Essential Emergency and Critical Care: a consensus among global clinical experts

Carl Otto Schell; Karima Khalid; Alexandra Wharton-Smith; Jacquie Oliwa; Hendry R. Sawe; Nobhojit Roy; Alex Sanga; John C. Marshall; Jamie Rylance; Claudia Hanson; Raphael K. Kayambankadzanja; Lee A. Wallis; Maria Jirwe; Tim Baker; Adam Asghar; Adam D. Laytin; Adrian J. Holloway; Ahmed Rhassane El Adib; Alexia Michaelides; Alvaro Coronado Munoz; Amos Muzuka; Analía Fernández; Andrea B. Pembe; Andreas Wellhagen; Andrew G. Smith; Anita Gadgil; Anna Hvarfner; Anuja Abayadeera; Asya Agulnik; Aurélie Godard; Balasubramanian Venkatesh; Bargo Mahamat Yousif; Benjamin Morton; Bhakti Sarang; Bharath Kumar Tirupakuzhi Vijayaraghavan; Bobby King; Brian Rice; C. Louise Thwaites; Chian Wern Tai; Christian Owoo; Cornelius Sendagire; Dan Brun Petersen; Daniel Tatay; David Lee Skinner; Denis Kinyua; Dhruva Ghosh; Diptesh Aryal; Donald Mlombwa; Duyen Thi Hanh Bui; Edwin R. Lugazia

doi:10.1136/bmjgh-2021-006585

Essential Emergency and Critical Care: a consensus among global clinical experts

Carl Otto Schell, Karima Khalid, Alexandra Wharton-Smith, Jacquie Oliwa, Hendry R. Sawe, Nobhojit Roy, Alex Sanga, John C. Marshall, Jamie Rylance, Claudia Hanson, Raphael K. Kayambankadzanja, Lee A. Wallis, Maria Jirwe, Tim Baker, Adam Asghar, Adam D. Laytin, Adrian J. Holloway, Ahmed Rhassane El Adib, Alexia Michaelides, Alvaro Coronado MunozAmos Muzuka, Analía Fernández, Andrea B. Pembe, Andreas Wellhagen, Andrew G. Smith, Anita Gadgil, Anna Hvarfner, Anuja Abayadeera, Asya Agulnik, Aurélie Godard, Balasubramanian Venkatesh, Bargo Mahamat Yousif, Benjamin Morton, Bhakti Sarang, Bharath Kumar Tirupakuzhi Vijayaraghavan, Bobby King, Brian Rice, C. Louise Thwaites, Chian Wern Tai, Christian Owoo, Cornelius Sendagire, Dan Brun Petersen, Daniel Tatay, David Lee Skinner, Denis Kinyua, Dhruva Ghosh, Diptesh Aryal, Donald Mlombwa, Duyen Thi Hanh Bui, Edwin R. Lugazia

Liverpool School of Tropical Medicine

Research output: Contribution to journal › Article › peer-review

72 Citations (Scopus)

Abstract

Background

Globally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.

Methods

In a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC’s Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements.

Results

The 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19.

Conclusion

The study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.

Original language	English
Article number	e006585
Pages (from-to)	e006585
Journal	BMJ Global Health
Volume	6
Issue number	9
DOIs	https://doi.org/10.1136/bmjgh-2021-006585
Publication status	Published - 21 Sept 2021

Keywords

COVID-19
health policy
health services research
health systems
surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/bmjgh-2021-006585Licence: CC BY

E006585Final published version, 1.08 MBLicence: CC BY

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Schell, C. O., Khalid, K., Wharton-Smith, A., Oliwa, J., Sawe, H. R., Roy, N., Sanga, A., Marshall, J. C., Rylance, J., Hanson, C., Kayambankadzanja, R. K., Wallis, L. A., Jirwe, M., Baker, T., Asghar, A., Laytin, A. D., Holloway, A. J., El Adib, A. R., Michaelides, A., ... Lugazia, E. R. (2021). Essential Emergency and Critical Care: a consensus among global clinical experts. BMJ Global Health, 6(9), e006585. Article e006585. https://doi.org/10.1136/bmjgh-2021-006585

@article{a59b762ae7ff42169eb82e08652a5892,

title = "Essential Emergency and Critical Care: a consensus among global clinical experts",

abstract = "BackgroundGlobally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.MethodsIn a Delphi process, consensus (>90\% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC{\textquoteright}s Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements.ResultsThe 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19.ConclusionThe study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.",

keywords = "COVID-19, health policy, health services research, health systems, surgery",

author = "Schell, \{Carl Otto\} and Karima Khalid and Alexandra Wharton-Smith and Jacquie Oliwa and Sawe, \{Hendry R.\} and Nobhojit Roy and Alex Sanga and Marshall, \{John C.\} and Jamie Rylance and Claudia Hanson and Kayambankadzanja, \{Raphael K.\} and Wallis, \{Lee A.\} and Maria Jirwe and Tim Baker and Adam Asghar and Laytin, \{Adam D.\} and Holloway, \{Adrian J.\} and \{El Adib\}, \{Ahmed Rhassane\} and Alexia Michaelides and Munoz, \{Alvaro Coronado\} and Amos Muzuka and Anal{\'i}a Fern{\'a}ndez and Pembe, \{Andrea B.\} and Andreas Wellhagen and Smith, \{Andrew G.\} and Anita Gadgil and Anna Hvarfner and Anuja Abayadeera and Asya Agulnik and Aur{\'e}lie Godard and Balasubramanian Venkatesh and Yousif, \{Bargo Mahamat\} and Benjamin Morton and Bhakti Sarang and Vijayaraghavan, \{Bharath Kumar Tirupakuzhi\} and Bobby King and Brian Rice and Thwaites, \{C. Louise\} and Tai, \{Chian Wern\} and Christian Owoo and Cornelius Sendagire and Petersen, \{Dan Brun\} and Daniel Tatay and Skinner, \{David Lee\} and Denis Kinyua and Dhruva Ghosh and Diptesh Aryal and Donald Mlombwa and Bui, \{Duyen Thi Hanh\} and Lugazia, \{Edwin R.\}",

year = "2021",

month = sep,

day = "21",

doi = "10.1136/bmjgh-2021-006585",

language = "English",

volume = "6",

pages = "e006585",

journal = "BMJ Global Health",

publisher = "BMJ Publishing Group",

number = "9",

}

Schell, CO, Khalid, K, Wharton-Smith, A, Oliwa, J, Sawe, HR, Roy, N, Sanga, A, Marshall, JC, Rylance, J, Hanson, C, Kayambankadzanja, RK, Wallis, LA, Jirwe, M, Baker, T, Asghar, A, Laytin, AD, Holloway, AJ, El Adib, AR, Michaelides, A, Munoz, AC, Muzuka, A, Fernández, A, Pembe, AB, Wellhagen, A, Smith, AG, Gadgil, A, Hvarfner, A, Abayadeera, A, Agulnik, A, Godard, A, Venkatesh, B, Yousif, BM, Morton, B, Sarang, B, Vijayaraghavan, BKT, King, B, Rice, B, Thwaites, CL, Tai, CW, Owoo, C, Sendagire, C, Petersen, DB, Tatay, D, Skinner, DL, Kinyua, D, Ghosh, D, Aryal, D, Mlombwa, D, Bui, DTH & Lugazia, ER 2021, 'Essential Emergency and Critical Care: a consensus among global clinical experts', BMJ Global Health, vol. 6, no. 9, e006585, pp. e006585. https://doi.org/10.1136/bmjgh-2021-006585

TY - JOUR

T1 - Essential Emergency and Critical Care: a consensus among global clinical experts

AU - Schell, Carl Otto

AU - Khalid, Karima

AU - Wharton-Smith, Alexandra

AU - Oliwa, Jacquie

AU - Sawe, Hendry R.

AU - Roy, Nobhojit

AU - Sanga, Alex

AU - Marshall, John C.

AU - Rylance, Jamie

AU - Hanson, Claudia

AU - Kayambankadzanja, Raphael K.

AU - Wallis, Lee A.

AU - Jirwe, Maria

AU - Baker, Tim

AU - Asghar, Adam

AU - Laytin, Adam D.

AU - Holloway, Adrian J.

AU - El Adib, Ahmed Rhassane

AU - Michaelides, Alexia

AU - Munoz, Alvaro Coronado

AU - Muzuka, Amos

AU - Fernández, Analía

AU - Pembe, Andrea B.

AU - Wellhagen, Andreas

AU - Smith, Andrew G.

AU - Gadgil, Anita

AU - Hvarfner, Anna

AU - Abayadeera, Anuja

AU - Agulnik, Asya

AU - Godard, Aurélie

AU - Venkatesh, Balasubramanian

AU - Yousif, Bargo Mahamat

AU - Morton, Benjamin

AU - Sarang, Bhakti

AU - Vijayaraghavan, Bharath Kumar Tirupakuzhi

AU - King, Bobby

AU - Rice, Brian

AU - Thwaites, C. Louise

AU - Tai, Chian Wern

AU - Owoo, Christian

AU - Sendagire, Cornelius

AU - Petersen, Dan Brun

AU - Tatay, Daniel

AU - Skinner, David Lee

AU - Kinyua, Denis

AU - Ghosh, Dhruva

AU - Aryal, Diptesh

AU - Mlombwa, Donald

AU - Bui, Duyen Thi Hanh

AU - Lugazia, Edwin R.

PY - 2021/9/21

Y1 - 2021/9/21

N2 - BackgroundGlobally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.MethodsIn a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC’s Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements.ResultsThe 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19.ConclusionThe study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.

AB - BackgroundGlobally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.MethodsIn a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC’s Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements.ResultsThe 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19.ConclusionThe study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.

KW - COVID-19

KW - health policy

KW - health services research

KW - health systems

KW - surgery

U2 - 10.1136/bmjgh-2021-006585

DO - 10.1136/bmjgh-2021-006585

M3 - Article

VL - 6

SP - e006585

JO - BMJ Global Health

JF - BMJ Global Health

IS - 9

M1 - e006585

ER -

Essential Emergency and Critical Care: a consensus among global clinical experts

Abstract

Keywords

UN SDGs

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