Recipe for Improvement of Emergency Medicine in Pakistan

Abdus Salam Khan, MD FACP
May, 2017

Emergency department deals with all situations and in order to keep the department clinically safe and avoid neglecting patients when they present sick, plenty of efforts are needed. Countless observations of patients have shown that the care delivered and the emergency rooms across part Khan is highly variable, non-standardized and delivered by the hands of untrained and unsupervised physicians. This is common knowledge now and people who had to go to the emergency always feel helpless.


In order to improve the quality of care and keep patients safe, we have to change the dynamics of emergency room working. Let us see what can our options be, and which of the options can prove to be the answer to our problems. When we talk about options for improvement we can come up with the following list.

1.       Diagnostic capabilities of all emergency rooms so patients can be diagnosed quicker.

2.       Increase number of beds in the emergency rooms in order to deal with the increased load of patients.

3.       Increase number of physicians working in the emergency room to share the burden of patient.

4.       The number of specialties as well as specialty physicians clear burden from emergency room and to improve the quality.

5.       Increase the number of trained people in the ER who have the training in emergency medicine.

6.       Implement a triage system that is easy to utilize and train yet robust enough to pick all sick ones.

7.       Recruit emergency consultants in all emergency departments so that the service quality can be improved.

8.       Develop pathways for common conditions and make sure all people at ED follow them. It will improve the care through protocols and pathway.

The list can go on and on, but these are all relevant issues. We know about most of them but what I feel is that two of the above interventions can produce better results than anything else. The two of these include triaging all patients and then having pathway based care to most of the conditions faced by the doctor in the emergency department.

We all should understand the real value of triage. It is the best intervention because it can predict most of the avoidable risks and safety issues before they develop into problems. It is my understanding that about 80% of the emergency department fights start because of perceived delay in treatment accompanied with bad outcome. So the strategy to pick the sickest patient in the quickest way through triage does make sense and through early management of this patient we can avoid a potential fight and make the department safe. The triage system also balances the resources of the department with the patient load that it receives at the door. Utilizing emergency severity index at my work place and also implementing it in Kashmir has really shown its worth. It is simple yet very robust , and has a long track record both in the USA and Pakistan. It serves great purpose and don’t utilize too many resources. Its drawback is that the triage person has to be well trained.

The second most pivotal intervention is pathway driven care. Pathways are not fixed care still they put reasonable emphasis on to the provider and results in standardized care. This helps most patients get appropriate care consistently. This care is based upon minimum set of standards that is tailored based upon the resources of that particular hospital. The level of care will drastically improve through audit and evaluation of pathway implementation.

With emphasis on good patient care and health care quality we need to provide our patients timely emergency care that should be safe, standardized and consistent.

I am very optimistic and want to see that day when we can safely send people to any emergency department across Pakistan and not to worry about preventable errors through the hands of emergency doctors.

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