Healthcare delivery is a very diverse and complex topic all over the world and similarly in Pakistan. This is especially more complex yet very important when it comes to care provision in the emergency department, as generally speaking it is not up to the mark and patients are usually not satisfied with the care that they receive. The reasons can be traced to a deficient and broken system, untrained staff providing the care, and lack of ownership at all levels. In the last two decades, the tide is turning towards better care in the emergency department, yet the goal is still far away.
The number of trained doctors who could work in the emergency department is slowly increasing and there are places where emergency medicine is practiced on the modern concepts and with quality in mind. These hospitals and training institutes strive on creating a uniform and quality-oriented system of emergency care. The mindset of people working in the emergency department is also very important. In order to create and maintain quality and advice further, it is important to accurately depict and document the quality and level of care. As it is said, “if we are not measuring the quality accurately then it would be impossible to make any improvement”. This requires a mindset that is quality-oriented and ready to accept and implement the change to make the system better.
What is quality;- Institute of medicine has defined quality as; “the degree to which health care services for individuals and populations increase the likelihood of desired health outcome and consistent with current professional knowledge”. In other words, quality care is always changing and becoming better in accordance with updated knowledge, patient’s needs, and technological advances. If we need to measure the quality of emergency care, we can measure the quality in terms of process measures, outcome measures, and structural measures.
Process measures.
This reflects the adherence of the system to the defined norms. For example, getting antibiotic within an hour for a septic patient, getting PCI done within a defined time for ST-elevation MI patients, or getting a CT scan of the head done in a defined time for a stroke patient.
Outcome measures.
It’s a very important and practical aspect of quality. Here the outcome of the care received by the patients is measured. For example outcome of CPR done in the ED, 30-day mortality of post-MI patients, post-discharge recovery and outcomes for stroke patients, or reattendance of any discharged patient for treatment failure.
Structural measures.
It shows the capacity of the hospital or organization including systems and processes. Through these measures, we calculate the staffing, the nurse to patient ratio, the service availability for CT scanners or Cath Lab, etc. etc..
Some of these measures should be calculated routinely and serially so we would know the gross direction of the quality of the organization. It will also give us the point which needs to be improved to improve and impact the quality.
In Pakistan, we know that we have a broken system that needs to be fixed, and through a coordinated effort of all stakeholders and continued data monitoring and improvement, we can improve the quality of care rendered to our patients. We have seen a change in the mindset of plenty of doctors and hospitals and there seems to be an acceptance for the trained Emergency Medicine doctors and nurses. The patients are also realizing that a trained doctor with a quality mindset can be their best insurance when they have an emergency and need treatment in the Emergency Department.