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Starting of EM educator.

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Abdus Salam Khan, MD FACP
May, 2019

Although we usually think the treatment of any condition is the responsibility of the doctors, yet it is well understood that a well educated patient about his disease or condition has a better chance of dealing with situation in much better and calmer way. (1)

In the spirit of being educator to the doctors themselves it is our duty to teach patients also. We do it through one to one teaching at each visit, which is the proper way of educating the patients by the doctors regarding their illness.(2) With the same spirit, through all kind of print and other electronic media the common man or the public is expected to be informed regarding their health and different aspects of sickness and disease prevention.

There is enormous need to educate people in terms of prevention and also treatment aspects in emergency situations. As a veil of focus is mostly emergency care, so we decided to educate people regarding aspects of emergency care and the process of treating the patients in emergency departments. This can, not only give them a perspective regarding emergency conditions, but will also enhance the understanding regarding steps of treatment. Afterall the medical decision making should be a shared responsibility of the physicians and the patient and the caregivers, as addressed by Chen et al in Dec 2016 in Academic Emergency medicine. (3)

It is our desire to have such an impact through education that the people should be aware of the steps to avoid the disease and sickness, and if they get afflicted with any condition they should be able to understand the way forward to deal with it as an informed patient. It will enhance treatment outcome and improve the level of satisfaction, decrease the burden of stress on the system. The education is being imported through the use of Internet and then through the social media. We have used the local language through short video messages and visuals to let people absorb the complex steps through stepwise approach. You can see that at YouTube as the EM educators channel. Our efforts are to match the needs of the patient with the required knowledge to make the illness as less problematic as possible.

The EM educators channel had been planned to be interactive in the way that the questions of the audience will be entertained regarding any topic that they feel the need to know more about. We will also include other specialties like cardiovascular diseases, neurology, gastroenterology, surgery and other aspects of treatment to give advice in the matters relating to the emergency situations. Although we have not seen any evidence in the emergency department regarding this but Irewall et al in Jan 2019 has shown the value of telephone based prevention in cases of follow up in TIA/ Stroke. (4)

I would hope is to educate our citizen and the people of the region and to fill the knowledge gap. We would appreciate your input and advice in this regard.

I can be reached at askhan65@yahoo.com.

References:

1- Paterick TE, Patel N, Tajik AJ, Chandrasekaran K. Improving health outcomes through patient education and partnerships with patients. Proc (Bayl Univ Med Cent). 2017;30(1):112–113.

2- Education for health promotion and disease prevention: convince them, don’t confuse them.

Beitz JM. Ostomy Wound Manage. 1998 Mar;44(3A Suppl):71S-76S; discussion 77S. Review.

3- The Role of Education in the Implementation of Shared Decision Making in Emergency Medicine: A Research Agenda. Esther H. Chen MD, Hemal K. Kanzaria MD, MSc, Kaoru Itakura MD, Juanita Booker‐Vaughns MaED, EdD, Kabir Yadav MD, Bryan G. Kane MD, https://doi.org/10.1111/acem.13059

4- Trials. 2019 Jan 15;20(1):52. Nurse-led, telephone-based secondary preventive follow-up benefits stroke/TIA patients with low education: a randomized controlled trial sub-study.

Irewall AL, Ögren J, Bergström L, Laurell K, Söderström L, Mooe T. doi: 10.1186/s13063-018-3131-4.

Quality improvement programs in Emergency Department.

Posted on by Abdus Salam

Abdus Salam Khan, MD FACP
May, 2019

Patient care is a team work especially in all emergency departments. It is because of the fact that the care is dependent on multiple factors. The patients are either unstable or have the potential to become unstable. They may be in pain and need immediate relief. There is always a mismatch between the Emergency Department resources and the load of the patients presented to it. Many tasks of different nature happening at the same time in a limited space in the emergency. Sometimes it is rightfully labeled as mini-hospital within a hospital. (1) (2)

People who work in the emergency departments know that it is a very complex task and providing care is not easy. The difficulty is both on the clinical as well as non-clinical fronts. On the clinical front it is the broad-based problems presented to the emergency care that has to be sorted out quickly thus requires a physician and nurse staff that is well versed in all most all disciplines from Pediatrics to gynecology to neurosurgery. On the non-clinical front, it is equally daunting task to make sure that all the work is done smoothly. Starting from the availability of bed in the emergency to the electricity, water and stationery on one hand and then all functioning equipment to availability of ward and ICU beds on the other hand, is all considered equally important.

The patient satisfaction hangs well in balance due to the interplay of all the above factors and then some more. The satisfaction depends upon the quality of clinical care as well as the process of care delivery. Improving the quality will improve the satisfaction. Although a good team of physicians and nurses who are well trained in emergency care would mean provision of better care, yet there is always room for the improvement(3). Similarly improving the process of care delivery improves the satisfaction.
Every modern emergency department should have a program of quality improvement. This way the ED assures that the care delivered is of the highest quality and that the points of care which require enhancement are identified and being worked on. There are plenty of quality improvement ways, like the PDCA cycle (Plan-DO-Check-Act), Six Sigma and lean management and plenty of others. These process improvement modalities work within the system and show the result by improving the process and decreasing chances of error. These work as a continuum and with the completion of each cycle the system is improved and then the people continue for the second cycle to improve it further. (2,4–6)

In the emergency departments across the world there are plenty of processes that need continuous improvement and so the emergency department staff takes these projects as part of the self-improvement as well as part of the improvement of patient care, and make it a lifelong commitment. This way the safety of the patients is ensured and there is trust of the patients and satisfaction level with the system. Without the trust the whole care is compromised. (7)

Quality projects that the people working in the emergency department can choose like outcome based audits and studies or satisfaction centered audits. In outcome based studies, we see different mon satisfaction centered audits, we see how satisfied the group of patients were with the care they received in the emergency. Both types of studies actually aim to look into the areas and points where improvement brings satisfaction to the patients and also can lead to better outcome. (7)(8)

Our emergency department should adopt these ways to improve the care and make it safe as well as trust worthy for our patients. Being a leading emergency department of Pakistan, we are hoping on the quality improvement journey to get all the benefits of improved and safe care for our patients as well as to teach our newly trained residents the mindset needed to provide the safe and effective care. We also plan to teach these initiatives to all our fellow emergency physicians across Pakistan so that what we feel is the benefit for all should come to all in the literal sense.

I can be reached at askhan65@yahoo.com.

References:

1. Gagel BJ. Health Care Quality Improvement Program: a new approach. Health care financing review. 1995;16(4).

2. Lattimer V, Brailsford S, Turnbull J, Tarnaras P, Smith H, George S, et al. Reviewing emergency care systems I: insights from system dynamics modelling. Emergency medicine journal : EMJ. 2004 Nov 1;21(6).

3. Wilson M, Welch J, Schuur J, O’Laughlin K, Cutler D. Hospital and emergency department factors associated with variations in missed diagnosis and costs for patients age 65 years and older with acute myocardial infarction who present to emergency departments. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2014 Oct;21(10).

4. Dellifraine J, Langabeer J, King B, King B. Quality improvement practices in academic emergency medicine: perspectives from the chairs. The western journal of emergency medicine. 2010 Dec;11(5).

5. White BA, Baron JM, Dighe AS, Camargo CA, Brown DFM, Brown DFM. Applying Lean methodologies reduces ED laboratory turnaround times. The American journal of emergency medicine. 2015 Nov;33(11).

6. Maniago E, Ardolic B, Peana J. ED Patient Flow: Utilizing the Six Sigma Approach to Reduce Emergency Department Overcrowding. Annals of Emergency Medicine. 2005 Sep 1;46(3).

7. Boudreaux ED, O’Hea EL. Patient satisfaction in the Emergency Department: a review of the literature and implications for practice. The Journal of emergency medicine. 2004 Jan;26(1).

8. Arts DGT, de Keizer NF, Scheffer G-J. Defining and improving data quality in medical registries: a literature review, case study, and generic framework. Journal of the American Medical Informatics Association : JAMIA. 2002;9(6).

PSEM. A new chapter in emergency medicine.

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Abdus Salam Khan, MD FACP
April, 2019

Professional societies have very important role to be performed. People look up to these societies to guide them or channelize the resources and also to develop ways to improve understanding regarding the profession. Our journey of emergency medicine reached an important milestone when our professional society got established. It is called Pakistan Society Of Emergency Medicine ( PSEM).

Emergency medicine has established roots in Pakistan for almost two decades. It was not an easy journey but persistent efforts of plenty of people at different levels made it a reality.

Our number of trainees has increased and so is the number of emergency physicians across Pakistan. Now the next phase for the emergency Medicine is underway. This step is to strengthen the society. The society was created for various reasons and some of those are listed here.

1. Creation of a common platform of emergency medicine for all to develop together.
2. Make emergency medicine development a combined goal rather than a personal achievement.
3. Help different institutions develop emergency medicine training programs to benefit our patients.
4. Propagate the understanding regarding the function of emergency departments and to increase proper utilization of emergency departments without wastage of resources.
5. Help create service standards and then clinical standards.
6. Help create educational standards for the emergency medicine trainings.
7. Help different organizations and entities deliver educational and training programs.

We are proud of our cohesiveness and also of being progressive in our conduct We love to collaborate and live to innovate. Our strength is in the mindset of not giving up, as we know that the path is quite difficult and task is too complex and huge yet we continue to move ahead day in and day out.

The work that is ahead of us as society is enormous and the society is getting ready for the task. We have started the membership drive and are aiming to gather around as many members as possible in a few weeks. Our training programs and trainees are enthusiastic in becoming part of PSEM. We will then initiate different committees to think, organize and work on the collectively agreed tasks to improve the emergency medicine for all the patients.

Collaboration with different entities will result in educational and training events for the trainees. Collaborators are both national and international with common goal of improving caliber of people providing care to the patients.

Research and guideline creation pertaining to local circumstances is also a great service that PSEM will take up. We have started a new journal which is the first one in Pakistan for the field of emergency medicine, and we are hopeful that the local researchers will trust us with their publications so that the journal will provide guidance to the people working in the emergency department across Pakistan.

We are strong believers of teamwork and would appreciate all the help extend it to us for emergency medicine development.