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CRITICAL CARE: Scientists urge better understanding of “critical illness” in provision of care

March 21, 2023
CRITICAL CARE: Scientists urge better understanding of “critical illness” in provision of care
A snip from the Frontiers in Health Services journal with an inset of the first author of the publication from Ifakara Health Institute, Elibariki Mkumbo. GRAPHIC | IFAKARA/KMC.

Scientists from Ifakara Health Institute and partner institutions have identified a lack of a unified understanding of the label ‘critical illness’ among health workers in Tanzania and Kenya which they caution can potentially hinder patients from getting urgent life-saving care.

This was revealed in a study published in the Frontiers in Health Services journal on February 7, 2023. The scientists conducted interviews with health workers with experience in providing care between January and December 2021 during the COVID-19 pandemic.

Elibariki Mkumbo, Karima Khalid, John Maiba and Tim Baker from Ifakara contributed to the study alongside Tamara Willows and Jacob McKnight from Oxford University, UK; Onesmus Onyango and Jacquie Oliwa from KEMRI-Wellcome Trust, Kenya; and Carl Otto Schell from Karolinska Institutet, Sweden.

A total of 30 health workers – 12 doctors and 18 nurses from 10 study hospitals – 5 in Kenya and 5 in Tanzania were interviewed. The selected hospitals were government owned at primary, secondary and tertiary levels representing various levels of care.

In the study, the scientists confirm that critical illness is a commonly used label in healthcare and yet appears to be differently understood by different health workers, which scientists believe to have a profound impact on the identification and management of patients.

“We have found that health workers understand the label ‘critical illness’ in diverse ways. The label can be used for patients that have a life-threatening state, are suffering from certain diagnoses, are receiving care in certain locations, or need a certain level of care.”

The scientists further warn about the variation in the understanding of critical illness among health workers which they argue can lead to inappropriate decisions about care, attentiveness, and the need to call for help and referral.

“Labels determine health workers’ attitudes towards patients in terms of the required critical illness label will likely change health workers’ levels of attentiveness to patients i.e., which patients require more attention and which are satisfied with less.”

According to the scientists, a recently proposed definition by Kayambankadzanja and colleagues, “a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided and the potential for reversibility”, could be useful for improving communication and care.

“Our findings stress the importance of developing a standard definition of critical illness and transmitting that knowledge to healthcare workers,” they say.

“We call for more studies from different settings to understand the impact of varied understandings of this key label on care provision and patient outcomes, and relatedly, for studies that would assess the impact of a standardized definition.”

>> Link to publication: https://pubmed.ncbi.nlm.nih.gov/36811083/