Global Challenges in Triage and Discharge Services Available to Intensive Care Patients. A Mixed-Methods Study.

Abstract

Introduction Integrated care improves patients’ outcome. Integration of services to provide care for the critically ill includes appropriate triage processes and delivery of post intensive care treatment in order to promote continuity of care. It is hypothesised that low resource settings limit the possibility of admitting patients to intensive care units and the service offered after discharge. Methods This mixed methods study involved 14 intensive care doctors from Europe, Africa and Asia. 14 doctors participated in a online survey and five of them in in-depth interviews. Nine of the 14 participants who completed the questionnaires described practice in a Low-Middle-Income Country, five respondents provided details of High-Income Country practice. Descriptive statistics and thematic analysis have been used to analise data. Results The study showed that resources impact on capacity and capability of intensive care triage and post discharge services (see additional information, figure 1 and 2), but countries with different level of income share the same criteria for triage and offer similar level of care to intensive care survivors (figure 3 and 4). Bed availability, lack of end of life procedures, and shortage of trained personnel are considered the main barriers to appropriate admission processes regardless of the locations represented in the study (figure 5). Participants identified the outreach services as a valid solution for timely decision making during triage and discharge from intensive care. Also it is agreed that post discharge services need to be strengthened in order to preserve and improve the health status achieved with critical care. The study participants shared the notion that relatives play an important role in supporting continuity of care and should be educated to assist the critically ill and their multiple needs. Limitations: The generalisability of results is limited by the study sample size. Also, the processes and services described in the study are not representative of the different levels of care available in each countries. Conclusion The global burden of critical illness could be tackled providing continuity of care. This could be achieved with appropriate infrastructures and education of professionals and relatives. Therefore the health systems in all resource settings may need to restructure they services to provide integrated care in order to address the multiple needs of critical care patients.