title: A cross-sectional survey of critical care services in Sri Lanka: a lower middle-income country.
abstract: OBJECTIVE
  To describe the extent and variation of critical care services in Sri Lanka as a first step towards the development of a nationwide critical care unit (CCU) registry.
  
  
  METHODS
  A cross-sectional survey was conducted in all state CCUs by telephone or by visits to determine administration, infrastructure, equipment, staffing, and overall patient outcomes.
  
  
  RESULTS
  There were 99 CCUs with 2.5 CCU beds per 100000 population and 13 CCU beds per 1 000 hospital beds. The median number of beds per CCU was 5. The overall admissions were 194 per 100000 population per year. The overall bed turnover was 76.5 per unit per year, with CCU mortality being 17%. Most CCUs were headed by an anesthetist. There were a total of 790 doctors (1.6 per bed), 1,989 nurses (3.9 per bed), and 626 health care assistants (1.2 per bed). Majority (87.9%) had 1:1 nurse-to-patient ratio, although few (11.4%) nurses had received formal intensive care unit training. All CCUs had basic infrastructure (electricity, running water, piped oxygen) and basic equipment (such as electronic monitoring and infusion pumps).
  
  
  CONCLUSIONS
  Sri Lanka, a lower middle-income country has an extensive network of critical care facilities but with inequalities in its distribution and facilities.
authors.affiliation: National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka; Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand; Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka. Electronic address: rashan@nicslk.com.
authors.forename: Rashan
authors.initials: R
authors.lastname: Haniffa
authors.affiliation: National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka; Intensive Care National Audit and Research Centre, London, United Kingdom.
authors.forename: A Pubudu
authors.initials: AP
authors.lastname: De Silva
authors.affiliation: National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka.
authors.forename: Saman
authors.initials: S
authors.lastname: Iddagoda
authors.affiliation: National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka.
authors.forename: Hasini
authors.initials: H
authors.lastname: Batawalage
authors.affiliation: Office of Deputy Director General (Medical Services), Ministry of Health, Colombo, Sri Lanka.
authors.forename: S Terrance G R
authors.initials: ST
authors.lastname: De Silva
authors.affiliation: Office of Director General of Health Services, Ministry of Health, Colombo, Sri Lanka.
authors.forename: Palitha G
authors.initials: PG
authors.lastname: Mahipala
authors.affiliation: Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand.
authors.forename: Arjen
authors.initials: A
authors.lastname: Dondorp
authors.affiliation: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Nicolette
authors.initials: N
authors.lastname: de Keizer
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
authors.forename: Saroj
authors.initials: S
authors.lastname: Jayasinghe
mesh_terms: D000488:Allied Health Personnel / Q000600:supply & distribution*; D003422:Critical Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D064648:Critical Care Nursing; D003430:Cross-Sectional Studies; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards / Q000600:supply & distribution; D008503:Medical Staff / Q000600:supply & distribution*; D009740:Nursing Staff / Q000600:supply & distribution*; D013188:Sri Lanka; D000078329:Workforce
keywords: Critical care resources; Critical care services; Critical care staffing; Lower middle-income country