Establishment of a high-dependency unit in Malawi

Morton, Ben ORCID: https://orcid.org/0000-0002-6164-2854, Banda, Ndaziona Peter, Nsomba, Edna, Ngoliwa, Clara, Antoine, Sandra, Gondwe, Joel, Limbani, Felix, Henrion, Marc, Chirombo, James, Baker, Tim, Kamalo, Patrick, Phiri, Chimota, Masamba, Leo, Phiri, Tamara, Mallewa, Jane, Mwandumba, Henry ORCID: https://orcid.org/0000-0003-4470-3608, Mndolo, Kwazizira Samson, Gordon, Stephen ORCID: https://orcid.org/0000-0001-6576-1116 and Rylance, Jamie ORCID: https://orcid.org/0000-0002-2323-3611 (2020) 'Establishment of a high-dependency unit in Malawi'. BMJ Global Health, Vol 5, Issue 11, e004041.

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Abstract

Adults admitted to hospital with critical illness are vulnerable and at high risk of morbidity and mortality, especially in sub-Saharan African settings where resources are severely limited. As life expectancy increases, patient demographics and healthcare needs are increasingly complex and require integrated approaches. Patient outcomes could be improved by increased critical care provision that standardises healthcare delivery, provides specialist staff and enhanced patient monitoring and facilitates some treatment modalities for organ support. In Malawi, we established a new high-dependency unit within Queen Elizabeth Central Hospital, a tertiary referral centre serving the country’s Southern region. This unit was designed in partnership with managers, clinicians, nurses and patients to address their needs. In this practice piece, we describe a participatory approach to design and implement a sustainable high-dependency unit for a low-income sub-Saharan African setting. This included: prospective agreement on remit, alignment with existing services, refurbishment of a dedicated physical space, recruitment and training of specialist nurses, development of context-sensitive clinical standard operating procedures, purchase of appropriate and durable equipment and creation of digital clinical information systems. As the global COVID-19 pandemic unfolded, we accelerated unit opening in anticipation of increased clinical requirement and describe how the high-dependency unit responded to this demand.

Item Type:	Article
Subjects:	WA Public Health > WA 105 Epidemiology WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WB Practice of Medicine > WB 26 Equipment and supplies WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 505 Viral respiratory tract infections
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > International Public Health Department Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI):	https://doi.org/10.1136/bmjgh-2020-004041
Depositing User:	Stacy Murtagh
Date Deposited:	23 Nov 2020 10:59
Last Modified:	23 Nov 2020 10:59
URI:	https://archive.lstmed.ac.uk/id/eprint/16184

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