Dr. Tushar Saikia on Emergency Service Delivery

Challenges faced by Doctors in Emergency Service Delivery 

Dr. Tushar Saikia pursued his MBBS from Rajiv Gandhi University of Health Sciences and further completed his Masters in Emergency Medicine from George Washington University, Washington DC . Later he did his Residency at Kokilaben Dhirubhai Ambani Hospital And Medical Research Institute. In the year 2016 he was posted in the Emergency Department in  Birmingham Heartlands Hospital UK sponsored by Royal College of Emergency Medicine, with his training done at Heart of England Foundation Trust, Birmingham UK. 

Currently he is a core trainee in Psychiatry from University of Leeds, Health and is currently placed at Humber Teaching Foundation Trust.

Pleasure to have you with us Dr. Saikia. Firstly we would like to congratulate you for your untiring resolve and efforts in ensuring quality healthcare is provided. We would love it if you could throw some light on the present opportunities and challenges in handling emergency cases.

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Where are you working right now?

I am working in Hull, East Riding, Yorkshire in multiple hospitals.

In what field of healthcare are you practicing?

Earlier I was posted in the emergency department of Heart of England Foundation Trust in Birmingham, where I used to deal with accidents and emergency cases. At present, I am associated with Mental Health.

What are the steps you follow in emergency medicine?

We deal with it according to the severity of  patient’s condition. There are three different areas Major, Minor and Resuscitation. Major Area being where the condition is not life threatening. Minor Area deals with minor problems like fever and resuscitation deals with whether the patient needs ventilator or not. We segregate the patient based on a scoring system named ‘NEWS’. It comprises of a check on vital parameters:

1. Blood Pressure
2. Heart Rate
3. Oxygen Saturation
4. Respiratory Rate
5. Temperature

Based on this theory we score the patient, higher score means the patient needs immediate attention. NEWS is repeated every hour. Unwell patients go on the monitor, which is a constant check of BP and heart rate.

Can you plug in the challenges that you have faced while dealing with an emergency situation?

Yes we face a number of challenges. Firstly, overcrowding, where a number of ambulances come in at the same time and out of say, 10 people, only 5 will need immediate attention. And due to lack of staff, it becomes difficult to see all of them. Secondly, in terms of record keeping, when you see a patient you need to write notes for every patient and if there is overcrowding of patients, you do not get sufficient time to make complete notes. This at times leads to incomplete recording and creating friction in the subsequent processes as well as a risk of incorrect diagnosis. This frantic moment can also cause loss/misplacement/mismatch of notes as well. Thirdly, in an emergency situation there are many challenging patients such as drug addicts or alcoholics who, in a state of inebriation, cause challenges for the doctors to treat them. The most common example of unwanted behavior is he or she pulling the chords of the ventilators. In such a situation a Seclusion Room or some remotely executable solution might really help.

In most of the cases that you have dealt with, what have the patients or their families complained about, starting from reaching the hospital to getting fully cured?

Many patients and their families complain of long waiting hours at several steps in the patient’s treatment. This often  is due to lack of staff. There are some patient cases who in spite of being treated are not discharged as they have to be seen by senior doctors so there is no room for new patients.

What can be improved in order to positively impact mental and psychological well – being of patients and their family members?

Many times patients wait for the decision by the hospital whether they have to stay in the hospital or not as they end up googling their symptoms which often misleads them to a major health problem. Due to this, they usually end up waiting in the hospital for longer hours.So any AI machine that can be introduced in such cases where the machine is able to differentiate diagnosis and recommend tests accordingly would be of great help.This will save both patients and the doctors time.

What are those machines or equipment that only 10% of the hospitals have and rest 90% do not?

Lack of adequate availability of specialized machines like ECMO (EXTRA CORPUSCULAR MEMBRANE OXYGENATOR).This machine serves like an artificial lung. If a patient’s lungs are in a very bad situation and he/she is not able to breathe, then ECMO does the function of the lungs. This machine is found only in a few hospitals.In India also there are less than 500 machines available, but now in case of COVID 19, the demand of ECMO is very high.

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Any machine or app that can share the load of the doctor by recording the medical notes of every patient can help ease the life of a medical practitioner thereby giving a boost to the efficiency in treating the patient. Also, provision of any seclusion rooms or any remotely working devices for drug addicts or alcoholics in emergency department is recommended for safety and security reasons.In addition to this, any artificial intelligence or machine driven app that can help in differential diagnosis of the patients and providing them with relevant tests can help in saving both the patient and doctors time.Lastly, highly specialized machines such as ECMO are required at large scale.