Assessment of shock management practices on patient outcomes at the intensive care units in Kisumu County, Kenya

Abstract

Shock continues to be a leading cause of death for critical illness patients, especially in developing nations where critical care facilities are inadequate and the use of best practices by medical professionals is inconsistent. There is inadequate information on the preparedness of facilities, compliance by medical personnel with shock management protocols, and patient outcome in Intensive Care Unit [ICU] facilities in Kenyan counties. : To assess the level of facility readiness for shock management in intensive care units of selected hospitals Kisumu County, Kenya and to determine the level of adherence to established shock management protocols among healthcare providers in intensive care units of selected hospitals Kisumu County, Kenya. The research adopted the Structure Process Outcomes Model by Donabedian. An integrated methodological concurrent cross-sectional analysis was carried out in four hospitals with functional Intensive Care Units in the county of Kisumu. Healthcare practitioners in shock management and retrospective documentation of adult patients with shock admitted during the period of April 2023 to April 2024 were enrolled into the study. The sample size consisted of 142 respondents who were recruited through the use of census technique. Census technique was utilized to recruit all 142 eligible health care practitioners; whereas 237 records of the patients were reviewed retrospectively; purposive sampling was used to identify 12 key informants and four focus group discussions among 32 health care practitioners. The research was carried out through the use of structured questionnaires, facility audit checklist, clinical observation checklist, retrospective medical record form, key informant interviews, and focus group discussion. Quantitative data were analyzed using descriptive and inferential statistical methods, such as chi-square test, t-test, ANOVA, Mann-Whitney U test, Kruskal Wallis test, multiple linear and logistic regressions. The level of the facilities’ readiness greatly differed among the hospitals, with the private hospitals being more structurally ready than the public hospitals (F(3,131)=18.76, p<0.001). The differences were significant regarding the functionality of the equipment (χ²=12.45, p=0.006), availability of the specialists, medication supply, and staffing. The healthcare professionals scored an average knowledge of 61.4%±12.8%, with consultants scoring highest and the Kenya Registered Community Health Nursing (KRCHN) nurses scoring lowest. Significant disparities in facility readiness and adherence to evidence-based shock management protocols exist across Intensive Care Units in Kisumu County and are associated with poor patient outcomes. Strengthening Intensive Care Unit infrastructure, ensuring consistent availability of essential equipment and medications, improving healthcare provider training, and promoting timely adherence to standardized shock management protocols are essential to improve survival among critically ill patients.