http://doi.org/10.33698/NRF0050 Jolly Jose, Jessil K.J, Remadevi C
Abstract : A descriptive study was conducted on the impact of road traffic accidents on hospitals and the rehabilitative needs of RTA victims. The study was conducted in Medical College Hospital, Thiruvananthapuram. All RTA cases which required inpatient care in the month of December 2002 were the subjects and they were followed up till discharge. Data were collected using interview schedule, observation proforma and functional independence measure (FIM). Data revealed that the average amount spent to care RTA victim is Rs.6124/- for the total duration of hospital stay. They have varying rehabilitative needs and had problems at the time of discharge like pain, unhealed wound and psychological problems. The results indicate the need for preventive strategies for RIA at the primary level.
Introduction
Road traffic accidents occupy the first position among accidents, which cause disability and death. India has one of the highest road traffic accident rates in the world. In 1991-60,000 people were killed in road traffic accidents as against 24,600 in 1980. The death toll is about 8 for every 1000 vehicles as compared to 1 in industrialized countries.
In Kerala more than 4000 people die every year due to road traffic accidents. Among all Indian states, Kerala is the first in accident rate, 75000 persons get injured in accidents in Kerala every year. In Thiruvananthapuram district there were 4114 accidents reported in 2001. Thus Road Traffic accidents are increasing day by day causing disabilities to the working population in our country and making a lot of impact on the health care delivery system in terms of utilization of our limited resources. In Government hospitals there is lack of adequate number of beds to care for the RTA victims.
The resources utilized by the RTA victims from the health care delivery system have increased a lot in the past years due to increased incidence of RTA. However, due to scarcity of beds, the hospital stay of such patients is minimized which results in many unmet nursing care needs at the time of discharge. The RTA victims after discharge need assistance in making suitable life style changes in meeting the activities of daily living, to live with physical handicap or disability, to find alternative modes of income to earn their livelihood and to solve the remaining health problems both physical and psycho-social. In the present study an attempt is made to assess the money spent for the RTA victims while admitted in the hospital and to evaluate their rehabilitative needs.
Objectives
- To calculate the money spent for caringroad traffic accident victims.
- To assess the manpower needed for caring road traffic accident victims.
- To assess the physical resources utilized for caring the RTA victims.
- Identify the rehabilitative needs of RTA victims.
Materials and methods
The research design was descriptive. The instruments for data collection were semi structured interview schedule, observation Proforma and functional independence measure (FIM) which is part of the Uniform Data System for Medical Rehabilitation (UDSMR) The study was conducted in the Medical College Hospital, Thiruvananthapuram. All road traffic accident cases which required in patient care in the month of December 2002 were taken for the study and followed up till discharge.
The treatment and care received by each patient were documented and the expenditure for medicines, investigations, other treatments and care provided were calculated. The calculations were done based on the minimum cost for medicines and other treatment. The manpower utilized was estimated from the available staffing pattern of selected wards and intensive care units of medical college hospital, Thiruvananthapuram.
The physical resources utilized like articles and special equipment’s used for treatment, surgical interventions, investigations and diet were assessed using the observation proforma. Other items for observation were duration of stay and setting, time spent per patient by doctor, nurse, nursing assistant, attendant, technician and others.
The rehabilitative needs of the patient at the time of discharge were identified by semi structured interview schedule and FIM. The semi structured interview schedule covered demographic data which include patient’s name, age, sex, and monthly income. Other items in the schedule include date and time of accident, vehicles involved and details of injury. Information was also secured on complications and disabilities present at the time of discharge from the hospital namely bed sore, contracture, gastric problems, loss of function, pain, respiratory problems, psychological problems, urinary tract infections and presence of infected or unhealed wound.
The FIM was an 18-item measure of physical, psychological and social function. It is an ordinal seven level scale with 18 items having scores ranging from 18 to 126. It uses the level of assistance an individual needs to grade functional status from total independence to total assistance. Self-care activities like feeding, grooming, bathing, upper body dressing and toileting, were assessed using FIM. Other categories in FIM were bowel and bladder function, functional mobility, communication and social cognition.
Results
Out of the 226 cases studied 59.8% were between the age 16-40 years. Out of which 13.3% belonged to 26-30 age group. 83% of the cases were males. 50.89% met with accident while driving a vehicle. 26.99% of the RTA victims were pedestrians. 57.52% of the RTA victims were riding two wheelers.
Two wheelers ranked highest among second vehicle involved in the accident i.e. 27.9%.
The following Table shows the type of injury among RTA victims
| Type of Injury | Percentage |
| Head injury | 62.3% |
| Injury to extremity
Fractures |
50.4%
46.9% |
| Injury to neck and chest | 17.7% |
| Injury to internal organ | 04.0% |
The average duration of hospital stay for RTA victim was 7.9 days. The expenditure for physical resources per RTA victim was Rs.960.95 for the total hospital stay. Total amount spent for caring RTA victim including physical resources, manpower like doctors, nurses, nursing assistants and attenders, treatment and diet, surgical interventions, investigations, consultations and for various articles used was estimated.
| Division of hospital | Amount spent
per RTA Victim(in Rupees) |
| NSICU | 14668.90 |
| SICU | 23674.84 |
| General Ward | 5118.73 |
Total amount spent to treat a RTA victim for the total duration of hospital stay was Rs.6124.45. Estimation of exact expenditure needs a detailed study including indirect costs also. On the basis of functional independencemeasure scores (FIM scores) 64.42% had scores above 126. A person who has scores above 50 is considered as having good prognosis. Only one patient had score below50.
The patients had varying rehabilitative needs namely assistance in taking food, grooming, bathing, dressing, toileting, bladder control, bowel control, transfers, locomotion, problems with vision, problem solving and social interaction.
Problems present at the time of discharge
| Problem | Percentage |
| Loss of function | 25.5 |
| Pain | 50.0 |
| Wound | 46.2 |
| Psychological problems | 10.1 |
| Bed sore | 3.4 |
| Respiratory problems | 4.8 |
| Gastric problems | 3.9 |
Discussion
Results indicate that there is a wide gap between money spent on patients admitted in the ICU and in the general wards. The money spent on patients in the general ward was found to be considerably low, i.e. Rs.5118/- Because the bed strength in the ICU is limited, the facilities in the ward should be improved for better management. The use of helmets should be encouraged by masseducation programmes which could reduce the incidence of head injury. The duration of hospital stay can be minimized if the primary care system is strengthened by back up referral of RTA cases to PHCs. Patients should be advised to contact the community health nurse or multi purpose workers in addressing their rehabilitative needs who in turn must be given adequate training in this regard.
The findings imply that there is considerable economic burden on hospitals due to RTA and nurses should take initiative in educating public about prevention of RTA. Nurses can plan the advice on discharge and health education based on the rehabilitation needs. Community health nurses can anticipate the care needed by a road traffic accident victim coming back from the hospital in his or her area. Families of RTA victims should be taught on available resources for rehabilitation
In view of the increase in road traffic accidents the nursing education programmes should incorporate adequate curriculum content in training student nurses in trauma, emergency nursing and rehabilitation nursing.
Nursing administrators should take initiative 1) to provide more nursing manpower to care for the RTA victims in the general wards. 2) In organizing in-service education programmes for nurses on the rehabilitative needs of RTA victims. 3) to encourage effective supervision by head nurses inorder to decreased the incidence of the problems present at the time of discharge.
To conclude, there should be more importance to the primary prevention of RTA by improving road conditions and enforcing existing laws.
References
- Cardona, V.D et al. Trauma Nursing from resuscitation through rehabilitation, 2nd edn. Philadelphia, W.B saunders company 1994.
- Chand, Mahesh. Worsening accident scenario in Kerala. National Transportation planning and research centre. Thiruvanan
- Dolan WD, Gilfford RW, Smith RJ et al. Automobile – related injuries. Journal of American Medical Association 1983; 249: 3216.
- Gloag D. British road traffic deaths fall but casualties rise – British Medical Journal 1995; 311:281.
- Subha Rao AN. Proceedings of 4th national trauma conference. Neurology India 1995; August 8-28.70
- Trawen A, Maraste P, Persson.V. International comparison of costs of a fatal casualty of road accidents in 1990 and 1999, Accident – Analysis and prevention. 2002; 34(3):323-32.