National audit of critical care resources in South Africa: Transfer of critically ill patients

Abstract

Objectives: To establish the efficacy of the current system of referral of critical care patients:
• from public hospitals with no ICU or HCU facilities to hospitals with appropriate facilities; and
• from public and private sector hospitals with ICU or HCU facilities to hospitals with appropriate facilities.
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:
A 100% sample was obtained. 77% of public and 16% of private hospitals have no ICU/HC units. Spread of hospitals was disproportionate across provinces.
There was considerable variation (less than one hour to six hours) in time to collect between provinces and between public hospitals that have or do not have ICU/HCU facilities. In the private hospitals, the mean time to collect was less than an hour.
In public hospitals without an ICU, the distance to an ICU was 100 kilometres or less for approximately 50% of hospitals and less than 10% of these hospitals was more than 300 kilometres away. For hospitals with units (public and private), the distance to an appropriate hospital was 100 kilometres or less for approximately 60% of units while for 10% of hospitals the distance was greater than 300 kilometres.
Public hospitals without units the majority of patients were transferred by non-ICU transport. Both public and private hospitals transferred ICU patients from one ICU to another ICU in non-ICU transport in some instances.
Conclusion: A combination of current resource constraints, the vast distances in some regions of the country and the historical disparities of health resource distribution represent a unique challenge which demands a novel approach to equitable health care appropriation.