An analysis of referrals to a level 3 intensive care unit in a resource-limited setting in South Africa
Background. With a shortage of intensive care unit (ICU) beds and rising healthcare costs in resource-limited settings, clinicians need to appropriately triage admissions into ICU to avoid wasteful expenditure and unnecessary bed utilisation. Objective. To assess the nature, appropriateness and ou...
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| Format: | Article |
| Language: | English |
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South African Medical Association
2023-07-01
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| Series: | Southern African Journal of Critical Care |
| Subjects: | |
| Online Access: | https://samajournals.co.za/index.php/sajcc/article/view/867 |
| _version_ | 1797326932749058048 |
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| author | U Jaganath K de Vasconcellos D L Skinner P D Gopalan |
| author_facet | U Jaganath K de Vasconcellos D L Skinner P D Gopalan |
| author_sort | U Jaganath |
| collection | DOAJ |
| description | Background. With a shortage of intensive care unit (ICU) beds and rising healthcare costs in resource-limited settings, clinicians need to appropriately triage admissions into ICU to avoid wasteful expenditure and unnecessary bed utilisation.
Objective. To assess the nature, appropriateness and outcome of referrals to a tertiary centre ICU.
Methods. A retrospective review of ICU consults from September 2016 to February 2017 at King Edward VIII Hospital was performed. The study was approved by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BE291/17). Data pertaining to patients’ demographics, referring doctor, diagnosis, comorbidities as well as biochemical and haemodynamic parameters were extracted. This information was then cross- referenced to the outcome of the ICU consultation. Data were descriptively analysed.
Results. Five hundred consultations were reviewed over a 6-month period; 52.2% of patients were male and the mean age was 44 years. Junior medical officers referred 164 (32.8%) of the consultations. Although specialist supervision was available in 459 cases, it was only utilised in 339 (73.9%) of these cases. Most referrals were from tertiary (46.8%) or regional (30.4%) hospitals; however, direct referrals from district hospitals and clinics accounted for 20.4% and 1.4% of consultations, respectively. The appropriate referral pathway was not followed in 81 (16.2%) consultations. Forty-five percent of consults were accepted; however, 9.3% of these patients died before arrival in ICU. A total of 151 (30.2%) patients were refused ICU admission, with the majority (57%) of these owing to futility. Patients were unstable at the time of consult in 53.2% of referrals and 34.4% of consults had missing data.
Conclusion. Critically ill patients are often referred by junior doctors without senior consultation, and directly from low-level healthcare facilities. A large proportion of ICU referrals are deemed futile and, of the patients accepted for admission, almost 1 in 10 dies prior to ICU admission. More emphasis needs to be placed on the training of doctors to appropriately triage and manage critically ill patients and ensure appropriate ICU referral and optimising of patient outcomes. |
| first_indexed | 2024-03-08T06:31:15Z |
| format | Article |
| id | doaj.art-5d9b3971cbf1482fab9a97630f30406d |
| institution | Directory Open Access Journal |
| issn | 1562-8264 2078-676X |
| language | English |
| last_indexed | 2024-03-08T06:31:15Z |
| publishDate | 2023-07-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | Southern African Journal of Critical Care |
| spelling | doaj.art-5d9b3971cbf1482fab9a97630f30406d2024-02-03T11:44:40ZengSouth African Medical AssociationSouthern African Journal of Critical Care1562-82642078-676X2023-07-01414810.7196/SAJCC.2023.v39i2.867872An analysis of referrals to a level 3 intensive care unit in a resource-limited setting in South AfricaU Jaganath0https://orcid.org/0000-0002-6406-0550K de Vasconcellos1https://orcid.org/0000-0002-1974-6633D L Skinner2P D Gopalan3https://orcid.org/0000-0002-3816-1171Discipline of Anaesthesiology, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South AfricaKing Edward VIII Hospital and Department of Anaesthesiology and Critical Care, University of KwaZulu-Natal, Durban, South Africa; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaPrivate practice, Busamed Hillcrest Private Hospital, Durban, South Africa; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaKing Edward VIII Hospital and Department of Anaesthesiology and Critical Care, University of KwaZulu-Natal, Durban, South Africa; Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South AfricaBackground. With a shortage of intensive care unit (ICU) beds and rising healthcare costs in resource-limited settings, clinicians need to appropriately triage admissions into ICU to avoid wasteful expenditure and unnecessary bed utilisation. Objective. To assess the nature, appropriateness and outcome of referrals to a tertiary centre ICU. Methods. A retrospective review of ICU consults from September 2016 to February 2017 at King Edward VIII Hospital was performed. The study was approved by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BE291/17). Data pertaining to patients’ demographics, referring doctor, diagnosis, comorbidities as well as biochemical and haemodynamic parameters were extracted. This information was then cross- referenced to the outcome of the ICU consultation. Data were descriptively analysed. Results. Five hundred consultations were reviewed over a 6-month period; 52.2% of patients were male and the mean age was 44 years. Junior medical officers referred 164 (32.8%) of the consultations. Although specialist supervision was available in 459 cases, it was only utilised in 339 (73.9%) of these cases. Most referrals were from tertiary (46.8%) or regional (30.4%) hospitals; however, direct referrals from district hospitals and clinics accounted for 20.4% and 1.4% of consultations, respectively. The appropriate referral pathway was not followed in 81 (16.2%) consultations. Forty-five percent of consults were accepted; however, 9.3% of these patients died before arrival in ICU. A total of 151 (30.2%) patients were refused ICU admission, with the majority (57%) of these owing to futility. Patients were unstable at the time of consult in 53.2% of referrals and 34.4% of consults had missing data. Conclusion. Critically ill patients are often referred by junior doctors without senior consultation, and directly from low-level healthcare facilities. A large proportion of ICU referrals are deemed futile and, of the patients accepted for admission, almost 1 in 10 dies prior to ICU admission. More emphasis needs to be placed on the training of doctors to appropriately triage and manage critically ill patients and ensure appropriate ICU referral and optimising of patient outcomes.https://samajournals.co.za/index.php/sajcc/article/view/867icu admissionicucritical carecritical caretriagereferral |
| spellingShingle | U Jaganath K de Vasconcellos D L Skinner P D Gopalan An analysis of referrals to a level 3 intensive care unit in a resource-limited setting in South Africa Southern African Journal of Critical Care icu admission icu critical care critical care triage referral |
| title | An analysis of referrals to a level 3 intensive care unit in a resource-limited setting in South Africa |
| title_full | An analysis of referrals to a level 3 intensive care unit in a resource-limited setting in South Africa |
| title_fullStr | An analysis of referrals to a level 3 intensive care unit in a resource-limited setting in South Africa |
| title_full_unstemmed | An analysis of referrals to a level 3 intensive care unit in a resource-limited setting in South Africa |
| title_short | An analysis of referrals to a level 3 intensive care unit in a resource-limited setting in South Africa |
| title_sort | analysis of referrals to a level 3 intensive care unit in a resource limited setting in south africa |
| topic | icu admission icu critical care critical care triage referral |
| url | https://samajournals.co.za/index.php/sajcc/article/view/867 |
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