In response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in intensive care units (ICUs) across Pakistan. An initial step in creating a plan toward strengthening Pakistan’s baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities. To assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was created from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles. A total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%). We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model, while 37.7% of hospitals did not have surge policies. On Chi-square analysis, statistically significant differences (p < 0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public–private and metropolitan–rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks. Pakistan has an underdeveloped critical care network with significant inequity between public–private and metropolitan–rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities.

中文翻译：

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巴基斯坦成人重症监护资源的差异：使用新型评分系统进行的全国调查和评估的结果

为应对 COVID-19 大流行，省和联邦政府共同努力，投资于重症监护基础设施和医疗设备，以弥补巴基斯坦重症监护病房 (ICU) 资源有限的差距。制定加强巴基斯坦基础重症监护能力计划的第一步是在国内进行需求评估，以评估差距并制定提高重症监护设施质量的战略。为了评估巴基斯坦的基线重症监护能力，我们对全国提供 COVID-19 护理的医院进行了一系列横断面调查。这些医院由巴基斯坦卫生服务学院 (HSA) 预先确定。调查是通过电话和现场访谈进行的，并基于一个独特的评估重症监护病房的清单，该清单由健康 4S 框架中的合作伙伴创建，即：空间、员工、物资和系统。这些组成部分被评分、加权平均，然后分成四分位数。共有 106 家医院接受了调查，其中大多数位于公共部门 (71.7%) 和大都市 (56.6%)。我们发现缺乏基础设施、人员配备和系统，因为只有 19.8% 的医院有负压室，44.4% 的医院有工作人员隔离设施。仅有 36.8% 的医院聘用了经过认证的重症监护医生，54.8% 的医院保持了理想的护士与患者比例。31.1% 的医院没有人员配备模型，而 37.7% 的医院没有激增政策。在卡方分析中，公共和私营部门之间以及大都市与农村环境在各种要素之间存在统计学上的显着差异（p < 0.05）。几乎所有等级都显示出公立-私立和都市-农村之间的显着差异，私立和都市医院在第一等级中的比例较大，而公立和农村医院在较低等级中的比例较大。巴基斯坦的重症监护网络欠发达，公共-私营和大都市-农村阶层之间存在显着不平等。我们希望未来的重症监护资源分配和能力发展项目能够减少这些差异。几乎所有等级都显示出公立-私立和都市-农村之间的显着差异，私立和都市医院在第一等级中的比例较大，而公立和农村医院在较低等级中的比例较大。巴基斯坦的重症监护网络欠发达，公共-私营和大都市-农村阶层之间存在显着不平等。我们希望未来的重症监护资源分配和能力发展项目能够减少这些差异。几乎所有排名都显示出公立-私立和都市-农村之间的显着差异，私立和都市医院在第一等级中的比例较大，而公立和农村医院在较低等级中的比例较大。巴基斯坦的重症监护网络欠发达，公共-私营和大都市-农村阶层之间存在显着不平等。我们希望未来的重症监护资源分配和能力发展项目能够减少这些差异。巴基斯坦的重症监护网络欠发达，公共-私营和大都市-农村阶层之间存在显着不平等。我们希望未来的重症监护资源分配和能力发展项目能够减少这些差异。巴基斯坦的重症监护网络欠发达，公共-私营和大都市-农村阶层之间存在显着不平等。我们希望未来的重症监护资源分配和能力发展项目能够减少这些差异。