Adamson S. Muula
Editor-in-Chief, Malawi Medical Journal
Professor and Head, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Malawi
Email address: amuula@kuhes.ac.mw
The health system delivery coin has two faces; on one face are the services offered and on the other side are complaints and dissatisfaction. Much of the complaints are on healthcare or medical and curative services. There are complaints about the shortage of medical doctors, clinical officers and nurses, but not so much concerns on the shortage of pharmacists, laboratory technicians, technologists and scientists, or public health professionals. It has been a long time since I last heard about the shortage of palliative care practitioners, public health workers, health administrators, environmentalists and nutritionist and dieticians. The medicalisation of the health systems is for now complete. Very few people are complaining about disease prevention and health promotion. Most of us have complains on real and imagined shortage of drugs, are not keen to listen to health promotion messages and strategies nor keen to make lifestyle changes that will prevent disease and promote health. The health system becomes synonymous with medical care system.
Medical care is important. There should be no doubt about this fact. The health system is also important; in which medical care is just one of its importance sub-sets. Within the medical services is the Emergency departments (EDs) of hospitals and other health facilities. I have heard, read and considered complaints about how long it takes for one to be seen when they show up at a health facility. How that “long” should be measured in Malawi has largely been left to feelings and perceptions. A patient who is waiting to be seen by a clinician most likely feels a time is passing. The patient who is before the clinician on the other hand, wishes to empty all her health concerns to a listening health provider. How long is too long before one is seen?
In the coming year, Malawi may need to re-open the “waiting times” conversation so as to garner some semblance of agreement and protect our hardworking clinicians from unfair feedback or criticism. One of the characteristics of a professional health worker is to absorb all sorts of criticisms levelled against her. However, with a little bit of agreement, knowledge and realistic expectations, some of these criticisms can be rephrased.
How long is too long before a patient must be seen at the Emergency Department? I will present the Australasian Triage Scale 1 which is used in Australia and New Zealand to answer this exact question in their context. There cannot be a one-size fits all expectation. That would be both unrealistic and nonsensical. The ATS varies on how soon people presenting to the ED need medical ought to be attended to. The ATS is mostly implemented by Emergency Room (ER) nurses. It is often the case that patients and their guardians have this illusion that the first professional person they meet at the ED is a nurse. The ATS categories are:
- Triage category 1 (Resuscitation): patient should be seen immediately (within seconds)
- Triage category 2 (Emergency): patient should be seen within 10 minutes
- Triage category 3 (Urgent): patient should be seen within 30 minutes
- Triage category 4 (Semi-urgent): patient should be seen within 60 minutes
- Triage category 5 (Non-urgent): patient should be seen within 120 minutes.
I have presented the ATS as an example of the attempt to set timelines for healthcare services. The ATS is useful and it is often supported by scales for specialized services; for instance for mental health, paediatrics, obstetrics and maternity. What inform/s the triage are: 1) the consequences of responding much later than these standards and 2) the resources context of the health system. Malawi needs to be figure out its own standards and even beat the ATS minimum timelines. How much time must not lapse from the time oxygen or blood is prescribed to when the patients start receiving these commodities? Once a prescription is obtained at the hospitals, when can we agree that a long time has passed before the pills are in the patient’s hands?
Standards will not stop complains; infact they shouldn’t. Feedback is a critical ingredient in healthcare. But we need the standards to work with.
Disclaimer
The views expressed in this editorial are author’s personal. There is no intention to purport that this editorial has the input or endorsement of any of the institutions or organisations to which the author is affiliated with.
Reference
- The Australasian College for Emergency Medicine Document. Australasian Triage Scale. Emergency Medicine, 2002; 14:335-6