White Paper on Early Critical Care Services in Low Resource Settings

This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-inc...

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Veröffentlicht in:	Annals of global health Jg. 87; H. 1; S. 105
Hauptverfasser:	Losonczy, Lia I., Papali, Alfred, Kivlehan, Sean, Calvello Hynes, Emilie J., Calderon, Georgina, Laytin, Adam, Moll, Vanessa, Al Hazmi, Ahmed, Alsabri, Mohammed, Aryal, Diptesh, Atua, Vincent, Becker, Torben, Benzoni, Nicole, Dippenaar, Enrico, Duneant, Edrist, Girma, Biruk, George, Naomi, Gupta, Preeti, Jaung, Michael, Hollong, Bonaventure, Kabongo, Diulu, Kruisselbrink, Rebecca J., Lee, Dennis, Maldonado, Augusto, May, Jesse, Osei-Ampofo, Maxwell, Osman, Yasein Omer, Owoo, Christian, Rouhani, Shada A., Sawe, Hendry, Schnorr, Daniel, Shrestha, Gentle S., Sohoni, Aparajita, Sultan, Menbeu, Tenner, Andrea G., Yusuf, Hanan, Adhikari, Neill K., Murthy, Srinvas, Kissoon, Niranjan, Marshall, John, Khoury, Abdo, Bellou, Abdelouahab, Wallis, Lee, Reynolds, Teri
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States Ubiquity Press 01.01.2021
Schlagworte:	Best practice Cost analysis Cost effectiveness Critical Care Critical Illness - therapy Delivery of Health Care Disease Education Emergency medical care Emergency medical services Emergency preparedness Emergency response Ethical standards Expert Consensus Document Health care Health care policy Health Facilities Heterogeneity High income Hospitalization Hospitals Humans Illnesses Industrialized nations Intensive care Medical personnel Patients Poverty Quality control R&D Regional development Research & development Strengthening Training
ISSN:	2214-9996, 2214-9996
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Abstract	This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient-these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single "best" care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country's current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient's geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources.
AbstractList	This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient-these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single "best" care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country's current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient's geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources.This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient-these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single "best" care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country's current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient's geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources. This White Paper has been formally accepted for support by the International Federation for Emergency Medicine (IFEM) and by the World Federation of Intensive and Critical Care (WFICC), put forth by a multi-specialty group of intensivists and emergency medicine providers from low- and low-middle-income countries (LMICs) and high-income countries (HiCs) with the aim of 1) defining the current state of caring for the critically ill in low-resource settings (LRS) within LMICs and 2) highlighting policy options and recommendations for improving the system-level delivery of early critical care services in LRS. LMICs have a high burden of critical illness and worse patient outcomes than HICs, hence, the focus of this White Paper is on the care of critically ill patients in the early stages of presentation in LMIC settings. In such settings, the provision of early critical care is challenged by a fragmented health system, costs, a health care workforce with limited training, and competing healthcare priorities. Early critical care services are defined as the early interventions that support vital organ function during the initial care provided to the critically ill patient-these interventions can be performed at any point of patient contact and can be delivered across diverse settings in the healthcare system and do not necessitate specialty personnel. Currently, a single "best" care delivery model likely does not exist in LMICs given the heterogeneity in local context; therefore, objective comparisons of quality, efficiency, and cost-effectiveness between varying models are difficult to establish. While limited, there is data to suggest that caring for the critically ill may be cost effective in LMICs, contrary to a widely held belief. Drawing from locally available resources and context, strengthening early critical care services in LRS will require a multi-faceted approach, including three core pillars: education, research, and policy. Education initiatives for physicians, nurses, and allied health staff that focus on protocolized emergency response training can bridge the workforce gap in the short-term; however, each country's current human resources must be evaluated to decide on the duration of training, who should be trained, and using what curriculum. Understanding the burden of critical Illness, best practices for resuscitation, and appropriate quality metrics for different early critical care services implementation models in LMICs are reliant upon strengthening the regional research capacity, therefore, standard documentation systems should be implemented to allow for registry use and quality improvement. Policy efforts at a local, national and international level to strengthen early critical care services should focus on funding the building blocks of early critical care services systems and promoting the right to access early critical care regardless of the patient's geographic or financial barriers. Additionally, national and local policies describing ethical dilemmas involving the withdrawal of life-sustaining care should be developed with broad stakeholder representation based on local cultural beliefs as well as the optimization of limited resources.
Author	Papali, Alfred Jaung, Michael Reynolds, Teri Gupta, Preeti Losonczy, Lia I. Khoury, Abdo Aryal, Diptesh Kivlehan, Sean Lee, Dennis Osman, Yasein Omer Maldonado, Augusto May, Jesse Benzoni, Nicole Kabongo, Diulu Shrestha, Gentle S. George, Naomi Dippenaar, Enrico Rouhani, Shada A. Alsabri, Mohammed Al Hazmi, Ahmed Becker, Torben Marshall, John Adhikari, Neill K. Moll, Vanessa Tenner, Andrea G. Calvello Hynes, Emilie J. Laytin, Adam Hollong, Bonaventure Bellou, Abdelouahab Calderon, Georgina Sohoni, Aparajita Kruisselbrink, Rebecca J. Yusuf, Hanan Murthy, Srinvas Schnorr, Daniel Sawe, Hendry Girma, Biruk Osei-Ampofo, Maxwell Wallis, Lee Atua, Vincent Kissoon, Niranjan Duneant, Edrist Sultan, Menbeu Owoo, Christian
AuthorAffiliation	11 Vila Central Hospital, VU 24 University of Toronto, CA 13 Indiana University, US 22 Fiji National University, FJ 39 Harvard, FR 31 Tribhuvan University, NP 7 University Hospital Zurich, CH 26 Emergency Medicine SMSB, SD 36 BC Children’s Hospital Research Institute, CA 34 UCSF, US 17 Brigham and Women’s Hospital, US 32 Highland Hospital, US 14 University of Cape Town, ZA 10 Nepal Mediciti Hospital, NP 21 McMaster University, CA 20 Yaoundé Central Hospital, CM 38 EUSEM, FR 28 Partners in Health, US 18 georgetown, US 4 University of Colorado, US 27 Korle-Bu Teaching Hospital, GH 33 SPHMMC, ET 5 Adventist Health Ukiah Valley, US 25 KATH, GH 30 Medicine Sans Frontier, US 2 University of North Carolina, US 12 University of Florida, US 3 Harvard, US 1 George Washington University, US 35 Sunnybrook Health Sciences Centre, CA 8 University of Maryland, US 29 Muhimbili University, TZ 16 Addis Ababa University, ET 15 Hôpital Universitaire de Mirebalais, HT 19 Baylor, US 6 Johns Hopkins, US 23 Universidad San Francisco de Quito, E
AuthorAffiliation_xml	– name: 40 WHO, CH – name: 30 Medicine Sans Frontier, US – name: 18 georgetown, US – name: 35 Sunnybrook Health Sciences Centre, CA – name: 22 Fiji National University, FJ – name: 33 SPHMMC, ET – name: 2 University of North Carolina, US – name: 13 Indiana University, US – name: 14 University of Cape Town, ZA – name: 21 McMaster University, CA – name: 28 Partners in Health, US – name: 16 Addis Ababa University, ET – name: 32 Highland Hospital, US – name: 36 BC Children’s Hospital Research Institute, CA – name: 37 University of British Columbia, CA – name: 6 Johns Hopkins, US – name: 12 University of Florida, US – name: 11 Vila Central Hospital, VU – name: 38 EUSEM, FR – name: 19 Baylor, US – name: 24 University of Toronto, CA – name: 34 UCSF, US – name: 4 University of Colorado, US – name: 9 Yemeni Association of Emergency Medicine and Disaster, YE – name: 31 Tribhuvan University, NP – name: 1 George Washington University, US – name: 15 Hôpital Universitaire de Mirebalais, HT – name: 3 Harvard, US – name: 10 Nepal Mediciti Hospital, NP – name: 17 Brigham and Women’s Hospital, US – name: 8 University of Maryland, US – name: 26 Emergency Medicine SMSB, SD – name: 27 Korle-Bu Teaching Hospital, GH – name: 29 Muhimbili University, TZ – name: 39 Harvard, FR – name: 7 University Hospital Zurich, CH – name: 23 Universidad San Francisco de Quito, EC – name: 25 KATH, GH – name: 20 Yaoundé Central Hospital, CM – name: 5 Adventist Health Ukiah Valley, US
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/34786353$$D View this record in MEDLINE/PubMed
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SubjectTerms	Best practice Cost analysis Cost effectiveness Critical Care Critical Illness - therapy Delivery of Health Care Disease Education Emergency medical care Emergency medical services Emergency preparedness Emergency response Ethical standards Expert Consensus Document Health care Health care policy Health Facilities Heterogeneity High income Hospitalization Hospitals Humans Illnesses Industrialized nations Intensive care Medical personnel Patients Poverty Quality control R&D Regional development Research & development Strengthening Training
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Title	White Paper on Early Critical Care Services in Low Resource Settings
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