Introduction
The intensive care unit (ICU) is defined as a designated area where close monitoring and life support treatments are provided for patients with potential or established organ failure. The ICU therefore provides a higher level of care and facilities than the general wards or intermediate care units, with such care being delivered by specially trained staff. [1] For the purposes of the p
The intensive care unit (ICU) is defined as a designated area where close monitoring and life support treatments are provided for patients with potential or established organ failure. The ICU therefore provides a higher level of care and facilities than the general wards or intermediate care units, with such care being delivered by specially trained staff. [1] For the purposes of the present document, critical care refers to care provided in an ICU.
Internationally, intensive care is faced with the challenge of resource scarcity and an exponentially increasing demand for ICU services. [2-5] ICU services are expensive and, although limited literature exists to quantify the burden of critical illness and resource scarcity in low- and middle-income countries (LMICs), practitioners in LIMCs experience daily the consequences of these limited resources. The motivation for this consensus statement is the universal experience of ICU practitioners in South Africa (SA) that as a consequence of critically limited resources, rationing and triage (prioritisation) decisions are frequently necessary, particularly in the publicly funded health sector. The development of a consensus statement and guideline for intensive care practitioners is intended to facilitate these decisions. These documents are important to ensure the ongoing provision of high-quality care to adult patients referred for intensive care. The recommendations and processes should provide for both the best utilisation of intensive care in SA, and the fair distribution of available resources. By promoting improved and consistent standards in decision-making practice, we aim to both protect and guide administrators and clinicians when faced with these difficult clinical and ethical challenges, and provide transparency to the public as to how decisions are made. [6]
The purpose of this consensus statement is to examine key questions that arise when considering the status of ICU resources in SA, and more specifically ICU admission, rationing and triage decisions in the South African context. The expert consensus group aimed to summarise current evidence and provide consensus-based recommendations addressing these questions. This statement is accompanied by a clinical practice guideline [7] that provides a framework to inform frontline triage policy and ensure the best utilisation of intensive care in SA, while maintaining the fair distribution of available resources.
The Critical Care Society of Southern Africa Consensus Statement on ICU Triage and Rationing (ConICTri)_SAMJ/SAJCC_July 2019, Vol. 35, No. 1