Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital.
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...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2019-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0224355 |
| _version_ | 1819022906740441088 |
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| author | Sofia Engdahl Mtango Edwin Lugazia Ulrika Baker Yvonne Johansson Tim Baker |
| author_facet | Sofia Engdahl Mtango Edwin Lugazia Ulrika Baker Yvonne Johansson Tim Baker |
| author_sort | Sofia Engdahl Mtango |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T04:30:27Z |
| format | Article |
| id | doaj.art-eb7ca1ef16144a41a3f1cee8e8522684 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T04:30:27Z |
| publishDate | 2019-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-eb7ca1ef16144a41a3f1cee8e85226842022-12-21T19:15:58ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-011410e022435510.1371/journal.pone.0224355Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital.Sofia Engdahl MtangoEdwin LugaziaUlrika BakerYvonne JohanssonTim BakerBACKGROUND: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.https://doi.org/10.1371/journal.pone.0224355 |
| spellingShingle | Sofia Engdahl Mtango Edwin Lugazia Ulrika Baker Yvonne Johansson Tim Baker Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital. PLoS ONE |
| title | Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital. |
| title_full | Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital. |
| title_fullStr | Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital. |
| title_full_unstemmed | Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital. |
| title_short | Referral and admission to intensive care: A qualitative study of doctors' practices in a Tanzanian university hospital. |
| title_sort | referral and admission to intensive care a qualitative study of doctors practices in a tanzanian university hospital |
| url | https://doi.org/10.1371/journal.pone.0224355 |
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