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Background: A lively, dynamic and interactive feedback system that can connect all the stakeholders and engage them in a sustainable loop of seamless information flow is quintessential for any organization with significant public interface. It is important to balance the asymmetry in the patient doctor relationship and empower the patients. Methodology: In this regard, process mapping of existing system was done. Ethnographic methods were used with triangulation of data for validity. Three key bottlenecks were identified; the system to collect feedback, the feedback form itself and the overall mindset about the feedback system. A de novo, systematic approach akin to the PDSA (Plan-Do-Study-Act) steps in quality improvement was adopted to create a new feedback system and its continuous incremental improvements thereon. Results: Short, attractive form with interactive emoticons graded over a likert scale was created and made accessible through standalone kiosks across the institute. Key attention to ease of access, minimizing the number of clicks, removing human interface and providing SMS/E-mail acknowledgement to feedbacks have all contributed to sustainability of the new system with consistently high turn-out/participation. Conclusion: Designing a customized, hospital specific feedback system rooted more in the experiences on ground is more sustainable and reliable rather than standardized surveys. The same has been reiterated in literature. They can also be used to assess the impact of new interventions. Robust feedback systems can be envisioned as part of accreditation and continuous quality improvement.

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Video recording is widely used for varied purposes in Emergency

INTRODUCTIONMedical direction is a system of physician-directed quality assurance that provides professional and public accountability for medical care provided in the prehospital setting. In an Emergency Medical Services (EMS) system, medical direction provides the operational framework and authorization for EMTs and others to provide emergency treatment outside the hospital. Ultimate responsibility and authority for patient care remains with the physician, as EMTs work as an extension of the physician's practice. 1 Quality improvement is important and should be developed through clear delegation of authority and responsibility for the specific components of medical direction to appropriate individuals. 2 Medical direction is an essential component of a prehospital care system. 3 It is a method of ensuring quality and accountability of the care provided and thus provides a method of risk management for the system.The national research council's subcommittee on medical direction in EMS systems defines three basic functions of medical direction: ABSTRACTMedical direction is a system of physician-directed quality assurance that provides professional and public accountability for medical care provided in the prehospital setting. In an Emergency Medical Services (EMS) system, medical direction provides the operational framework and authorization for EMTs and others to provide emergency treatment outside the hospital. While attending and transporting critical patients to a definitive care setting, there is a need for advanced interventions and administration of drugs to the patients, this will alleviate patient suffering and ultimately allow the patient to be delivered to a receiving hospital in an already improved clinical state whenever possible. The Emergency Medical Technician (EMT) in the ambulance is not licensed to administer drugs to the patient on his own. As EMTs are not aware of administering drugs to the patients in critical situation, there is an urgent need to increase the percentage of critical cases with ERCP advice handled by EMT. The current descriptive study has been conducted to identify the hurdles and gaps preventing communication among the EMT and ERCP among a sample of 40 Emergency Medicine staff through a structured questionnaire. The study showed that there are substantial hurdles when the EMT wants to talk to the emergency physician, which can be removed by a few changes like adopting a new method of enhancing skills and training activities, revision of policies and protocols and a few managerial activities.