Establishing a critical care network in Asia to improve care for critically ill patients in low- and middle-income count
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EDITORIAL
Open Access
Establishing a critical care network in Asia to improve care for critically ill patients in low- and middle-income countries CRIT CARE ASIA
Keywords: Critical care, Quality improvement, Registry, Low- and middle-income countries
Introduction When undertaking quality improvement (QI) initiatives, one of the greatest burdens is repeated data collection. Intensive care registries, such as those commonly used in high-income countries (HICs), have enabled systematic capture of routine information needed to measure intensive care unit (ICU) performance [1]. Once considered unfeasible in resource-limited settings, newer cloud-based platforms are gaining increasing traction. Collaborative surveillance platforms, such as NICS-MORU and PRICE, which have mobile and desktop applications, have established methods for daily capture of individual patient-level information and have shown that—even in resourcelimited settings—the systematic evaluation of patient care throughout the hospital journey is feasible at scale using coalesced minimal data sets [2, 3]. Quality of care Poor quality of care has resulted in an estimated additional five million deaths, and six trillion US dollars in economic losses worldwide [4, 5]. In South and SouthEast Asia, a region which accounts for over 25% of the world’s population, poor quality health care is one of the biggest drivers of excess morbidity and mortality [4]. Recent recommendations from the Lancet Global Health Commission have called for greater investment in systems that strengthen evaluation and improvement, and a focus Correspondence: Collaboration for Research, Implementation and Training in intensive CARE in ASIA, Mahidol Oxford Tropical Research Unit, 3/F, 60th Anniversary Chalermprakiat Building, 420/6 Rajvithi Road, Bangkok, Thailand
on healthcare that is reflective of and sensitive to the diverse needs of communities [5]. Critical care is expensive and complex. Many barriers impede the optimal care of critically ill patients, especially in resource-restricted settings [6]. Basic equipment for monitoring, treatment and diagnosis is often unavailable and maintenance is suboptimal [7]. Supplies of laboratory consumables and essential medications can be unpredictable and the provision of basic commodities, such as oxygen, electricity and running water, unreliable. Despite these challenges, demand for these services continues and with it the need to establish systems by which quality of care can be continually improved.
Barriers to quality improvement in LMICs Lack of information for quality evaluation
The ability to continually evaluate care and empower stakeholders to identify priorities for improvement is a crucial but missing component of QI [4, 8]. In low- and middle-income countries (LMICs), the lack of reliable facility-level and national information has hampered the implementation of QI initiatives and prevented clinicians from identifying local research priorities [2]. Limited success of quality improvement
Many of the basic principles of ‘good
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