An implementation research study on developing a high quality patient-centric integrated model for emergency care system in selected districts of India

The current emergency care system in India suffers from severe fragmentation, leading to gaps in the delivery of care.NITI Aayog, recently unveiled two detailed reports assessing the nation’s secondary and tertiary healthcare, as well as district-level emergency and injury care. The evaluations revealed significant disparities in care delivery, attributed to gaps in prehospital emergency medicine (ambulance) services, healthcare infrastructure, workforce, and medical provisions. The findings indicated that emergency and injury cases comprised 36% of annual hospital admissions.. However, research on emergency care systems in India remains sparse, leaving policy-makers and planners with limited guidance for resource allocation and program development.

 To develop and successfully implement an integrated emergency care system, it is imperative to take into consideration the current state of emergency care, identify gaps in the system, and assess the scope for improvement.

India’s emergency care system, while evolving, still confronts several challenges. Notable progress has been made in recent years, but considerable obstacles persist. These range from limited community access and inadequate infrastructure to poor coordination between health facilities, personnel shortages,lack of public awareness, scarcity of training resources and a disjointed continuum of care. This spans from on scene care ,prehospital care , primary care facilities, all the way to tertiary care hospitals. Additionally, there’s a notable absence of robust public-private partnerships, leading to inefficiencies, delays in care, and subpar patient outcomes.

Timely access is paramount for an effective emergency care system, as it can drastically reduce fatalities and long-term disabilities arising from emergency situations. However, in the current landscape, a majority of emergency services in India are restricted predominantly to the tertiary level, leaving prehospital, primary, and secondary care systems with limited capabilities and accessibility. This misalignment greatly impacts health outcomes.

To address these gaps, there’s an urgent need to develop a district-based, high-quality, integrated, patient-centric emergency care system model in India. The proposed model aims to manage time-sensitive emergencies more adeptly by creating a seamless continuum of services. These services would span different healthcare facilities and would be interconnected through effective communication, transportation, and both referral and counter-referral systems. As of now, large-scale implementation research, using an integrated approach to develop a scalable patient-centric emergency care system, remains sparse in India

This will be a muti-district implementation research conducted along with the State health department with a concurrent mixed methods design. The study will be conducted to develop and implement a high-quality emergency care system with a focus on following time-sensitive emergencies:

a)Trauma and Burns

b) ST-Elevated Myocardial Infarction (STEMI)

c) Stroke

d) Acute Respiratory Illness

e) Postpartum Hemorrhage and Preeclampsia

● Neonatal Emergencies

● Snake Bite and Poisoning.

The study will start with formative research which will identify gaps and help in developing the initial model (M0) of integrated emergency. The model will be optimized using qualitative research and outcome indicators through three iterative cycles of 3 months each, implementing it through a single selected hub and spoke cluster designed as a continuum of care pathway that spans from the community, through prehospital, to various levels of care. The final high-quality integrated emergency care model will be scaled up to the entire district in consultation with the State government and its impact on population coverage will be evaluated