Interventions for improving critical care in low- and middle-income countries: a systematic review
An erratum to this article was published (Intensive Care Med, Jul 2024 ↗)
Authors' conclusion
The evidence for QI in critical care in LMICs is sparse and at high risk of bias but suggests that multifaceted interventions are most effective.
Study context
- Population
- Adult critical care in low- and middle-income countries (LMICs)78 studies
- Comparison
- Quality improvement intervention strategies for adult critical care in LMICs
- Outcome
- Effectiveness of Quality Improvement (QI) interventions (process and outcome measures)
Methodological detailsvote counting with binomial test, narrative synthesis (Consolidated Framework for Implementation Research), Risk of bias assessed with ROB 2.0/ROBINS-I, MEDLINE, EMBASE, Cochrane Library and ClinicalTrials.gov searched 1st September 2022; English full texts published after 2000
- Vote counting with binomial test
- Narrative synthesis (Consolidated Framework for Implementation Research)
- Risk of bias assessed with ROB 2.0/ROBINS-I
- MEDLINE, EMBASE, Cochrane Library and ClinicalTrials.gov searched 1st September 2022; English full texts published after 2000
Pooled result
As reported in the abstract
- Most common strategies: Education, A&F and Protocols/Guidelines/Bundles/Checklists (PGBC)
- Risk of bias high
- Education and A&F: P = 0.008
- PGBC with Education and A&F: P = 0.001, p < 0.001
- Vote counting, binomial test
Further pooled results
- Facilitators: stakeholder engagement, organisational readiness for implementation, adaptability of interventions
- Barriers: lack of resources, incompatibility with clinical workflows
Original publication
Interventions for improving critical care in low- and middle-income countries: a systematic review. Intensive Care Med. Published 15 May 2024. doi:10.
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