Results from the first audit of an intensive care unit in Botswana

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Results from the first audit of an intensive care unit in Botswana


JournalSouthern African Journal of Critical Care
Publication date – Aug – 2020
Authors – A O MilanI, M CoxII, K MolebatsiIII
KeywordsAPACHE II score, clinical audit, HIV., ICU, middle-income country
Open access – Yes
SpecialityAnaesthesia
World region Southern Africa
Country: South Africa
Language – English
Submitted to the One Surgery Index on September 1, 2020 at 12:08 am
Abstract:

BACKGROUND: Botswana is an economically stable middle-income country with a developing health system and a large HIV and infectious disease burden. Princess Marina Hospital (PMH) is the largest referral and teaching hospital with a mixed eight-bed intensive care unit (ICU
OBJECTIVES: To conduct an audit of PMH ICU in order to investigate major admission categories and quantify morbidity and mortality figures using a validated scoring system for quality improvement, education and planning purposes
METHODS: PMH medical records and laboratory data were accessed to record demographics, referral patterns, diagnoses, HIV status, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II scores and mortality rates
RESULTS: A total of 182 patients >14 years of age were enrolled over a 12-month period from April 2017 – March 2018. Patient’s mean age was 42.9 years, males represented 56.6% of the study population and surgical conditions accounted for 46% of diagnostic categories. Sixty percent of the patients were HIV-negative and 12% had no HIV status recorded. The mean APACHE II score was 25 and the mean length of stay in ICU was 10.3 days. Higher APACHE II scores were associated with higher mortality regardless of HIV status. The overall mortality was 42.8% and there was no difference in mortality rates in ICU or at 30 days between HIV-positive and HIV-negative ICU patient groups
CONCLUSIONS: The PMH ICU population is young with a high mean APACHE II score, significant surgical and HIV burdens and a high mortality rate. PMH ICU has significant logistical challenges making comparison with international ICUs challenging, and further research is warranted

OSI Number – 20656

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