Improved system imminent at GPHC’s A&E Unit

Feb 02, 2014 News

By Romila Boodram
Come next month, the country’s largest and busiest hospital will see an upgrade in the system of one of its most critical areas.
According to newly-qualified Medicine Specialist, Dr. Zulfikar Bux, several changes are being made to reduce the time persons have to wait while at the Georgetown Public Hospital Corporation (GPHC)’s Accident and Emergency Unit (A&E).

Medicine Specialist,
Dr. Zulfikar Bux

Also, plans are in the pipeline to improve and upgrade the Unit and make it a place where people “leave without a complaint”.
Starting with the triage system, Dr. Bux said that instead of having a nurse going to each patient as they come in, to take their basic information, plans will be put in place to have the triage doctor “going to each patient and having a brief chat with them:. In that case, the doctor will have an idea as to who is waiting for what.
“As it is right now, they (patients) come in and wait on the triage nurse. Waiting time depends on the workload. Once they get registered, they wait to enter the emergency room.
“We are revamping our protocol, the triage doctor will have a word with every patient as they come in, so he will have an idea as to what is going on, because in some cases persons are sick and just can’t wait on the triage nurse,” Dr. Bux explained.
Triage is the process of determining the priority of patients’ treatment based on the severity of their condition.
“When patients come in the emergency unit they are characterized according to three statuses: Non-urgent, urgent and immediate. When it comes to an immediate patient, the decision is made between the doctor and the nurse working in the triage area. The decision can be made by visual inspection, you know when someone was in an accident by just looking at them,” Dr. Bux said.

FOLLOWING PROTOCOL
He added that the staffers at the emergency unit are not being “haphazard” when it comes to characterizing patients.
“We are following a protocol that has been designed by the Vanderbilt Medical Centre in collaboration with the GPHC.”
Dr. Bux further informed that an immediate patient goes right into the emergency room and gets “looked after” without waiting.
An urgent patient is triaged and is re-checked within an hour to two, depending on the workload, while a non-urgent patient can actually wait relatively long periods.
“They can wait up to 6-8 hours, because we always have to give priority to the immediate and urgent patients ,and as you know, this is the national referral hospital; we get patients from all the other hospitals,” the emergency doctor stressed.
Asked whether, for instance, chest pain is considered a “serious” case, Dr. Bux explained that it depends on several factors.
“It various according to the age of the patient, their medical history and their vital signs…The possibility of an 18-year-old person having a heart attack is very low as compared with an 80-year-old.”

The entrance to GPHC’s Accident and Emergency Unit.

According to the head of the Emergency unit, medical practitioners can determine how sick a person is by checking their vital signs – body temperature, pulse rate (heart rate), blood pressure and respiratory rate.
“If you are having medical complications, there will be an abnormality in at least one or two of the vital signs. Once we detect that there is an abnormality in that person’s vital signs, he or she will be considered an immediate patient and they will go into the emergency room,” Dr. Bux said.
He further asserted that an immediate patient might be walking and looks strong, and when they enter the emergency room, the rest of the crowd will behave badly, thinking that priority was given to that patient.
“We have realized that a lot of people aren’t aware of how the emergency room works, so we are working on videos to put outside the room (in the triage area) to educate people as to why they are waiting, what is what, and who comes in first and who has to wait.
If we educate people, they will become less aggressive, and people should know that the average waiting time in the United States is four hours. The last time we did a census (at GPHC), the average waiting time was about three hours. And again, it depends on the status of the patient. An immediate patient has no waiting time,” Dr. Bux related.
There are currently 15 registered medical practitioners working in the emergency room at the GPHC daily, with at least five registered nurses on each shift.
“We have three shifts – the 08:00am to16:00hrs, 16:00hrs to 24:00hrs, 24:00hrs to 08:00am. We have six doctors on the morning shift and six in the afternoon and because the load of patients decreases in the night, we have three doctors working on the midnight shift,” Dr Bux stressed. .

Dealing with the crowd
According to Dr. Bux, his team will be addressing the crowd through three factors to improve the patient turnover.
These factors are the input, throughput and the output.
“The input is what is coming in and how can we address that. We realized that by actually having the triage doctor to direct patients to their right places will reduce the load. We will give them a form with their vital signs and refer them to the outpatient department,” Dr. Bux said.
The output is where they (patients) are going after being seen by a doctor in the emergency room.
“We are trying to get a discharge coordinator to assist with the discharge process, so that for patients who are discharged, we can see how to expedite their discharge or refer them to their designated wards so that other persons in the emergency room can go up in a timely basis.”
The throughput (the amount of material or items passing through the system) is basically the process between the Input (when the patient enters the Emergency Room (ER)) and when they leave.
“The emergency room came under the surgery department before. Recently the Board (GPHC’s Board of directors) approved the ER to become an independent department so we have more autonomy to function at an independent level,” Dr. Bux related.
He added that the hospital’s Quality Improvement Department is working with the emergency room to improve its operation in terms of the delivery of health care.
Dr. Bux said that plans will be put in place to have a shift supervisor, who will be a senior doctor, to manage each shift.
“The doctor will go through all the patients and make sure that no one has to wait for a long time. He will also ensure that the doctors are functioning and if there are issues, the other doctors will coordinate with him.”
A system will also be put in place to have the doctors accountable for patients in a timelier manner.
“We are putting an efficient system in place where patients are followed through by the doctors. What used to happen is one doctor sees the patient and because the investigation takes time, the doctor leaves, and another doctor takes over and has to see the patient all over again which is time consuming,” the ER doctor related.
“The plan is to have individual doctor to doctor, where there are patient cards for these doctors when they leave, so if another doctor comes, instead of seeing the patient all over again, they will see the chart and know what the plan is and follow it.
On average, the hospital’s ER sees as many as 250 patients daily.