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Observational Study
. 2023 May;16(5):727-735.
doi: 10.1016/j.jiph.2023.02.022. Epub 2023 Mar 10.

Resource utilization and preparedness within the COVID-19 pandemic in Tunisian medical intensive care units: A nationwide retrospective multicentre observational study

Mohamed Boussarsar  1 , Khaoula Meddeb  2 , Radhouane Toumi  2 , Emna Ennouri  2 , Samia Ayed  3 , Fatma Jarraya  3 , Jalila Ben Khelil  3 , Oussama Jaoued  4 , Hajer Nouira  4 , Souheil El Atrous  4 , Fatma Essafi  5 , Imen Talik  5 , Takoua Merhabane  5 , Ahlem Trifi  6 , Eya Seghir  6 , Sami Abdellatif  6 , Hamdi Doghri  7 , Badra Bahri  7 , Nebiha Borsali  7 , Ines Fathallah  8 , Meriam Ksouri  8 , Nadia Kouraichi  8 , Amira Ben Jazia  9 , Hassan Ben Ghezala  9 , Nozha Brahmi  9 ; CoVenTn Study Group
Affiliations
Observational Study

Resource utilization and preparedness within the COVID-19 pandemic in Tunisian medical intensive care units: A nationwide retrospective multicentre observational study

Mohamed Boussarsar et al. J Infect Public Health. 2023 May.

Abstract

Background: The worldwide SARS-CoV-2 pandemic represents the most recent global healthcare crisis. While all healthcare systems suffered facing the immense burden of critically-ill COVID-19 patients, the levels of preparedness and adaptability differed highly between countries.

Aim: to describe resource mobilization throughout the COVID-19 waves in Tunisian University Medical Intensive Care Units (MICUs) and to identify discrepancies in preparedness between the provided and required resource.

Methods: This is a longitudinal retrospective multicentre observational study conducted between March 2020 and May 2022 analyzing data from eight University MICUs. Data were collected at baseline and at each bed expansion period in relation to the nation's four COVID-19 waves. Data collected included epidemiological, organizational and management trends and outcomes of COVID-19 and non-COVID-19 admissions.

Results: MICU-beds increased from 66 to a maximum of 117 beds. This was possible thanks to equipping pre-existing non-functional MICU beds (n = 20) and creating surge ICU-beds in medical wards (n = 24). MICU nurses increased from 53 to 200 of which 99 non-ICU nurses, by deployment from other departments and temporary recruitment. The nurse-to-MICU-bed ratio increased from 1:1 to around 1·8:1. Only 55% of beds were single rooms, 80% were equipped with ICU ventilators. These MICUs managed to admit a total of 3368 critically-ill patients (15% of hospital admissions). 33·2% of COVID-19-related intra-hospital deaths occurred within the MICUs.

Conclusion: Despite a substantial increase in resource mobilization during the COVID-19 pandemic, the current study identified significant persisting discrepancies between supplied and required resource, at least partially explaining the poor overall prognosis of critically-ill COVID-19 patients.

Keywords: COVID-19; Healthcare workers; Intensive care unit; Preparedness; Public health.

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Conflict of interest statement

Conflict of interest All the authors certify that they have no affiliations with/or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Visual presentation of regional indexed distribution of ICU beds within the public and private hospitals in Tunisia within the COVID-19 pandemic. *H, hospital-ICU beds; *P, private-ICU beds; MICU, Medical Intensive Care Unit; SICU, surgical Intensive Care Unit; ICU, Intensive Care Unit.
Fig. 2
Fig. 2
MICU-beds and healthcare workers’ mobilization across respective COVID-19 pandemic waves in Tunisian University MICUs. Fig. 2 displays trends of MICU-beds, healthcare workers, and doctors (colored bar chart) and managed patients (blue curve) within the eight MICUs according to the respective pandemic waves referred to by the spikes of national COVID-19 mortality incidence (gray bar chart).
Fig. 3
Fig. 3
Compared maximum bed capacity, ICU-nurses and deployed-nurses, admitted COVID-19 patients and deaths within respective eight Tunisian University Medical-ICUs. * 1·78, nurse-to-ICU-bed ratio. ICU, Intensive Care Unit.
See this image and copyright information in PMC

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