• Juan Scribante and Sats Bhagwanjee.
• Department of Anaesthesiology, University of the Witwatersrand and Johannesburg Hospital, Johannesburg, South Africa. juan.scribante@wits.ac.za
• S. Afr. Med. J. 2007 Dec 1;97(12 Pt 3):1319-22.

ObjectivesTo evaluate the distribution and functioning of South African intensive care units (ICUs) and high care units (HCUs), in particular the extent to which units were 'closed units'.Design And SettingA descriptive, non-interventive, observational study design was used. An audit of all public and private sector ICUs and HCUs in South Africa was undertaken.ResultsA 100% sample was obtained. A total of 396 acute care public and 256 private hospitals were identified; 23% of public hospitals had ICUs and/or HCUs compared with 84% of private hospitals. In the public hospitals there were 210 units and 238 units in the private hospitals. Only 7% of public units and less than 1% of private units were 'ideal closed units'. A total number of 3,414 ICU and high care beds were identified; 71% of beds were in open units versus 29% in closed units. The distribution of ICU and ICU/high care beds comprised 64% in private sector and 36% (1,223) in public units. A total of 244,024 patients were admitted to all units in South Africa during 2002, of whom 63% were to private units and 37% to public sector units.ConclusionIn the face of already limited resources (financial and human) and given the emphasis on primary care medicine (with consequent limited capacity for further ICU development), it is crucial that existing facilities are maximally utilised. Like the USA we are not in a position to implement the Leapfrog recommendations and must modify our approach to dealing with South African realities.

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