed TS in ICU through training on rights, responsibilities, communication, coordination and insurance schemes and incentives for involved HRH.…”

“…Given these limitations, leaderships directed TS in ICU through training on rights, responsibilities, communication, coordination and insurance schemes and incentives for involved HRH. [58] Mukhsam et al [59] described strategies by University Malaysia Sabah, Borneo, to mitigate impact of COVID-19 within campus, with a focus on MH through TS. Strict policies on screening, usage of personal protective equipment and attendance were implemented.…”

Indonesian Anesthesiologists Preparedness for COVID-19 Surge Capacity in the Early Pandemic

“…The hospital management must appropriately plan for catastrophe preparedness. Therefore, hospitals require disaster management plans because they ensure that when a disaster strikes, the hospital is prepared, there is no confusion, and the response is more efficient, effective, and sensible (19).…”

Task shifting healthcare services in the post-COVID world: A scoping review

“…An evaluation in Indonesia identified inadequacies in space, equipment and specialist distribution. To address these, leaderships initiated TS within ICUs through training on rights, responsibilities, communication, coordination and incentives for providers [46]. At the University Malaysia Sabah in Borneo, strategies were implemented to mitigate COVID-19's…”

“…In contrast, quick policy interventions and effective delegation on part of a Bornean university showcased how key TS was in preventing SARS-CoV-2 case importations and achieving zero-COVID status on campus [51]. Similarly, hospital leaderships in Indonesia recognised deficiencies in ICUs in and shifted services through quick training programs and incentivisation [46]. Policy rooted in TS through lay providers substantially improved ART uptake during the pandemic [53].…”