Establishment of a high-dependency unit in Malawi.

Autor:	Morton B; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK ben.morton@lstmed.ac.uk.; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi., Banda NP; Department of Medicine, College of Medicine, Blantyre, Malawi., Nsomba E; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi., Ngoliwa C; Queen Elizabeth Central Hospital, Blantyre, Malawi., Antoine S; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi., Gondwe J; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi., Limbani F; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi., Henrion MYR; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi., Chirombo J; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi., Baker T; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden., Kamalo P; Queen Elizabeth Central Hospital, Blantyre, Malawi., Phiri C; Queen Elizabeth Central Hospital, Blantyre, Malawi., Masamba L; Queen Elizabeth Central Hospital, Blantyre, Malawi., Phiri T; Queen Elizabeth Central Hospital, Blantyre, Malawi., Mallewa J; Department of Medicine, College of Medicine, Blantyre, Malawi., Mwandumba HC; 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., Mndolo KS; Queen Elizabeth Central Hospital, Blantyre, Malawi., Gordon S; 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., Rylance J; 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.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2020 Nov; Vol. 5 (11).
DOI:	10.1136/bmjgh-2020-004041
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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