New Delhi: With nearly 50,00,000 Indians dying due to medical negligence every year, experts believe that a specialised course focusing on how a critically ill or injured patient should be exactly handled could bring down the figure by nearly 50 percent, if imparted to hospital staff including doctors across the country.
The Acute Critical Care Course (ACCC), developed in the early 1980s in the west, has come as a boon for medical institutions abroad by reducing the death rate of patients by nearly 10 per cent even in serious health complications including sepsis.
The two-day course has even become mandatory for surgical trainees both in the US and UK, which annually lose over 4,00,000 and 98,000 patients respectively due to medical errors.
In India, the situation is worst as a Harvard study recently showed that nearly 50,00,000 deaths occur in India annually due to medical errors triggered by lack of practical knowledge among the doctors and nurses to handle patients when brought to the hospital.
The ACCC basically aims to train the medicine specialist and the surgeons of various specialisation such as surgical, gynecology, orthopedics and emergency to suspect and identify patients at a risk of deterioration, said Ajay Sharma, a leading transplant specialist and consultant with the at Royal Liverpool University Hospital in the United Kingdom.
The comprehensive course includes imparting training to the new and existing doctors of a hospital receiving critical care patients either on a high fidelity simulation or preserved dead bodies to make them understand the crucial steps to prevent errors.
The fundamentals taught as part of the course are not just confined to general surgery, but also to the cases of gynecology, gastrointestinal, cardiovascular, and pulmonary.
Sharma, who along with his team often visits India to train medical specialists at various hospitals about the ACCC, said that the course is immensely helpful for doctors having inadequate knowledge of patients and their clinical conditions when brought to the hospital and similarly for the trainee doctors who do have adequate practical knowledge of the medications and drug interactions.
“Most of the new doctors are not well-versed in identifying and managing unexpected adverse events which have enormous impact on the outcome of a patient’s health. The ACCC is an opportunity to practice these issues and challenges while helping in honing the technical and non-technical skills of the individual in a simulated environment,” Sharma said.
The ACCC which was introduced in India in around 2012 has not spread far and wide with only 450 doctors across the nation completing the course. Surprisingly, even major hospitals, mostly in the rural belts, continue to ignore it despite most of the medical error cases causing death being reported in tier 2 and tier 3 cities where the concept of critical care does not exist.
So far, only 10 hospitals and doctors bodies’ including Delhi’s University College of Medical Science, Kasturba Medical College, Maulana Azad Medical College among others have come forward to promote the need for hospitals to adopt the course which are
M C Misra, former director of All India Institute of Medical Sciences and a fellow of Royal College of Surgeons of Edinburg said the ACCC is an initiative specially designed for those hospitals where doctors do not have practical knowledge about handling patients that require critical care.
“The deteriorating health of most of the patients can be identified well in time if the residents are trained in how to use simple principles of applied physiology. Timely steps are much more effective than last minute heroic measures,” Misra, among the pioneers pushing for the implementation of the ACCC course in the hospitals, said.
The concept of ACCC came into existence after England’s Hillsborough disaster of Human crush in 1989 when over 96 people were killed and nearly 800 injured during a FA cup semi-final match between Liverpool and Nottingham Forest.
According to authorities, the death toll could have been much lower if adequate medical arrangements were available in hospitals and the staffers too were trained well.
Experts said that the surgical residents are not formally trained in assessing and handling ill patients using simple principles of applied physiology. They are rather uncomfortable in providing simple life-saving maneuvers and in defining key priorities in the management of sick patient.
“This intense course helps the doctors to develop the technical and non-technical skills of managing such patients,” Selva Kumar, a globally renowned cardiovascular surgeon and the associate medical director UK’s Herfordshire said.
Kumar further said that the course teaches on how to correctly execute the basic timely procedures such as ensuring a proper breathing passage for a critically ill or injured patient instead of stopping the bleeding that can be secondary.
“This course takes care of prevention of small mistakes that makes it life threatening for the patient, be it administering IV fluids in patients, minor surgeries or anything else,” said Geeta Shetty, consultant breast surgeon in University of Birmingham, and faculty for mentoring surgeons at Royal College of Surgeons of England.
“In many cases of medical negligence in India, delay in taking care of breathing leads to organ dysfunction and poorer outcome even if given the best treatment,” she added. ENDS