National audit of critical care resources in South Africa: open versus closed intensive and high care units

Abstract

Objectives: To evaluate the distribution and functioning of South African ICUs and high care units, in particular the extent to which units were “closed units”.
Design and Setting: Descriptive, non-interventive, observational study design was used. An audit of all public and private sector ICU and high care units in South Africa was undertaken.
Results: 100% sample was obtained. 396 acute care public and 256 private hospitals were identified. 23% of public hospitals had ICU and/or HCU compared to 84% of private hospitals. In the public hospitals there were 210 units and 238 units in the private hospitals. Only 7% of public units and less than 1% of private units were “ideal closed units”.
A total number of 3 414 ICU and high care beds were identified. 71% of beds were in open units versus 29% in closed units. The distribution of ICU and ICU/high care beds comprised 64% in private sector and 36% (1 223) in public units. A total of 244 024 patients were admitted to all units in South Africa during 2002 of which 63% were to private units and 37% were to public sector units.
Conclusion: In the face of already limited resources (financial and human) and given the emphasis on primary care medicine (with consequent limited capacity for further ICU development), it is crucial that existing facilities are maximally utilised. Like the US we are not in position to implement the Leapfrog recommendations and must modify our approach to dealing with South African realities.