A STUDY OF SICKNESS & ADMISSION PATTERN OF

PATIENTS ATTENDING AN EMERGENCY

DEPARTMENT IN A TERTIARY CARE HOSPITAL

Key Words: Emergency, Emergency Department (ED), Casualty, co morbidities, disciplines,

admissions

ABSTRACT

Emergency Medicine is yet to be considered as a specialty and the emergency care needs of the
patients are catered through the “casually” department in most hospitals in India. However, the
workload on this department and the emerging needs of the department as well as patients, play a
very crucial role in providing quality services and operational profitability in hospitals. A study
was undertaken to analyze the sickness pattern of patients coming to the Emergency Department
(ED) and their subsequent pattern of admission vis-a-vis the type of sickness they reported to the
Casualty. This apex tertiary care hospital Casualty, which receives approximately 500-600
patients every day, accounts for 11% of the admissions to the hospital. On an average, 20-25
patients are admitted daily from the Casualty. Findings showed that the majority of the patients
are admitted under General Medicine; of which, respiratory disorders accounted for the
maximum number.

Co morbidities in the form of Diabetes Mellitus and Hypertension were found to be common. It
was also found out that once patients were admitted to the ward of the concerned specialty, the
rest got accommodated in the emergency wards. A very small percentage of the patients were
admitted to private wards from the Casualty. Interestingly, most of the admissions took place in
the afternoon shift. While disciplines like Neurosurgery, Cardiology and Gastroenterology had
bulk of the admissions, Dental surgery, Dermatology and Psychiatry accounted for the least
number of admissions.

INTRODUCTION

“Emergency” is defined as a condition determined clinically, or considered by the patient or his

relative as requiring urgent medical, dental or allied service, failing which it would result in loss
of life or limb. “Medical Emergency” is defined as a situation when the patient requires urgent
and high quality medical care to prevent loss of life or limb and initiate action for the restoration
of normal healthy life. Emergency Medicine is not a specialty in India as yet and hence, very few
hospitals in our country currently have Emergency Medicine Department (EMD). However,
most hospitals have an area designated as “Casualty”, which is most often staffed by junior
doctors and is inadequately equipped to effectively handle emergencies.1

Emergency Care should be of high quality, cost effective and compassionate. The Accident &
Emergency services are one of the mainstays in the chain of medical care offered by the present
day hospitals. The need for effective emergency healthcare delivery through an Emergency
Department (ED) is well recognized and all hospitals must be able to provide basic life support
through their Emergency Services to the patients in need. With emergency department
admissions accounting for about 40 percent of all hospital admissions in most countries,
managing and improving processes in the ED is crucial to both care quality and operational
profitability2. In 1961, Platt Committee (UK) recommended the name Accident & Emergency
Department (A & E Dept.) for “casualty” services. In India, the Central Council of Health in
1963 urged all State Governments to set up Emergency Medical Services in all major towns &
cities3. Common denominators of any successful Emergency Care are4:

• Availability of adequate physical facilities, equipments and supply of all life saving drugs
and surgical items.
• Immediate professional attention after arrival in the hospital ED (Emergency
Department)
• Continued and contant medical support till the patient is in the ED.
• Speedy diagnosis and resuscitation so as to make it possible for integrating a patient into
an existing system of patient care services in the institution.

AIM & OBJECTIVES

The aim of the present study was to analyze the illness profile of patients attending the
Emergency Department (Casualty) at the tertiary care hospital; and their subsequent admission
pattern.

The key objectives were to:

• Determine the workload of the hospital Emergency Department (Casualty) and find out
trends over a specified period of time (3 months) in terms of number of patients as well
as available emergency beds.
• Ascertain the category of patients (attending Casualty) based on the type of illness they
are diagnosed to have during the specified period of time.
• Analyze the admission patterns under various medical and surgical disciplines during the
specified time period with the type of sicknesses the patients reported with.
• Elicit the correlation between the pattern of admission and illness profile.