Emergency and Critical Care Life-Saving Treatments, Procedures, and Patient Support
Background
Globally, critical illness results in millions of deaths each year. Although many of these deaths are potentially preventable, the essential life-saving care of critically ill patients is often neglected in health systems.
Essential Emergency and Critical Care (EECC) has been developed as the care that should be provided to all critically ill patients in all hospitals worldwide.
EECC includes effective care that is low-cost and low-complexity for the identification and treatment of critically ill patients across all medical specialties, including the basic diagnosis-specific care for critically ill patients with COVID-19.
Methods
In a Delphi process, agreement (>90% consensus) was sought from a diverse panel of global clinical experts.
The panel reviewed proposed treatments and actions based on previous guidelines and the WHO/ICRC's Basic Emergency Care.
The results from the Delphi process were then organized into:
- A coherent and feasible package of clinical processes
- A list of hospital readiness requirements
Results
The Delphi panel included 269 experts from 59 countries.
These experts had clinical experience in various acute medical specialties and represented all resource settings.
The agreed EECC package includes:
- 40 clinical processes
- 67 hospital readiness requirements
- Additional recommendations specific to COVID-19
Conclusion
This study defined the essential care that should be provided to all critically ill patients.
Keywords
COVID-19, health systems, health policy, health services research, surgery
Key Questions
What Is Already Known?
- Critical illness is common worldwide.
- COVID-19 has caused a global surge of critically ill patients.
- There are major gaps in the quality of care for critically ill patients, especially in low-staffed and low-resource settings.
- Mortality rates remain high.
- EECC is the effective lifesaving care of low-cost and low-complexity that all critically ill patients should receive in all hospital wards worldwide.
What Are the New Findings?
- The clinical processes that make up EECC have been defined through global expert consensus.
- The essential care for critically ill COVID-19 patients has been specified.
- The resource requirements for hospitals to deliver this care have been identified.
What Do the New Findings Imply?
- The findings can be used across medical specialties in hospitals worldwide.
- They can help prioritize and implement essential care to reduce preventable deaths.
- Including EECC processes may improve pandemic preparedness and strengthen health systems.
Introduction
Critical illness is defined as a state of ill health with vital organ dysfunction and a high risk of imminent death.
It is common in hospitals worldwide and represents the most severe form of acute illness resulting from any underlying condition.
Each year, critical illness causes millions of deaths globally.
The COVID-19 pandemic has increased morbidity and mortality and has led to a worldwide surge in critical illness.
Many deaths caused by critical illness are potentially preventable.
When a patient's airway, breathing, or circulation becomes compromised, early identification and timely treatment can save lives.
However, this basic life-saving care is often overlooked.
Essential clinical processes may be neglected:
- In specialized care settings
- In both high-resource and low-resource environments
- In adult and pediatric care
- In emergency units
- In hospital wards
- In intensive care units
Improving how health systems manage critical illness could save many lives.
To improve outcomes using care that is feasible in all hospital wards and settings, the concept of Essential Emergency and Critical Care (EECC) was developed.
Essential Emergency and Critical Care (EECC)
EECC is defined as the care that should be provided to all critically ill patients of all ages in all hospitals worldwide.
EECC is based on three principles:
- Priority to patients with the most urgent clinical needs, including early identification and timely care
- Provision of life-saving treatments that support failing vital organ functions
- Focus on effective care that is low-cost and low-complexity
The clinical processes and resource requirements for EECC had not previously been clearly defined.
Because critically ill patients may suffer from any underlying condition, EECC is designed to be integrated into all acute medical specialties.
This study sought consensus from a diverse group of global clinical experts to define the content of EECC.
An additional aim, due to the ongoing pandemic, was to establish consensus on the essential diagnosis-specific care for critically ill patients with COVID-19.
Methods
The study was conducted in three phases.
Phase I
A three-round online modified Delphi process was carried out in November and December 2020.
The Delphi method uses anonymous responses from an expert panel, with repeated rounds of questions and controlled feedback, to reach consensus on a topic.
This approach was chosen because:
- EECC is a new concept
- Its content had not been previously defined
- A large and diverse group of experts was needed
To participate in the panel, experts were required to have clinical experience in caring for critically ill patients.
To ensure diversity, it was decided that at least 50% of invited participants should represent a broad range of clinical backgrounds and resource settings.
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According to research on Critical Care Life-Saving Treatments, Procedures, and Patient Support
