In a span of seven months, mortality due to trauma and non-trauma at the emergency department of Rajiv Gandhi Government General Hospital (RGGGH) has dropped. Accident and emergency protocols that were rolled out on a pilot basis in January 2018 have streamlined emergency care, reducing delay in attending to patients, through triaging and prompt initiation of investigations and treatment.
With the implementation of the Tamil Nadu Accident and Emergency Care Initiative (TAEI) protocols, the casualty ward of RGGGH has undergone a sea change. Today, it is a full-fledged Emergency Department (ED), receiving an average of 220 cases everyday, according to R. Jayanthi, dean of RGGGH.
“During a review of the last seven months, we found a significant drop in the mortality rates. Deaths due to trauma and non-trauma have almost halved. Death due to trauma has reduced from 8.27% in January to 4.89% in July. In non-trauma cases, the mortality rate has come down from 5.51% in January to 2.72% in July,” she said.
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While the emergency room was modernised, the initiative revamped the entire process-flow of emergency care. To start with, a patient’s arrival is intimated by the 108 ambulance’s emergency medical technician, on a dedicated TAEI number, that puts the hospital’s medical/paramedical team on alert. The patient is received by members of a green brigade, comprising persons trained in safe transportation of those with spinal or cervical injury, she explained.
“There are three triages, each having a trained nurse to categorise the patients, depending on the physiology and nature of injury. There is a red zone for patients in need of immediate attention, yellow zone for those who need admission and green zone for those who are stable and ambulatory,” said V. Rajesh, TAEI coordinator, RGGGH.
Inside the red zone, there are three resuscitation bays and five beds. The yellow zone has 17 beds and the green zone five.
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“There are separate teams of doctors for the red and yellow zones. We distribute patients and provide simultaneous attention. This has reduced the time taken to attend to a patient. A patient is now attended to, in two to three minutes,” he said. In fact, formalities for medico-legal cases have been pushed back, making treatment the priority.
An emergency laboratory, comprising an arterial blood gas analyser and cell counter has been created.
Doctors say this has cut down the time taken for investigations by several hours, helping in expediting treatment.
The ED has doctors drawn from almost all specialties, such as neurosurgery, orthopaedics, anaesthesia and general surgery, round-the-clock.
J. Mariano Anto Bruno Mascarenhas, nodal officer and technical head, TAEI, said there are 75 TAEI centres in government medical colleges and district headquarters hospitals in the State.
“The next objective is to standardise emergency room (ER) care, by implementing uniform ER layout, equipments, consumables, drugs, protocols and quality checking mechanisms across all centres. The aim is to bring down mortality, morbidity and improve the outcome at all centres,” he said.