In an era marked by increasing global populations and longer lifespans, healthcare systems worldwide face escalating demands. A critical component of these systems is the provision of acute curative services, designed to respond effectively to life-threatening emergencies, sudden flare-ups of chronic conditions, and a spectrum of health issues requiring prompt medical attention. Integrating emergency interventions and services seamlessly with primary care and public health initiatives is paramount to building robust and comprehensive healthcare systems. This article delves into the concept of acute care, aiming to clarify its definition, highlight its significance, and advocate for its strengthened role within healthcare frameworks.
Defining Acute Care: A Comprehensive Overview
To foster productive discussions and guide the strategic development of healthcare systems, clear and universally understood definitions are essential. The World Health Organization (WHO) defines health systems as encompassing “all organizations, institutions, and resources whose primary purpose is to promote, restore and/or maintain health.” Health services, within this framework, are “aimed at contributing to improved health or to the diagnosis, treatment, and rehabilitation of sick people.” These services can be viewed as the actions taken to organize necessary inputs, including promotion, prevention, cure, rehabilitation, and palliative care, and are oriented towards both individuals and populations.
Similarly, a precise definition of What Is Acute Care is crucial. Medical dictionaries often emphasize the time-sensitive nature of acute conditions. Therefore, acute care can be defined as encompassing all promotive, preventive, curative, rehabilitative, or palliative actions, directed at individuals or populations, with the primary goal of improving health. A defining characteristic of acute care is that its effectiveness is significantly dependent on timely and often rapid intervention.
While many healthcare services benefit from timely delivery, acute curative services are uniquely time-critical, irrespective of the specific disease. However, the concept of acute care has historically been poorly defined and under-resourced in many developing healthcare systems. A practical working definition of acute care focuses on the most time-sensitive, individually-oriented diagnostic and curative interventions aimed at improving health outcomes.
A more detailed definition of acute care encompasses the healthcare system components, or care delivery platforms, specifically designed to manage sudden, often unexpected, urgent, or emergent episodes of injury and illness. These conditions, if not addressed swiftly, can lead to severe disability or death. The spectrum of acute care includes a range of essential clinical functions, such as emergency medicine, trauma care, pre-hospital emergency care, acute care surgery, critical care, urgent care, and short-term inpatient stabilization. These domains are visually represented in Figure 1.
Fig. 1. Domains within Acute Care
[Image of Domains in acute care – Fig. 1 from original article]
Domains in acute care encompassing treatment of surgical and medical emergencies, ambulatory urgent care, pre-hospital stabilization, community-based emergency response, and intensive critical care
Figure 1 illustrates the diverse yet interconnected domains within acute care:
- a) Acute Surgical Needs: Addressing individuals with urgent surgical conditions, including life-threatening injuries, acute appendicitis, or strangulated hernias.
- b) Acute Medical and Potentially Surgical Needs: Managing patients with severe medical emergencies like acute myocardial infarctions (heart attacks) or acute cerebrovascular accidents (strokes), as well as evaluating patients presenting with acute abdominal pain.
- c) Ambulatory Urgent Care: Providing medical care outside of a traditional hospital emergency department, typically on a walk-in basis for unscheduled needs, such as ankle injuries or fever in children.
- d) Pre-Definitive Treatment Stabilization: Treating individuals with acute needs before definitive treatment can be administered, for instance, providing intravenous fluids to a critically injured patient before surgery.
- e) Community-Based Emergency Response: Delivering initial care in the community setting until the patient can reach a formal healthcare facility, such as ambulance services or local healthcare provider interventions for acute health problems.
- f) Critical Care: Specialized care for patients with life-threatening conditions requiring intensive support and constant monitoring, often in intensive care units (ICUs), such as patients with severe respiratory distress needing intubation or those experiencing seizures due to conditions like cerebral malaria.
The Consequences of Fragmented Healthcare Systems: The Acute Care Gap
In 2007, the WHO emphasized the urgent need to strengthen global health systems. However, clear definitions and objectives, particularly concerning health service delivery, often remain lacking. While countries typically develop consensus lists of priority health problems with input from international organizations, and orient health services towards preventing and controlling these priorities, a crucial element is often overlooked: the impact of time on the effectiveness of interventions.
Preventive strategies are primarily focused on reducing the likelihood of new cases by mitigating disease risk factors. The earlier preventive measures are implemented, the more effectively incidence rates can be lowered. Conversely, curative strategies aim to reduce disability or death among existing cases. The priority assigned to curative interventions depends heavily on their time-sensitivity, effectiveness, and cost. Crucially, for curative services, the relationship between time and effectiveness varies significantly, underscoring the vital importance of ensuring patients receive the right intervention at the right place and at the right time.
Failing to adequately consider the time-critical nature of curative services leads to fragmentation within healthcare systems. This fragmentation manifests as poor coordination of care and imprecise application of clinical interventions. A stark example is the delay in administering antibiotics to patients with sepsis, which can drastically increase the risk of death or long-term disability. Such fragmented care ultimately reduces the number of Disability-Adjusted Life Years (DALYs) that can be averted with available resources, hindering the overall efficiency and impact of healthcare investments.
Acute Care’s Vital Contribution to Integrated Health Systems
Acute care, as a distinct clinical service, is designed to address immediately life- or limb-threatening health conditions, regardless of the underlying cause. This inherent characteristic positions acute care as a fundamental pillar in building strong and resilient health systems – a horizontal approach that strengthens the entire system, rather than vertical programs that focus on specific diseases and may inadvertently create silos. Importantly, many of the resources – material, consumable, and human – required for effective acute care platforms are the same resources needed for traditional, disease-centered programs.
It’s also crucial to dispel common misconceptions surrounding acute care. It is not merely synonymous with ambulance transport, nor is it solely dependent on high-technology interventions. Instead, excellent acute care is defined by its temporal element – the rapid response to immediate threats to life and limb – and often involves a strategic redistribution of resources to minimize preventable death and disability. Integrating acute care with preventive and primary care services creates a comprehensive healthcare paradigm that encompasses all essential aspects of healthcare delivery, ensuring a holistic and effective approach to patient well-being.
The prevailing conceptual framework often categorizes health problems into communicable diseases, non-communicable diseases, and injuries. The current global discourse on non-communicable diseases vividly illustrates how care fragmentation can arise when the time-sensitivity of curative interventions is disregarded. In 2008, non-communicable diseases were responsible for 36 million (63%) of the 57 million deaths worldwide. A significant and growing proportion of global deaths from non-communicable diseases and injuries occur in low- and middle-income countries undergoing epidemiological transitions.
Strategies to combat morbidity and mortality from non-communicable diseases have largely emphasized prevention and primary care. For instance, guidelines for managing diabetes in primary health care settings in resource-limited areas often focus on long-term management. However, while crucial, these guidelines often underemphasize the time-sensitive aspects, even though conditions like diabetic ketoacidosis can be acutely life-threatening. The essential role of acute care in mitigating the escalating burden of disease and injuries has been significantly underestimated, leading to gaps in comprehensive healthcare strategies.
Acute care plays an indispensable role in preventing death and disability, a role that primary care, while vital, is often not equipped to fulfill, particularly in emergency situations. Within healthcare systems, acute care also serves as a critical entry point for individuals experiencing emergent and urgent health crises. A well-defined understanding of acute care allows for the development of metrics to effectively evaluate acute care services, assess the disease burden they address, and establish clear goals for advancing acute care, especially in low- and middle-income countries.
Historically, the fragmented specialty areas encompassed within acute care have struggled to achieve significant growth in their respective clinical domains at the international level. This is partly due to a lack of standardized metrics and coordinated health service delivery models. Conceptualizing acute care as an integrated care platform enables these previously splintered areas to move forward with a unified agenda, fostering collaboration and progress.
Key Steps Forward: Strengthening Acute Care Globally
Many simple, effective, and cost-efficient acute care interventions can be life-saving, often within the critical first 24 hours of an emergency. These include interventions provided in basic surgery wards in district hospitals, addressing trauma, high-risk pregnancies, and other common surgical emergencies. The global conversation surrounding acute care is gaining momentum, evidenced by initiatives like the formation of the African Federation for Emergency Medicine in 2009 and the Academic Emergency Medicine Consensus Conference focused on global health and emergency care research.
To further advance the development and integration of acute care systems, several key steps are essential:
- Developing Acute Care Service Delivery Models: Creating tailored acute care service delivery models specifically for low- and middle-income countries that function in conjunction with existing preventive and primary care services. These models should address both life-threatening and limb-threatening conditions, as well as acute exacerbations of prevalent non-communicable diseases.
- Improving Inter-professional Coordination: Enhancing coordination among acute care providers, including emergency physicians, surgeons, and obstetricians, to ensure the efficient and effective delivery of critical acute care services.
- Developing Research Methodologies: Establishing robust research methods to quantify the burden of acute care diseases and injuries, incorporating health economics and cost-effectiveness analyses. This data is crucial to justify the strategic integration of acute care within broader health systems.
- Fostering National and International Dialogue: Promoting national and international discussions to encourage the improved integration of acute care within local and national health systems, raising awareness and driving policy changes.
This article serves as a call to action for leaders, policymakers, and academics to recognize the pivotal contribution of robust acute care systems in managing patients with both communicable and non-communicable diseases, as well as injuries. However, the development of acute care systems must not be misused as justification for diverting resources to poorly equipped and inadequately managed health facilities. Aligning key stakeholders, both within and across countries, to support the development of the optimal mix of acute and preventive services needed to address the growing global disease burden is an urgent priority for health systems and for society as a whole.
Acknowledgements
The authors gratefully acknowledge Linda J Kesselring for her invaluable assistance.
Funding:
JM Hirshon received funding from the National Institutes of Health Fogarty International Center (Grant 5D43TW007296).
Competing interests:
None declared.
