1.1 Background of Study
USAID reported in 2009 that in Nigeria out surveyed 107 healthcare centre, 20% health care givers washed their hand before and after giving injection, 63% receive vaccination, 43% have no training or information on how to dispose waste, 32% use an off-site disposal method, 20% burn waste of theirs in the open hole which burn freely to the air, this shows that we have a long way to go in achieving a stable and good health care environment to start with and making sure our emergency are safe and secured for the patients to come. Also from the report release by the Economic Global Forum, life expectancy rate of the people in Nigeria is on the average as 47% for the female, 46% for the male, this gives an insight to the level of their survival at the emergency unit.
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In order to improve the chances of survival, there’s need for improvement on the performance level of the emergency for quality of life for both adult and children; the emergency unit of the hospitals is responsible to provide initial urgent treatments for patients with severe form of illness and injuries. Emergency unit was first introduced in the 20th century in response to the need to manage critical illness and acute health emergency situations, it has been observed in Nigeria that most patients about 54 percent end up at the hospital emergency as a last resort after seeking help elsewhere, like from healthcare traditional givers, praying houses, dealers in drugs and so on, due to self acclaimed knowledge, belief and lacking of enlighten and ignorance and sometimes because they cannot afford the bill of the modern healthcare centre as they belief their other options are cheaper. However some of the healthcare centre has their own challenges like inadequate facility and management staff which falls the expectation of the patients, because the expectation of an emergency unit is to increase survival chances for accident victims or patients that need urgent attention with acute critical situations, and through the emergency unit, one can have an insight of the equipments, organization and level of man human resources of the healthcare institution, as some emergency department have poor electricity supply nor do they have a standby power supply which has decrease the survival chances of the patients.
In Nigeria most of the emergency situations are road accidents usually motor cycle bikes and automobiles cars, heart attack also known as cardiovascular attack, asthmatic challenge, domestically accidents, riot violence and occupational hazards and others in which from this research we will find out seasonal trends and projection to provide the hospital management with a good information and how to improve on their future budget and funding. Observing that road traffic accidents are on the increase and the major cases at the hospital emergency as seen that in Nigeria hospital emergency unit, one of three persons dies and these have claimed more lives since the civil war ( from Time Series Analysis of Emergency Unit )
The emergency management team of the emergency unit exists so as to address issues concerning the healthcare management of the unit which over sees the maintenance and development of the emergency procedures, coordination of staff, ensuring they are qualified and have professional knowledge of the field, adequate supply and maintenance of new age equipments and facilities, proper human resources training and on time attention to patients on arrival at the hospital emergency.
It has been observed that time pressure continually increase at the emergency, therefore effectiveness, efficiency and speed have become very important and highly demanded at the emergency unit of the hospitals to eliminate complains of long wait by patients and avoid them leaving before being attended to making them unsatisfied and risk of being expose to more dangers, volume of patients have been lost to about 10 percent because threshold for left before exam (LBE) of 1 percent shows that for every nine patients who LBE due to long wait lines or long time wait and left for another hospitals.
Patients dissatisfaction is not all that suffers here but the risk of their survival at critical emergency situations and can be expressed through angry family members over waiting for long, in the case of accidents, patients are not being attended to immediately unless there is a police report about the situation, these situation have result to some patient’s death and eliminated their chances of survival. Fifty percent of the issue of efficiency here is system issue while the other fifty percent is management issues, the five sub-unit of the emergency unit include:
- Staffing of qualified doctors and nurses
- Clerical unit staff of cleaners and attendants
- X-ray and lab unit
- Chart flow system
- Patients admission unit
The efficiency and speed from this units and there turnaround time determines the performance rating to be high, moderate or low, hence a need to put in place strategies for doing thing better and faster (Clinical & practice management 2004)
Another task is to include emergency medicine physician who is someone who intervenes to resuscitate and stabilize acute patients that need urgent attention, this person is physician who practice basically at the emergency unit trained to take care of adult and children patients with serious injuries or illness that requires an immediate attention medically, although he/she does not provide a long term care to continual care he/she makes sure emergency patients are stable and at a safe state before referring them to other units of the hospital and sometimes the intensive-care unit. Also the emergency medicine aside general medicine attention include surgery which include surgical sub-specialties, they see a lot of patients, giving them immediate attention and making sure they get continuous medical attention after them at the hospital or discharging them from the hospital if they do not need any further medical observations, then the professional emergency medicine physician, who is believed to have broad knowledge in very important fields like, resuscitation of trauma, cardiac arrest, life support, procedure for surgical situations and managing advance airway problems, amidst other skills needed is the ability to stabilize and resuscitate a patient from a critical situation, manage a difficult anesthesia i.e. difficult airways, attending to dislocated joint and fractured bones, treating a heart attack, ability to stop a nose bleed, vagina bleeding from pregnant patients, conduct, read and interpret x-rays from the radiology (World Health Organization).
It is also important to improve on pain management at the emergency because this is one common thing present at the emergency yet it might be difficult to identify pain in some patients and unfortunately there is no test that can prove or disprove a patient’s pain level, more than 60 percent of patients at the emergency have pains symptoms, due to the fact that there is no vivid signs, but can easily be read from the expression of the face, body reactions or language and instinct and guts understanding of the healthcare giver can be useful to validate a patient’s rate of pain, many studies have shown that there is inadequacy to which pain is treated, in most cases it can only be suppress with analgesic after which survey feedback shows about 43 percent of the patients were still in severe or moderate pain and 50 percent of patients show that their post-operative management of pain has proven to be inadequate unfortunately one of the barriers to effective pain management is proper training, even in the medical schools few hours only are dedicating to the study of analgesia while the healthcare givers are expected to pick up these knowledge at the clinical locations during rotations. With the new pain management standards set with some guidelines by the American Pain Society (APS), World Health Organization (WHO) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), these have been applied to emergency medicine where healthcare practitioners are asked to ask screening questions to assist in easily identification of patients in pain, these should be assessed and documented, staff with relevant link to the emergency unit should be adequately trained and importantly the patience be involved in decision making of their pain managing situation not forgetting to put in place policies and procedures for effective pain management at the emergency unit (practical pain management)
1.2 Problem Discussion
The major challenge of the emergency unit is inadequate implementation of the management emergency system, not adequately or fully manned, making it to lack in complete resources, under qualified or unqualified healthcare staff with improper training and development of their skills. It has been observed that most emergency unit of the hospitals in Nigeria do not have an emergency medicine physician so is professional in the field of emergency, someone that is always readily available to give urgent attention to an acute critical situation, resuscitating the emergency patients and bring them to a point of stability, the presence of an emergency medicine physician eliminate any time wastage in getting the hospital doctors or nurses to attend to the emergency patients.
Secondly, just like a need to include an emergency medicine physician, a police protocol officer should be included in the management emergency team (MET) system, because in Nigeria, when there is an accident especially a traffic road accident, the victims are rushed to the hospital emergency unit by witnesses and just kind hearted people and in most cases they are not allowed to sign a consent form to secure the urgent commencement of treatment, and sometimes due to delay to reach out to the victims, a police officer is required to give a police report to guarantee the commencement of treatment, most times the patients die in the process of delay in signing of the consent form for their treatment as most of them are unconscious in the situation, therefore including a police protocol officer means putting a police officer their standby to meet this need and eliminating any time wastage, hence increasing the survival rate of accident victims in the emergency unit.
Thirdly inadequate facilities and equipment at the emergency department, most of the equipments are either outdated or faulty and most times absence of the needed equipments. It is very important for an hospital emergency to be well equip with recent high technology machines to meet up with the new age change and demand, so that time wasting can be eliminated and proper healthcare attention given to increase the survival level of the patients, presence of oxygen at all times cannot be over emphasize, but most hospitals in Nigeria do not have this on standby and has become a major challenge and have cause the lost of lives.
Lastly, the level of power supply is a challenge and big issue in my country Nigeria, the absence of adequate and uninterrupted power supply to the hospitals has been a big challenge, some patients have lost their lives due to this problem, either in the middle of medical attention the light goes off or there is no light at all to start a treatment, especially those that need presence of light before treatment commencement, the only alternative in this situation is to get a standby generator that can also supply electricity but this is not fully guarantee because it might just break down in the middle of an operation, and have caused the hospital management to increase the medical bills so that they can maintain the extra expense, this can leave the patients with inability to make up for the bill and increase the level of LBE (leave before exam) patients.
1.3 Research Purpose
From the above discussed problem, there is need to urgently address the problems associated in Plateau state hospital, as they are faced with all this challenges, and eliminating this challenges means improving a high performing emergency for the hospital emergency management team, increasing the survival rate and decreasing the mortality rate for patients brought to the emergency. The essence of this research to help improve health care performances at the hospital emergencies, in terms of quality healthcare service rendering, adequate and proper emergency equipments, with adequate and well trained health care givers (man power), protocol observations, security presence and general presence of emergency team and it’s necessity, which summarizes the improvement for the MET (Medical Emergency Team) systems of the hospitals, therefore reducing the mortality rates which has been observed to be on a high rate at the emergencies and increasing the survival level of emergency victims. Most times when accident victims are rushed to the hospital, the medical personnel cannot attend to these patients immediately due to absence of protocol officers to give in their consent or due to the immediate absence of the medical personnel at the emergency because they are attending to some patients within the same hospital, amidst attending to other challenges. The delays to give prompt attention in the process have caused the death rate at the emergency to increase. To attain this, some important questions need to be asked and clarified:
- What is healthcare givers qualification in Nigeria focusing on the Plateau State hospital?
- What knowledge, attitude and skills do the healthcare givers have towards emergency situations of the hospital
- Do the hospital have a first aid box
- Are the emergency management team staff trained on how to use the first aid box
- What is the status of the equipments available at the emergency
1.4 Objectives of the Study
- To have the enlightenment knowledge of the situation currently for the healthcare emergency unit of the plateau state hospital
- To efficiently know those qualified to be healthcare personnel and their specializations.
- To understand what and who makes up for the emergency management team and how to improve on the system
- To identify the modes of practices and how the patients are attended to at the Plateau state hospital emergency.
- To add knowledge to the operations of the emergency unit of the hospital
1.4 Research Hypotheses
The patients are the most vulnerable in the situation of emergency; therefore it is very important to access the knowledge, practice, behaviors and attitudes of the healthcare givers towards making the emergency high performing, for effectiveness and efficiencies of the outcome. Formulating the hypothesis includes:
- Improving the MET system by including an emergency medicine physician and a police protocol officer, this will strengthen the MET and eliminate a lot of time wastage
- Training and development of the MET members so that they can improve on there skills
- Improving on the right attitude for the job for the personnel
- Putting in the right ethical practices for the emergency unit
- Improving the equipment of the emergency unit
- Proper training on how to use this equipments, especially the on new high technology machines
- Basic first aid training on use of the first aid box at the emergency unit
- Questionnaires will be distributed to get a surveyed feedback from the patients, their relatives and the healthcare givers (Nurses, doctors and attendant)
My focus here is at the emergency unit of the hospital only; therefore other patients in the hospitals are my delimitations as I will not investigate the performance level nor measures or controls of any other patient survival at the hospital except those at the emergency.
1.7 Outline of Study
This research study is divided into five chapters, where chapter one is the general introduction where all the content are discussed, then chapter two which involves the general review of related literature, generally know as literature review, base on the works and research other authors have done in their books, journals and articles on improving the MET system for a high performing emergency unit, chapter three provides an in-depth methodology on the study, by extracting the feedback gotten through the questionnaires shared and reviewed, chapter four where the result gotten from the previous chapter will be analyzed and result be presented from the data followed by discussing the findings. The last chapter is five, showing conclusion base on the findings from the research, through the study, research and questionnaires for further recommendations.
1.8 Operational Definition of Terms
Emergency Department: is a department of the hospital responsible for providing urgent medical treatment and specializing in acute care for patients arriving to the hospital due to injuries, attacks, accidents or any casualty requiring an urgent attention
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Management Emergency Team (MET) System: they are made up of a group of hospital personnel who are responsible to give acute care to patients arriving at the hospital in a capacity of a emergency manager, doctor, nurses, emergency medicine physician, attendants and sub-staff like the cleaners and waste management team.
Healthcare Personnel: is someone who has been trained to give healthcare services to the patients, who need them, they can involve professionals
Sub-staff: are the supporting staff to the emergency unit, they include the cleaners and waste management team.
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