The Emergency Room visit

Oct 19, 2014 News

(With Dr Zulfikar Bux, Head of GPHC’s A&E, Asst. Prof. of Emergency Medicine)
An Emergency Room (ER) is defined as a section of a medical institution that is staffed and equipped to provide

Dr Zulfikar Bux

rapid care, especially for those who are stricken with sudden and acute illness or who are victims of severe trauma.
The Accident and Emergency department (A&E) of the Georgetown Public Hospital Corporation (GPHC) is one such emergency room. Along with the essential task of emergency care for everyone, the GPHC A&E also has the unique responsibility of being the National referral emergency centre. Patients from all over Guyana are referred to this facility for complicated emergency care which is unavailable at the referring institution.
An average of 200 sick or seriously injured patients are seen every 24 hours at the A&E. Patients that visit this department are given priority by their level of urgency and not always by their time of presentation. Patients are not discriminated because of their gender, ethnicity or cultural background. The patients that are the sickest will always have priority over those that are healthier.
At any point in time the staff of this emergency room may be fighting for a patient with a massive heart attack, or a detrimental gunshot wound or both and still be able to see the child who has an asthma attack. Taking care of these variable case presentations at the same time takes immense coordination which may never be understood by the lay person, but is a vital component of emergency care.
Informing the public of their expected encounter during a visit is vital in improving the patient understanding of the functioning of the Emergency Room. It is important therefore that we highlight a patient’s encounter according to the order and section they visit.
TRIAGE
This week we will begin with the first point of contact for the patient, the Triage section. Triage simply means “to sort out” and is the process of determining the priority of patients’ treatments based on the severity of their condition. This process is very complex and is therefore protocolized to prevent errors in care. As the patient enters the emergency room, they will encounter a triage nurse and a doctor. The triage nurse and doctor have multiple patients to categorize and will always tend to the most sick first. They work in cohesion to ensure that every patient is categorized according to their level of urgency.
There are three levels of urgency that a patient can be categorized into after simple questioning and examination.
The first category is ‘Immediate’. Patients in this category are very sick and need medical care instantly. These patients will be taken into the “in room” for care right away. The second category is ‘Urgent’. These patients are sick, but their condition is such that they can wait for care in triage under observation by the triage doctor and nurse.
The third category is ‘Non-urgent’. Patients in this category have non-life threatening conditions which can wait for longer periods or can be seen at a clinic or health centre. The triage doctor will usually make the decision on whether a non-urgent patient needs to be seen at the A&E or can be referred with a note to a GPHC outpatient clinic or health centre.
Patients that are triaged and are not ‘Immediate’ will be directed into specific points in the triage area, and are under close observation from the triage doctor and nurse while they await “in room” care. A patient information desk is usually staffed with a patient advocate to answer questions that patients or their relatives may have during this time.
Waiting times for urgent patients to be seen can be up to three hours after which a review is required.
Non-urgent patients may have longer waiting time and this depends on the capacity of the ER at the time, and the flow of sicker patients into the ER. There are cases of waiting times exceeding 24 hours in developed countries. At GPHC the average waiting time fluctuates around the four-hour mark and Non-urgent patients rarely have to wait more than 12 hours for a disposition plan. Average emergency waiting times in the Caribbean and some developed countries are infrequently below this mark.
Although the GPHC A&E’s waiting times are comparable with those of some countries of the developed world, the staff of this department is always striving for better. The task of dealing with the different degrees of patients’ presentation efficiently and in a timely manner will always be a challenge. Nevertheless, once that challenge is there, the GPHC A&E will always have a goal to improve on.

Pic name Bux

Caption: Dr Zulfikar Bux