
| 10.1136/bmjgh-2020-004041
http://scihub22266oqcxt.onion/10.1136/bmjgh-2020-004041
 33214176!7678231!33214176
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BMJ+Glob+Health 2020 ; 5 (11): � Nephropedia Template TP
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Establishment of a high-dependency unit in Malawi #MMPMID33214176Morton B; Banda NP; Nsomba E; Ngoliwa C; Antoine S; Gondwe J; Limbani F; Henrion MYR; Chirombo J; Baker T; Kamalo P; Phiri C; Masamba L; Phiri T; Mallewa J; Mwandumba HC; Mndolo KS; Gordon S; Rylance JBMJ Glob Health 2020[Nov]; 5 (11): � PMID33214176show ga
Adults admitted to hospital with critical illness are vulnerable and at high risk of morbidity and mortality, especially in sub-Saharan African settings where resources are severely limited. As life expectancy increases, patient demographics and healthcare needs are increasingly complex and require integrated approaches. Patient outcomes could be improved by increased critical care provision that standardises healthcare delivery, provides specialist staff and enhanced patient monitoring and facilitates some treatment modalities for organ support. In Malawi, we established a new high-dependency unit within Queen Elizabeth Central Hospital, a tertiary referral centre serving the country's Southern region. This unit was designed in partnership with managers, clinicians, nurses and patients to address their needs. In this practice piece, we describe a participatory approach to design and implement a sustainable high-dependency unit for a low-income sub-Saharan African setting. This included: prospective agreement on remit, alignment with existing services, refurbishment of a dedicated physical space, recruitment and training of specialist nurses, development of context-sensitive clinical standard operating procedures, purchase of appropriate and durable equipment and creation of digital clinical information systems. As the global COVID-19 pandemic unfolded, we accelerated unit opening in anticipation of increased clinical requirement and describe how the high-dependency unit responded to this demand.|*COVID-19/nursing/prevention & control/therapy[MESH]|*Hospital Units[MESH]|*Tertiary Care Centers[MESH]|Critical Care Nursing/education/organization & administration[MESH]|Critical Illness/therapy[MESH]|Hospital Design and Construction[MESH]|Humans[MESH]|Malawi[MESH]|Quality of Health Care[MESH]
  
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