Improving door-to-doctor and door-to-analgesia time in a tertiary teaching hospital emergency department through a novel 'Red Box' system

To evaluate the effectiveness of a new patient flow system, 'The Red Box' on the quality of patient care in respect of the time taken for the care to be delivered to the patient. A pre-post study was conducted looking at the door-to-doctor [DTD] and door-to-analgesia [DTA] times for cases presenting to the Emergency Department [ED] of a tertiary teaching hospital 'The National University of Malaysia Medical Center' between the periods of July and September 2005 against July and September 2008. Demographic data, ED presentation time, time seen by first doctor, and time first analgesia given were collected in both periods and analyzed. A total of 1,000 cases were enrolled. Group A [pre-Red Box] and group B [post-Red Box] comprised 500 cases each. The mean DTD time for group A was 29 minutes [SD +/- 3 minutes] and for group B was 3 minutes [SD +/- 1 minute], with a 98.8% reduction [p<0.001]. For DTA time, group A recorded a mean of 46 minutes [SD +/- 3 minutes], and group B recorded a mean of 9 minutes [SD +/- 2 minutes], an 80.4% reduction [p<0.001]. The implementation of a red box system improved the quality of emergency patient care in the ED of a tertiary teaching hospital as evidenced by significant reductions in DTD and DTA time

A Study of House Officers in a Teaching Hospital on Knowledge, Perception of Skills and Confidence Level in Performing CPR

Cardio-pulmonary Resuscitation (CPR) is important and should be mastered by House Officers (HO). House officers who have just completed their studies are assigned to acute medical and surgical wards. If a patient in the ward has a cardiac arrest (CA), these doctors are usually the first to attend. Therefore an HO must be confident with CPR skills. They must be competent in performing CPR. The authors assessed 26 new HOs from Universiti Kebangsaan Malaysia Hospital (HUKM) with respect to their self-perception about CPR skills, confidence level in performing CPR and knowledge in performing CPR. Knowledge was assessed by a questionnaire. We found that 16 of 26 (61.5%) assessed themselves to have inadequate knowledge and 46.2% had no confidence in performing CPR. The mean score of the written test was 5.7 ± 1.8. Seven out of 26 (27.0%) HOs had incorrect hand placement position for CPR. Only 4 and 9 out of 26 HOs had their sternal paddle and cardiac apex paddle positions correctly placed respectively. In conclusion, knowledge, perception of skills and confidence levels of HOs on CPR are inadequate and need further assessment and improvement. Medical schools need to review their CPR curriculum in order to prepare HOs adequately to work in emergency situations.