There are two major ways a patient finds his or herself in a Nigerian hospital. This is either as an emergency case in which he is taken to the Emergency Department or through a scheduled clinic visit as a new or follow up case. This write up is just to give an idea of what these settings may look like and to see if some of these relate to what you have experienced.
Patient 'A' arrives at the back of a van owned by the Federal road safety. He has been involved in an accident. He is not conscious, has no relatives with him but owns a phone and a wallet with ATM cards and some money. What do you think the average response will be in a Nigerian hospital?
There are some basic steps that every patient coming into the hospital must follow. Opening a new case note for a patient or locating the old one if he is a returning patient, admitting nurse getting a bed ready in the emergency room, getting his vitals and paging the emergency department doctor. As easy as these steps may sound, you will be surprised at the time used in getting these accomplished.
After the patient has been evaluated and is suspected to have several fractures and a head injury, the investigation phase kicks in . Most times while evaluating a patient there is an attempt to take blood samples and other body fluid samples to run basic investigations required for treatment. This goes hand in hand with the stabilization of the patient. Samples are sent to the laboratory and the radiographer is paged to alert him of the case in question. He lets you know when he is free to perform the X-rays or CT scan as the case may be.
This also sounds very straight forward. I would let you know now that this whole process is not as easy as it sounds. The doctor writes out his line of management, fills out order forms for the medications , equipment and investigations needed and hands these forms over to the relative of the patient who runs around to make payments, return with receipt and medications. These receipts accompanies the samples for investigation if not they would not get a result.
This process is very stressful and enough to take you round the hospital a couple of times. But remember that patient 'A' came without a relative and has no real identification which will make his case more difficult. Assuming in extreme cases that a case note is opened for him and most of what is needed to stabilize him is taken form the hospital pharmacy unit and a credit note is opened in his name. His investigation results begin to come back and he would require blood transfusion. This is a major problem in most hospitals. I have never witnessed blood being in excess in the blood banks. At this point you are asked to get a relative who will replace blood being given to a patient. As easy as that may sound, I have witnessed a bottle neck in this process which led to the mortality of a patient managed in a hospital I rendered my services to.
This is just what happens in the Emergency department before admission into the wards. He is stable and is now being evaluated by the various medical specialist who have received consults on the patients case. He is seen by the orthopedic team and neurosurgeon and will require admission and a scheduled surgery to realign the fracture sustained. A new set of investigations are written and another set of equipment's and medications are to be purchased plus theater fees. He also needs another set of blood cross matched in preparation for this procedure.
Having painted the picture of the average experience in an emergency situation in the Nigerian hospital. Let me see if I can paint a different picture. Just imagine if there was an emergency number around the nation that one can call when there has been an accident. The operator of this number will send the nearest squad to retrieve the patient and resuscitate him. The squad will be trained on the basic resuscitation techniques, vitals monitoring and ways to properly retrieve patients from sites of accidents with proper vehicles and equipment.
The nearest hospital will be contacted by the emergency squad with patients biophysical profile plus presenting complaint with a short summary and average time of arrival. That way the hospital is already expecting the patient and the nurses, doctors, radiology unit and other allied medical practitioners will be waiting with all necessary items for the treatment of this patient. The squad will also work with the road safety to identify relatives and alert them on the patients state and where he is being taken to. This process will save the patient and hospital staff a lot of time for interventions that will be required in the hospital.
I can already hear some people saying this will be hard to put together all over Nigeria but I beg to differ. The government can work with the telecommunication industry to have a department for emergency response with standard questions to ask and the directory of squads around the country. This emergency number should be a single code country wide. For example when you dial the number, you are asked what the emergency is, where you are, who is speaking and given safety instructions with an assurance that a squad is headed your way with approximate time of arrival.
The government should also partner with private sector individuals to setup emergency squads for every senatorial district and local government. These emergency response unit should have a direct line to the emergency unit of all hospitals in the state they operate. Another way of doing it is for the government to hire an train emergency squad response teams in all the road safety offices all over the country. I would prefer the former rather than the later idea because of the general attitude people have when they work for the government which is not found in the private sector.
That is a new line of job creation in the country and people will pay for the services through their final medical bill which will be sent to the company that brought in the patient.
In the second part of this write up, I would like to take a look at the clinic visit scenario and possible ways to make the hospital experience a stress free one. I would also like to hear your own experience and what you think would have made your experience a better one. Thank you
Patient 'A' arrives at the back of a van owned by the Federal road safety. He has been involved in an accident. He is not conscious, has no relatives with him but owns a phone and a wallet with ATM cards and some money. What do you think the average response will be in a Nigerian hospital?
There are some basic steps that every patient coming into the hospital must follow. Opening a new case note for a patient or locating the old one if he is a returning patient, admitting nurse getting a bed ready in the emergency room, getting his vitals and paging the emergency department doctor. As easy as these steps may sound, you will be surprised at the time used in getting these accomplished.
After the patient has been evaluated and is suspected to have several fractures and a head injury, the investigation phase kicks in . Most times while evaluating a patient there is an attempt to take blood samples and other body fluid samples to run basic investigations required for treatment. This goes hand in hand with the stabilization of the patient. Samples are sent to the laboratory and the radiographer is paged to alert him of the case in question. He lets you know when he is free to perform the X-rays or CT scan as the case may be.
This also sounds very straight forward. I would let you know now that this whole process is not as easy as it sounds. The doctor writes out his line of management, fills out order forms for the medications , equipment and investigations needed and hands these forms over to the relative of the patient who runs around to make payments, return with receipt and medications. These receipts accompanies the samples for investigation if not they would not get a result.
This process is very stressful and enough to take you round the hospital a couple of times. But remember that patient 'A' came without a relative and has no real identification which will make his case more difficult. Assuming in extreme cases that a case note is opened for him and most of what is needed to stabilize him is taken form the hospital pharmacy unit and a credit note is opened in his name. His investigation results begin to come back and he would require blood transfusion. This is a major problem in most hospitals. I have never witnessed blood being in excess in the blood banks. At this point you are asked to get a relative who will replace blood being given to a patient. As easy as that may sound, I have witnessed a bottle neck in this process which led to the mortality of a patient managed in a hospital I rendered my services to.
This is just what happens in the Emergency department before admission into the wards. He is stable and is now being evaluated by the various medical specialist who have received consults on the patients case. He is seen by the orthopedic team and neurosurgeon and will require admission and a scheduled surgery to realign the fracture sustained. A new set of investigations are written and another set of equipment's and medications are to be purchased plus theater fees. He also needs another set of blood cross matched in preparation for this procedure.
Having painted the picture of the average experience in an emergency situation in the Nigerian hospital. Let me see if I can paint a different picture. Just imagine if there was an emergency number around the nation that one can call when there has been an accident. The operator of this number will send the nearest squad to retrieve the patient and resuscitate him. The squad will be trained on the basic resuscitation techniques, vitals monitoring and ways to properly retrieve patients from sites of accidents with proper vehicles and equipment.The nearest hospital will be contacted by the emergency squad with patients biophysical profile plus presenting complaint with a short summary and average time of arrival. That way the hospital is already expecting the patient and the nurses, doctors, radiology unit and other allied medical practitioners will be waiting with all necessary items for the treatment of this patient. The squad will also work with the road safety to identify relatives and alert them on the patients state and where he is being taken to. This process will save the patient and hospital staff a lot of time for interventions that will be required in the hospital.
I can already hear some people saying this will be hard to put together all over Nigeria but I beg to differ. The government can work with the telecommunication industry to have a department for emergency response with standard questions to ask and the directory of squads around the country. This emergency number should be a single code country wide. For example when you dial the number, you are asked what the emergency is, where you are, who is speaking and given safety instructions with an assurance that a squad is headed your way with approximate time of arrival.
The government should also partner with private sector individuals to setup emergency squads for every senatorial district and local government. These emergency response unit should have a direct line to the emergency unit of all hospitals in the state they operate. Another way of doing it is for the government to hire an train emergency squad response teams in all the road safety offices all over the country. I would prefer the former rather than the later idea because of the general attitude people have when they work for the government which is not found in the private sector.
That is a new line of job creation in the country and people will pay for the services through their final medical bill which will be sent to the company that brought in the patient.
In the second part of this write up, I would like to take a look at the clinic visit scenario and possible ways to make the hospital experience a stress free one. I would also like to hear your own experience and what you think would have made your experience a better one. Thank you
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