RESUMEN
BACKGROUND: There is a considerable paucity with regards to the research available on the quality and quantity of clinical teaching in the national emergency department (ED) setups. With the onset of the age of modern medicine, the outlook towards to the time worn tradition of triage and detailed medical evaluation must be revoked. Despite the variety of programs being conducted in the country, a comparable entity common to al is patients' clinical outcomes which can be measured using simple parameters which can be easily acquired compiling hospital registry entries. METHODS: A retrospective observational study was conducted in the emergency department of Max Hospital, Saket, New Delhi. A period of 22 months prior to the start of the program and like-wise 22 months after initiation of the program was collected from the hospital registry. The Emergency Medicine program in consideration was the Masters in emergency Medicine (MEM) Program affiliated with George Washington University, NY, USA. Patients of all age groups and gender registering in the Emergency Department and so were all the doctors working in the ED before and after initiation of the program. RESULTS: An improvement was noted in terms of total admissions through the ED per month, average length of stay of admitted as well as discharged patients; return to ED within 24 hours; leave against medical advice and patient complaints. A reduction was noted in number of discharges from the ED. Despite a numerical worsening on the patient's death in ED a graphical improvement can be noted considering the month wise representation of data. CONCLUSION: We can make a coherent conclusion that there is an improvement in the outcome of the entire patient related aspects in the Emergency Department considering the all two time frames included in the study. The difference can be very well attributed to the integration of the structural Academic Program in the development of the Emergency Physicians. This leads us to make a conclusive analysis regarding a positive impact of the Relative Value of Education of Emergency Physicians not only in patient outcome but also in physicians and administrative outlook towards an overall better emergency care.
RESUMEN
@#BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to "wrong triage" in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more lives. METHODS: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a paramedic. RESULTS: By using the proportion test, we found that correct triaging was significantly different (P=0.005) in proportion between the two groups: group B (80％) with triage tool performed better in triaging the bomb blast victims than group A (50％) without the bombing specific triage tool performed. CONCLUSION: Development of bombing specific triage tool can reduce under triaging.