Intensive Care Unit Bed Utilization and Head Injury Burden in a Resource-Poor Setting

Introduction In high-income countries (HICs), the intensive care unit (ICU) bed density is approximately 20-32 beds/100 000 population compared with countries in sub-Saharan Africa, like Malawi, with an ICU bed density of 0.1 beds/100 000 population. We hypothesize that the ICU bed utilization in Malawi will be high. Methods This is an observational study at a tertiary care center in Malawi from August 2016 to May 2018. Variables used to evaluate ICU bed utilization include ICU length of stay (LOS), bed occupancy rates (average daily ICU census/number of ICU beds), bed turnover (total number of admissions/number of ICU beds), and turnover intervals (number of ICU bed days/total number of admissions – average ICU LOS). Results 494 patients were admitted to the ICU during the study period. The average LOS during the study period was 4.8 ± 6.0 days. Traumatic brain injury patients had the most extended LOS (8.7 ± 6.8 days) with a 49.5% ICU mortality. The bed occupancy rate per year was 74.7%. The calculated bed turnover was 56.5 persons treated per bed per year. The average turnover interval, defined as the number of days for a vacant bed to be occupied by the successive patient admission, was 1.63 days. Conclusion Despite the high burden of critical illness, the bed occupancy rates, turn over days, and turnover interval reveal significant underutilization of the available ICU beds. ICU bed underutilization may be attributable to the absence of an admission and discharge protocols. A lack of brain death policy further impedes appropriate ICU utilization.