The medical profession has become too vast for a small team of professionals to manage without any aid especially when handling heavy case loads or emergencies. During such times, seamless worklfow from a well-coordinated medical team could save the patient, before the doctor comes on board.

Doctors surely know that in medicine, especially during emergencies, seconds and minutes could mean a difference between life and death or lifelong disability. Fatalities in health care, resulting in injury or death to the patient, due to system weakness are a matter of considerable concern, especially when it relates to the response time dynamics. Because this is one area where simple and precise processes and discipline can help improve patient outcome.

Research done by an Israeli team of doctors show that on average, a medical team has to perform nearly 178 tasks on a patient admitted to the ICU. Moreover, all tasks have their order, and the order cannot be skipped without risking serious complications to the patient, or even death. Even in the simplest cases, missing a step in care can lead to devastating complications.

Response time effectiveness- Story from Austrian Alps

Like India, many nations have their own quirky medical cases for which they have to devise systems. In a corner of the Austrian Alps, near the town of Klagenfurt, the local community hospital once received a call from a woman frantically saying her daughter had fallen into a frozen lake. The ambulance rushed to the scene but the girl had no pulse, her pupils were not responding to light, in short, she was as good as dead.

But the team continued resuscitation, brought her to the hospital, and tried to revive her. Her hypothermia was treated, and the doctors had to cut open her chest to clear the water and debris from her lungs through a bronchoscope. She was then put on the ventilator and she slowly recovered after a few months. Eventually, she went back to being normal after rehabilitation, although it took nearly two years for that.

A few months before, in the same hospital, patients used to die in such a case. Mainly because some trained professional, such as a cardiothoracic surgeon, an anaesthesiologist or someone would be missing. Time would pass until they arrived, and the patient inevitably died.

The hospital then decided to devise a strict protocol. They trained the emergency response staff in some basic resuscitation and revival measures, trained hospital staff to keep the emergency room ready for the patient’s arrival, and the team of specialists on their toes to attend to any eventuality.

This simple step ensured everyone was ready and saved valuable time for many patients. Later, patients who were wheeled in after the system was implemented almost always survived, by the sheer power of coordination and speeding up of response times.

Setting systems

Being an extremely complicated discipline, with the WHO now listing nearly 13000 diseases and ailments of the human body, medical professionals cannot rely on their memories and instincts any more, especially in a setting like India when the ratio of doctor to patients is almost phenomenally beyond what a doctor can handle as a normal human.

Although these systems cannot always cover up for a basic lack of resources, professionalism or the disparate doctor-patient ratio, it can help in covering up for any mistake or inordinate occurrence by devising systems, checklists, and protocols for cases which are regularly seen in specific hospitals.

Precise and clear communication is the key in high tension situations

Dr. Atul Gawande, best known for his evangelical zeal in implementing checklists in hospitals, especially in critical settings such as surgeries and emergency rooms, mainly because many common procedures in hospitals only require clockwork precision and following scientific methods rather than the active application of a doctor’s diagnostic and medical skills, advocates using simple yet powerful tools (checklists) and talking to each other to make sure they were doing the right thing.

In critical situations, when patients are wheeled in for emergency operations and tensions are high, Gawande often advocates clear and concise communication regarding the patient’s condition, the parameters and the task at hand. Sometimes, hospital including senior nurses can often provide some vital insights for the surgeons.

What are the lessons

Indian hospitals are staffed by extremely competent doctors who can deliver the best care in the world. However, the story is different when support systems are concerned. Especially in situations such as accidents, the usual response time is around fifteen minutes to thirty minutes and much higher in peak times in major cities.

However, when the patient load is high, medicos can proactively talk to administration officials to set systems in place for high-load days or for cases which are repeatedly seen in hospitals. In such situations, although India needs to do more on improving public infrastructure, keeping the hospital staff ready, the ambulance stocked with adequate medications and trained staff onboard can be pivotal to a patient’s survival.

For instance, drafted responses to perceived incidents such as fire-related injuries during the Diwali festival, can avoid fatalities. The faster the response time, the lower will be the risk. The clearer the communication, the greater the likelihood of a response to correct the problem.