Rajesh Kumar, a labourer in his mid 30s, who was referred from a hospital in Ludhiana to the Post Graduate Institute of Medical Education and Research (PGIMER)’s Advanced Trauma Centre after he suffered a fracture in his spine. After being initially attended, an orthopaedic said he needed clearance from neurosurgeon and the patient kept lying for two days without any treatment. Finally, the family gave up and took the patient back to Ludhiana. Like many, he was also the victim of lack of coordination among various specialties at the institute’s trauma centre.
A study by the institute’s departments of hospital administration and community medicine has found that it is complete mess at the Advanced Trauma Centre when it comes to providing treatment to a patient suffering from multiple trauma injuries and requires to be treated by different specialties.
Under the study, records of 210 patients of polytrauma (requiring treatment from multiple surgical specialties) in the emergency OPD at the trauma centre were examined for a period of two months. The study was published in the World Journal of Emergency Medicine in 2013.
The study found that there is a complete lack of coordination among various specialties when it comes to treating multiple injury patients, who require treatment by more than one specialty. The results of the study showed that the problems faced at various steps while managing polytrauma patients were observed mostly in cases requiring consultations of three-four departments.
“The lack of coordination was probably the main cause leading to delay in management of polytrauma patients. This led to an increase in average length of stay of the patient in the emergency department,” the study observed.
The PGIMER gets around 10 patients everyday at the Advanced Trauma Centre, who suffer from multiple injuries. Most of these patients are injured in road accidents.
The study found that when treatment was required to be done by two specialties, patients had no problem at any stage. During the management, most of the problems (60%) occurred at stage three, when the doctor of the specialty concerned did not attend the call within 24 hours of information as per the predetermined criteria.
The study found that there are frequent complaints, in particular, regarding the management of patients with polytrauma, which leads to delays in their discharge.
Delayed discharge of these patients leads to an increase in average length of stay of the patients, further resulting in unavailability of beds to other patients requiring emergency treatment.
WHAT CAN BE DONE?
A well functioning polytrauma team with a team manager, a proper triage system, good coordination, documentation and a well-defined standard operating procedure is the key to the proper management of polytrauma patients.
HOW MUCH TIME IT TAKES
Assessment of polytrauma patients by general surgeon
WITHIN 1 HOUR
Preparation of treatment plan, referral of patient, and info to different specialties
WITHIN 1 HOUR
Patient attended by specialties as per treatment plan
Patient attended by other specialties not initially planned by general surgeon
Clearance given by different specialties
Responsibility of patient for treatment and discharge