Boosting ICU capacity during the COVID-19 pandemic in the western Balkan region, The Republic of Srpska experience

Abstract

Background: Response to the outbreak of poliomyelitis in mid-1950 led to recognition and consequent development of critical care. Seventy years later the humankind was struck by COVID-19, another major challenge for critical care medicine which was especially big in Low-Resources-Settings where more than two thirds of the world population live, including the population of the Republic of Srpska (RS).

Design and methods: The main aim was to show an overview of all interventions in order to boost hospitals' capacities to the level which is sufficient to manage high amount of critically ill COVID-19 patients in the RS. A before-after cohort study design was conducted to evaluate the effects of interventions for increase in preparedness and capacity of ICUs for admission and treatment of COVID-19 critically ill patients in nine hospitals in the RS. Results: Following interventions, the biggest and university affiliated hospital in the RS has increased ICU capacities: total number of ICU beds increased by 38% and number of ventilators by 114%. Availability of machines for veno-venous extracorporeal membrane oxygenation (vvECMO) increased by 100%. Number of doctors who were involved in treatment of critically ill patients increased by 47% and nurse/patient's ratio reached 1:2.5. Similarly, all other hospitals experienced boosting of ICU beds by 189% and ventilators by 373% while number of doctors increased by 108% and nurse/patient's ratio reached 1:4.

Conclusion: All interventions implemented during COVID-19 pandemic outbreak in the RS resulted in increasing capacity for treatment of critically ill patients, but the education of health care professionals was identified as the most important conducted intervention.

Keywords: Critical care medicine; capacity boosting; low resources settings.

Figure 1.

Geographical distribution of all hospitals in The Republic of Srpska and paths of critically ill patients’ referrals. UCC RS: University Clinical Centre of the Republic of Srpska; GH: general hospital; UH: University hospital.

Figure 2.

Timeline of interventions performed to health care system of the Republic of Srpska in relation to pandemic waves. 1—Equipment purchase (ICU ventilators) 2—reorganization and construction works in UCC RS, 3—visiting the intensivists from MICU UCC RS to other hospitals in RS with an aim to evaluate organization of their ICU services, 4—beginning of reconstruction in order to create new ICUs for the treatment of COVID 19 critically ill patients, 5—starting the unofficial critical care training of doctors and nurses by critical care experts from MICU UCC RS, 6—start of the WHO support in unofficial critical care training for health care workers in the Republic of Srpska, 7—start of the very first criticall care education for undergraduate medical students at the Medical School in Foca (University East Sarajevo), 8—implementation of Fundamental Critical Care Support Course in MICU UCC RS for doctors from all hospitals of the Republic of Srpska, 1a—continued procurement of equipment, 9—creation of new department for treatment of COVID-19 critically ill patients, named NIV center, 10—implementation of the intensive care teaching curricula for medical students (Medical School in Foca), 11—adaptation of the curricula for all specializations in the field of non-surgical medicine branches (Medical schools in Banja Luka and Foca), 12—establishment of critical care department at the Medical School University of Banja Luka, 13—the very first textbook named: “Basics of critical care” published (Publisher: Medical School University of Banja Luka).