Simple jQuery Dropdowns
Please use this identifier to cite or link to this item: http://repository.li.mahidol.ac.th/dspace/handle/123456789/41527
Title: Impact of a structured ICU training programme in resource-limited settings in Asia
Authors: Rashan Haniffa
Yoel Lubell
Ben S. Cooper
Sanjib Mohanty
Shamsul Alam
Arjun Karki
Rajya Pattnaik
Ahmed Maswood
R. Haque
Raju Pangeni
Marcus J. Schultz
Arjen M. Dondorp
Nuffield Department of Clinical Medicine
Mahidol University
Ispat General Hospital
Chittagong Medical College Hospital
Friends of Patan Hospital Nepal
Academic Medical Centre, University of Amsterdam
Keywords: Agricultural and Biological Sciences;Biochemistry, Genetics and Molecular Biology
Issue Date: 1-Mar-2017
Citation: PLoS ONE. Vol.12, No.3 (2017)
Abstract: © 2017 Haniffa et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objective To assess the impact on ICU performance of a modular training program in three resourcelimited general adult ICUs in India, Bangladesh, and Nepal. Method A modular ICU training programme was evaluated using performance indicators from June 2009 to June 2012 using an interrupted time series design with an 8 to 15 month pre-intervention and 18 to 24 month post-intervention period. ICU physicians and nurses trained in Europe and the USA provided training for ICU doctors and nurses. The training program consisted of six modules on basic intensive care practices of 23 weeks each over 20 months. The performance indicators consisting of ICU mortality, time to ICU discharge, rate at which patients were discharged alive from the ICU, discontinuation of mechanical ventilation or vasoactive drugs and duration of antibiotic use were extracted. Stepwise changes and changes in trends associated with the intervention were analysed. Results Pre-Training ICU mortality in Rourkela (India), and Patan (Nepal) Chittagong (Bangladesh), was 28%, 41% and 62%, respectively, compared to 30%, 18% and 51% post-intervention. The intervention was associated with a stepwise reduction in cumulative incidence of in-ICU mortality in Chittagong (adjusted subdistribution hazard ratio [aSHR] (95% CI): 0.62 (0.40, 0.97), p = 0.03) and Patan (aSHR 0.16 (0.06, 0.41), p<0.001), but not in Rourkela (aSHR: 1.17 (0.75, 1.82), p = 0.49). The intervention was associated with earlier discontinuation of vasoactive drugs at Rourkela (adjusted hazard ratio for weekly change [aHR] 1.08 (1.03, 1.14), earlier discontinuation of mechanical ventilation in Chittagong (aHR 2.97 (1.24, 7.14), p = 0.02), and earlier ICU discharge in Patan (aHR 1.87 (1.02, 3.43), p = 0.04). Conclusion This structured training program was associated with a decrease in ICU mortality in two of three sites and improvement of other performance indicators. A larger cluster randomised study assessing process outcomes and longer-Term indicators is warranted.
URI: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85015445197&origin=inward
http://repository.li.mahidol.ac.th/dspace/handle/123456789/41527
ISSN: 19326203
Appears in Collections:Scopus 2016-2017

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.