Developing Systems in Medical Care

Dr Purushottam Kumar Garg

Today in Aaj Ki Baat, there was news about TV team of Rajat Sharma Ji talking to a doctor in Mumbai. This doctor was indicating that the government should make guidelines for plasma therapy based on the same principles as for organ donation in India. He was frustrated as well due to so much fraud around plasma therapy and there seems to be. no system to check it's spread.

It is a really pathetic situation in India, always. We saw the same chaos for the admission process of patients in Delhi hospitals ( and hospitals elsewhere, but not reported as it is happening all over) I suggested an admission coordination committee or process.

Now I am presenting a cookbook, which can be started by one or a group of few hospitals for their hospitals. Do not expect the government will wake up and do something sensible like this. They are "busy" in something else.

Cookbook:

With the recent influx of patient’s, both COVID and non-COVID related, XYZ Hospital system has been working on a process change for our ED patients that are in need of transfer to a higher level of care. Or the patient who wants to be evaluated for treatment in Inpatient capacity.

This new process will hopefully be more convenient for patients and help avoid unnecessary hours in the ED or seeking a place, an inpatient bed for medical care. The patient should first be directed to places where biometrics can be taken and the patient goes to the process of evaluation and sorting process. It will include the stabilization process.

If we have a patient that has completed stabilizing treatment and is only in need of inpatient services, then the goal is to get these patients directly bedded by the coordination team. This will be facilitated through the joint transfer centre who will make all the calls and move once they have taken input from the families. If the patient is unstable, the care is initiated and their admission will take priorities which will include a fast track admission and professional care. Special contact numbers will be given to patients' families to get updated when they want. The communication will be done by social workers and case managers and will leave the medical team time to attend to patients' care-related decisions and steps.

All patients or their families will be requested to call the special numbers for registering them in the system and that protocol will be very brief which does not take more than a minute or two. This way patients can reach the appropriate facility without hassle.

The transfer centre should connect you to the correct facility provider after a determination is made as to whether the patient needs to go to the ED or can be a direct admit based on needs.

A similar system can be put in place for secure plasma therapy. An entity which will earn the trust of people, where they can call and get involved as a donor or recipient of care.

Our PMR, Medical record system will have this feature where we will be asking people if they had COVID or not and if they did, will they be willing to be a donor for sole intention to save somebody's life. Then Seva Sanik will co-ordinate and will get a chance to earn the respect and trust of all people in Bharat.

This should take the burden off the majority of people who are ensured that a standard of care is established for one and all and that care will be given. If they have any concern, a 24h/7 response team should be available to answer and ensure that concerns are taken care off within reasonable time which should not be more that one hour in any circumstances. If this happens, it will restore the faith of people in the system of their country.