From Sweden to Malawi, 96% of critically Ill patients are not in ICUs
The Hospital Burden of Critical Illness across Global Settings Study, published on the 25th March in The BMJ Global Health, has revealed that the burden of critical illness falls almost entirely on general wards and not ICUs, in both high and low resource settings. Until now, research on critical care has mainly focused on patients in ICUs.
Methods
International prospective study: 3,652 patients in 8 hospitals in 3 countries
High and low resource settings: Malawi, Sri Lanka and Sweden
Patients classified as critically ill: at least one severely deranged vital sign. Patients were followed-up for 30 days to assess outcomes
Key Findings
Critical Illness prevalence is high: 12% (1 in 8) of patients in hospitals are critically ill.
Care is almost always on General Wards: 96% of the critically ill are being treated in general wards rather than in specialized units
Critically Ill Patients have a high mortality: 19% of critically ill patients die in hospital within 30 days (compared to 3% of those not critically ill)
Findings consistent in both high and low resource settings: from Sweden to Malawi via Sri Lanka - the results were similar
Implications
Challenges the assumption that critical illness is mainly treated in ICUs. In reality, 96% of critically ill patients are cared for in general wards and other parts of the hospital without specialised critical care resources.
Global Health Systems are not set up for this challenge. In low-income countries ICUs are scarce. In high-income countries resources are concentrated in specialist units.
Cost-effective essential emergency and critical care (EECC) in general wards could save many lives. Simple interventions—such as improved monitoring of vital signs, timely administration of oxygen and fluids, and better training for ward staff—could significantly improve patient outcomes
“The findings show that critical illness outside ICUs is not a phenomenon that is limited to low resource settings. Provision of low-cost feasible Essential Emergency and Critical Care across hospitals is a massive opportunity to save lives at scale around the world.”
— Dr Otto Schell, First Author, Hospital Burden of Critical Illness across Global Settings Study
See how EECC Global is turning this evidence into action.
Schell CO, Kayambankadzanja, RK, Beane A, et al. Hospital burden of critical illness across global settings: a point prevalence and cohort study in Malawi, Sri Lanka and Sweden. BMJ Global Health 2025;0:e017119.