ICU Resource Allocation Challenges in Neurocritical Care: Insights from a Zambian Hospital
Phoebe Chen1, Kasakula Kaunda2, Vanessa Salasky3, Stanley Zimba4, Ngosa Mumba4, Deanna Saylor5, Morgan Prust1
1Yale University School of Medicine, 2Mansa General Hospital, Mansa, Zambia, 3Virtua Health, 4University Teaching Hospital, Lusaka, Zambia, 5Johns Hopkins University School of Medicine
Objective:
Identify resource gaps and opportunities to improve critical care with local stakeholders in the intensive care unit (ICU) of a Zambian hospital, focusing on the care of patients with critical neurological illnesses.
Background:
With the rising global burden of neurocritical illnesses disproportionately impacting low- and middle-income countries (LMICs), it is vital to build inpatient systems of care for acute neurologic illness in resource-limited health systems. Characterizing the resource challenges of LMIC hospital environments is essential for building neurocritical care capacities globally.
Design/Methods:
Individual interviews were conducted with nine health care workers involved in ICU care at a major hospital in Zambia using a semi-structured interview guide. Interviews were recorded, transcribed, and thematically analyzed.
Results:
Participants consisted of 2 nurses, 6 doctors, and 1 clinical support staff member. They reported significant limitations in ICU resources including workforce and staff expertise in critical and neurocritical care, diagnostics such as neuroimaging and EEG, and essential medications and equipment such as anti-seizure medications and central lines. Participants favored more support for palliative and post-discharge care due to significant mortality reported after ICU discharge to a lower-acuity unit or following complications at home. Participants also proposed improving care coordination between medical teams and introducing standardized protocols for neurological emergencies. Participants’ primary critique of the current ICU triage process was that it was first-come-first-served without clear prioritization criteria or intensivist oversight, resulting in frequent admission of patients with poor neurologic prognoses and long ICU length-of-stay. All participants supported introducing an ICU triage system to prioritize patients with higher likelihood of recovery in a reasonable time frame.
Conclusions:
ICU workers in Zambia favored an outcomes-based ICU triage protocol over a first-come-first-served approach. In low resource settings, conducting an ICU needs assessment and developing a triage protocol may be key steps toward optimizing care for critically ill neurological patients.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.