Special course may help cut deaths due to medical errors

October 29, 2018 12:00 am | Updated 05:01 am IST - New Delhi

A two-day module is mandatory for surgical trainees in the U.S. and the U.K.

With nearly 50,00,000 Indians dying due to medical negligence every year, experts claim that a specialised course for doctors and hospital staff focusing on how a critically ill or injured patient should be handled could bring down the figure by almost 50%.

The Acute Critical Care Course (ACCC), developed in the early 1980s in Europe, has come as a boon for medical institutions abroad by reducing the death rate of patients by nearly 10%, even in serious health complications including sepsis, said Ajay Sharma, a transplant specialist and consultant at the Royal Liverpool University Hospital in the U.K.

The two-day course has become mandatory for surgical trainees both in the U.S. and the U.K., which annually lose over four lakh and 98,000 patients, respectively, due to medical errors, Mr. Sharma said.

A study by the Harvard University last year showed that nearly 50 lakh deaths occur in India annually due to medical errors triggered by lack of practical knowledge among the doctors and nurses to handle patients when brought to the hospital.

The ACCC aims to train the medicine specialists and the surgeons of various specialisation such as surgical, gynaecology, orthopaedics and emergency to suspect and identify patients at a risk of deterioration, Mr. Sharma said.

He said “implementing the course in Indian hospitals, especially in the rural areas, can bring down the mortality rates due to medical negligence by nearly 50%.”

The comprehensive course includes imparting training to the new and existing doctors of a hospital receiving critical care patients either on a high fidelity simulation or preserved dead bodies to make them understand the crucial steps to prevent errors.

M.C. Misra, former director of All India Institute of Medical Sciences (AIIMS) and a fellow at the Royal College of Surgeons of Edinburg, said the ACCC is specially designed for those hospitals where doctors do not have practical knowledge about handling patients that require critical care.

Timely steps

“The deteriorating health of most of the patients can be identified well in time if the residents are trained in how to use simple principles of applied physiology. Timely steps are much more effective than last-minute heroic measures,” Mr. Misra, one of the pioneers in pushing for the implementation of ACCC in the Indian hospitals, said.

“This course takes care of prevention of small mistakes that make it life-threatening for the patient, be it administering IV fluids in patients, minor surgeries or anything else, agreed Geeta Shetty from the University of Birmingham in the U.K.

Medical negligence

“In many cases of medical negligence in India, delay in taking care of breathing leads to organ dysfunction and poorer outcome even if given the best treatment, Ms. Geeta said.

The fundamentals, Mr. Sharma added, taught as part of the course are not just confined to general surgery, but also to the cases of gynaecology, gastrointestinal, cardiovascular, and pulmonary.

“Most of the new doctors are not well-versed in identifying and managing unexpected adverse events which have an enormous impact on the outcome of a patient’s health,” said Mr. Sharma.

“The ACCC is an opportunity to practice these issues and challenges while helping in honing the technical and non-technical skills of the individual in a simulated environment,” he said.

Mr. Sharma and his team have trained medical specialists at various Indian hospitals in ACCC since 2012, when the course was introduced in India.

Limited spread

However, ACCC has not spread far and wide in India with only 450 doctors across the country completing the course, experts said.

Even major hospitals, mostly in the rural belts, continue to ignore it despite most of the medical error cases causing death being reported in tier 2 and tier 3 cities where the concept of critical care does not exist.

The concept of ACCC came into existence after England’s Hillsborough disaster, a fatal human crush during an FA Cup semi-final match between Liverpool and Nottingham Forest in 1989 when over 96 people were killed and nearly 800 injured.

According to the experts, the death toll could have been much lower if adequate medical arrangements were available in hospitals and the staffers were trained well.

ACCC can help the doctors to develop the technical and non-technical skills of managing such patients, said Selva Kumar, a leading cardiovascular surgeon based in the U.K.

Mr. Kumar noted that the course teaches how to correctly execute the basic timely procedures such as ensuring a proper breathing passage for a critically ill or injured patient instead of stopping the bleeding that can be secondary.

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