Abdus Salam Khan, MD FACP – October, 2016
The health care industry is not like any other industry which is primarily derived on the concept of making money and maximize our profit. The hospitals in private sector although are part of that business industry but due to the nature of their interaction with human life, any hint of avoidable mistake can land them in hot water. People who are willing to pay for the treatment can be equally difficult to deal with in cases of unexpected outcome.
Let us talk a bit about unexpected outcomes before we talk about standardization and its importance. We know that by nature human interactions have an inherent risk for mistake. These instances can be either due to incompetence or negligence. Physicians at times take risk when treating their patients with good intentions and at other times underestimate the situation regarding their patients clinical situations.
Let us understand what incompetent caregiver means. Competence reflects the skill of successfully carrying out a specified task. In cases of healthcare providers like doctors and nurses, right exposure and proper supervision creates that difference which enables the providers with competence to deal with tough situations. Emergency situations are those area of care that competent nurses and doctors can make a difference through proper healthcare delivery. Though with the same token if it gets out of hand then it becomes very hard to avoid bad outcome or unhappy and not satisfied patient.
Because of time sensitive issues and broad range of conditions bringing patients to the emergency department, it has the potential for the unanticipated outcome. A doctor may delay a needed consultation due to obscure symptoms and then realize that the critical time for surgery have passed. Or similarly may choose to give or withhold a treatment that proves to be a faulty decision when seen from hindsight.
How to avoid these situations and keep patients safe from the hands of negligent or incompetent staff? One of the ways could be to have trained and experienced staff at all healthcare facilities. It is ideal yet still comes with its own flaws. The other doable alternative would be to standardize the care at the emergency departments, and define the standards based upon Pakistani situation. A standardized care is safe for the patients and also reliable. Patients would expect consistent treatment and they will be satisfied because of less chances of avoidable mistake. A standardized care means the most common conditions or the diseases will be thought of by the staff first and acted upon readily rather than thinking about those conditions that are uncommon or have more educational value than actual incidence. Thus we treat those conditions first which are more deadly or very common, and when within specified time the condition does not improve we start thinking about other causes and less likely conditions. It may seem a long process, but it is the way to provide safe care and avoid bad outcome.
A standardized care is either pathway driven or based upon treatment algorithm. It creates a basis for the care to be uniform and with less chances of human error or mistake. A pathway is based upon patients condition and it guides the nurses and the doctors the ways to stabilize and diagnose patients. Although experienced doctors use it as reference only, but for the junior doctors and nurses it serves as a good safety net to provide needed care that is based upon evidence and sound logic. The treatment and the pathways updated based upon the result of the previous audits and experiences. That’s the cycle of improvement that should be present in each and every institution and hospital.
These algorithms and pathways when created with local circumstances in mind and updated through the process of audit and evidence are best ways to elevate the level of care in resource poor countries like Pakistan. Patients can expect a certain level of care consistent with their level of sickness, when they come and see doctors and nurses in emergency. It would create a less tense situation for the staff caring for the patients as they would be providing safer care for the patients. It will also serve to create awareness regarding the availability of resources required for the provision of certain level of treatment. It is my hope that we create pathway driven algorithms in all emergency departments across Pakistan.
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