The Impact of Introducing a Curriculum in Social Emergency Medicine (SEM) at a Private Tertiary Care Center in Karachi, Pakistan.

Abstract

Introduction: The ability to identify and address the negative Social Determinants of Health (SDH) through education in Social Emergency Medicine (SEM) can lead to improvement in Emergency Medicine (EMed) process flow, bounce back and acuity of patients. This can have far reaching implications in a resource limited country like Pakistan. Method: A SEM based curriculum was administered to the EMed residents at a tertiary care center in Karachi, Pakistan. Pre, Post and Delayed Post-test was conducted for knowledge of EMed residents and analyzed using Repeated Measures ANOVA (RMANOVA). Bounce back and acuity of patients was compared in the pre-intervention (2020) and post-intervention year (2021) using frequency with percentages. Result: A significant improvement was seen in post intervention (p < 0.001) and follow up knowledge (p < 0.001) of residents. Bounce back rate was higher in 2020, pre SEM curriculum (43%) as compared to the post SEM curriculum year 2021 (27.7%). The acuity at bounce back was P1 (more seriously ill) in 826 (47.2%) and P2 in 532 (30.4%) in 2020 out of the 125 (7.1%) patients with Acuity P1 at their Index visit (p < 0.001). In 2021, this reduced to Acuity P4 (less seriously ill) in 65.2% patients with their initial Acuity at Index Visit being P3 in 301 (65.6%) and P2 in 97 (21.1%) (p < 0.001). Conclusion: The study highlights the beneficial impact of an educational intervention in SEM upon the bounce back and acuity of patients in the EMed department of a low resource setup. This can be scaled up to other EMed departments across Pakistan for the improvement of EMed process flow and Key Performance Indicators (KPIs).