Referral and admission to intensive care: A qualitative study of doctors’ practices in a Tanzanian university hospital


Autoři: Sofia Engdahl Mtango aff001;  Edwin Lugazia aff002;  Ulrika Baker aff003;  Yvonne Johansson aff001;  Tim Baker aff003
Působiště autorů: Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden aff001;  Department of Anaesthesia & Intensive Care, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania aff002;  College of Medicine, University of Malawi, Blantyre, Malawi aff003;  Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224355

Souhrn

Background

Intensive care is care for critically ill patients with potentially reversible conditions. Patient selection for intensive care should be based on potential benefit but since demand exceeds availability, rationing is needed. In Tanzania, the availability of Intensive Care Units (ICUs) is very limited and the practices for selecting patients for intensive care are not known. The aim of this study was to explore doctors’ experiences and perceptions of ICU referral and admission processes in a university hospital in Tanzania.

Methods

We performed a qualitative study using semi-structured interviews with fifteen doctors involved in the recent care of critically ill patients in university hospital in Tanzania. Inductive conventional content analysis was applied for the analysis of interview notes to derive categories and sub-categories.

Results

Two main categories were identified, (i) difficulties with the identification of critically ill patients in the wards and (ii) a lack of structured triaging to the ICU. A lack of critical care knowledge and communication barriers were described as preventing identification of critically ill patients. Triaging to the ICU was affected by a lack of guidelines for admission, diverging ideas about ICU indications and contraindications, the lack of bed capacity in the ICU and non-medical factors such as a fear of repercussions.

Conclusion

Critically ill patients may not be identified in general wards in a Tanzanian university hospital and the triaging process for the admission of patients to intensive care is convoluted and not explicit. The findings indicate a potential for improved patient selection that could optimize the use of scarce ICU resources, leading to better patient outcomes.

Klíčová slova:

Critical care and emergency medicine – Hospitals – Intensive care units – Medical doctors – Nurses – Surgical and invasive medical procedures – Tanzania – Triage


Zdroje

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PLOS One


2019 Číslo 10