The need for appropriate critical care service provision at non-tertiary hospitals in South Africa
van Zyl-Smit, R.; Burch, V.; Willcox, P.
South African Medical Journal 97(4): 268 270 272
2007
ISSN/ISBN: 0256-9574 PMID: 17446951 Document Number: 609573
A prospective study was conducted to define and quantify the critical care service provided by the G F Jooste Hospital, a secondary-level hospital in Cape Town, South Africa. 859 medical patients admitted to the 8-bed high-care unit (HCU) of the hospital in 2003 were surveyed. Collectively, acute coronary syndromes, diabetic emergencies, drug overdose/poisoning and sepsis accounted for 76.6% of patients admitted. The median age of patients at admission was 45.3 years, with a median hospital stay of 2 days. The overall mean APACHE score was 10+or-7, with an overall HCU mortality of 10.7% (in-hospital mortality, 14.8%). Mechanical ventilation was required by 213 patients (24.8% of admissions). The mortality rate for ventilated patients was 30.1% (in-hospital, 38.5%). While this was significantly higher than the 4.3% for non-ventilated patients (in-hospital, 7.0%), it compares favourably with local and international data. Ventilated survivors had a significantly lower mean APACHE II score than the ventilated non-survivors (15 vs. 19). This was true for all survivors compared with non-survivors (9 vs. 18). These findings demonstrate a good patient outcome overall, given that this HCU provides limited intensive care unit facilities (mechanical ventilation) to more than 200 patients/year despite inadequate staff-patient ratios (1:2) and limited training. It is concluded that non-tertiary hospitals with mechanical ventilation facilities are currently providing much needed critical care in the Western Cape.