Question

Identify a challenge in the management of acute conditions and discuss whether the selected improvements will result in improved clinical outcomes.

Answer 1

A disease is classified as acute illnesses when it is of short duration. They can be minor or they may be serious illnesses. Minor acute illnesses include the commonest problems such as upper respiratory tract infections, minor allergies or skin rashes. Major acute illnesses occur as an acute exacerbation of an underlying chronic illness like in case of myocardial infarction or diabetic coma, it can occur as a sudden onset of a previously undiagnosed condition, such as epilepsy or stroke or an acute emotional or psychological problem.

The rapid onset of symptoms may be a diagnostic puzzle and may need the help of another working group. The rapidly appearing symptoms determine the nature of the illness.

Healthcare personnel may face many challenges in managing acute illness. They are :

• Difficulty in triaging the symptoms.
• Stigma and discrimination when managing psychiatric illnesses.
• Inability to manage aggression potential
• Lack of adequately qualified personnel
• Lack of other resources

In most of the settings, the GPs remain responsible for assessing the majority

of acutely ill patients. In most of the hospitals, the emergency department is loaded with patients with acute illness. Acute major illnesses may require emergency treatment to reduce the impact. The prompt and accurate analysis and a triage system in the emergency department are essential in managing this. Triage tags also allow the providers who are moving patients to the treatment area to locate and move the most critical patients immediately.

In the US the triage classification systems are used a number of other purposes, including:

1. In QA reviews, such as correlating assigned triage classification with final care delivery and waiting times

2. Management of costs of delivery of emergency healthcare

3. Data collected by government agencies to analyze the appropriateness of care delivery in Eds.

For an effective triage system, the triage process and rules must be easily understandable, can be easily applied, widely accepted, promote appropriate placement, able to predict the ED resource use and able to predict prognosis. Triage is not an endpoint but a beginning of the care. The triage rules/assignment should be linked to diagnosis and care plans. The analysis of triage and other outcome data made the immediate care for life-threatening problems is not difficult EDs. A system that is well organized and resourced, and with sufficient capacity to deal with variability in demand helped the functioning of EDs easy and need-based.

Challenges of triaging are :

• deciding what information should be collected at the time of triage
• determining how this information should be used to assign patients to tracks and prioritize them within tracks.
• Proper training and policies of the hospital can over come to the challenges and effectively utilize the triage system.