INTRODUCTION: As the COVID-19 pandemic threatens to strain health care systems worldwide, the presence of gaps in the global critical care capacity has become glaringly obvious, particularly in less developed countries like Pakistan To identify existing gaps, an assessment of the critical care units across Pakistan was carried out METHODS: A novel checklist for assessing critical care units was developed based on the Partners in Health 4S Framework Our checklist evaluated the following key components: Space/Infrastructure, Staffing, Stuff/Equipment, and Systems/Protocols A series of surveys was conducted using telephonic and on-site interviews at hospitals identified by the Ministry of Health in Pakistan RESULTS: Critical care facilities at 53 hospitals were surveyed The majority were from the public sector (62%) and located in metropolitan cities (62%) In terms of infrastructure, the majority of units were adequate, with gaps primarily being identified for negative-pressure rooms (21%), donning-doffing areas (58%) and isolation rooms (64%) In terms of staffing, the majority of hospitals had trainee doctors (94%) and nursing staff (100%) available, with gaps being identified in terms of presence of qualified intensivists (47%) and ancillary staff (ethicists - 17%, dietitians - 45%) Furthermore, an adequate nurse-to-patient ratio of 1:2 or 1:3 was only present in 53% of the hospitals Equipment was present in the majority of facilities including ventilators (96%, n=9 7±1 1) and BIPAP machines (85%, n=4 5±0 6), with a relative lack of high-flow nasal cannulas (64%, n=3 2±0 9) More than 80% of hospitals had protocols in place for COVID-19 management and staffing, but fewer had them for patient surge (60%), clinician credentialing (58%) and risk mitigation (49%) On chi-square analysis, statistically significant differences (p&lt;0 05) were noted between public and private sectors as well as metropolitan and rural hospitals in terms of availability of negative pressure rooms, ancillary staff like dietitians, and optimal nurse-to-patient ratio CONCLUSIONS: The results from this study will be pivotal to guide policy makers in devising strategies for improving the quality of critical care units across Pakistan during the COVID-19 pandemic and beyond
Assessing national critical care capacity: A snapshot of facilities across pakistan