1
|
Sultan M, Zewdie A, Priyadarshani D, Hassen E, Tilahun M, Geremew T, Beane A, Haniffa R, Berenholtz SM, Checkley W, Hansoti B, Laytin AD. Implementing an ICU registry in Ethiopia-Implications for critical care quality improvement. J Crit Care 2024; 81:154525. [PMID: 38237203 PMCID: PMC10996997 DOI: 10.1016/j.jcrc.2024.154525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Intensive care units (ICUs) in low- and middle-income countries have high mortality rates, and clinical data are needed to guide quality improvement (QI) efforts. This study utilizes data from a validated ICU registry specially developed for resource-limited settings to identify evidence-based QI priorities for ICUs in Ethiopia. MATERIALS AND METHODS A retrospective cohort analysis of data from two tertiary referral hospital ICUs in Addis Ababa, Ethiopia from July 2021-June 2022 was conducted to describe casemix, complications and outcomes and identify features associated with ICU mortality. RESULTS Among 496 patients, ICU mortality was 35.3%. The most common reasons for ICU admission were respiratory failure (24.0%), major head injury (17.5%) and sepsis/septic shock (13.3%). Complications occurred in 41.0% of patients. ICU mortality was higher among patients with respiratory failure (46.2%), sepsis (66.7%) and vasopressor requirements (70.5%), those admitted from the hospital ward (64.7%), and those experiencing major complications in the ICU (62.3%). CONCLUSIONS In this study, ICU mortality was high, and complications were common and associated with increased mortality. ICU registries are invaluable tools to understand local casemix and clinical outcomes, especially in resource-limited settings. These findings provide a foundation for QI efforts and a baseline to evaluate their impact.
Collapse
Affiliation(s)
- Menbeu Sultan
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Ayalew Zewdie
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia; Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | | | - Ephrem Hassen
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Melkamu Tilahun
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Tigist Geremew
- Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | - Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Scotland, UK.
| | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Scotland, UK.
| | - Sean M Berenholtz
- Johns Hopkins University School of Medicine, Department of Anesthesia and Critical Care Medicine, Baltimore, MD, USA.
| | - William Checkley
- Johns Hopkins University School of Medicine, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA.
| | - Bhakti Hansoti
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, MD, USA.
| | - Adam D Laytin
- Johns Hopkins University School of Medicine, Department of Anesthesia and Critical Care Medicine, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, MD, USA.
| |
Collapse
|
2
|
Njoki C, Simiyu N, Kaddu R, Mwangi W, Sulemanji D, Oduor P, Dona DG, Otieno D, Abonyo TT, Wangeci P, Kabanya T, Mutuku S, Kioko A, Muthoni J, Kamau PM, Beane A, Haniffa R, Dondorp A, Misango D, Pisani L, Waweru-Siika W. EPidemiology, clinical characteristics and Outcomes of 4546 adult admissions to high-dependency and intensive care units in Kenya (EPOK): a multicentre registry-based observational study. Crit Care Explor 2024; 6:e1036. [PMID: 38356864 PMCID: PMC7615640 DOI: 10.1097/cce.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Objective to describe clinical, management and outcome features of critically ill patients admitted to intensive care units (ICUs) and high dependency units (HDUs) in Kenya. Design prospective registry-based observational study. Setting three HDUs and eight ICUs in Kenya. Patients consecutive adult patients admitted between January 2021 and June 2022. Interventions none. Measurements and main results data was entered in a cloud based platform using a common data model. Study endpoints included case mix variables, management features and patient centred outcomes. Patients with Coronavirus disease 2019 (COVID-19) were reported separately. Of the 3892/4546 patients without COVID-19, 2445 patients (62.8%) were from HDUs and 1447 (37.2%) from ICUs. Patients had a median age of 53 years (interquartile range [IQR] 38-68), with HDU patients being older but with a lower severity (APACHE II 6 [3-9] in HDUs vs 12 [7-17] in ICUs; p<0.001). One out of four patients were postoperative with 604 (63.4%) receiving emergency surgery. Readmission rate was 4.8%. Hypertension and diabetes were prevalent comorbidities, with a 4.0% HIV/AIDS rate. Invasive mechanical ventilation (IMV) was applied in 3.4% in HDUs vs. 47.6% in ICUs (P<0.001), with a duration of 7 days (IQR 3-21). There was a similar use of renal replacement therapy (4.0% vs. 4.7%; P<0.001). Vasopressor use was infrequent while half of patients received antibiotics. Average length of stay was 2 days (IQR 1-5). Crude HDU mortality rate was 6.5% in HDUs versus 30.5% in the ICUs (P<0.001). Of the 654 COVID-19 admissions, most were admitted in ICUs (72.3%) with a 33.2% mortality. Conclusions We provide the first multicenter observational cohort study from an African ICU national registry. Distinct management features and outcomes characterise HDU from ICU patients. Study registration Clinicaltrials.gov (reference number NCT05456217, date of registration 07 Nov 2022).
Collapse
Affiliation(s)
- Carolyne Njoki
- Department of Anesthesia, Aga Khan University, Nairobi, Kenya
| | - Nabukwangwa Simiyu
- Department of Anesthesia and Intensive Care, Kisii Hospital, Kisii, Kenya
| | - Ronnie Kaddu
- Intensive Care Unit, Aga Khan Mombasa Hospital (AKM), Mombasa, Kenya
| | - Wambui Mwangi
- Intensive Care Unit, Nyeri County Hospital, Nyeri, Kenya
| | - Demet Sulemanji
- Department of Anesthesia and Intensive Care, MP Shah Hospital, Nairobi, Kenya
- Department of Anesthesia, Aga Khan University, Nairobi, Kenya
| | - Peter Oduor
- Department of Anesthesia and Intensive Care, Nakuru referral Hospital, Nakuru, Kenya
| | | | | | | | - Patricia Wangeci
- Department of Anesthesia and Intensive Care, Nakuru referral Hospital, Nakuru, Kenya
| | - Thomas Kabanya
- Intensive Care Unit, Nyeri County Hospital, Nyeri, Kenya
| | - Selina Mutuku
- Intensive Care Unit, Aga Khan Mombasa Hospital (AKM), Mombasa, Kenya
| | - Annastacia Kioko
- Department of Anesthesia and Intensive Care, Kisii Hospital, Kisii, Kenya
| | - Joy Muthoni
- Intensive Care Unit, Aga Khan Mombasa Hospital (AKM), Mombasa, Kenya
| | - Peter Mburu Kamau
- Department of Anesthesia and Intensive Care, MP Shah Hospital, Nairobi, Kenya
| | - Abigail Beane
- Nat Intensive Care Surveillance-MORU, Colombo, Sri Lanka
- Critical Care Society of Kenya, Nairobi, Kenya
| | - Rashan Haniffa
- Nat Intensive Care Surveillance-MORU, Colombo, Sri Lanka
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Arjen Dondorp
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - David Misango
- Department of Anesthesia, Aga Khan University, Nairobi, Kenya
| | - Luigi Pisani
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | | |
Collapse
|
3
|
Mortara M, Turay MS, Boyle S, Caracciolo C, Bah S, Kargbo H, Hanciles E, John-Cole V, Scapini E, Benoni R, Dissanayake V, Beane A, Haniffa R, Adetunji AO, Taylor W, Pisani L. Impact and burden of sickle cell disease in critically ill obstetric patients in a high dependency unit in Sierra Leone-a registry based evaluation. BMC Pregnancy Childbirth 2023; 23:580. [PMID: 37573345 PMCID: PMC10422830 DOI: 10.1186/s12884-023-05888-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/31/2023] [Indexed: 08/14/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) in pregnancy is associated with worse maternal and neonatal outcomes. There is limited available data describing the burden and outcomes of critically ill obstetric patients affected by SCD in low-income settings. OBJECTIVES We aimed to define SCD burden and impact on mortality in critically-ill obstetric patients admitted to an urban referral hospital in Sierra Leone. We hypothesized that SCD burden is high and independently associated with increased mortality. METHODS We performed a registry-based cross-sectional study from March 2020 to December 2021 in the high-dependency unit (HDU) of Princess Christian Maternity Hospital PCMH, Freetown. Primary endpoints were the proportion of patients identified in the SCD group and HDU mortality. Secondary endpoints included frequency of maternal direct obstetric complications (MDOCs) and the maternal early obstetric warning score (MEOWS). RESULTS Out of a total of 497 patients, 25 (5.5%) qualified to be included in the SCD group. MEOWS on admission was not different between patients with and without SCD and SCD patients had also less frequently reported MDOCs. Yet, crude HDU mortality in the SCD group was 36%, compared to 9.5% in the non SCD group (P < 0.01), with an independent association between SCD group exposure and mortality when accounting for severity on admission (hazard ratio 3.40; 95%CI 1.57-7.39; P = 0.002). Patients with SCD had a tendency to longer HDU length of stay. CONCLUSIONS One out of twenty patients accessing a HDU in Sierra Leone fulfilled criteria for SCD. Despite comparable severity on admission, mortality in SCD patients was four times higher than patients without SCD. Optimization of intermediate and intensive care for this group of patients should be prioritized in low-resource settings with high maternal mortality.
Collapse
Affiliation(s)
- Milena Mortara
- Department of Anesthesia and Intensive Care, University of Piemonte Orientale, Novara, Italy
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Momoh Sitta Turay
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Sonia Boyle
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Claudia Caracciolo
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
- Section of Operational Research, Doctors with Africa-Cuamm, Padova, Italy
| | - Sarjoh Bah
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Henry Kargbo
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Eva Hanciles
- Department of Anesthesia and Intensive Care, Connaught Hospital, University of Sierra Leone, Freetown, Sierra Leone
| | - Valerie John-Cole
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Ester Scapini
- Anesthesia and Intensive Care Medicine, University of Bari, Bari, Italy
| | - Roberto Benoni
- Section of Operational Research, Doctors with Africa-Cuamm, Padova, Italy
| | - Vishmi Dissanayake
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Abi Beane
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Rashan Haniffa
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Adeniji O Adetunji
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Williamson Taylor
- Princess Christian Maternity Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Luigi Pisani
- Section of Operational Research, Doctors with Africa-Cuamm, Padova, Italy.
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.
- Intensive Care Unit, Miulli Regional Hospital, Acquaviva Delle Fonti, Italy.
| |
Collapse
|
4
|
Tolppa T, Pari V, Pell C, Aryal D, Hashmi M, Shamal Ghalib M, Jawad I, Tripathy S, Tirupakuzhi Vijayaraghavan BK, Beane A, Dondorp AM, Haniffa R. Determinants of Implementation of a Critical Care Registry in Asia: Lessons From a Qualitative Study. J Med Internet Res 2023; 25:e41028. [PMID: 36877557 PMCID: PMC10028509 DOI: 10.2196/41028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/25/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The Collaboration for Research, Implementation, and Training in Critical Care in Asia (CCA) is implementing a critical care registry to capture real-time data to facilitate service evaluation, quality improvement, and clinical studies. OBJECTIVE The purpose of this study is to examine stakeholder perspectives on the determinants of implementation of the registry by examining the processes of diffusion, dissemination, and sustainability. METHODS This study is a qualitative phenomenological inquiry using semistructured interviews with stakeholders involved in registry design, implementation, and use in 4 South Asian countries. The conceptual model of diffusion, dissemination, and sustainability of innovations in health service delivery guided interviews and analysis. Interviews were coded using the Rapid Identification of Themes from Audio recordings procedure and were analyzed based on the constant comparison approach. RESULTS A total of 32 stakeholders were interviewed. Analysis of stakeholder accounts identified 3 key themes: innovation-system fit; influence of champions; and access to resources and expertise. Determinants of implementation included data sharing, research experience, system resilience, communication and networks, and relative advantage and adaptability. CONCLUSIONS The implementation of the registry has been possible due to efforts to increase the innovation-system fit, influence of motivated champions, and the support offered by access to resources and expertise. The reliance on individuals and the priorities of other health care actors pose a risk to sustainability.
Collapse
Affiliation(s)
- Timo Tolppa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
| | - Vrindha Pari
- Chennai Critical Care Consultants Group, Chennai, India
| | - Christopher Pell
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
- Department of Global Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Diptesh Aryal
- Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal
| | | | | | - Issrah Jawad
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
| | - Swagata Tripathy
- Department of Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Chennai Critical Care Consultants Group, Chennai, India
- Critical Care Medicine Department, Apollo Hospital, Chennai, India
- Indian Registry of IntenSive Care, Chennai, India
| | - Abi Beane
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Arjen M Dondorp
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | |
Collapse
|
5
|
Kifle F, Kifleyohanes T, Moore J, Teshome A, Biccard BM. Indications, Challenges, and Characteristics of Successful Implementation of Perioperative Registries in Low Resource Settings: A Systematic Review. World J Surg 2023; 47:1387-1396. [PMID: 36656359 PMCID: PMC10156757 DOI: 10.1007/s00268-023-06909-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2022] [Indexed: 01/20/2023]
Abstract
Perioperative registries can be utilised to track outcomes, develop risk prediction models, and make evidence-based decisions and interventions. To better understand and support initiatives to establish clinical registries, this study aimed to assess the indications, challenges, and characteristics of successful perioperative registries in low-resource settings, where there is unmet surgical demand and patients have a mortality rate up to double that of high-income countries. We conducted a librarian-assisted literature search of international research databases of articles published between January 1969 and January 2021. Studies were filtered using predefined criteria and responses to two Mixed Method Appraisal Tool screening questions. A Direct Content Analysis Method was used to synthesis. e data for eligible studies based on predefined criteria. The search identified 2793 abstracts. After removing duplicates and excluding studies that did not meet eligibility criteria, twelve studies were included, conducted in South America (n = 4), Africa (n = 5), the Middle East (n = 2), and Asia (n = 1). The lack of context-specific data for determining and evaluating patient outcomes (n = 7) was the major indication for implementation. Organising local research teams and engaging stakeholders in the host country were associated with successful implementation. Inadequate funding for data collectors and monitoring data quality were identified as challenges (n = 4). The goal of a perioperative registry is to generate data to influence and support quality improvement, and national surgical policies. Efforts to establish perioperative registries in low- and middle-income countries should engage local teams and stakeholders and seek to overcome challenges in data collection and monitoring.
Collapse
Affiliation(s)
- Fitsum Kifle
- Division of Global Surgery, University of Cape Town (UCT), Cape Town, South Africa. .,College of Medicine, Asrat Weldyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia. .,African Perioperative Research Group, Network for Perioperative and Critical Care (APORG-N4PCc), Addis Ababa, Ethiopia.
| | - Tewodros Kifleyohanes
- College of Medicine, Asrat Weldyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.,African Perioperative Research Group, Network for Perioperative and Critical Care (APORG-N4PCc), Addis Ababa, Ethiopia
| | - Jolene Moore
- College of Medicine, Asrat Weldyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia.,School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,African Perioperative Research Group, Network for Perioperative and Critical Care (APORG-N4PCc), Addis Ababa, Ethiopia
| | | | - Bruce M Biccard
- Division of Global Surgery, University of Cape Town (UCT), Cape Town, South Africa.,African Perioperative Research Group, Network for Perioperative and Critical Care (APORG-N4PCc), Addis Ababa, Ethiopia.,Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| |
Collapse
|
6
|
Pisani L, Rashan T, Shamal M, Ghose A, Kumar Tirupakuzhi Vijayaraghavan B, Tripathy S, Aryal D, Hashmi M, Nor B, Lam Minh Y, Dondorp AM, Haniffa R, Beane A. Performance evaluation of a multinational data platform for critical care in Asia. Wellcome Open Res 2022; 6:251. [PMID: 35141427 PMCID: PMC8812332 DOI: 10.12688/wellcomeopenres.17122.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 02/02/2023] Open
Abstract
Background: The value of medical registries strongly depends on the quality of the data collected. This must be objectively measured before large clinical databases can be promoted for observational research, quality improvement, and clinical trials. We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries of critically ill patients established in seven Asian low- and middle-income countries (LMICs). Methods: The Critical Care Asia federated registry platform enables ICUs to collect clinical, outcome and process data for aggregate and unit-level analysis. The evaluation used the standardised criteria of the Directory of Clinical Databases (DoCDat) and a framework for data quality assurance in medical registries. Six reviewers assessed structure, coverage, reliability and validity of the ICU registry data. Case mix and process measures on patient episodes from June to December 2020 were analysed. Results: Data on 20,507 consecutive patient episodes from 97 ICUs in Afghanistan, Bangladesh, India, Malaysia, Nepal, Pakistan and Vietnam were included. The quality level achieved according to the ten prespecified DoCDat criteria was high (average score 3.4 out of 4) as was the structural and organizational performance -- comparable to ICU registries in high-income countries. Identified strengths were types of variables included, reliability of coding, data completeness and validation. Potential improvements included extension of national coverage, optimization of recruitment completeness validation in all centers and the use of interobserver reliability checks. Conclusions: The Critical Care Asia platform evaluates well using standardised frameworks for data quality and equally to registries in resource-rich settings.
Collapse
Affiliation(s)
| | - Luigi Pisani
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand,Doctors with Africa CUAMM, Padova, Italy,
| | - Thalha Rashan
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Maryam Shamal
- NICS-MORU collaboration, Crit Care Asia Afghanistan team, Kabul, Afghanistan
| | - Aniruddha Ghose
- Department of Medicine, Chattogram Medical Centre, Chattogram, Bangladesh
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Indian Registry of IntenSive care, IRIS, Chennai, India,Chennai Critical Care Consultants, Chennai, India,Critical Care Medicine,, Apollo Hospitals, Chennai, India
| | - Swagata Tripathy
- Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Diptesh Aryal
- Critical Care and Anesthesia, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Madiha Hashmi
- Department of Critical Care, Ziauddin University, Karachi, Pakistan
| | - Basri Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine,, International Islamic University Malaysia (IIUM), Kuala Lumpur, Malaysia
| | - Yen Lam Minh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Rashan Haniffa
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Abi Beane
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| |
Collapse
|
7
|
Pisani L, Rashan T, Shamal M, Ghose A, Kumar Tirupakuzhi Vijayaraghavan B, Tripathy S, Aryal D, Hashmi M, Nor B, Lam Minh Y, Dondorp AM, Haniffa R, Beane A. Performance evaluation of a multinational data platform for critical care in Asia. Wellcome Open Res 2022; 6:251. [PMID: 35141427 PMCID: PMC8812332 DOI: 10.12688/wellcomeopenres.17122.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 02/02/2023] Open
Abstract
Background: The value of medical registries strongly depends on the quality of the data collected. This must be objectively measured before large clinical databases can be promoted for observational research, quality improvement, and clinical trials. We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries of critically ill patients established in seven Asian low- and middle-income countries (LMICs). Methods: The Critical Care Asia federated registry platform enables ICUs to collect clinical, outcome and process data for aggregate and unit-level analysis. The evaluation used the standardised criteria of the Directory of Clinical Databases (DoCDat) and a framework for data quality assurance in medical registries. Six reviewers assessed structure, coverage, reliability and validity of the ICU registry data. Case mix and process measures on patient episodes from June to December 2020 were analysed. Results: Data on 20,507 consecutive patient episodes from 97 ICUs in Afghanistan, Bangladesh, India, Malaysia, Nepal, Pakistan and Vietnam were included. The quality level achieved according to the ten prespecified DoCDat criteria was high (average score 3.4 out of 4) as was the structural and organizational performance -- comparable to ICU registries in high-income countries. Identified strengths were types of variables included, reliability of coding, data completeness and validation. Potential improvements included extension of national coverage, optimization of recruitment completeness validation in all centers and the use of interobserver reliability checks. Conclusions: The Critical Care Asia platform evaluates well using standardised frameworks for data quality and equally to registries in resource-rich settings.
Collapse
Affiliation(s)
| | - Luigi Pisani
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand,Doctors with Africa CUAMM, Padova, Italy,
| | - Thalha Rashan
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Maryam Shamal
- NICS-MORU collaboration, Crit Care Asia Afghanistan team, Kabul, Afghanistan
| | - Aniruddha Ghose
- Department of Medicine, Chattogram Medical Centre, Chattogram, Bangladesh
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Indian Registry of IntenSive care, IRIS, Chennai, India,Chennai Critical Care Consultants, Chennai, India,Critical Care Medicine,, Apollo Hospitals, Chennai, India
| | - Swagata Tripathy
- Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Diptesh Aryal
- Critical Care and Anesthesia, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Madiha Hashmi
- Department of Critical Care, Ziauddin University, Karachi, Pakistan
| | - Basri Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine,, International Islamic University Malaysia (IIUM), Kuala Lumpur, Malaysia
| | - Yen Lam Minh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Rashan Haniffa
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Abi Beane
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| |
Collapse
|
8
|
Tirupakuzhi Vijayaraghavan BK, Gupta E, Ramakrishnan N, Beane A, Haniffa R, Lone N, de Keizer N, Adhikari NKJ. Barriers and facilitators to the conduct of critical care research in low and lower-middle income countries: A scoping review. PLoS One 2022; 17:e0266836. [PMID: 35511911 PMCID: PMC9071139 DOI: 10.1371/journal.pone.0266836] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 03/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Improvements in health-related outcomes for critically ill adults in low and lower-middle income countries need systematic investments in research capacity and infrastructure. High-quality research has been shown to strengthen health systems; yet, research contributions from these regions remain negligible or absent. We undertook a scoping review to describe barriers and facilitators for the conduct of critical care research. METHODS We searched MEDLINE and EMBASE up to December 2021 using a strategy that combined keyword and controlled vocabulary terms. We included original studies that reported on barriers or facilitators to the conduct of critical care research in these settings. Two reviewers independently reviewed titles and abstracts, and where necessary, the full-text to select eligible studies. For each study, reviewers independently extracted data using a standardized data extraction form. Barriers and facilitators were classified along the lines of a previous review and based on additional themes that emerged. Study quality was assessed using appropriate tools. RESULTS We identified 2693 citations, evaluated 49 studies and identified 6 for inclusion. Of the included studies, four were qualitative, one was a cross-sectional survey and one was reported as an 'analysis'. The total number of participants ranged from 20-100 and included physicians, nurses, allied healthcare workers and researchers. Barriers identified included limited funding, poor institutional & national investment, inadequate access to mentors, absence of training in research methods, limited research support staff, and absence of statistical support. Our review identified potential solutions such as developing a mentorship network, streamlining of regulatory processes, implementing a centralized institutional research agenda, developing a core-outcome dataset and enhancing access to low-cost technology. CONCLUSION Our scoping review highlights important barriers to the conduct of critical care research in low and lower-middle income countries, identifies potential solutions, and informs researchers, policymakers and governments on the steps necessary for strengthening research systems.
Collapse
Affiliation(s)
| | - Ena Gupta
- Department of Pulmonary and Critical Care Medicine, Einstein Health Network, Philadelphia, Pennsylvania, United States of America
| | | | - Abi Beane
- Mahidol-Oxford Tropical Research Unit, Bangkok, Thailand
| | - Rashan Haniffa
- Mahidol-Oxford Tropical Research Unit, Bangkok, Thailand
- Department of Anaesthesia and Critical Care Medicine, University College London, London, United Kingdom
| | - Nazir Lone
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicolette de Keizer
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Neill K. J. Adhikari
- Interdepartmental Division of Critical Care Medicine, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| |
Collapse
|
9
|
Phua J, Lim CM, Faruq MO, Nafees KMK, Du B, Gomersall CD, Ling L, Divatia JV, Hashemian SMR, Egi M, Konkayev A, Mat-Nor MB, Shrestha GS, Hashmi M, Palo JEM, Arabi YM, Tan HL, Dissanayake R, Chan MC, Permpikul C, Patjanasoontorn B, Son DN, Nishimura M, Koh Y. The story of critical care in Asia: a narrative review. J Intensive Care 2021; 9:60. [PMID: 34620252 PMCID: PMC8496144 DOI: 10.1186/s40560-021-00574-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background Asia has more critically ill people than any other part of our planet. The aim of this article is to review the development of critical care as a specialty, critical care societies and education and research, the epidemiology of critical illness as well as epidemics and pandemics, accessibility and cost and quality of critical care, culture and end-of-life care, and future directions for critical care in Asia.
Main body Although the first Asian intensive care units (ICUs) surfaced in the 1960s and the 1970s and specialisation started in the 1990s, multiple challenges still exist, including the lack of intensivists, critical care nurses, and respiratory therapists in many countries. This is aggravated by the brain drain of skilled ICU staff to high-income countries. Critical care societies have been integral to the development of the discipline and have increasingly contributed to critical care education, although critical care research is only just starting to take off through collaboration across groups. Sepsis, increasingly aggravated by multidrug resistance, contributes to a significant burden of critical illness, while epidemics and pandemics continue to haunt the continent intermittently. In particular, the coronavirus disease 2019 (COVID-19) has highlighted the central role of critical care in pandemic response. Accessibility to critical care is affected by lack of ICU beds and high costs, and quality of critical care is affected by limited capability for investigations and treatment in low- and middle-income countries. Meanwhile, there are clear cultural differences across countries, with considerable variations in end-of-life care. Demand for critical care will rise across the continent due to ageing populations and rising comorbidity burdens. Even as countries respond by increasing critical care capacity, the critical care community must continue to focus on training for ICU healthcare workers, processes anchored on evidence-based medicine, technology guided by feasibility and impact, research applicable to Asian and local settings, and rallying of governments for support for the specialty.
Conclusions Critical care in Asia has progressed through the years, but multiple challenges remain. These challenges should be addressed through a collaborative approach across disciplines, ICUs, hospitals, societies, governments, and countries.
Supplementary Information The online version contains supplementary material available at 10.1186/s40560-021-00574-4.
Collapse
Affiliation(s)
- Jason Phua
- FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, Singapore.,Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mohammad Omar Faruq
- General Intensive Care Unit, Emergency and COVID ICU, United Hospital Ltd, Dhaka, Bangladesh
| | - Khalid Mahmood Khan Nafees
- Ministry of Health, Department of Critical Care Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Bin Du
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Beijing, China
| | - Charles D Gomersall
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Moritoki Egi
- Department of Anesthesiology and Intensive Care Medicine, Kobe University Hospital, Kobe, Japan
| | - Aidos Konkayev
- Anaesthesiology and Reanimatology Department, Astana Medical University, Astana, Kazakhstan.,Anaesthesia and ICU Department, Institution of Traumatology and Orthopedics, Astana, Kazakhstan
| | - Mohd Basri Mat-Nor
- Department of Anaesthesiology and Intensive Care, International Islamic University Malaysia, Kuantan, Malaysia
| | - Gentle Sunder Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
| | | | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Hon Liang Tan
- Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Rohan Dissanayake
- Department of Intensive Care Medicine, Gosford Hospital, Gosford, NSW, Australia
| | - Ming-Cheng Chan
- Section of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,College of Science, Tunghai University, Taichung, Taiwan
| | - Chairat Permpikul
- Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Boonsong Patjanasoontorn
- Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Do Ngoc Son
- Critical Care Unit, Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | | |
Collapse
|
10
|
Finazzi S, Paci G, Antiga L, Brissy O, Carrara G, Crespi D, Csato G, Csomos A, Duek O, Facchinetti S, Fleming J, Garbero E, Gianni M, Gradisek P, Kaps R, Kyprianou T, Lazar I, Mikaszewska-Sokolewicz M, Mondini M, Nattino G, Olivieri C, Poole D, Previtali C, Radrizzani D, Rossi C, Skurzak S, Tavola M, Xirouchaki N, Bertolini G. PROSAFE: a European endeavor to improve quality of critical care medicine in seven countries. Minerva Anestesiol 2021; 86:1305-1320. [PMID: 33337119 DOI: 10.23736/s0375-9393.20.14112-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present PROSAFE, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. The project involved 343 ICUs in seven countries. All patients admitted to the ICU were eligible for data collection. METHODS The PROSAFE network collected data using the same electronic case report form translated into the corresponding languages. A complex, multidimensional validation system was implemented to ensure maximum data quality. Individual and aggregate reports by country, region, and ICU type were prepared annually. A web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database. RESULTS The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. Organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. Conversely, ICU equipment differed, and patient outcomes showed wide variations among countries. CONCLUSIONS PROSAFE is a permanent, stable, open access, multilingual database for clinical benchmarking, ICU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. Its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor.
Collapse
Affiliation(s)
- Stefano Finazzi
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy
| | - Giulia Paci
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy
| | | | - Obou Brissy
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy
| | - Greta Carrara
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy
| | - Daniele Crespi
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy
| | | | - Akos Csomos
- Hungarian Army Medical Center, Budapest, Hungary
| | - Or Duek
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | | - Joanne Fleming
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy
| | - Elena Garbero
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy -
| | - Massimo Gianni
- Department of Anesthesiology and Intensive Care, Regional Valle d'Aosta Hospital, Aosta, Italy
| | | | - Rafael Kaps
- General Hospital Novo Mesto, Novo Mesto, Slovenia
| | | | - Isaac Lazar
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | | - Matteo Mondini
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy
| | - Giovanni Nattino
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy.,Division of Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Carlo Olivieri
- Department of Anesthesiology and Intensive Care, ASL Vercelli, Vercelli, Italy
| | - Daniele Poole
- Department of Anesthesiology and Intensive Care, San Martino Hospital, Belluno, Italy
| | - Claudio Previtali
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy
| | - Danilo Radrizzani
- Department of Anesthesiology and Intensive Care, Hospital of Legnano, Legnano, Milan, Italy
| | - Carlotta Rossi
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy
| | - Stefano Skurzak
- Department of Anesthesiology and Intensive Care, San Giovanni Battista Hospital, Turin, Italy
| | - Mario Tavola
- Department of Anesthesiology and Intensive Care, ASST Lecco, Lecco, Italy
| | | | - Guido Bertolini
- GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy
| | | |
Collapse
|
11
|
Aryal D, Beane A, Dondorp AM, Green C, Haniffa R, Hashmi M, Jayakumar D, Marshall JC, McArthur CJ, Murthy S, Webb SA, Acharya SP, Ishani PGP, Jawad I, Khanal S, Koirala K, Luitel S, Pabasara U, Paneru HR, Kumar A, Patel SS, Ramakrishnan N, Salahuddin N, Shaikh M, Tolppa T, Udayanga I, Umrani Z. Operationalisation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 trials in a low and lower-middle income critical care learning health system. Wellcome Open Res 2021; 6:14. [PMID: 33604455 PMCID: PMC7883321 DOI: 10.12688/wellcomeopenres.16486.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
The Randomized Embedded Multifactorial Adaptive Platform (REMAP-CAP) adapted for COVID-19) trial is a global adaptive platform trial of hospitalised patients with COVID-19. We describe implementation in three countries under the umbrella of the Wellcome supported Low and Middle Income Country (LMIC) critical care network: Collaboration for Research, Implementation and Training in Asia (CCA). The collaboration sought to overcome known barriers to multi centre-clinical trials in resource-limited settings. Methods described focused on six aspects of implementation: i, Strengthening an existing community of practice; ii, Remote study site recruitment, training and support; iii, Harmonising the REMAP CAP- COVID trial with existing care processes; iv, Embedding REMAP CAP- COVID case report form into the existing CCA registry platform, v, Context specific adaptation and data management; vi, Alignment with existing pandemic and critical care research in the CCA. Methods described here may enable other LMIC sites to participate as equal partners in international critical care trials of urgent public health importance, both during this pandemic and beyond.
Collapse
Affiliation(s)
- Diptesh Aryal
- Critical Care and Anaesthesia, Nepal Mediciti Hospital, Lalitpur, Bagmati Pradesh, 44600, Nepal
| | - Abi Beane
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand, 10400, Thailand.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Arjen M Dondorp
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand, 10400, Thailand.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine Monash University, Melbourne, Victoria, Australia
| | - Rashan Haniffa
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand, 10400, Thailand.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Madiha Hashmi
- Department of Critical Care, Ziauddin University, Karachi, Sindh, Pakistan
| | - Devachandran Jayakumar
- Chennai Critical Care Consultants, Chennai, Tamil Nadu, 600 040, India.,Critical Care Medicine, Apollo Specialty Hospital OMR, Chennai, Tamil Nadu, India
| | - John C Marshall
- The Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Ontario, Canada
| | - Colin J McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.,Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Srinivas Murthy
- Faculty of Medicine, University of British Columbia School of Medicine, Vancouver, British Columbia, Canada
| | - Steven A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine Monash University, Melbourne, Victoria, Australia.,School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.,St John of God Hospital, Subiaco, Western Australia, Australia
| | - Subhash P Acharya
- Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati Pradesh, 44600, Nepal
| | - Pramodya G P Ishani
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Issrah Jawad
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Sushil Khanal
- Critical Care Medicine, Grande International Hospital, Kathmandu, Bagmati Pradesh, 44600, Nepal
| | - Kanchan Koirala
- Critical Care and Anaesthesia, Nepal Mediciti Hospital, Lalitpur, Bagmati Pradesh, 44600, Nepal
| | - Subekshya Luitel
- Nepal Intensive Care Foundation, Kathmandu, Bagmati Pradesh, Nepal
| | - Upulee Pabasara
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Hem Raj Paneru
- Pulmonary and Critical Care, Hospital for Advanced Medicine and Surgery, Kathmandu, Bagmati Pradesh, Nepal
| | - Ashok Kumar
- Department of Chest Medicine and Critical Care, Ziauddin University, Karachi, Sindh, Pakistan
| | - Shoaib Siddiq Patel
- South East Asian Research in Critical care and Health, Remedial Centre Hospital, Karachi, Sindh, Pakistan
| | | | - Nawal Salahuddin
- Pulmonary & Critical Care Medicine, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Mohiuddin Shaikh
- South East Asian Research in Critical care and Health, Remedial Centre Hospital, Karachi, Sindh, Pakistan
| | - Timo Tolppa
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Ishara Udayanga
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Zulfiqar Umrani
- Office of Research, Innovation & Commercialization (ORIC), Zuiddin University, Karachi, Pakistan
| |
Collapse
|
12
|
Addressing priorities for surgical research in Africa: implementation of a multicentre cloud-based peri-operative registry in Ethiopia. Anaesthesia 2021; 76:933-939. [PMID: 33492690 PMCID: PMC8248420 DOI: 10.1111/anae.15394] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/14/2022]
Abstract
In resource‐constrained settings, where inequalities in access to and quality of surgical care results in excess mortality, peri‐operative care registries are uncommon. A south‐south collaboration supported the implementation of a context specific, clinician‐led, multicentre real‐time peri‐operative registry in Ethiopia. Peri‐operative information, including the Ethiopian Ministry of Health’s national ‘Saving Lives through Safe Surgery initiative’, was linked to real‐time dashboards, providing clinicians and administrators with information on service utilisation, surgical access, national surgical key performance indicators and measures of quality of care. We recruited four hospitals representing 285 in‐patient beds from the Amhara and Southern Nations Nationalities and Peoples regions and Addis Ababa city, and reported on 1748 consecutive surgical cases from April 2019 to April 2020. Key performance indicators included: compliance with the World Health Organization’s Surgical Safety Checklist in 1595 (92.1%) surgical cases; adverse events during anaesthesia in 33 (3.1%) cases; and surgical site infections in 21 (2.0%) patients. This collaboration has successfully implemented a multicentre digital surgical registry that can enable measurement of key performance indicators for surgery and evaluation of peri‐operative outcomes. The peri‐operative registry is currently being rolled out across the Amhara region and Addis Ababa city administration. It will provide continuous granular healthcare information necessary to empower clinicians to drive context‐specific priorities for service improvement and research, in collaboration with national stakeholders and international research consortiums.
Collapse
Affiliation(s)
-
- Debre Birhan University and Debre Birhan Comprehensive Specialized Hospital, Ethiopia
| |
Collapse
|
13
|
Hashmi M, Beane A, Murthy S, Dondorp AM, Haniffa R. Leveraging a Cloud-Based Critical Care Registry for COVID-19 Pandemic Surveillance and Research in Low- and Middle-Income Countries. JMIR Public Health Surveill 2020; 6:e21939. [PMID: 33147162 PMCID: PMC7717923 DOI: 10.2196/21939] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/04/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 pandemic has revealed limitations in real-time surveillance needed for responsive health care action in low- and middle-income countries (LMICs). The Pakistan Registry for Intensive CarE (PRICE) was adapted to enable International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)–compliant real-time reporting of severe acute respiratory infection (SARI). The cloud-based common data model and standardized nomenclature of the registry platform ensure interoperability of data and reporting between regional and global stakeholders. Inbuilt analytics enable stakeholders to visualize individual and aggregate epidemiological, clinical, and operational data in real time. The PRICE system operates in 5 of 7 administrative regions of Pakistan. The same platform supports acute and critical care registries in eleven countries in South Asia and sub-Saharan Africa. ISARIC-compliant SARI reporting was successfully implemented by leveraging the existing PRICE infrastructure in all 49 member intensive care units (ICUs), enabling clinicians, operational leads, and established stakeholders with responsibilities for coordinating the pandemic response to access real-time information on suspected and confirmed COVID-19 cases (N=592 as of May 2020) via secure registry portals. ICU occupancy rates, use of ICU resources, mechanical ventilation, renal replacement therapy, and ICU outcomes were reported through registry dashboards. This information has facilitated coordination of critical care resources, health care worker training, and discussions on treatment strategies. The PRICE network is now being recruited to international multicenter clinical trials regarding COVID-19 management, leveraging the registry platform. Systematic and standardized reporting of SARI is feasible in LMICs. Existing registry platforms can be adapted for pandemic research, surveillance, and resource planning.
Collapse
Affiliation(s)
-
- Collaboration for Research, Improvement and Training in Critical Care in Asia, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Please see acknowledgements section for list of collaborators, Bangkok, Thailand
| | - Madiha Hashmi
- Department of Critical Care, Ziauddin University, Karachi, Pakistan
| | - Abi Beane
- Collaboration for Research, Improvement and Training in Critical Care in Asia, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Srinivas Murthy
- Department of Pediatrics, University of British Colombia, Vancouver, BC, Canada
| | - Arjen M Dondorp
- Collaboration for Research, Improvement and Training in Critical Care in Asia, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rashan Haniffa
- Collaboration for Research, Improvement and Training in Critical Care in Asia, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| |
Collapse
|
14
|
Morton B, Banda NP, Nsomba E, Ngoliwa C, Antoine S, Gondwe J, Limbani F, Henrion MYR, Chirombo J, Baker T, Kamalo P, Phiri C, Masamba L, Phiri T, Mallewa J, Mwandumba HC, Mndolo KS, Gordon S, Rylance J. Establishment of a high-dependency unit in Malawi. BMJ Glob Health 2020; 5:e004041. [PMID: 33214176 PMCID: PMC7678231 DOI: 10.1136/bmjgh-2020-004041] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 11/19/2022] Open
Abstract
Adults admitted to hospital with critical illness are vulnerable and at high risk of morbidity and mortality, especially in sub-Saharan African settings where resources are severely limited. As life expectancy increases, patient demographics and healthcare needs are increasingly complex and require integrated approaches. Patient outcomes could be improved by increased critical care provision that standardises healthcare delivery, provides specialist staff and enhanced patient monitoring and facilitates some treatment modalities for organ support. In Malawi, we established a new high-dependency unit within Queen Elizabeth Central Hospital, a tertiary referral centre serving the country's Southern region. This unit was designed in partnership with managers, clinicians, nurses and patients to address their needs. In this practice piece, we describe a participatory approach to design and implement a sustainable high-dependency unit for a low-income sub-Saharan African setting. This included: prospective agreement on remit, alignment with existing services, refurbishment of a dedicated physical space, recruitment and training of specialist nurses, development of context-sensitive clinical standard operating procedures, purchase of appropriate and durable equipment and creation of digital clinical information systems. As the global COVID-19 pandemic unfolded, we accelerated unit opening in anticipation of increased clinical requirement and describe how the high-dependency unit responded to this demand.
Collapse
Affiliation(s)
- Ben Morton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Edna Nsomba
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Sandra Antoine
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Joel Gondwe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Felix Limbani
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Marc Yves Romain Henrion
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - James Chirombo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Leo Masamba
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Tamara Phiri
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Jane Mallewa
- Department of Medicine, College of Medicine, Blantyre, Malawi
| | - Henry Charles Mwandumba
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Medicine, College of Medicine, Blantyre, Malawi
| | | | - Stephen Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Medicine, College of Medicine, Blantyre, Malawi
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Medicine, College of Medicine, Blantyre, Malawi
| |
Collapse
|
15
|
Adhikari NKJ, Arali R, Attanayake U, Balasundaram S, Beane A, Chakravarthy V, Channanath Ashraf N, Darshana S, Devaprasad D, Dondorp AM, Fowler R, Haniffa R, Ishani P, James A, Jawad I, Jayakumar D, Kodipilly C, Laxmappa R, Mangal K, Mani A, Mathew M, Patodia S, Pattnaik R, Priyadarshini D, Pulicken M, Rabindrarajan E, Ramachandran P, Ramesh K, Rani U, Ranjit S, Ramaiyan A, Ramakrishnan N, Ranganathan L, Rashan T, Dominic Savio R, Selva J, Tirupakuzhi Vijayaraghavan BK, Tripathy S, Tolppa T, Udayanga I, Venkataraman R, Vijayan D. Implementing an intensive care registry in India: preliminary results of the case-mix program and an opportunity for quality improvement and research. Wellcome Open Res 2020; 5:182. [PMID: 33195819 PMCID: PMC7642994 DOI: 10.12688/wellcomeopenres.16152.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/19/2022] Open
Abstract
Background: The epidemiology of critical illness in India is distinct from high-income countries. However, limited data exist on resource availability, staffing patterns, case-mix and outcomes from critical illness. Critical care registries, by enabling a continual evaluation of service provision, epidemiology, resource availability and quality, can bridge these gaps in information. In January 2019, we established the Indian Registry of IntenSive care to map capacity and describe case-mix and outcomes. In this report, we describe the implementation process, preliminary results, opportunities for improvement, challenges and future directions. Methods: All adult and paediatric ICUs in India were eligible to join if they committed to entering data for ICU admissions. Data are collected by a designated representative through the electronic data collection platform of the registry. IRIS hosts data on a secure cloud-based server and access to the data is restricted to designated personnel and is protected with standard firewall and a valid secure socket layer (SSL) certificate. Each participating ICU owns and has access to its own data. All participating units have access to de-identified network-wide aggregate data which enables benchmarking and comparison. Results: The registry currently includes 14 adult and 1 paediatric ICU in the network (232 adult ICU beds and 9 paediatric ICU beds). There have been 8721 patient encounters with a mean age of 56.9 (SD 18.9); 61.4% of patients were male and admissions to participating ICUs were predominantly unplanned (87.5%). At admission, most patients (61.5%) received antibiotics, 17.3% needed vasopressors, and 23.7% were mechanically ventilated. Mortality for the entire cohort was 9%. Data availability for demographics, clinical parameters, and indicators of admission severity was greater than 95%. Conclusions: IRIS represents a successful model for the continual evaluation of critical illness epidemiology in India and provides a framework for the deployment of multi-centre quality improvement and context-relevant clinical research.
Collapse
Affiliation(s)
- Neill K J Adhikari
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rajeshwari Arali
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Children's Hospital, Chennai, India
| | - Udara Attanayake
- Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | | | - Abi Beane
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka.,Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Vijay Chakravarthy
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | | | - Sri Darshana
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Dedeepiya Devaprasad
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Arjen M Dondorp
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Robert Fowler
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rashan Haniffa
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka.,Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Pramodya Ishani
- Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Augustian James
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Issrah Jawad
- Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Devachandran Jayakumar
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Chamira Kodipilly
- Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Rakesh Laxmappa
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Nanjappa Hospital, Shimoga, India
| | - Kishore Mangal
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Eternal Hospitals, Jaipur, India
| | - Ashwin Mani
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Meghena Mathew
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Sristi Patodia
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Rajyabardhan Pattnaik
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Ispat General Hospital, Rourkela, India
| | | | - Mathew Pulicken
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Pushpagiri Hospital, Tiruvalla, India
| | - Ebenezer Rabindrarajan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Pratheema Ramachandran
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Kavita Ramesh
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, ABC Hospitals, Vishakapatnam, India
| | - Usha Rani
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Suchitra Ranjit
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Children's Hospital, Chennai, India
| | - Ananth Ramaiyan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India
| | - Nagarajan Ramakrishnan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Lakshmi Ranganathan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Thalha Rashan
- Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Raymond Dominic Savio
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Jaganathan Selva
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Mehta Hospitals, Chennai, India
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Swagata Tripathy
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Timo Tolppa
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Ishara Udayanga
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Network for Improving Critical care Systems and Training, NICST, Colombo, Sri Lanka
| | - Ramesh Venkataraman
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,Critical Care Medicine, Apollo Hospitals, Chennai, India
| | - Deepak Vijayan
- Indian Registry of IntenSive care, IRIS, Chennai, India.,Critical Care Medicine, Kerala Institute of Medical Sciences, Thiruvananthapuram, India
| |
Collapse
|
16
|
Establishing a critical care network in Asia to improve care for critically ill patients in low- and middle-income countries. Crit Care 2020; 24:608. [PMID: 33059761 PMCID: PMC7558669 DOI: 10.1186/s13054-020-03321-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/19/2022] Open
|
17
|
Hashmi M, Taqi A, Memon MI, Ali SM, Khaskheli S, Sheharyar M, Hayat M, Shiekh M, Kodippily C, Gamage D, Dondorp AM, Haniffa R, Beane A. A national survey of critical care services in hospitals accredited for training in a lower-middle income country: Pakistan. J Crit Care 2020; 60:273-278. [PMID: 32942162 PMCID: PMC7441021 DOI: 10.1016/j.jcrc.2020.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe the extent and variation of critical care services in Pakistan. MATERIALS AND METHODS A cross-sectional survey was conducted in all intensive care units (ICUs) recognised for postgraduate training to determine administration, infrastructure, equipment, staffing, and training. RESULTS There were 151 hospitals recognised for training, providing 2166 ICU beds and 1473 ventilators. Regional distribution of ICU beds per 100,000 population ranged from 1.0 in Sindh to none in Gilgit Baltistan (median 0.7). A senior clinician trained in critical care was available in 19 (12.1%) of units. One-to-one nurse-to-bed ratio during the day was available in 84 (53.5%) of units, dropping to 75 (47.8%) at night. Availability of 1:1 nursing also varied between provinces, ranging from 56.5% in Punjab compared to 0% in Azad Jamu Kashmir. Similarly, there was disparity in the availability of ventilators between provinces. All ICUs had basic infrastructure (electricity, running water, piped oxygen) and basic equipment (electronic monitoring and infusion pumps). CONCLUSION Pakistan, a lower middle-income country, has an established network of critical care facilities with access to basic equipment, but inequalities in its distribution. Investment in critical care training for doctors and nurses is needed.
Collapse
Affiliation(s)
- Madiha Hashmi
- Ziauddin University, 4/B, Saharah-e-Ghalib, Block 6, Clifton Karachi, 7500, Sindh, Pakistan
| | - Arshad Taqi
- Kaul Associates, 14 AbuBaker Block, New Garden Town, Lahore, Punjab, Pakistan
| | - Muhammad I Memon
- Pakistan Institute of Medical Sciences, Ibn-e-Sina Road, G-8/3, Islamabad, Islamabad Capital Territory, Pakistan
| | - Syed Muneeb Ali
- Pakistan Institute of Medical Sciences, Ibn-e-Sina Road, G-8/3, Islamabad, Islamabad Capital Territory, Pakistan
| | - Saleh Khaskheli
- People's University of Medical & Health Sciences for Women, Nawabshah, Shaheed Benazirabad, 67480, Sindh, Pakistan
| | - Muhammad Sheharyar
- Lady Reading Hospital, Soekarno Road, Peshawar, Khyber Pakhtunkhwa 25000, Pakistan
| | - Muhammad Hayat
- North West General Hospital, Sector A-3, Phase 5, Hayatabad, Peshawar, Khyber Pakhtunkhwa 25100, Pakistan
| | - Mohiuddin Shiekh
- South East Asian Research in Criticalcare and Health, Remedial Centre Hospital, D-9, Block-I, North Nazimabad, Karachi 74700, Pakistan
| | - Chamira Kodippily
- Network for Improving Critical Care Systems and Training, 2nd floor, YMBA Building, Colombo 08, Sri Lanka
| | - Dilanthi Gamage
- Network for Improving Critical Care Systems and Training, 2nd floor, YMBA Building, Colombo 08, Sri Lanka
| | - Arjen M Dondorp
- Department of Malaria and Critical Illness, Mahidol Oxford Tropical Medicine Research Unit, 3/F, 60th Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok 10400, Thailand
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, 2nd floor, YMBA Building, Colombo 08, Sri Lanka; Department of Malaria and Critical Illness, Mahidol Oxford Tropical Medicine Research Unit, 3/F, 60th Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok 10400, Thailand; Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Abi Beane
- Network for Improving Critical Care Systems and Training, 2nd floor, YMBA Building, Colombo 08, Sri Lanka; Department of Malaria and Critical Illness, Mahidol Oxford Tropical Medicine Research Unit, 3/F, 60th Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok 10400, Thailand; Amsterdam Institute for Global Health and Development, University of Amsterdam, Paasheuvelweg 25, 1105, BP, Amsterdam, Netherlands.
| |
Collapse
|
18
|
Litton E, Guidet B, de Lange D. National registries: Lessons learnt from quality improvement initiatives in intensive care. J Crit Care 2020; 60:311-318. [PMID: 32977140 DOI: 10.1016/j.jcrc.2020.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/29/2020] [Accepted: 08/11/2020] [Indexed: 01/01/2023]
Abstract
National clinical quality registries (CQRs) are effective tools for improving the outcomes of patients admitted to the intensive care unit (ICU), and are increasingly important as healthcare needs evolve. A high-quality ICU CQR is built from a foundation of common requirements and challenges. First, performance indicators of the structure, process, or outcomes of patient care should measure what is important. Second, high data quality is essential and can be collected and curated through standardized processes. Third, standardized mortality ratio (SMR) is a cornerstone for benchmarking ICU performance, but application requires a comprehensive understanding of its context and potential pitfalls. Fourth, data collection alone is insufficient. Quality improvement comes from closing the feedback loop by identifying and managing unwarranted practice variation. Fifth, the process of improving healthcare is fundamentally a human enterprise, subject to behavioural change, including those that modify performance. Sixth, ICU CQRs must be dynamic to meet the needs of an evolving healthcare system and stakeholders. Finally, these lessons are far from comprehensive. Sharing perspectives on the development of ICU CQRs can help maximise their value as a powerful platform for informing policy development and improving the outcomes of patients admitted to the ICU.
Collapse
Affiliation(s)
- Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Robin Warren Drive, Perth 6065, Australia; St John of God Hospital, Salvado Road, Subiaco, Perth 6009, Australia.
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Service de Réanimation, Paris F75012, France
| | - Dylan de Lange
- Intensive Care Unit, University Medical Centre, Utrecht 85500, Netherlands
| |
Collapse
|
19
|
Adhikari NKJ, Arali R, Attanayake U, Balasundaram S, Beane A, Chakravarthy V, Channanath Ashraf N, Darshana S, Devaprasad D, Dondorp AM, Fowler R, Haniffa R, Ishani P, James A, Jawad I, Jayakumar D, Kodipilly C, Laxmappa R, Mangal K, Mani A, Mathew M, Patodia S, Pattnaik R, Priyadarshini D, Pulicken M, Rabindrarajan E, Ramachandran P, Ramesh K, Rani U, Ranjit S, Ramaiyan A, Ramakrishnan N, Ranganathan L, Rashan T, Dominic Savio R, Selva J, Tirupakuzhi Vijayaraghavan BK, Tripathy S, Tolppa T, Udayanga I, Venkataraman R, Vijayan D. Implementing an intensive care registry in India: preliminary results of the case-mix program and an opportunity for quality improvement and research. Wellcome Open Res 2020; 5:182. [DOI: 10.12688/wellcomeopenres.16152.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The epidemiology of critical illness in India is distinct from high-income countries. However, limited data exist on resource availability, staffing patterns, case-mix and outcomes from critical illness. Critical care registries, by enabling a continual evaluation of service provision, epidemiology, resource availability and quality, can bridge these gaps in information. In January 2019, we established the Indian Registry of IntenSive care to map capacity and describe case-mix and outcomes. In this report, we describe the implementation process, preliminary results, opportunities for improvement, challenges and future directions. Methods: All adult and paediatric ICUs in India were eligible to join if they committed to entering data for ICU admissions. Data are collected by a designated representative through the electronic data collection platform of the registry. IRIS hosts data on a secure cloud-based server and access to the data is restricted to designated personnel and is protected with standard firewall and a valid secure socket layer (SSL) certificate. Each participating ICU owns and has access to its own data. All participating units have access to de-identified network-wide aggregate data which enables benchmarking and comparison. Results: The registry currently includes 14 adult and 1 paediatric ICU in the network (232 adult ICU beds and 9 paediatric ICU beds). There have been 8721 patient encounters with a mean age of 56.9 (SD 18.9); 61.4% of patients were male and admissions to participating ICUs were predominantly unplanned (87.5%). At admission, most patients (61.5%) received antibiotics, 17.3% needed vasopressors, and 23.7% were mechanically ventilated. Mortality for the entire cohort was 9%. Data availability for demographics, clinical parameters, and indicators of admission severity was greater than 95%. Conclusions: IRIS represents a successful model for the continual evaluation of critical illness epidemiology in India and provides a framework for the deployment of multi-centre quality improvement and context-relevant clinical research.
Collapse
|
20
|
Prescott HC, Iwashyna TJ, Blackwood B, Calandra T, Chlan LL, Choong K, Connolly B, Dark P, Ferrucci L, Finfer S, Girard TD, Hodgson C, Hopkins RO, Hough CL, Jackson JC, Machado FR, Marshall JC, Misak C, Needham DM, Panigrahi P, Reinhart K, Yende S, Zafonte R, Rowan KM. Understanding and Enhancing Sepsis Survivorship. Priorities for Research and Practice. Am J Respir Crit Care Med 2019; 200:972-981. [PMID: 31161771 PMCID: PMC6794113 DOI: 10.1164/rccm.201812-2383cp] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/31/2019] [Indexed: 12/25/2022] Open
Abstract
An estimated 14.1 million patients survive sepsis each year. Many survivors experience poor long-term outcomes, including new or worsened neuropsychological impairment; physical disability; and vulnerability to further health deterioration, including recurrent infection, cardiovascular events, and acute renal failure. However, clinical trials and guidelines have focused on shorter-term survival, so there are few data on promoting longer-term recovery. To address this unmet need, the International Sepsis Forum convened a colloquium in February 2018 titled "Understanding and Enhancing Sepsis Survivorship." The goals were to identify gaps and limitations of current research and shorter- and longer-term priorities for understanding and enhancing sepsis survivorship. Twenty-six experts from eight countries participated. The top short-term priorities identified by nominal group technique culminating in formal voting were to better leverage existing databases for research, develop and disseminate educational resources on postsepsis morbidity, and partner with sepsis survivors to define and achieve research priorities. The top longer-term priorities were to study mechanisms of long-term morbidity through large cohort studies with deep phenotyping, build a harmonized global sepsis registry to facilitate enrollment in cohorts and trials, and complete detailed longitudinal follow-up to characterize the diversity of recovery experiences. This perspective reviews colloquium discussions, the identified priorities, and current initiatives to address them.
Collapse
Affiliation(s)
- Hallie C. Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
| | - Theodore J. Iwashyna
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Linda L. Chlan
- Nursing Research Division, Department of Nursing, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Karen Choong
- Department of Pediatrics
- Department of Critical Care, and
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Bronwen Connolly
- Lane Fox Respiratory Unit, St. Thomas’ Hospital, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Paul Dark
- National Specialty Lead for Critical Care, National Institute for Health Research, and
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Timothy D. Girard
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Ramona O. Hopkins
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah
- Center for Humanizing Critical Care at Intermountain Healthcare, Murray, Utah
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah
| | - Catherine L. Hough
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - James C. Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Flavia R. Machado
- Anesthesiology, Pain, and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil
| | - John C. Marshall
- Department of Surgery
- Department of Critical Care Medicine, and
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Cheryl Misak
- Department of Philosophy, University of Toronto, Toronto, Ontario, Canada
| | - Dale M. Needham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Pinaki Panigrahi
- Department of Pediatrics, Georgetown University Medical Center, Washington, DC
| | - Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Stiftung Charité Klinik für Anäesthesie Operative Intensivmedizin, Charité Universitätsmedizin, Berlin, Germany
| | - Sachin Yende
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Veterans Affairs Pittsburgh Healthcare System, Pittsburg, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts; and
| | - Kathryn M. Rowan
- Intensive Care National Audit and Research Centre, London, United Kingdom
| | - on behalf of the International Sepsis Forum
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Nursing Research Division, Department of Nursing, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
- Department of Pediatrics
- Department of Critical Care, and
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Lane Fox Respiratory Unit, St. Thomas’ Hospital, Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
- National Specialty Lead for Critical Care, National Institute for Health Research, and
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah
- Center for Humanizing Critical Care at Intermountain Healthcare, Murray, Utah
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee
- Anesthesiology, Pain, and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil
- Department of Surgery
- Department of Critical Care Medicine, and
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Philosophy, University of Toronto, Toronto, Ontario, Canada
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, and
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Department of Pediatrics, Georgetown University Medical Center, Washington, DC
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Stiftung Charité Klinik für Anäesthesie Operative Intensivmedizin, Charité Universitätsmedizin, Berlin, Germany
- Veterans Affairs Pittsburgh Healthcare System, Pittsburg, Pennsylvania
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts; and
- Intensive Care National Audit and Research Centre, London, United Kingdom
| |
Collapse
|
21
|
Mowafi H, Ngaruiya C, O'Reilly G, Kobusingye O, Kapil V, Rubiano AM, Ong M, Puyana JC, Rahman AKMF, Jooma R, Beecroft B, Razzak J. Emergency care surveillance and emergency care registries in low-income and middle-income countries: conceptual challenges and future directions for research. BMJ Glob Health 2019; 4:e001442. [PMID: 31406601 PMCID: PMC6666805 DOI: 10.1136/bmjgh-2019-001442] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 03/17/2019] [Indexed: 12/17/2022] Open
Abstract
Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. Using these articles, a working group was convened by the US National Institutes of Health Fogarty International Center to discuss challenges and potential solutions for established systems to better understand global emergency care in LMICs. The working group focused on potential uses for emergency care surveillance and registry data to improve the quality of services provided to patients. Challenges included a lack of dedicated resources for such research in LMIC settings as well as over-reliance on facility-based data collection without known correlation to the overall burden of emergency conditions in the broader community. The group outlined potential solutions including incorporating data from sources beyond traditional health records, use of standard clinical forms that embed data needed for research and policy making and structured population-based research to establish clear linkages between what is seen in emergency units and the wider community. The group then identified current gaps in LMIC emergency care surveillance and registry research to form a research agenda for the future.
Collapse
Affiliation(s)
- Hani Mowafi
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christine Ngaruiya
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gerard O'Reilly
- Department of Epidemiology & Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Olive Kobusingye
- Department of Disease Control & Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Vikas Kapil
- Center for Global Health Leadership, Centers for Disease Control and Prevention Center for Global Health, Atlanta, Georgia, USA
| | - Andres M Rubiano
- Department of Neurosurgery, Universidad El Bosque, Bogota, Colombia
| | - Marcus Ong
- Department of Emergency Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Juan Carlos Puyana
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Rashid Jooma
- Department of Neurosurgery, Aga Khan University Medical College Pakistan, Karachi, Sindh, Pakistan
| | - Blythe Beecroft
- CGHS, John E Fogarty International Center, Bethesda, Maryland, USA
| | - Junaid Razzak
- Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
22
|
Beane A, De Silva AP, Athapattu PL, Jayasinghe S, Abayadeera AU, Wijerathne M, Udayanga I, Rathnayake S, Dondorp AM, Haniffa R. Addressing the information deficit in global health: lessons from a digital acute care platform in Sri Lanka. BMJ Glob Health 2019; 4:e001134. [PMID: 30775004 PMCID: PMC6352842 DOI: 10.1136/bmjgh-2018-001134] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/08/2018] [Accepted: 12/13/2018] [Indexed: 12/19/2022] Open
Abstract
Lack of investment in low-income and middle-income countries (LMICs) in systems capturing continuous information regarding care of the acutely unwell patient is hindering global efforts to address inequalities, both at facility and national level. Furthermore, this of lack of data is disempowering frontline staff and those seeking to support them, from progressing setting-relevant research and quality improvement. In contrast to high-income country (HIC) settings, where electronic surveillance has boosted the capability of governments, clinicians and researchers to engage in service-wide healthcare evaluation, healthcare information in resource-limited settings remains almost exclusively paper based. In this practice paper, we describe the efforts of a collaboration of clinicians, administrators, researchers and healthcare informaticians working in South Asia, in addressing the inequality in access to patient information in acute care. Harnessing a clinician-led collaborative approach to design and evaluation, we have implemented a national acute care information platform in Sri Lanka that is tailored to priorities of frontline staff. Iterative adaptation has ensured the platform has the flexibility to integrate with legacy paper systems, support junior team members in advocating for acutely unwell patients and has made information captured accessible to diverse stakeholders to improve service delivery. The same platform is now empowering clinicians to participate in international research and drive forwards improvements in care. During this journey, we have also gained insights on how to overcome well-described barriers to implementation of digital information tools in LMIC. We anticipate that this north-south collaborative approach to addressing the challenges of health system implementation in acute care may provide learning and inspiration to other partnerships seeking to engage in similar work.
Collapse
Affiliation(s)
- Abi Beane
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | | | | | - Saroj Jayasinghe
- Department of Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Mandika Wijerathne
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ishara Udayanga
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
| | | | | | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| |
Collapse
|
23
|
Vijayaraghavan BKT, Venkatraman R, Ramakrishnan N. Critical Care Registries: The Next Big Stride? Indian J Crit Care Med 2019; 23:387. [PMID: 31485112 PMCID: PMC6709833 DOI: 10.5005/jp-journals-10071-23227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
How to cite this article: Vijayaraghavan BKT, Venkatraman R, Ramakrishnan N. Critical Care Registries: The Next Big Stride? Indian J Crit Care Med 2019;23(8):387.
Collapse
Affiliation(s)
| | - Ramesh Venkatraman
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | |
Collapse
|