The burden on emergency centres to provide care for critically ill patients in Addis Ababa, Ethiopia

Abstract

Introduction: Given the scarcity of critical care hospital beds in Africa, emergency centres (ECs) are increasingly charged with caring for critically ill patients for extended periods of time. The objective of this study was to improve the understanding of the nature and outcomes of critically ill patients with prolonged treatment times of more than six hours in two ECs in Addis Ababa, Ethiopia. Methods: This study was conducted over three months in two ECs of urban tertiary care hospitals in Addis Ababa. Structured questionnaires were completed by six emergency and critical care nurses. EC patients were included if they met the Society for Critical Care Medicine (SCCM) intensive care unit (ICU) admission criteria and stayed in the EC for more than 6 h. We collected initial demographic and clinical information, data about the patients’ clinical course in the EC, and data regarding the patients’ disposition. We used descriptive statistics for analysis. Results: A total of 291 patients, over the course of three months, had an EC stay that exceeded six hours. The median length of stay for these patients was 48 h (interquartile range: 25–72 h). The most common categories of illness were neurological disease in 87 patients (30%) and cardiovascular disease in 61 patients (21%). The most frequent aetiologies of critical illness were severe head trauma and severe sepsis with multi-organ failure (26 patients, 9% each). A total of 94 patients (32%) died in the EC, while 86 (30%) were discharged directly from the EC without hospital admission. Discussion: ECs in Addis Ababa face a heavy burden in caring for a large number of critically ill patients over a long period of time, with relatively high mortality rates. These findings should promote supporting emergency centres to strengthen and expand ICU capacity to provide appropriate critical care services. Keywords: Emergency medicine, Critical care, Overcrowding, Ethiopia