Most Critically Ill Patients Aren’t in ICUs

When we think about critical illness, we often imagine intensive care units (ICUs) filled with high-tech machines and teams of specialists. But a new study published in BMJ Global Health reveals a surprising reality: most critically ill patients aren’t in ICUs at all. In fact, the vast majority are cared for in general hospital wards—often without the resources they need to survive.

The Hidden Crisis in Critical Care

The study, conducted across hospitals in Malawi, Sri Lanka, and Sweden, found that 1 in 8 hospital patients (12%) was critically ill, meaning they had at least one dangerously abnormal vital sign. But what’s even more concerning is that 96% of these patients were not in ICUs—they were in general wards, where staff may not have access to life-saving equipment or training.

The consequences are severe. Nearly 1 in 5 critically ill patients (19%) died in hospital—a mortality rate seven times higher than for non-critically ill patients. These numbers highlight an urgent issue: hospitals everywhere, from well-funded to low-resource settings, are struggling to provide essential emergency and critical care (EECC) outside of ICUs.

Key findings from the HBCiGS study

Why This Matters for Global Health

We often assume that intensive care is the backbone of critical care. But this study challenges that belief. In low-income countries, ICU beds are scarce—sometimes fewer than one per 100,000 people. But even in high-income countries, ICU capacity is limited, and almost all critically ill patients receive care on regular wards.

This means that strengthening emergency and critical care in general hospital wards is a global priority. The good news? Many life-saving interventions are simple and cost-effective:

• Better monitoring of vital signs to detect early warning signs of deterioration.

• Timely oxygen and fluid therapy for patients struggling to breathe or experiencing shock.

• Basic airway management for unconscious patients.

• Training ward staff to recognise and respond to critical illness.

These interventions don’t require expensive technology or specialist teams—they just need to be made a priority.

A Call to Action: Improving Critical Care Everywhere

This research is a wake-up call. It shows that critical illness is a widespread problem, not just in the most under-resourced hospitals, but across healthcare systems worldwide. The question is: how do we respond?

Ministries of health, hospitals, and global health organisations must invest in essential emergency and critical care to improve survival rates—no matter where a patient is treated. This means training staff, providing simple but vital resources, and ensuring every hospital ward is equipped to handle critical illness.

At EECC Global, we are committed to making this happen. By supporting research, training, and advocacy, we can help ensure that every critically ill patient—whether in an ICU or a general ward—gets the care they need to survive.

Want to be part of the change? Get in touch with us today to learn more about our work and how you can help.