Improving Care of Critically Unwell Patients through Development of a Simulation Programme in a Malawian Hospital

Abstract

Introduction: Malawi is one of the world’s poorest countries with very limited healthcare spending and a lack of post-graduate training for healthcare workers, including in critical illness management. Critical illness simulation courses have been shown to be an effective training tool and form a key part of training for healthcare professionals in the developed world. However, these courses can be difficult and costly to set. We therefore developed an affordable and simple to run programme for use in a regional hospital in Malawi.Methods: We delivered a series of lectures alongside a simulation course based around critical illness management, including cardio-pulmonary-resuscitation. The course was taught by a visiting physician who trained a local clinical officer to continue running the course in the future. Feedback on candidate confidence in managing acutely unwell patients was collected before and after the course.Results: All staff in the unit attended the course. Median candidate confidence across all seven assessed areas increased significantly.Conclusions: Despite the basic equipment used in our course, we received very positive feedback and feel that this highlights that significant improvements in staff skillset, and therefore patient outcomes, can be achieved using a relatively simple and low cost intervention that can also easily be continued by local members of staff, ensuring sustainability. Introduction of similar courses in other resource poor settings may help improve patient outcomes without the significant financial outlay and lack of future-proofing seen with many healthcare initiatives that are deployed, and are often unsuccessful, in the developing world.