Critical Illness Beyond the ICU – What Is Essential?

In health care, critical illness stands out as the most severe form of any illness. Unlike traditional hospital care, which often follows a vertical organizational structure based on specialty, critical illness requires a more inclusive and universally applicable approach. The concept of essential emergency and critical care (EECC) is a groundbreaking paradigm that transcends barriers of diagnosis, age, medical specialization, and hospital location. EECC represents first-tier, life-saving, cost-effective care that is grounded in the principle of equity. This differs from advanced critical care, usually conducted in ICUs with specialized staff, facilities, and technologies. EECC is the foundational management of patients in the hospital, wherever they are (Figure) (Crit Care 2018;22:284).

Crafted through a global consensus in 2021 by 269 experts encompassing clinicians, researchers, and policymakers worldwide, EECC includes 40 clinical processes for the timely identification and treatment of critically ill patients, along with 66 essential resources necessary for hospitals to be adequately prepared (Table) (BMJ Glob Health 2021;6:e006585). EECC clinical processes encompass the prompt identification and care of critically ill patients, with vital signs-based triage occurring at various points, including patient arrival, routine assessments, concerns raised by health care workers, and postsurgery or anesthesia. The treatment arm focuses on organ support, including oxygen therapy, intravenous fluid resuscitation, and maintaining a free airway. Additional processes cover intravenous access, cervical spine stabilization, antibiotic administration, pain and anxiety management, temperature control, feeding, and patient mobilization. EECC ensures patient-centered, respectful care that emphasizes clear communication, coordination with other providers, and appropriate escalation of care.

To prevent the death of our patient, the implementation of early essential care for complications in childbirth could have played a crucial role. In the case presented, it is unclear how promptly the signs of danger were recognized before the decision to refer the patient. EECC emphasizes early detection through regular monitoring of vital signs at the bedside, a practice that aids in predicting mothers at risk of postpartum hemorrhage. Continuous monitoring and organ support should persist during patient transfer, and the absence of essential monitoring devices or an oxygen source in the ambulance in this case underscores an area where EECC implementation could make a substantial difference, potentially saving lives.

This case serves as a poignant example of how the failure to provide fundamental care can lead to complications that even advanced interventions may not be able to avert, resulting in the tragic loss of a mother. Hospitals adopting EECC for all patients would have a system-wide approach to managing critical illness, preventing deterioration, and saving lives at a low cost. This approach would bridge gaps between different departments, specialties, and levels of care.

Looking toward the future of EECC, four main agendas are identified: research, policy, advocacy, and training (BMJ Glob Health 2021;6:e006585). Ongoing research evaluates the effective coverage, impact of interventions, and effectiveness of implementation strategies. Policy efforts are essential to garner support and ensure a swift translation of research findings into practice. The EECC global network collaborates with key policymakers at various levels, engaging with governments, the World Health Organization, the World Bank, and other development partners. Multidisciplinary members representing the EECC network collaborate with professional societies to align goals and practices (eeccnetwork.org).

The network, accessible at eeccnetwork.org, invites interested individuals around the globe to join and contribute to a collaborative space for health care providers, educators, policy advocates, and researchers. This network serves as a hub for sharing experiences and staying updated on opportunities for implementation and knowledge generation, all with the overarching vision that “no one should die in a hospital from a cause that EECC could prevent” (Crit Care 2018;22:284).

Furthermore, the EECC online course, offered in collaboration with Stanford University, provides free continuing medical education/continuing professional development for physicians and nurses, empowering them to deliver EECC wherever they may be. The course is accessible at stanesglobal.com/course/essential-emergency-and-critical-care.