Bangalore is one of the fastest growing cities in India. It is located in Karnataka state and has a population of 4.5 million (1991 census). The population is increasing at a rapid rate and the resources are not sufficient to keep pace with the increasing demand. Bangalore has a large number of hospitals and nursing homes in public and private sectors and, inspite of these, people are not satisfied with the quality of care provided in the casualty and emergency departments.
Casualty and emergency services are expected to provide immediate therapeutic and diagnostic care on emergency basis round the clock. Any delay may mean loss of life or prolonged morbidity. Hospital managers face a challenge to provide quick and competent care which can lives and also reduce severity and duration of illness.
The need for evaluation of casualty services in Bangalore has been felt. A study of the available facilities may be starting point in order to identify strategies to improve the services. This study has been taken up in order to achieve the following objectives.
1. To assess the available facilities in casualty and emergency departments of major hospitals in Bangalore.
2. To identify those components of casualty services which require improvement.
At the beginning, a list of 25 major hospitals was drawn up and incidentally, these hospitals are participating in a major study on Road accidents in Bangalore. A questionnaire covering various aspects of casualty services like manpower, equipment, building, protocol, demand on the services, procedures followed, etc., was developed,. Suitable changes were made after the original version. The questionnaire was mailed to Medical Superintendents of all the 25 major hospitals in Bangalore and they were requested to fill in the questionnaire. Responses thus obtained have been analyzed to identify the current state-of-the-art of emergency care services.
The city of Bangalore has a wide range of hospitals extending form public sector and private hospitals along with medical college hospitals and Nursing Homes. The study centres had an appropriate mix of these hospitals. 2 of the hospitals have been functioning for more than 100 years and only 2 of the hospitals were started beyond 1994. The total bed strength of the hospitals varied from 50-1000 and casualty bed strength from 2-43. The average number of patients seen in the Casualty varied from 8-150.
Nearly 70% of the hospitals reported that facilities like waiting room, treatment room, observation or holding room, emergency laboratory, isolation beds, etc., were available. Other basic amenities like drinking water, toilets, canteen were present in 80-90% of the hospitals. The total staff strength in terms of doctors, specialists, trainees, nurses, medico social workers, technicians and group ‘D’ staff varied from hospital to hospital.
In majority of the hospitals, immediate care for patients was provided by non—specialists duty doctors (Casualty medical officers). The specialists services were available in 92% of the hospitals mainly by on call basis. Only 50% of the hospitals reported that their staff were sent for periodic training in emergency care.