Improving delivery of our patient care

Abdus Salam Khan, MD FACP
August, 2018

When patients present to the emergency department, they put their trust in the hands of the treating physicians and expect better care delivery and eventually outcome of the treatment. Ethically physicians are expected to do no harm and go good to the patients. The emergency department care delivery is no different than other aspects of medical care, yet due to its work flow and acuity of the condition, pose a very challenging situation for the physicians and nurses.

The situation is further complicated by our broken healthcare system in general when we go through patients after patients. Patients with limited history, delayed presentation, cost constraints and undue expectation. Lack of trust in the system further complicates the situation. Faced with all these negatives, how can we still improve the care delivery and be morally sound.

As physicians and nurses the burden is on us to set the environment that is safe for the patients, their attendants, ourselves and also our institutions. We need to create the trust between all involved in the care delivery. This is the most essential part of the care delivery and requires verbal and non-verbal communications as well as life saving competencies.

Our current system of emergency care delivery relies on junior and untrained doctors and nurses for the initial care of the patients. The emergency departments lack experienced and trained physicians and nurses, thus contributing to the lack of trust by the patients on the system of care in the emergency departments. It is also a painful fact that the emergency departments are usually less staffed while dealing with enormous load of patients and among those the sick patients also. Physicians and nurses are forced to do multitasking with most sick and be understaffed thus resulting in constant threats of bad outcome and disaster, which will further complicate the situation.

In order to improve this delivery of care so the care would be safe for all those who are involved in care delivery, it is imperative that we have a multipronged approach. In the center of all the care delivery rests the effective communication. In order for the communication to be effective, we need to have clear understanding and a team based approach. Our treating doctors and nurses should have a clear idea of the task at hand and know the population that they practice in. There is no short cut to the understanding about your own patient mindset. If we know how to approach the patient and do effective communication then we have done justice to the situation.

I am not discrediting the value and need for the scientific knowledge, but in the emergency department, this scientific knowledge is the necessary companion but not the most important tool for the effective care. The doctors and nurses working in the emergency department should definitely be knowledgeable and have to keep updating their knowledge through continuous learning process.

It is also must that the people working in the emergency department should be taught ways of effective communication and also be taught about situational awareness. The outcome of the medical treatment is not always predictable, but our response to it should always be. That standardized way of dealing with the emergencies result in effective delivery of care regardless of the result.

In the end, I like to stress again on acquiring competencies in effective communication and situational awareness. Our patients expect this from all of the people working in the emergency departments.

I can be reached at

This entry was posted in Administrator's Post. Bookmark the permalink.