Background: Intensive care unit (ICU) beds are scarce resources in low- and middle-income countries. Currently there is little literature that quantifies the extent of the demand placed on these resources or examines their allocation.
Objectives: To analyse the number and nature of referrals to ICUs in the Pietermaritzburg metropolitan area, South Africa, over a 1-year period, to observe the triage process involved in selecting patients for admission.
Methods: A retrospective review of the patients referred to ICUs at Grey's and Edendale hospitals, Pietermaritzburg, was performed over a year. The spectrum of patients was evaluated with respect to various demographics, and the current triage process was observed.
Results: The Pietermaritzburg Metropolitan Critical Care service (PMCCS) received 2,081 patient referrals, 53.4% (1,111/2,081) of males and 46.6% (970/2,081) of females, with a mean patient age of 32 years. The majority of referrals were of surgical patients (39.3%, 818/2 081), followed by medical (18.9%, 393/2,081), trauma (18.6%, 387/2,081) and obstetrics and gynaecology (11.7%, 244/2,081). The chief indications for referral were the need for cardiovascular and respiratory support. Of these referrals, 72.0% (1,499/2,081) were accepted and planned for admission and 28.0% (582/2,081) were refused ICU care. Of the patients accepted, 60.7% (910/1,499) experienced delays prior to admission and 37.4% (561/1 499) were never physically admitted to the units.
Conclusions: The PMCCS receives a far greater number of patient referrals than it is able to accommodate, necessitating triage. Patient demographics reflect a young patient population referred with chiefly surgical pathology needing physiological support.