The Critical Care Society of Southern Africa Consensus Guideline on ICU Triage and Rationing (ConICTri)
In South Africa (SA), administrators and intensive care practitioners are faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low- to middle-income countries experience the consequences...
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| Veröffentlicht in: | The Southern African journal of critical care Jg. 35; H. 1b; S. 53 |
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
Pretoria, South Africa
South African Medical Association
2019
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| Schlagworte: | |
| ISSN: | 1562-8264, 2078-676X, 2078-676X |
| Online-Zugang: | Volltext |
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| Zusammenfassung: | In South Africa (SA), administrators and intensive care practitioners are faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low- to middle-income countries experience the consequences of limited resources daily. Critically limited resources necessitate that rationing and triage (prioritisation) decisions are routinely necessary in SA, particularly in the publicly funded health sector.BackgroundIn South Africa (SA), administrators and intensive care practitioners are faced with the challenge of resource scarcity as well as an increasing demand for intensive care unit (ICU) services. ICU services are expensive, and practitioners in low- to middle-income countries experience the consequences of limited resources daily. Critically limited resources necessitate that rationing and triage (prioritisation) decisions are routinely necessary in SA, particularly in the publicly funded health sector.The purpose of this guideline is to utilise the relevant recommendations of the associated consensus meeting document and other internationally accepted principles to develop a guideline to inform frontline triage policy and ensure the best utilisation of adult intensive care in SA, while maintaining the fair distribution of available resources.PurposeThe purpose of this guideline is to utilise the relevant recommendations of the associated consensus meeting document and other internationally accepted principles to develop a guideline to inform frontline triage policy and ensure the best utilisation of adult intensive care in SA, while maintaining the fair distribution of available resources.An overall conceptual framework for the triage process was developed. The components of the framework were developed on the basis that patients should be admitted preferentially when the likely incremental medical benefit derived from ICU admission justifies admission. An estimate of likely resource use should also form part of the triage decision, with those patients requiring relatively less resources to achieve substantial benefit receiving priority for admission. Thus, the triage system should maximise the benefits obtained from ICU resources available for the community. Where possible, practical examples of what the consensus group agreed would be considered appropriate practice under specified South African circumstances were provided, to assist clinicians with practical decision-making. It must be stressed that this guideline is not intended to be prescriptive for individual hospital or regional practice, and hospitals and regions are encouraged to develop specified local guidelines with locally relevant examples. The guideline should be reviewed and revised if appropriate within 5 years.RecommendationsAn overall conceptual framework for the triage process was developed. The components of the framework were developed on the basis that patients should be admitted preferentially when the likely incremental medical benefit derived from ICU admission justifies admission. An estimate of likely resource use should also form part of the triage decision, with those patients requiring relatively less resources to achieve substantial benefit receiving priority for admission. Thus, the triage system should maximise the benefits obtained from ICU resources available for the community. Where possible, practical examples of what the consensus group agreed would be considered appropriate practice under specified South African circumstances were provided, to assist clinicians with practical decision-making. It must be stressed that this guideline is not intended to be prescriptive for individual hospital or regional practice, and hospitals and regions are encouraged to develop specified local guidelines with locally relevant examples. The guideline should be reviewed and revised if appropriate within 5 years.In recognition of the absolute need to limit patient access to ICU because of the lack of sufficient intensive care resources in public hospitals, this guideline has been developed to guide policy-making and assist frontline triage decision-making in SA. This document is not a complete plan for quality practice, but rather a template to support frontline clinicians, guide administrators and inform the public regarding appropriate triage decision-making.ConclusionIn recognition of the absolute need to limit patient access to ICU because of the lack of sufficient intensive care resources in public hospitals, this guideline has been developed to guide policy-making and assist frontline triage decision-making in SA. This document is not a complete plan for quality practice, but rather a template to support frontline clinicians, guide administrators and inform the public regarding appropriate triage decision-making. |
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| Bibliographie: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 IJ chose the participants, participated in the Delphi process and face-to-face round-table meeting, led the literature review of a designated section, drafted and graded associated recommendations. Participated in revisions to the drafts, and approved the final manuscripts. Endorsement: The Guideline is endorsed by the Critical Care Society of Southern Africa (CCSSA). Funding: The authors would like to thank the CCSSA for supporting the cost of the venue for the face-to-face meeting and accommodation of the participants. The costs of air travel for national participants was supported by the CCSSA Congress, Sun City, 2017. The CCSSA is a non-profit organisation dedicated to delivering appropriate, quality care to the critically ill. It was founded in 1970, and represents doctors, nurses and allied health practitioners working in the field of intensive care medicine. The CCSSA provides professional development; research; guidelines; protocols; accreditation; training; conferences and seminars to its members and possesses recognised expertise in the practice of intensive care. The Society has developed numerous administrative guidelines and clinical practice parameters for the intensive care practitioner. New guidelines and practice parameters are continually developed, and current ones are systematically reviewed and revised to promote professional conduct, appropriate delivery of care and ethical practice for all practitioners in Critical Care. The authors declare that the views or interests of the funding bodies have not influenced the final recommendations. VKWL devised and performed literature searches, reviewed methodology, participated in revisions to the drafts, and approved the final manuscripts. AL developed and supervised the methodology, performed literature searches, participated in manuscript drafting and revisions to the drafts, and approved the final manuscripts. DG, AA, SC, RW, EH, SM, ST, GR, CM, RM, BE, BL, KA participated in the Delphi process and face-to-face round-table meeting, led the literature review of a designated section, drafted and graded associated recommendations. Participated in revisions to the drafts, and approved the final manuscripts. FP chose the participants, co-chaired the face-to-face round-table meeting, co-drafted the initial consensus key questions, took part in the Delphi process, led the literature review of a designated section, drafted and graded associated recommendations. Participated in revisions to the drafts, and approved the final manuscripts. Author Contributions: GMJ led the consensus process, developed and supervised the methodology, and chaired the face-to-face round-table meeting. Responsible for initial drafting of consensus key questions and supervised the Delphi process, including the drafting and grading of recommendations. Drafted the manuscripts, supervised revisions to the drafts, and approved the final manuscripts. Conflicts of interest: GMJ: Steering committee member and international instructor of the Basic Assessment and Support in Intensive Care (BASIC) educational collaboration, that received unrestricted educational grants from Maquet, Hamilton Medical and Draeger. LRM: Immediate Vice President of the Critical Care Society of Southern Africa. DG, AA, SC, RW, VKWL, EH, AL, IJ, SM, ST, GAR, CM, BE, BL, KA, FP: The remaining authors have stated that they do not have any potential conflicts of interest. |
| ISSN: | 1562-8264 2078-676X 2078-676X |
| DOI: | 10.7196/SAJCC.2019.v35i1b.380 |