Q&A: Prioritizing ‘basic actions’ could help prevent deaths from critical illness

An international panel of clinical experts has developed a blueprint they said contains steps to reduce the millions of “potentially preventable” deaths caused by critical illness annually.

The Essential Emergency and Critical Care (EECC) concept includes a set of actions and treatments that should be implemented in hospitals around the world, the panel said. Examples include the utilization of “vital signs-based triage” such as BP and pulse rates to identify critical illness; performing such triage during and after surgery or anesthesia and when moving a patient who is critically ill; and, when necessary, inserting IVs, prescribing proper antibiotics for sepsis, treating pain and anxiety and preventing delirium.

Nearly all 269 experts who helped develop the EECC have worked in clinical settings, 52% of whom worked in high-income countries.

The full list of actions were published in BMJ Global Health.

“With the EECC package, we present health workers and policy makers with an essential toolbox consisting of effective and low-cost care that all hospitals should be able to provide,” Carl Otto Schell, a PhD student in the department of global public health and consultant in internal medicine and cardiology at Karolinska Institutet in Sweden, said in a press release. “By adopting these, in some cases small changes in practices, hospitals around the world would be able to reduce the high mortality rates of critically ill patients.”

Healio Primary Care spoke with Schell to learn more about the EECC concept.

Healio Primary Care: What prompted you to compile these interventions for critically ill patients?

Schell: Our observation that lifesaving basic actions were prioritized below many other less important actions in hospitals around the world, both in high- and low-resource settings. We identified this as a global system error, a suboptimization within health care.

Healio Primary Care: How were the interventions selected?

Schell: The most effective, low cost and low complex and lifesaving actions were selected in agreement of greater than 90% among clinical experts from 59 countries using a Delphi consensus. We can therefore be confident that the most important components are included and that EECC would be feasible to implement in hospitals around the world.

Healio Primary Care: How can this consensus document improve outcomes for COVID-19?

Schell: It can assist in setting priorities, so that the most important lifesaving actions would not be forgotten anymore in clinical care and in health care planning and avoid, for example, the tragic oxygen shortages seen too often in the pandemic.

Healio Primary Care: How can the consensus document improve outcomes for CVD?

Schell: In CVD, just like for other conditions when there is the risk of a cardiac arrest, EECC actions will prevent deterioration and extend the time available for the provision of specialized treatments, saving lives. Ensuring good EECC practices are in place at your hospital will keep patients safe in the ward.

Healio Primary Care: What are the most important interventions that you want internists and primary care physicians to be aware of? Why?

Schell: All of them. These actions are basic and known to health care — the big problem is that they are insufficiently prioritized and implemented. Future research should address how this has become the case, but the know-do gap should be closed now. Importantly, EECC actions are designed to be able to task-share from physicians to other professionals.

Healio Primary Care: Is there anything else on this topic you wish to add?

Schell: EECC could assist priorities when leveraging learnings from the pandemic to strengthen health systems, eg, the huge initiatives from international agencies such as ACT-A and the Global Fund, and within Ministries of Health to scale-up oxygen production and supply.

References:

40 simple steps to reduce deaths from critical Illness. https://news.ki.se/40-simple-steps-to-reduce-deaths-from-critical-illness. Accessed Sept. 23, 2021. Published Accessed Nov. 11, 2021.

Schell CO, et al. BMJ Glob Health. 2021;doi:10.1136/bmjgh-2021-006585