Adeel Khatri - Academia.edu (original) (raw)
Papers by Adeel Khatri
AEM Education and Training, Nov 21, 2023
BMJ Open, Jul 1, 2023
Introduction A quasi-experimental study was conducted to estimate the impact of sequential emerge... more Introduction A quasi-experimental study was conducted to estimate the impact of sequential emergency department (ED) capacity building interventions on key performance indicators such as patients' length of stay (LOS) and wait time (WT) during the COVID-19 pandemic. This was achieved through augmenting personnel education and head count, space restructuring and workflow reorganisation. Setting and participants This study included 268 352 patients presenting from January 2019 to December 2020 at Indus Hospital and Health network Karachi, a philanthropic tertiary healthcare facility in a city of 20 million residents. A follow-up study was undertaken from January to December 2021 with 123 938 participants. Primary and secondary outcome measures These included mean and median ED-LOS and WT for participants presenting in different cohorts. The results of the pre-COVID-19 year 2019 (phase 0) were compared with that of the COVID-19 year, 2020 (phases 1-3 corresponding to peaks, and phase 4 corresponding to reduction in caseloads). The follow-up was conducted in 2021 to see the sustainability of the sequential capacity building. Results Phases 1, 2 and 3 had a lower mean adjusted LOS (4.42, 3.92 and 4.40 hours) compared with phase 0 (4.78 hours, p<0.05) with the lowest numbers seen in phase 2. The same held true for WT with 45.1, 23.8 and 30.4 min in phases 1-3 compared with 49.9 in phase 0. However, phase 4 had a higher LOS but a lower WT when compared with phase 0 with a p<0.05. Conclusion Sequential capacity building and improving the operational flow through stage appropriate interventions can be used to off-load ED patients and improve process flow metrics. This shows that models created during COVID-19 can be used to develop sustainable solutions and investment is needed in ideas such as ED-based telehealth to improve patient satisfaction and outcomes.
International Journal of Healthcare Simulation
Professional development in simulation-based education (SBE) is a complex process. Individual com... more Professional development in simulation-based education (SBE) is a complex process. Individual components have overlapping boundaries and relationships, rendering them suitable for Complex Adaptive Systems (CAS). This complexity is multifold in low-resource settings, unfamiliar with simulation, and augmented by hierarchical culture and linguistic diversity. This study aimed to conduct a professional development course through SBE using principles of CAS for faculty in a Pakistani medical college. A simulation educator team (six on-site, three online) from Pakistan and North America constructed and facilitated a 6-hour-long hybrid course following CAS in three phases. Planning phase consisted of needs assessment and inclusion of stakeholders in decision-making. Implementation phase involved remote facilitators joining the in-person team using Zoom and demonstrating evidence-based practices in case design, pre-briefing, facilitation and debriefing. In the evaluation phase, participants...
BMC Medical Education
Introduction An enhanced knowledge of Emergency Medicine (EM) personnel regarding negative Social... more Introduction An enhanced knowledge of Emergency Medicine (EM) personnel regarding negative Social Determinants of Health (SDH) can impact EM service provision in a resource limited country like Pakistan. Interventions to build capacity in identifying and addressing these SDH through education in Social Emergency Medicine (SEM) can be one of the ways in which EM key performance indicators (KPIs) can be improved. Method A SEM based curriculum was administered to the EM residents at a tertiary care center in Karachi, Pakistan. Pre, post and delayed post-test was conducted for knowledge of EM residents and analyzed using Repeated Measures ANOVA (RMANOVA). Clinical impact of this intervention was assessed through the ability of the residents to identify the patients’ SDH and determining appropriate disposition. Comparison of the bounce-back of patients in the pre-intervention (2020) and post-intervention year (2021) year was appreciated to see the clinical impact of this intervention. Re...
Introduction: The ability to identify and address the negative Social Determinants of Health (SDH... more 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 acui...
Pakistan Journal of Medical Sciences, Nov 16, 2022
The World Health Organization (WHO) surveillance data has reported 599,825,400 confirmed cases an... more The World Health Organization (WHO) surveillance data has reported 599,825,400 confirmed cases and 6,469,458 deaths globally. 6 Emergency departments (ED) are combating the full spectrum of the disease, as patients' progress to respiratory failure within 24 hours 7 with a mortality of 2-3%. 4 This steep progression poses a challenge in clinical decisionmaking 6 and highlights the importance of patient risk stratification, in low-resource ED'S. Two risk prediction scores developed for COVID-19 are of significance. The Brescia-COVID Respiratory Severity Score (BCRSS) was developed during the COVID-19 outbreak in Brescia, Italy. It is a ninelevel (0-8) algorithm that determines patient disease severity at presentation and apportions stepwise treatment recommendation. It requires re-assessment and re-scoring after intervention and tracks the level of respiratory severity. 8 The CALL (Comorbidity, Age, Lymphocytes, Lactate dehydrogenase [LDH]) score has also been shown to predict disease progression and inhospital mortality in with; sensitivity 77.25%, specificity 58%, positive predictive value 57.77% and negative predictive value 77.44%. 1 IHHN is a free of cost, tertiary care center situated in district Korangi, Karachi, Pakistan. The ED provides
Objective: To determine gender based differences in risk factors and distribution of coronary art... more Objective: To determine gender based differences in risk factors and distribution of coronary artery disease (CAD) in patients undergoing coronary angiography. Methodology: This was cross sectional, observational study. We studied 851 patients who underwent coronary angiography at a tertiary care centre. Patients were interviewed regarding their basic demographics, cardiovascular risk factor profiles and disease status. CAD burden was quantified and compared across sex groups. Data underwent statistical analysis using SPSS V 19. Level of significance was 0.05. Results: We included total 851 patients. 209 patients (117M, 32F) had STEMI, 310 (213M, 97F) had NSTEMI 286 (200M, 86F) had unstable angina, 54 (27M, 27F) had stable angina. Normal angiogram was reported in 24% of females whiles it was reported in 11.5% in males. Single vessel disease (SVD) was 17.9% and 16.5% in male and female respectively. Double vessel disease (DVD) was 27% and 22% in male and female respectively. Triple v...
JPMA. The Journal of the Pakistan Medical Association, 2017
To determine the benefit of prophylactic platelet transfusion on clinical outcomes in patients wi... more To determine the benefit of prophylactic platelet transfusion on clinical outcomes in patients with dengue fever. The retrospective cohort study was conducted at Patel Hospital, Karachi, and comprised record of patients fulfilling World Health Organisation's diagnostic criteria for dengue between 2009 and 2015. We excluded patients with known auto-immune thrombocytopenia, isolated infection with a pathogen other than dengue virus, drug-induced thrombocytopenia and patients requiring therapeutic transfusion. SPSS 21 was used for data analysis. Of the 639 dengue patients, 209(32.7%) were transfused platelets (group 1) while 430(67.3%) were not (group 2). There was a significant difference in minor bleeding episodes (65(31.1%) in the transfused group vs. 59(13.7%) in the non-transfused group; p=0.000). Similarly, 4(1.9%) patients died in group 1vs. 1(0.2%) in group 2 (p=0.024). The mean cost of hospital stay was Rs26,733±5,780 in group 1 vs. Rs5,266±3,627 in group 2 (p=0.000). Prop...
Pakistan Journal of Medical Sciences
Background: Moving away from invasive ventilation towards timed position change and non-invasive ... more Background: Moving away from invasive ventilation towards timed position change and non-invasive ventilation is especially of benefit in low and middle income countries, where judicious use of the available healthcare resources is the need of the day. Our study was conducted prospectively to develop strategies for non-invasive ventilation in combination with timed position change of patients to see its impact on their outcome.Objectives: Non-invasive ventilation has proven to be of benefit in COVID-19 related acute lung injury. The objective of this prospective, cross sectional study was to develop a protocol for the use of non-invasive ventilation with timed position change to improve COVID-19 patients’ outcomes in the Emergency Department (ED). Methods: All patients presenting with confirmed or suspected COVID-19 were enrolled in the study from March 2020 to October 2020. Data was collected to see the effect of timed position change and non-invasive ventilation on these patients a...
Background: Dengue is globally the most common arboviral disease. As the primary immunopathologic... more Background: Dengue is globally the most common arboviral disease. As the primary immunopathological target in dengue is the endothelium, presentations beyond the typical triad of fever, myalgias, and thrombocytopenia are increasingly encountered. Severe systemic organ involvement can occur even without evidence of dengue hemorrhagic fever (DHF). These manifestations of dengue have been termed the “expanded dengue syndrome” by WHO. Aim: To observe the types and frequency of organ involvement in patients admitted with acute dengue fever. Methods: This is a retrospective cross-sectional study. Records of patients above 18 years admitted with acute dengue fever from December 2016 to December 2017 were reviewed. Patients fulfilling WHO criteria for probable or confirmed acute dengue fever were included. Patients with definite laboratory evidence of other systemic infections and patients with autoimmune or hematological disease were excluded. Data were obtained for 129 patients and analyz...
Pakistan Journal of Medical Sciences
Objective: To discuss the referral mechanisms established for safe and expeditious inter-facility... more Objective: To discuss the referral mechanisms established for safe and expeditious inter-facility transfer of COVID 19 positive patients to ensure their referrals through establishing proper communication channels. Methods: Mobile phone and WhatsApp based groups, administrated by The Indus Hospital were established in April 2020. Through detailed reports and frequent communication, factors like bed and ventilator availability across these facilities are shared. Weekly reports through zoom meetings updating the key stake holders, discussion of problems faced and planning for the week ahead are also done. Result: The establishment of these groups has been successful in ensuring referral to and from The Indus Hospital to various healthcare facilities across Karachi using appropriate ambulance services. Conclusion: The development of referral mechanisms is the need of the day that has been highlighted through the COVID 19 pandemic. It is our hope that these mechanisms are sustained afte...
AEM Education and Training, Nov 21, 2023
BMJ Open, Jul 1, 2023
Introduction A quasi-experimental study was conducted to estimate the impact of sequential emerge... more Introduction A quasi-experimental study was conducted to estimate the impact of sequential emergency department (ED) capacity building interventions on key performance indicators such as patients' length of stay (LOS) and wait time (WT) during the COVID-19 pandemic. This was achieved through augmenting personnel education and head count, space restructuring and workflow reorganisation. Setting and participants This study included 268 352 patients presenting from January 2019 to December 2020 at Indus Hospital and Health network Karachi, a philanthropic tertiary healthcare facility in a city of 20 million residents. A follow-up study was undertaken from January to December 2021 with 123 938 participants. Primary and secondary outcome measures These included mean and median ED-LOS and WT for participants presenting in different cohorts. The results of the pre-COVID-19 year 2019 (phase 0) were compared with that of the COVID-19 year, 2020 (phases 1-3 corresponding to peaks, and phase 4 corresponding to reduction in caseloads). The follow-up was conducted in 2021 to see the sustainability of the sequential capacity building. Results Phases 1, 2 and 3 had a lower mean adjusted LOS (4.42, 3.92 and 4.40 hours) compared with phase 0 (4.78 hours, p<0.05) with the lowest numbers seen in phase 2. The same held true for WT with 45.1, 23.8 and 30.4 min in phases 1-3 compared with 49.9 in phase 0. However, phase 4 had a higher LOS but a lower WT when compared with phase 0 with a p<0.05. Conclusion Sequential capacity building and improving the operational flow through stage appropriate interventions can be used to off-load ED patients and improve process flow metrics. This shows that models created during COVID-19 can be used to develop sustainable solutions and investment is needed in ideas such as ED-based telehealth to improve patient satisfaction and outcomes.
International Journal of Healthcare Simulation
Professional development in simulation-based education (SBE) is a complex process. Individual com... more Professional development in simulation-based education (SBE) is a complex process. Individual components have overlapping boundaries and relationships, rendering them suitable for Complex Adaptive Systems (CAS). This complexity is multifold in low-resource settings, unfamiliar with simulation, and augmented by hierarchical culture and linguistic diversity. This study aimed to conduct a professional development course through SBE using principles of CAS for faculty in a Pakistani medical college. A simulation educator team (six on-site, three online) from Pakistan and North America constructed and facilitated a 6-hour-long hybrid course following CAS in three phases. Planning phase consisted of needs assessment and inclusion of stakeholders in decision-making. Implementation phase involved remote facilitators joining the in-person team using Zoom and demonstrating evidence-based practices in case design, pre-briefing, facilitation and debriefing. In the evaluation phase, participants...
BMC Medical Education
Introduction An enhanced knowledge of Emergency Medicine (EM) personnel regarding negative Social... more Introduction An enhanced knowledge of Emergency Medicine (EM) personnel regarding negative Social Determinants of Health (SDH) can impact EM service provision in a resource limited country like Pakistan. Interventions to build capacity in identifying and addressing these SDH through education in Social Emergency Medicine (SEM) can be one of the ways in which EM key performance indicators (KPIs) can be improved. Method A SEM based curriculum was administered to the EM residents at a tertiary care center in Karachi, Pakistan. Pre, post and delayed post-test was conducted for knowledge of EM residents and analyzed using Repeated Measures ANOVA (RMANOVA). Clinical impact of this intervention was assessed through the ability of the residents to identify the patients’ SDH and determining appropriate disposition. Comparison of the bounce-back of patients in the pre-intervention (2020) and post-intervention year (2021) year was appreciated to see the clinical impact of this intervention. Re...
Introduction: The ability to identify and address the negative Social Determinants of Health (SDH... more 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 acui...
Pakistan Journal of Medical Sciences, Nov 16, 2022
The World Health Organization (WHO) surveillance data has reported 599,825,400 confirmed cases an... more The World Health Organization (WHO) surveillance data has reported 599,825,400 confirmed cases and 6,469,458 deaths globally. 6 Emergency departments (ED) are combating the full spectrum of the disease, as patients' progress to respiratory failure within 24 hours 7 with a mortality of 2-3%. 4 This steep progression poses a challenge in clinical decisionmaking 6 and highlights the importance of patient risk stratification, in low-resource ED'S. Two risk prediction scores developed for COVID-19 are of significance. The Brescia-COVID Respiratory Severity Score (BCRSS) was developed during the COVID-19 outbreak in Brescia, Italy. It is a ninelevel (0-8) algorithm that determines patient disease severity at presentation and apportions stepwise treatment recommendation. It requires re-assessment and re-scoring after intervention and tracks the level of respiratory severity. 8 The CALL (Comorbidity, Age, Lymphocytes, Lactate dehydrogenase [LDH]) score has also been shown to predict disease progression and inhospital mortality in with; sensitivity 77.25%, specificity 58%, positive predictive value 57.77% and negative predictive value 77.44%. 1 IHHN is a free of cost, tertiary care center situated in district Korangi, Karachi, Pakistan. The ED provides
Objective: To determine gender based differences in risk factors and distribution of coronary art... more Objective: To determine gender based differences in risk factors and distribution of coronary artery disease (CAD) in patients undergoing coronary angiography. Methodology: This was cross sectional, observational study. We studied 851 patients who underwent coronary angiography at a tertiary care centre. Patients were interviewed regarding their basic demographics, cardiovascular risk factor profiles and disease status. CAD burden was quantified and compared across sex groups. Data underwent statistical analysis using SPSS V 19. Level of significance was 0.05. Results: We included total 851 patients. 209 patients (117M, 32F) had STEMI, 310 (213M, 97F) had NSTEMI 286 (200M, 86F) had unstable angina, 54 (27M, 27F) had stable angina. Normal angiogram was reported in 24% of females whiles it was reported in 11.5% in males. Single vessel disease (SVD) was 17.9% and 16.5% in male and female respectively. Double vessel disease (DVD) was 27% and 22% in male and female respectively. Triple v...
JPMA. The Journal of the Pakistan Medical Association, 2017
To determine the benefit of prophylactic platelet transfusion on clinical outcomes in patients wi... more To determine the benefit of prophylactic platelet transfusion on clinical outcomes in patients with dengue fever. The retrospective cohort study was conducted at Patel Hospital, Karachi, and comprised record of patients fulfilling World Health Organisation's diagnostic criteria for dengue between 2009 and 2015. We excluded patients with known auto-immune thrombocytopenia, isolated infection with a pathogen other than dengue virus, drug-induced thrombocytopenia and patients requiring therapeutic transfusion. SPSS 21 was used for data analysis. Of the 639 dengue patients, 209(32.7%) were transfused platelets (group 1) while 430(67.3%) were not (group 2). There was a significant difference in minor bleeding episodes (65(31.1%) in the transfused group vs. 59(13.7%) in the non-transfused group; p=0.000). Similarly, 4(1.9%) patients died in group 1vs. 1(0.2%) in group 2 (p=0.024). The mean cost of hospital stay was Rs26,733±5,780 in group 1 vs. Rs5,266±3,627 in group 2 (p=0.000). Prop...
Pakistan Journal of Medical Sciences
Background: Moving away from invasive ventilation towards timed position change and non-invasive ... more Background: Moving away from invasive ventilation towards timed position change and non-invasive ventilation is especially of benefit in low and middle income countries, where judicious use of the available healthcare resources is the need of the day. Our study was conducted prospectively to develop strategies for non-invasive ventilation in combination with timed position change of patients to see its impact on their outcome.Objectives: Non-invasive ventilation has proven to be of benefit in COVID-19 related acute lung injury. The objective of this prospective, cross sectional study was to develop a protocol for the use of non-invasive ventilation with timed position change to improve COVID-19 patients’ outcomes in the Emergency Department (ED). Methods: All patients presenting with confirmed or suspected COVID-19 were enrolled in the study from March 2020 to October 2020. Data was collected to see the effect of timed position change and non-invasive ventilation on these patients a...
Background: Dengue is globally the most common arboviral disease. As the primary immunopathologic... more Background: Dengue is globally the most common arboviral disease. As the primary immunopathological target in dengue is the endothelium, presentations beyond the typical triad of fever, myalgias, and thrombocytopenia are increasingly encountered. Severe systemic organ involvement can occur even without evidence of dengue hemorrhagic fever (DHF). These manifestations of dengue have been termed the “expanded dengue syndrome” by WHO. Aim: To observe the types and frequency of organ involvement in patients admitted with acute dengue fever. Methods: This is a retrospective cross-sectional study. Records of patients above 18 years admitted with acute dengue fever from December 2016 to December 2017 were reviewed. Patients fulfilling WHO criteria for probable or confirmed acute dengue fever were included. Patients with definite laboratory evidence of other systemic infections and patients with autoimmune or hematological disease were excluded. Data were obtained for 129 patients and analyz...
Pakistan Journal of Medical Sciences
Objective: To discuss the referral mechanisms established for safe and expeditious inter-facility... more Objective: To discuss the referral mechanisms established for safe and expeditious inter-facility transfer of COVID 19 positive patients to ensure their referrals through establishing proper communication channels. Methods: Mobile phone and WhatsApp based groups, administrated by The Indus Hospital were established in April 2020. Through detailed reports and frequent communication, factors like bed and ventilator availability across these facilities are shared. Weekly reports through zoom meetings updating the key stake holders, discussion of problems faced and planning for the week ahead are also done. Result: The establishment of these groups has been successful in ensuring referral to and from The Indus Hospital to various healthcare facilities across Karachi using appropriate ambulance services. Conclusion: The development of referral mechanisms is the need of the day that has been highlighted through the COVID 19 pandemic. It is our hope that these mechanisms are sustained afte...