Project Title

Adaptive model to strengthen facility-based integrated emergency care system for providing quality emergency care among red triage patients (Time sensitive and other emergencies) at all levels of health care facilities

Program Officer

Dr. Stuti Bhargava | Scientist 'E' Division of Delivery & Implementation Research

NHRP Area

Acute Emergency Care

Project Status

Ongoing

Date of Start

June 2023

Duration

36 months

  • Summary

  • The ICMR National Health Research Priority (NHRP) project on Integrated Emergency Care aims to improve facility-based emergency care for 10 most common red-triaged conditions. As a part of the project objectives a comprehensive gap assessment of emergency care services was conducted across 52 health facilities representing multiple levels of the healthcare system across 3 districts (Naharlagun-Arunachal Pradesh, Ayodhya-Uttar Pradesh and Gaya-Bihar).
  • The assessment identified critical gaps and barriers, including limited administrative ownership of emergency departments, weak monitoring and evaluation mechanisms, inadequate infrastructure; absence of standardized triage and referral protocols; inefficient patient flow and processes within emergency areas; shortages of trained human resources; and inconsistent availability of essential drugs and diagnostic services. The project aims to improve these facility based care especially for treating ten most common life threatening conditions (STEMI, Stroke, Trauma, Shock, Unconscious, Respiratory distress, Poisoning & snake bites, Burn, Pediatric emergencies, Obstetrics-gynae emergencies) across all levels of health care.

  • Public Health Relevance

  • The 1978 Alma-Ata Declaration made primary healthcare key to "Health for all." India then pursued Universal Health Coverage (UHC) through Ayushman Bharat, aiming for SDG 3.8 by shifting from fragmented to need-based healthcare across all levels. In 2019, the World Health Assembly recognized that integrated Emergency Care Services (ECS) are essential for time-sensitive care. Although India has numerous health facilities, existing literature indicates that the emergency care system (ECS) remains fragmented and suffers from shortages of supplies and human resources. To fix this gap, the current study seeks to develop a standardized ECS model for primary, secondary, and tertiary care.

  • Problem Statement

  • 90% of deaths and 84% of DALYs around the world were due to emergency conditions. The emergency care system suffers from fragmentation of services from pre-hospital care to facility-based care. WHA resolution 72.16 emphasizes the importance of Integrated ECS (2019). Emergency Care System (ECS) represent an area of great potential for reducing morbidity and mortality in low-income and middle-income countries (LMICs). The Collaborative on Enhancing Emergency Care Research in LMICs seeks to promote research that improves immediate and long-term outcomes for clients and populations with emergent conditions. The study aims to describe systems approaches and research strategies for ECS in LMICs.

  • Objectives

  • 1. To Identify barriers and facilitators to providing quality emergency care in red triaged patients (STEMI, Stroke, Trauma, Shock, Unconscious, Respiratory distress, Poisoning & snake bites, Burn, Pediatric emergencies, Obstetrics-gynae emergencies) at all level of healthcare facilities.
  • 2. Co-design/ co-create the contextually appropriate implementation strategies for strengthening the facility-based emergency care.
  • 3. Co-implementation/ Implementation: a. Co-implementation of the contextually relevant model. Documenting the process of implementation (acceptability, adoption, feasibility, fidelity) b. Independent implementation of model by implementation.
  • 4. Contextualize model optimization through iterative learning cycles and feedbacks (PDCA/PDSA cycle).
  • 5. Documentation of implementation of activities and quality indicators.
  • 6. To measure the impact of implementation research on following Key performance indicators for the following emergency care system i.e. Triage, Resuscitation (intervention), Referral/Disposition and organization of emergency.
  • 7. Co-develop the exit plan for sustenance with stakeholders.

  • Project Sites

  • 1. AIIMS, New Delhi
  • 2. Ayodhya, Uttar Pradesh
  • 3. Gaya, Bihar
  • 4. Naharlagun, Arunachal Pradesh

  • Anticipated Outcomes

  • 1. To identify barriers and facilitators to providing quality emergency care to patients with Time-sensitive conditions.
  • 2. Co-design contextually appropriate implementation strategies.
  • 3. Co-implementation of the contextually relevant model.
  • 4. Model optimization through iterative learning cycles and feedback.
  • 5. Co-develop the exit plan for sustenance with stakeholders.

  • Activities

  • Policy Implications & Public Health Impact

  • This study will lead to improved quality of care leading to improved outcomes. It will provide a model to improve the quality of Emergency care that improves care of Red Triage patients for our country for primary, secondary and tertiary level healthcare facilities. It can be escalated nation-wide. Further, it will give insight to policy makers and planners to prioritize their policies and investments. The utilized key performance indicators can be made an integral part of monitoring and evaluation systems at facility level, state level as well as national level to sustain quality of emergency care.

  • Publications

  • 1. Sinha TP, Bhoi S, Sharma D, Chauhan S, Magan R, Sahu AK, Bhargava S, Nayar PD, Kannan V, Lodha R, Kacchawa G. Strengthening facility-based integrated emergency care services for time sensitive emergencies at all levels of healthcare in India: An implementation research study protocol. Health research policy and systems. 2024 Sep 9; 22(1):125.

  • Achievements

  • 1. Implementation models of NHRP Integrated Emergencies Project were discussed Post Budget Webinar (Union budget 2026- 2027) for Ministry of Health and Family Welfare, GOI to strengthen emergency and trauma care across district hospitals in India.
  • 2. State level meetings with healthcare administrators in Arunachal Pradesh and Uttar Pradesh to facilitate implementation across the entire state.
  • 3. Dedicated funding allocated in State budget Arunachal Pradesh (2026-2027) to set up emergency and trauma care centres in all districts in a phased manner.
  • 4. Implementation of National Triage Protocol across health care facilities.
  • 5. Improved care of Time sensitive chest pain, stroke, trauma, dyspnea, and snakebite across Healthcare facilities.
  • 6. Starting Academic Emergency Medicine (Postgraduate DNB at Arunachal Pradesh)-TRIHMS.
  • 7. TRIHMS recognized as Centre of excellence for Emergency and Trauma Care by MOHFW, GOI.
  • 8. Over 500 Healthcare workers trained in managing time sensitive conditions.