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

English version

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
prolekare.web.journal.doi_sk: https://doi.org/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 – Medical doctors – Nurses – Tanzania – Surgical and invasive medical procedures – Intensive care units

Zdroje

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