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Abstract Details

ICU Resource Allocation Challenges in Neurocritical Care: Insights from a Zambian Hospital
General Neurology
P6 - Poster Session 6 (11:45 AM-12:45 PM)
11-006

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.

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.

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.
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.
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.
Authors/Disclosures
Phoebe Chen
PRESENTER 		Ms. Chen has nothing to disclose.
Kasakula Kaunda (UTH Internal Medicine Department) Kasakula Kaunda has nothing to disclose.
Vanessa Salasky, MD (University of Maryland) Dr. Salasky has nothing to disclose.
Stanley Zimba, MBBS (University Teaching Hospital) Dr. Zimba has nothing to disclose.
Ngosa Mumba Ngosa Mumba has nothing to disclose.
Deanna Saylor, MD, MHS, FÂ鶹´«Ã½Ó³»­ (Johns Hopkins Hospital) Dr. Saylor has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Â鶹´«Ã½Ó³»­. The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from Â鶹´«Ã½Ó³»­. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and Â鶹´«Ã½Ó³»­al Innovation Commitees with American Neurological Association that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
Morgan Prust, MD (Yale University School of Medicine) Dr. Prust has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Edelman & Edelman, PC.