Failure to get lab reports quickly, inability to maintain the mandated ratio of patient to doctor and nurse, and deployment of junior doctors mean that apart from the delay in treatment to 70% of the patients at the Post Graduate Institute of Medical Education and Research (PGIMER), around 30% are made to wait for treatment for an average of 16 hours, as doctors tag their status as ‘under observation’ after preliminary diagnosis.
The study was conducted by the School of Public Health of the institute and published in the July issue of Journal of Emergencies, Trauma and Shock. It was based on interviews of around 600 patients.
The study found that the institute was looking after around 154 patients at a time, five times its original capacity. The doctor/nurse and patient ratio was also poor. The guidelines adopted by American Academy of Emergency Medicine say that one physician is required per 2.5 patients/hour and the nurse, patient ratio should not exceed 1:3. However, at the emergency block of the institute, 10-11 resident doctors and 12-14 nurses cater to the average daily load of 150 patients, a ratio of around 1:10.
The area of the block is adequate only for a patient load of 29,000 against the present 70,000, as mandated by the guidelines of Australian College of Emergency Medicine. More than 25% of patients arrived in the block between 9 am and noon.
“The volume of patients reporting to the block was observed to be the major determinant of the waiting time, if resources are fixed. The resources need to be matched to the workload on an hour-by-hour basis, in spite of the inherent variation in workload,” the study said.
The emergency block needs attention. The best solution to improving the facility is to ensure that top health officials or ministers of the neighbouring states meet and discuss ideas. Over the past decade, the institute’s directors have tended to focus on developing infrastructure related to their department only. The emergency has been nobody’s child.
Dr Virendra Singh, president, PGI faculty association.
75,000 yearly patient load against capacity of 29,000
154 patients lying in the emergency at any given point of time
10-11 resident doctors available
12-14 nurses available
1 doctor and nurse for 15 patients (approximate figure)
THE ENDLESS WAITING
16 hours: 30% of patients lying in emergency wait for this long for treatment
38 hours waiting period for surgery
17% wait for an average of an hour for lab reports
15% wait for an average of two hours for the doctor’s decision on discharge from emergency.
DOCTORS TAKING SAMPLES: 12% patients were found waiting for specialised tests with the median waiting time of 12 hours, as blood samples for test were taken by resident doctors.
CONSULTATION QUEUE: The waiting for a consultant doctor was much higher than recommended. High proportion of junior resident doctors and lack of standard operating procedures lead to this.
Deployment of experienced staff
Formulation of benchmark for various services (waiting time, service time) with annual audit mechanisms
Posting a laboratory technician in the area for collecting blood samples to ease the work load on resident doctors.