Last January when government decided to expand casualty area of Sher-e-Kashmir Institute of Medical Sciences (SKIMS), the move was expected to improve quality of emergency healthcare delivery at the institute, with augmentation of infrastructure and manpower. A year on, there is little improvement in delivery of emergency service. A patient vying for attention of a doctor or trying to get a nurse to adjust an oxygen line is a common sight inside the emergency ward. Under the expansion program the bed strength inside medical emergency was more than doubled, to 70 beds from existing 30 beds. In addition, there are 12 beds in surgical emergency. A doctor working in medical emergency said that on some days over 150 patients are admitted in the emergency. “Some patients are shifted on beds, some on wheelchairs and others are taken care of on stretchers,” he said. The department has an emergency operation theatre, emergency USG facility, emergency CT and other emergency diagnostic facilities. The emergency area of SKIMS was expanded to ease load on doctors and quality care to patients. Over the years, even though the facilities have been expanded, the patient load has also grown manifold. On an average, the emergency witnesses a load of 400-500 patients in OPD every day. These include patients with heart attack, stroke, cancer, diabetes, blood pressure, infections and all sorts of emergencies. The department admits 60-70 patients daily, according to data maintained by SKIMS. “But the gross shortage of staff to cater to this growing load is not only hitting services but also putting extra load on the “already overburdened” staff,” said the doctor. The emergency medicine department has only two faculty members. A source at the hospital said that the department needs at least six faculty members, given the patient load. There are 30 doctors working at the department, which includes 13 junior residents, five senior residents and eight postgraduates. These doctors work without any break, all days of the week. Unlike out-patient departments which run from 10 am to 4 pm and provide care to those admitted under their specialty, the doctors in emergency work round the clock to take care of all patients arriving at the hospital, as emergency cases. Most of these patients require close management. Moreover, in terms of nursing staff, before expansion of the emergency area, there were 12 nurses to cater to patient needs. After the bed capacity was expanded, there has been no addition to the staff of nurses. During most times of the day, only two to three nurses are working in one emergency. An official at SKIMS said that the Institute had proposed an addition of 100 posts of nurses to address gross shortage of nursing staff. However, two years on, the proposal is yet to see light of day. “Now, recently, Government has asked the Institute to re-submit the proposal,” the official said. A senior faculty at SKIMS said in 2012 the state government had submitted Rs 452 crore proposal to Government of India for creation of a stand-alone Emergency and Trauma block at the institute. However, the proposal didn’t see light of the day. The separate block for emergency and trauma cases would have helped the Institute focus on its mandate – to provide desired tertiary care facilities to patients. “If the major rush of patients that arrives as emergency is taken out of the institute, we would have the hospital see patients who actually require the SKIMS,” the faculty member said. He added that currently the institute was “just one big primary health center” where a patient with mere acidity would compete for space with a patient having heart block. “The institute needs to evolve and for that it needs to re-imagine its role and responsibilities,” another faculty member said.
SKIMS: It’s an emergency
