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ORIGINAL ARTICLE
Sheetal Singh, Angel R Singh

Policies and Procedures for Sound-alike and Look-alike Medications

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:53] [Pages No:15-20][No of Hits : 1283]


ABSTRACT

The sound-alike and look-alike (SALA) drug is one of the most common causes of medication error and is of fear globally. Thus, the probability for error due to confusing drug names is very high. The SALA drug names have become a significant challenge to pharmacists, nurses, patients, and doctors . With thousands of drugs currently on the market, the probability for error is significant. The purpose of this article is to formulate a policy that would help in minimizing medication errors arising with the use of SALA medications.

Keywords: Medication errors, Medication management, Patient safety, SALA medications

How to cite this article: Singh S, Singh AR. Policies and Procedures for Sound-alike and Look-alike Medications. Int J Res Foundation Hosp Healthc Adm 2017;5(1):15-20.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
VK Tadia, Monalisa, Suneeta Dubey

Accreditation is not a One-time Process: Quality Assessment of Intensive Care Unit during Post-NABH Accreditation Period in a Tertiary Care Hospital

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:53] [Pages No:29-41][No of Hits : 940]


ABSTRACT

Accreditation is an integral part of quality and it is not a onetime process. This study was done to know the extent to which hospitals maintain the standards after obtaining accreditation. This study tries to find out the gaps in standards during the postaccreditation period. The objective of the study was to assess the policies of the intensive care unit (ICU) with reference to standard protocols of the National Accreditation Board for Hospital and Health Care Providers (NABH) and measures taken by the management to maintain the standards. Data was collected from a 285-bedded NABH-accredited hospital that had five ICUs and four recovery rooms by means of nonparticipant observation, semistructured interviews. Data on indicators was collected by using the hospital management information system; the questionnaire on satisfaction was filled by 30 patients/relatives who were admitted in the ICU for more than a week. Quality team was interviewed to know the perception of the management toward quality and accreditation. To know the compliance of the staff to the NABH standards, a surprise check was done in three ICUs of the hospital.
Data analysis showed that the organization was not able to maintain the standards, as it had done at the time of accreditation. The quality team strongly accepted that accreditation helps in maintaining and improving quality, whereas the data from ICUs showed a wide variation in compliance. Three ICUs from the same hospital were having different compliance rates for standards, which shows that staff was not aware about the standard protocol to be followed. The patient-satisfaction questionnaire also showed that the patients were not satisfied with the services given.

Keywords: Accreditation, Continuous quality improvement, Postaccreditation, Quality.

How to cite this article: Tadia VK, Monalisa, Dubey S. Accreditation is not a One-time Process: Quality Assessment of Intensive Care Unit during Post-NABH Accreditation Period in a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2017;5(1):29-41.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
SK Patnaik, Shakti K Gupta, S Kant, R Pillay

Analyzing Competencies of Indian Health Care Leaders: Way Forward for Next Generation

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:53] [Pages No:47-53][No of Hits : 885]


ABSTRACT

Introduction: Indian health care is experiencing a paradigm shift in terms of requirement of resources and changing demographic patterns. The customer-oriented and quality-conscious competitive environment has intensified the need for health care organizations to attain higher levels of organizational performance. Competencies of health care leaders play a pivotal role in deciding the organizations’ way forward and competencies are the cornerstone of organizational performance and quality standards. A cross-sectional study of select health care leaders of India was done from various hospitals and other health delivery agencies to identify and analyze the gaps in competencies.

Materials and methods: A cross-sectional study was planned amidst health care leaders of India so as to assess their leadership competencies. Health care leaders of India were identified after focused group discussion and senior health care leaders, such as directors, deans, CEOs, and principals were shortlisted for this study. Two structured questionnaires were administered to health care leaders of various hospitals in India. The ratings in the questionnaire were on a Likert scale ranging from very poor to excellent. Respondents were asked to self-evaluate various competencies and the same were analyzed using Statistical Package for the Social Sciences statistical software. Interpretation of results of data analysis was done.

Results: A total of 300 questionnaires were sent of which 106 questionnaires were completed and returned by select health care leaders. About 78 were doctors and 28 were nursing executives. The study has been able to identify deficiencies in the perceived “existing competency” and “required competency” levels in the selected competencies.

Conclusion: The findings of this study suggest that there is deficiency in perceived “existing competency” and “required competency” levels in the selected competencies of health care leaders. Indian health care leaders are operating at operational levels and have not graded themselves highly in transformational roles. There is a need for training to bridge the competency gap of Indian health care leaders.

Keywords: Accountability, Competencies, Health care, Health leaders, Medical technology, Process management, Strategic orientation.

How to cite this article: Patnaik SK, Gupta SK, Kant S, Pillay R. Analyzing Competencies of Indian Health Care Leaders: Way Forward for Next Generation. Int J Res Foundation Hosp Healthc Adm 2017;5(1):47-53.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL RESEARCH
Jordan H Llego, Mohammad O Al Shirah

Patient Satisfaction in Tertiary Private Hospitals in Najran, Kingdom of Saudi Arabia

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:53] [Pages No:42-46][No of Hits : 659]


ABSTRACT

Aim: This study is aimed to assess the level of satisfaction of patients in tertiary private hospitals in Najran, Kingdom of Saudi Arabia.

Materials and methods: This study used descriptive crosssectional design through a survey questionnaire.

Results: A great majority (57%) of respondents are male. Almost half (46.7%) of the respondents are 26 to 35 years old, some (30.3%) are more than 35 years old. The majority (54.5%) of hospitalized patients are married. Some (35.8%) of them reached the secondary level and some (31.5%) completed college. A great majority (57.6%) of the respondents’ salary was below 5,000 SR. A great majority pay their hospitalization by themselves (60.6%). Mean scores revealed: For facilities, the mean was 4.12, standard deviation (SD) = 0.85. For general services, the mean was = 4.13, SD= 0.77. The physician services scored mean = 4.06, SD= 0.88. The highest level of satisfaction according to mean is nursing services with mean= 4.22, SD= 0.80 and the lowest among the variables is convenience with mean= 4.05, SD= 0.84. The overall level of patient satisfaction with the services they received indicated by the mean is 3.91, SD= 1.1.

Conclusion: Researchers conclude that patients catered by the private tertiary hospitals in Najran Saudi Arabia are more of males, at middle adulthood, and are married who reached the secondary level and have an income of below 5,000 SR and have no health insurance. The level of satisfaction of patients in the private tertiary hospitals is satisfactory and that nursing service has the highest satisfaction level, which is very satisfactory.

Clinical significance: The findings of this study are beneficial to the success of the organization. A patient who is satisfied will spread his experience to other people. A satisfied patient will also equate to return of investment. Meeting satisfaction of patients will also decrease the risk of malpractice lawsuits.

Keywords: Malpractice lawsuits, Patient satisfaction, Tertiary private hospitals.

How to cite this article: Llego JH, Al Shirah MO. Patient Satisfaction in Tertiary Private Hospitals in Najran, Kingdom of Saudi Arabia. Int J Res Foundation Hosp Healthc Adm 2017;5(1):42-46.

Source of support: Nil

Conflict of interest: Noen


 
ORIGINAL ARTICLE
Ritwik Chawla, Saakshi Kaushik

Incidence of Patient Identification Errors observed before Medication and Procedure/Intervention.

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:66] [Pages No:100-106][No of Hits : 1922]


ABSTRACT

Objectives: To identify the number of individuals for whom double identification check was done before administering medication and before procedure/intervention, as per Continual Quality Improvement 3j indicator of National Accreditation Board of Hospitals (4th edition) and hospital policy.

Materials and methods: The study was a concurrent, observational recording of the study population which included doctors/ surgeons, nurses, and/or technicians before administration of any medication and before beginning of any procedure/intervention. The observations were recorded on a prepared checklist to find the compliance of incidence of patients’ double identification.

Results: A total of 34 observations were recorded before administering medication to a patient. In 18 cases, wristbands were not being used, and identification details were incorrect in 4 cases. Of 34 cases, identifiers were illegible in 6 cases. The major area where the error was high was noncompliance to verbal confirmation of identity (ID) and checking it from the patient’s file. Out of 34 observations before a procedure/intervention, 9 errors were identified in cases where the ID band was not used for verification, and identification details on the band were illegible in 5 cases. In six cases, the patient’s name was not verbally confirmed with the patient or carer. Furthermore, in 10 cases, verbally confirmed name was not checked with the patient’s file. Out of 34 cases, double identification was not done in 13 cases.

Conclusion: Many nurses, doctors, and technicians in clinical settings do not verify patient ID before performing a task, resulting in more than one-third of staff not conforming themselves with the double identification procedure. The study also showed that over three-fourths of the total invasive procedures are compliant to double identification. On the contrary, noninvasive procedures showed less than one-fourth compliance to double identification.

Keywords: Band, Compliance, Double identification, Identification, National Accreditation Board for hospitals and health care providers, Wristband.

How to cite this article: Chawla R, Kaushik S. Incidence of Patient Identification Errors observed before Medication and Procedure/Intervention. Int J Res Foundation Hosp Healthc Adm 2016;4(2):100-106.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
VK Tadia, SK Gupta, SK Arya, A Lathwal, K Jain, R Ahlawat

Why switch to Rental? Costing of Laundry Services at an Apex Tertiary Care Hospital from the View of Outsourcing based on Rental Linen Management Services

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:66] [Pages No:79-88][No of Hits : 1854]


ABSTRACT

Introduction: Modern hospitals are matrix organizations with a high investment in terms of capital, labor, and resources. It is imperative for the hospital administration to provide right material of right quality at the right time. Hospitals that set up in-house laundry operations generally make the decision without thoroughly identifying and accounting for total linen and laundry costs. Now evidence has emerged that hospitals that outsource were seeing improved linen utilization rates. If proper and clean linen is not provided, this can result in patient dissatisfaction. Further, innovations in laundry equipment have led to tremendous increases in efficacy. So, there is a need to ascertain the cost incurred in providing linen and laundry services so as to gauge the plausibility of transitioning to outsourcing-based models.

Aims and objectives: To study the cost incurred in providing linen and laundry services at an apex tertiary care hospital and to evaluate outsourcing model based on rental linen management.

Materials and methods: A descriptive, cross-sectional, retrospective, record-based study was conducted during a period of 1 month from March 1, 2016 to March 31, 2016.

Observations: The quantity of monthly linen washed in Dr Rajendra Prasad Centre was found to be 22,465 kg. The monthly laundry expenditure in Dr RP Centre was Rs. 1,415,295. The linen procurement expenditure per month at Dr RP Centre was Rs. 419,386. So total expenditure on linen and laundry per month at Dr RP Centre was Rs. 1,834,681. Thus, cost/kg (with inclusion of linen cost) was Rs. 82.

Discussion and conclusion: The rate quoted by a leading vendor to supply washed, sterilized linen to the hospital was Rs. 55 per kg. Since the expenditure incurred per kg at Dr RP Centre was Rs. 82, this amounted to a saving of around Rs. 27 per kg. It would mean saving of around Rs. 606,555 per month and Rs. 7,278,660 per annum. So, it was recommended that rental linen management services may be hired for Dr RP Centre after taking care of functional, operational, and strategic contingency.

How to cite this article: Tadia VK, Gupta SK, Arya SK, Lathwal A, Jain K, Ahlawat R. Why switch to Rental? Costing of Laundry Services at an Apex Tertiary Care Hospital from the View of Outsourcing based on Rental Linen Management Services. Int J Res Foundation Hosp Healthc Adm 2016;4(2):79-88.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Bryal D’souza, Arun MS, Bijoy Johnson

Comparative Analysis of Cost of Biomedical Waste Management in Rural India

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:50] [Pages No:11-15][No of Hits : 1812]


ABSTRACT

Introduction: The quantum of waste generated from medical care and activities is a global matter of concern. Improper management of biomedical waste (BMW) has a grave health impact on the community, health care professionals, and the environment.1 It is mandatory by law that every medical organization that generates waste should have a system, process, and resources in place for segregating BMW within the organization for proper disposal. The present article deals with the understanding of various costs associated in BMW management process that will help the health care organization to prioritize their spending and focus on areas that require spending to achieve compliance in process of BMW management.

Materials and methods: Descriptive cross-sectional study was carried out, to study the compliance of BMW management at three different hospitals with respect to Bio-Medical Waste (Management and Handling) Rules, 2011. A retrospective study was conducted to analyze cost data for a 1-year time period. Cost involved in BMW management was analyzed and classified as capital and recurring costs. The study was undertaken in Udupi taluk, and the taluk comprises 11 hospitals (1 Government and 10 private hospitals). The hospitals were selected using convenient sampling as taking permission to conduct the study was difficult. Only three hospitals were permitted to carry out the study.

Results and discussion: Compliance was found to be better in accredited hospital than in nonaccredited hospital. This could be attributed to strict adherence to standard operating procedures and regular training of staff. Cost involved in BMW management was analyzed as capital and recurring costs. Since most of the hospital outsource final disposal, capital costs are significantly less compared to recurring costs. Among the recurring costs, maximum expenditure is on consumables like color-coded bags. Cost per bed per day for handling BMW was calculated and it was found to be higher in smaller hospitals.

Keywords: Biomedical waste, Cost analysis, Health care waste, Medical waste.

How to cite this article: Bryal D’souza, Arun MS, Johnson B. Comparative Analysis of Cost of Biomedical Waste Management in Rural India. Int J Res Foundation Hosp Healthc Adm 2016;4(1):11-15.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
VK Tadia, R Ahlawat, SK Arya, DK Sharma

A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:50] [Pages No:31-34][No of Hits : 1386]


ABSTRACT

It is generally believed that big changes can be brought about by big interventions. Sometimes, small interventions also can show spectacular results. This case describes the impact of simple intervention, audit and feedback on change in the behavior of clinicians. In this case, the impact of simple intervention in the form of passive feedback has been documented. All the prescriptions received in pharmacy during the period of study were scrutinized for specific prescription errors. An overall error rate of 0.12% was observed in phase 1 of the study, which was reduced to 0.04% during phase 2 of the study after implementation of the intervention, which further dropped to zero during phase 3. It was concluded that a simple audit and feedback nudged the recipients of the feedback to modify their behavior.

Keywords: Audit, Feedback, Nudge, Passive feedback, Prescription behaviour.

How to cite this article: Tadia VK, Ahlawat R, Arya SK, Sharma DK. A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior. Int J Res Foundation Hosp Health Adm 2016;4(1):31-34.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
H Anand, V Siddharth, V Goyal, VK Koushal

Lead Time in Drug Procurement: A Study of Tertiary Care Teaching Hospital of North India

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:50] [Pages No:16-19][No of Hits : 1124]


ABSTRACT

Pharmaceutical procurement is a complex process that involves many steps, agencies, and manufacturers. Procurement lead time is defined as the time required to acquire the supplies and services and then placing them in the hands of the user. This study was done to study the lead time in drugs procurement at Government Medical College and Hospital, Chandigarh. It was aimed at calculating the average lead time in the procurement of drugs for year 2009-2010 in Pharmacy Department. Observational study along with retrospective record analysis was done to calculate the average internal and external lead time. Standardized format was used to retrieve data from the procurement records. Average lead time between the preparation of indent and receipt of drugs was observed to be 162 days, out of which 117 days (71%) accounted for internal lead time and external lead time was 47 days (29%). Internal lead time was approximately four times that of external lead time. Various reasons were noted for longer duration of internal lead time and every effort should be made to bring it down to the minimum, so as to ensure the availability of the right medicine in the right quantity, in the right time at the right place.

Keywords: Drug Procurement, Lead time, Pharmacy.

How to cite this article: Anand H, Siddharth V, Goyal V, Koushal VK. Lead Time in Drug Procurement: A Study of Tertiary Care Teaching Hospital of North India. Int J Res Foundation Hosp Healthc Adm 2016;4(1):16-19.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Kasturi Shukla, Priyadarshini Chandrashekhar, Shweta Mehta

How Prepared are Hospital Employees for Internal Fire Disasters? A Study of an Indian Hospital

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:50] [Pages No:20-24][No of Hits : 1060]


ABSTRACT

Introduction: In case of internal disasters, such as fire in hospitals, health services to the community are severely hampered with the additional morbidity of victims, such as employees and visitors present when the disaster strikes. Risk assessment and fire preparedness are most crucial proactive measures to prevent fire disasters and minimize the loss in a hospital; however, scanty studies are available on this topic.

Materials and methods: This cross-sectional study was conducted at a multispecialty hospital in Mumbai, Maharashtra (India), during March-April 2014. Fire-Safety Preparedness Framework (FSPF) was designed with four domains (risk and vulnerability assessment, response mechanisms and strategies, preparedness plan and information management) for evaluation of fire safety preparedness of hospital employees. Baseline variables were summarized; instrument was tested for reliability using Cronbach’s alpha and content validity through review by experts. The number of correct responses for each question was further analyzed across the type of employee.

Results: The instrument showed high reliability (Cronbach’s alpha = 0.89, p-value ≤ 0.01) and content validity. A total of 207 employees (mean age 32 ± 8.3 years, 63% females) consented and participated in the study. Out of 20 questions, awareness was high (≥ 90%) only for three questions from “Response mechanism and strategies” domain. For the remaining questions, awareness was moderate to low. The awareness varied highly with the type of employee.

Conclusion: The FSPF is a reliable tool for application in the Indian context for hospital employees. Disaster preparedness training and drill need to involve employees from all departments as awareness levels varied highly with type of employee.

Keywords: Disaster preparedness, Fire safety, Hospital.

How to cite this article: Shukla K, Chandrashekhar P, Mehta S. How Prepared are Hospital Employees for Internal Fire Disasters? A Study of an Indian Hospital. Int J Res Foundation Hospc Health Adm 2016;4(1):20-24.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Saakshi Kaushik, Ritwik Chawla, Shalini Bhalla

Prescriptions Written in Capital Letters in Compliance with National Accreditation Board of Hospital Standards

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:66] [Pages No:89-99][No of Hits : 919]


ABSTRACT

Objectives: (1) To study compliance rate of prescriptions written in capital letters according to continual quality improvement (CQI) 3j indicator of National Accreditation Board of Hospital (NABH) (4th edition). (2) To study compliance to doctors and patient detail, legibility of prescriptions, strength and dose, frequency, route of administration, dosage form, abbreviation for drug, allergy detail, and leading zeros in the dose.

Materials and methods: Convenient randomly selected Medication Administration Record (MAR) sheets from wards and intensive care units (ICUs) were studied. One hundred thirty-two prescriptions were identified for errors pertaining to doctor’s details, patient’s details, and medication details. Errors were captured on a prepared checklist for a period of 11 days. Results were analyzed by Microsoft Excel.

Results: Results were expressed in percentages for wards and ICUs respectively. Six hundred twenty four and 652 drugs were observed in wards and ICUs respectively. Doctor’s name was present in 79.6 and 83.3%. Out of 55 prescriptions in both wards and ICUs, patient’s name compliance was 94.5 and 96.4% and patient’s weight was 83.6 and 81.8% respectively. Compliance for drugs in capital was 98 and 100% for wards and ICUs respectively. Details pertaining to medication were also found out subsequently on various parameters.

Conclusion: The study revealed that the level of completeness of handwritten prescriptions was low in terms of doctor’s details and patient’s weight, which indicates unsatisfactory commitment of the prescribers to follow the hospital guidelines of prescribing. Majority of prescriptions showed compliance to medication written in capital but still the compliance to clear and legible prescriptions is three-fourths of the total prescriptions.

Keywords: Accreditation, Compliance, Medication administration record, NABH, Prescriptions, Quality.

How to cite this article: Kaushik S, Chawla R, Bhalla S. Prescriptions Written in Capital Letters in Compliance with National Accreditation Board of Hospital Standards. Int J Res Foundation Hosp Healthc Adm 2016;4(2):89-99.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Kanika Jain, Sujeet K Sinha, Deepti Jain, Reena Kumar

Does Health Insurance give Us an Assurance? A Study on the Extent of Coverage of Health Insurance at a Tertiary Care Hospital in North India

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:50] [Pages No:25-30][No of Hits : 613]


ABSTRACT

Introduction: Health insurance is emerging fast as an important mechanism to finance health care needs of the people. Complexity of the health insurance industry has been much talked about and less understood in the Indian scenario. Hence, it is imperative to assess the level of awareness that the population has with respect to health insurance policies.

Materials and methods: Cross-sectional prospective study conducted over a period of 6 months, at the third-party administrator (TPA) desk of the hospital. The data was collected using a preformed close-ended questionnaire after obtaining consent from all the participants. Only patients admitted in the hospital availing cashless hospitalization were included in the study. The study was undertaken with the objective to determine the level of awareness about insurance policies and procedures among those insured and identify the problems faced by those insured when availing cashless treatment. Responses to the variables in the questionnaire were compiled and tabulated using Excel 2010.

Results: Response rate of 76% was observed. 56% of the study population were planned admissions and 44% were admitted through emergency department. The study showed that about 56% of the principal policy holders were between 30 and 50 years of age. The awareness regarding the terms and conditions of the health care insurance policy and the servicing TPA was found to be 70%. However, on interacting with patients it came to light that despite being appraised by their insurance agent, they faced challenges while availing health care benefits under health care insurance and were ignorant about the procedure involved.
For the current admission, in 78% of the cases, the TPA responded within 24 hours of intimation; however, in 22% cases there were delays in response from the TPA mostly attributed to communication gap between the Insurance Company and the TPA. Preexisting disease was not covered in 14% cases. 82% cases had to wait for more than 2 hours for the final clearance from the TPA. Over the years, as ascertained in 2016 also, the scenario of insurance has not undergone significant change.

Conclusion: Strategies to optimize claims by bringing about a uniformity in the rates being charged by the hospitals for different procedures are needed to increase coverage.

Keywords: Awareness, Health insurance, Third-party administrators.

How to cite this article: Jain K, Sinha SK, Jain D, Kumar R. Does Health Insurance give Us an Assurance? A Study on the Extent of Coverage of Health Insurance at a Tertiary Care Hospital in North India. Int J Res Foundation Hospc Health Adm 2016;4(1):25-30.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
SV Saraswati

An Evidence-based Study on Traffic Flow in Operation Theater

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:66] [Pages No:70-78][No of Hits : 540]


ABSTRACT

Introduction: An unusual amount of brisk and continuous traffic of people as well as goods crisscrossing every zone of the theater was noticed at an operation theater (OT) of a cardiothoracic center. Many storage areas were filled with cartons of various sizes which are good media for fungi and bacteria. Interactions with the theater staff and a study of the stores revealed that the traffic of people and goods was interconnected, and improper stores management was the root cause of the increased traffic. The focus of this study was to identify possible reasons for unusual traffic in the OT and to arrive at solutions in an objective manner for optimizing it.

Aim: The aim was to assess the traffic flow in an OT with the purpose to devise and implement measures for optimal and even flow of traffic during surgery and to create an additional operating room (OR) and instrument room and to improve the overall indoor air quality (IAQ).

Materials and methods: Scholarly articles regarding ventilation, traffic flow, and inventory management were reviewed along with information available onsite. The method of descriptive study was adopted. Data were collected after analyzing the traffic flow charts, prestudy questionnaire, nonstructured interview results, and nonparticipant observation study. Tools for the study included: (1) Anecdotal evidence, (2) checklists, and (3) rating scales of three different groups. Compliance levels of five different categories of people in the OT were assessed. Air efficiency microbial culture studies and wound swab cultures were carried out during and postimplementation.

Results: The process also resulted in generation of optimal traffic of staff and goods inside the ORs and decreased air turbulence, collateral benefits, such as (1) creating space for an additional OR, (2) creating a sterile area for storage of instrument packs, (3) optimal space management by segregation of bulk stores, (4) organized inventory control and indenting, and (5) good ventilation in ORs. Changes made in administration and training program increased awareness and compliance levels among staff. No surgical site infection was reported during poststudy observation period.

Conclusion: The study has resulted in improvisations originally conceived, planned, and implemented by the author at the work station. This study facilitated optimizing traffic of people and goods in OT and stores and in improving IAQ. Excellent cooperation among staff, clean and pleasant ambience, peaceful work situation, laid out standard operating procedures segregated stores, and well-designed work hours boosted the morale of the entire staff.

Clinical significance: One of the main sources of airborne contamination in ORs is dead skin cells called “squames,” each around 15 μm or less in diameter shed by staff and patients. A proportion of these may carry harmful bacteria. The rate of shedding increases with movement. This study focused on optimizing traffic of people and goods in the OT and thereby resulted in improving overall IAQ.

Keywords: 5S Methodology, Heating, ventilating, and airconditioning, Indoor air quality, Operating room, Operation theater, Standard operating procedures, Storage, Surgical site infection, Traffic flow, Ventilation.

How to cite this article: Saraswati SV. An Evidence-based Study on Traffic Flow in Operation Theater. Int J Res Foundation Hosp Healthc Adm 2016;4(2):70-78.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Arif Raza

Use of CRABEL Scores to improve Quality of Medical Records Documentation in Hospitals

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:50] [Pages No:5-10][No of Hits : 526]


ABSTRACT

Introduction: This study is based on an approach employed by a medical college hospital for improving the adequacy of documentation in their medical records. The hospital utilized CRABEL scoring tool to screen and score their medical records and then used this information as a feedback to their clinical departments for encouraging them to improve their record documentation.

Aim: The study aims to determine whether the approach of the hospital resulted in any significant change in adequacy of their medical record documentation.

Materials and methods: Baseline sample of 250 current medical records (stratified random) from four clinical departments were scored using CRABEL scoring method to determine baseline average score and number of files with high scores (score > 0.85). Feedbacks on scores were given to departments, along with the information on areas for improvement. Scoring and feedback were repeated every month for six consecutive months, with sample size of 230 to 271. Trends in average score and number of files with high scores were observed. Difference between average scores of baseline sample and sample at the end of 6 months was statistically tested. Number of files with high scores, in departments where approach was carried out was compared with number of files with high scores, in departments were approach was not carried out, to check statistically significant difference, if any

Results: The trend showed a continuous monthly improvement in both average scores and number of files with high scores. Improvement was found in files of all clinical departments with minor variations. The chi-square test and Student’s t test showed a significant difference at p < 0.05 (p for chi square - 0.001 and for t-test - 0.04).

Conclusion: The hospital’s approach was found to be successful in improving the adequacy of documentation in medical records.

Clinical significance: Medical record constitutes the most important record in a clinical setting. Completeness of medical record is essential for proper patient care, but is a challenge in most organization. The approach has proven successful in this study and can be replicated in other settings for improvement.

Keywords: Case-control study, CRABEL, Documentation of records, Medical record, Scoring of medical record.

How to cite this article: Raza A. Use of CRABEL Scores to improve Quality of Medical Records Documentation in Hospitals. Int J Res Foundation Hosp Healthc Adm 2016;4(1):5-10.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Parul Tyagi, Zameera Naik, Maria Ana Karina Erica De Piedade Sequeira

Knowledge of Appropriate Prescription of Dental Radiographs among Interns of Two Dental Institutes of Belagavi City: A Questionnaire Study

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:66] [Pages No:61-65][No of Hits : 513]


ABSTRACT

Aim: To assess the level of knowledge of appropriate prescription of dental radiographs amongst Interns of two dental institutes of Belagavi city.

Materials and methods: A cross-sectional study was conducted on 120 interns of 2 dental institutes of Belagavi city. The knowledge of appropriate prescription of dental radiographs was assessed using a structured, close ended and self-designed questionnaire.

Results: Knowledge of appropriate prescription of dental radiographs was significantly lower in Institute 1 than Institute 2 (p=0.001*).Only a small % of 33.76 and 38.66 of interns of institutes 1,2 respectively had an above average knowledge. Thus, it is inferred that the awareness level of interns of correct prescription of radiographs is lower than expected.

Conclusion: The lack of awareness could be due to various factors such as a lack of previous knowledge, inadequate quality and quantity of educational courses and so on. Thus, students should receive the necessary education on correct prescription of radiographs to ensure their correct prescription, circumventing unnecessary exposure and their consequent detrimental effects.

Clinical significance: Radiographic examination is an important diagnostic tool used by dentists leading to an increased exposure to radiation. However, unessential exposure may lead to detrimental effects such as mutations, genetic changes and so on. One efficient way of decreasing exposure is to avoid their application when not indicated. Thus, it is the professional duty of a dentist to have adequate and accurate knowledge of prescription of radiographs. The present study shows the necessity to optimize educational tools to increase the theoretical knowledge of students and consequently improve clinical application of the knowledge gained.

Keywords: Dental education, Preventive care, Radiograph prescription, Radiation risks.

How to cite this article: Tyagi P, Naik Z, De Piedade Sequeira MAKE. Knowledge of Appropriate Prescription of Dental Radiographs among Interns of Two Dental Institutes of Belagavi City: A Questionnaire Study. Int J Res Foundation Hosp Healthc Adm 2016;4(2):61-65.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Neeraj Garg, Shakti K Gupta, Amit Lathwal, Ruchi Garg

A Study of Cost incurred in providing Emergency Care Services in an Apex Tertiary Care Hospital

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:50] [Pages No:45-50][No of Hits : 506]


ABSTRACT

Introduction: An emergency department (ED), also known as accident and emergency (A&E), emergency room (ER), or casualty department, is a medical treatment facility specializing for acute care of patients who present without prior appointment, either by their own means or by ambulance. In spite of the emergency beds forming only a fraction of the hospital beds, they consume a relatively large proportion of the hospitals resources. There is a requirement to ascertain the cost incurred in providing emergency care treatment to the patients coming to an apex tertiary care center, whose principal mandate is to provide tertiary care treatment. The study will not only help in allocating funds to the ED in an apex tertiary care facility but will also be useful if the hospital authorities decide to outsource the emergency services to a third party.

Aims and objectives: To study the cost incurred in providing emergency care services in an apex tertiary care hospital. To identify the various cost centers pertaining to patient care in the emergency care department and to estimate the cost of rendering patient care in ED and the cost of running the emergency per day.

Materials and methods: Six months’ retrospective data were collected from the ED, accounts section, engineering section, stores department, radiology department, emergency lab, computer facility, etc. The cost was apportioned to per patient as well per hour in rendering emergency care services.

Observations: The total cost incurred in providing emergency care services in the hospital under study was Rs 2034 per patient, while Rs 31,000 are spent per hour in running the emergency care facility.

Discussion: Almost 40 to 50% of the total cost incurred on providing emergency care services goes to the salary head of the staff working in the ED. The next major sources of expenditure are the radiology and lab investigations.

Conclusion: The study suggests that a considerable amount of hospital funds are spent on providing emergency care services in the apex tertiary care facility, whose primary mandate is to provide tertiary care services. The possibility of complete outsourcing or partial outsourcing in the form of radiology investigations and hiring humanpower on a contract basis can be a viable solution, to reduce the cost on providing emergency care, which can better be utilized in providing high-end tertiary care facilities.

Keywords: Accident and emergency, Tertiary care hospital, Unit cost.

How to cite this article: Garg N, Gupta SK, Lathwal A, Garg R. A Study of Cost incurred in providing Emergency Care Services in an Apex Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2016;4(1):45-50.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Madhav Madhusudan Singh, Shakti Kumar Gupta, YK Gupta, DK Sharma, Aarti Kapil

To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:56] [Pages No:13-24][No of Hits : 7731]


ABSTRACT

Introduction: As antimicrobial resistance continues to increase and new antimicrobial development stagnates, antimicrobial stewardship programs are being implemented worldwide. The goal of antimicrobial stewardship is to optimize antimicrobial therapy with maximal impact on subsequent development of resistance. Thirty to fifty percent of hospitalized patients receive antimicrobial therapy. Previous data suggest that inappropriate use results in higher mortality rates, longer lengths of stay, and increased medical costs. Antimicrobial stewardship programs (ASPs) reduce the improper use of antimicrobials and improve patient safety. Despite increased awareness about the benefits of these programs, few medical and surgical ASPs exist and fewer comprehensive studies evaluate their effects.

Aim: To study the antimicrobial stewardship program in a large tertiary care teaching center.

Objectives

  • To study the antibiotic prescribing practices in a tertiary care government hospital
  • To compare the antibiotic prescribing practices with the standard guidelines available with the hospital
  • To make recommendation if any for rational use of antibiotics.

Materials and methods

  • Review of literature
  • Prospective study of 15 days in selected general medicine and general surgery ward in which 5 to 6 reading will be taken in to know the antibiotic prescribed to patients.
  • Retrospective study of 15 days for study of patient records to know the antibiotic prescribed to patients.
  • Interaction with faculty and senior residents of general medicine and surgery to know about the pattern of infection and antibiotic prescription.
  • Interaction with microbiology department and their faculty to know the microbial resistance pattern and possible suggestion which need to be incorporated in antibiotic Stewardship program.

Results: The present study on antibiotic prescribing practices was undertaken in a super specialty hospital at New Delhi. A sample size of 100 case records was considered. There is no such stewardship program in tertiary care hospital, although it was demanded in various forum and meetings. There are no recommendations available either for patients of renal failure or other such compromised metabolic or immune states in the form of written antibiotic stewardship program of the hospital. The appropriateness of antibiotics prescribed in the case records was examined in light of the antibiotic stewardship program of the hospital. It was found that the overall adherence to antibiotic stewardship program was nil as no existing antibiotic stewardship program is exiting in this hospital. Gautum Dey in a study conducted at this hospital in New Delhi found that in 40.7% preoperative cases and 60.3% postoperative cases two or more than two antibiotics were given. The author has also commented that there was no evidence of adhering to antibiotic stewardship program or utilising culture and sensitivity reports to guide the therapy. The data obtained from the present study on further analysis has shown that in seven cases, the antibiotics prescribed were inadequate in terms of dose and duration. Thus resulting in an apparently lower cost of treatment than what was recommended by the antibiotic stewardship program of the hospital. Although such inappropriate prescription results in increased chances of antibiotic resistance, the immediate or short-term effects are not very conclusive. It is observed that there were 26 (26%) cases in medical and 12 (12%) cases in surgery disciplines in which the initial and final diagnosis was different. Uncertainty about the final diagnosis promotes empirical prescribing practices.

Conclusion: Antimicrobial stewards are a prominent part of local and national efforts to contain and reverse antimicrobial resistance. A range of intervention options is available with varying levels of resources and can yield substantial improvements in morbidity, mortality, quality of care, and cost. The cost of delivering such programs is dwarfed by the benefits and provides an opportunity for hospital epidemiologists to garner support. This suggests that antimicrobial management programs belong to the rarefied group of truly cost saving quality improvement initiatives. Considering the enormous implications of antibiotic resistance, it is necessary that we act in haste, lest our wonder drugs and magic bullets become ineffectual. Future systems promise greater integration and analysis of data, facilitated delivery of information to the clinician, and rapid and expert decision support that will optimize patient outcomes while minimizing antimicrobial resistance. They may also offer our best hope for avoiding an ‘Antibiotic armageddon’. In addition, the ASP plays an integral role in providing guidance to clinicians and ensures that the appropriate antimicrobial agents are used.

Keywords: Antibiotic, Stewardship program, Antimicrobial resistance, Rational use.

How to cite this article: Singh MM, Gupta SK, Gupta YK, Sharma DK, Kapil A. To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center. Int J Res Foundation Hosp Healthc Adm 2015;3(1):13-24.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sheetal Singh, DK Sharma, Sanjeev Bhoi, Sapna Ramani Sardana, Sonia Chauhan

Code Blue Policy for a Tertiary Care Trauma Hospital in India

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:114-122][No of Hits : 4243]


Abstract

“Code Blue” is generally used to indicate a patient requiring resuscitation or in need of immediate medical attention, most often as the result of a respiratory arrest or cardiac arrest. When called overhead, the page takes the form of “Code Blue, (floor), (room)” to alert the resuscitation team where to respond. Every hospital, as a part of its disaster plans, sets a policy to determine which units provide personnel for code coverage. In theory, any emergency medical professional may respond to a code, but in practice the team makeup is limited to those with advanced cardiac life support or other equivalent resuscitation training. Frequently, these teams are staffed by physicians (from anesthesia and internal medicine in larger medical centers or the emergency physician in smaller ones), respiratory therapists, pharmacists, and nurses. A code team leader will be a physician in attendance on any code team; this individual is responsible for directing the resuscitation effort and is said to “run the code”. This phrase was coined at Bethany Medical Center in Kansas City, Kansas. The term “code” by itself is commonly used by medical professionals as a slang term for this type of emergency, as in “calling a code” or describing a patient in arrest as “coding”.1

The purpose of this study is to make available policy with regard to Code Blue which can be followed in a tertiary care hospitals. It was a descriptive cross-sectional study carried out between January and June 2015. The study population included doctors, nursing personnel, paramedical staff and quality managers of tertiary care hospital from public and private hospitals. Checklist was made after an exhaustive review of literature which was then improvised. The checklist was discussed in focused group discussion held on 1 June 2015, and suggestions were incorporated. Validation of the checklist was also done by experts in various private and public hospitals. Subsequently, interaction was done with study population against the backdrop of the checklist and Code Blue policy was formulated.

Keywords: Cardiac arrest, Code Blue, Crash cart.

How to cite this article: Singh S, Sharma DK, Bhoi S, Sardana SR, Chauhan S. Code Blue Policy for a Tertiary Care Trauma Hospital in India. Int J Res Foundation Hosp Healthc Adm 2015;3(2):114-122.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Sameer Mehrotra, Sunil Basukala, Pawan Kapoor, Sunil Kant, RK Ranyal, Punit Yadav, Swati Varshney, SK Patnaik, Madhav Madhusudan Singh

Application of 3D Music Inventory Control Technique for the Controlled Drugs in Intensive Care Unit of a Tertiary Care Hospital

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:56] [Pages No:5-9][No of Hits : 3441]


ABSTRACT

Approximately 35% of annual hospitals budget is spent on buying materials and supplies, including medicines. The medical store is one of the most extensively used facilities of the hospital and hence it is essential that health managers use scientific methods to achieve efficient management and patient satisfaction.

Aims and objectives: To apply selective inventory control techniques for the drugs used in intensive care unit of tertiary care teaching hospital.

Materials and methods: The annual consumption and expenditure incurred on each item of controlled drugs in medical intensive care unit (ICU) for the years 2013 to 2014 was analyzed, and inventory control techniques, i.e. ABC, VED and ABC-VED matrix analysis, were applied.

Results: It was observed that 13 medicines (43.33%) out of 30 were classified in the category1 (AV + BV + CV + AE + AD) for stringent control.

Conclusion: Scientific inventory control management to be applied for efficient management of medical stores.

Keywords: ABC, VED analysis, Inventory control.

How to cite this article: Mehrotra S, Basukala S, Kapoor P, Kant S, Ranyal RK, Yadav P, Varshney S, Patnaik SK, Singh MM. Application of 3D Music Inventory Control Technique for the Controlled Drugs in Intensive Care Unit of a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2015; 3(1):5-9.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLES
Madhav Madhusudan Singh, Saroj Kumar Patnaik, Pradeep Srivastva, Harish K Satia, Mahavir Singh

Planning and Designing of Clinical Engineering Department in a Hospital

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:129-134][No of Hits : 2895]


Abstract

Biomedical/clinical engineering departments (CED) with expertise in engineering and technology management have a vital role to play in determining the potential for implementation and cost-effectiveness of new medical technologies through technology assessment. It provides planned preventive maintenance and repair facility in a state of optimum operational efficiency along with conducts training and research in clinical engineering. For a successful design, the workflow should be kept in mind in terms of its functional needs that are related to space. The clinical engineering and maintenance unit may consist of functional areas dependent on the operational policy and service demand. Heating, ventilation and air-conditioning (HVAC), lighting and acoustic, electrical, fire planning should be done with deliberation and as per specification.

Keywords: Biomedical/clinical engineering, Planned preventive maintenance, Repair facility.

How to cite this article: Singh MM, Patnaik SK, Srivastva P, Satia HK, Singh M. Planning and Designing of Clinical Engineering Department in a Hospital. Int J Res Foundation Hosp Healthc Adm 2015;3(2):129-134.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Ginny Kaushal, Prakash Doke, Aejaz Shah, Vivek Verma

An Analysis of Knowledge, Attitude and Practices regarding Standard Precautions of Infection Control and Impact of Knowledge and Attitude of ICU Nurses on Self-reported Practices of Infection Control

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:86-90][No of Hits : 2046]


Abstract

Context: World Health Organization (WHO) defines healthcare-associated infection (HCAI) as infection acquired in hospital or a healthcare setting by a patient who was admitted for a reason other than that infection. The healthcare associated infections are one of the leading causes of mortality, morbidity and increase cost. Adherence to standard precautions for infection control and simple techniques like effective hand hygiene is essential for reducing healthcare associated infections. However, compliance of healthcare workers to hand hygiene (HH) guidelines are reportedly poor. It is important, therefore, to instill adequate knowledge and good attitudes and practices at the time of primary training of the healthcare workers. This study is an attempt to identify gaps in knowledge, attitudes and practices (KAP) to improve existing training programs and give recommendation to enhance good practices in the future.

Aims: The aim of the study is to analyze KAP of nursing professionals of intensive care units (ICUs) in a tertiary care hospital and to find the impact of knowledge and attitude of the ICU nurses on self-reported practices.

Settings and design: The study design is a survey research which has used a self-administered questionnaire to compare the KAP of nursing professionals of an ICU in a tertiary care hospital.

Materials and methods: The WHO standard precautions for infection control were used as a guideline for preparing the self-administered questionnaire. The scoring system was based on a study done by Uba et al (2015).

Statistical analysis: Correlation and analysis of variance (ANOVA) were used to establish associations between the independent and dependent variables.

Results: Participants had an average level of knowledge (79%), good attitude (89%) toward infection control guidelines and very good self-reported practices (91%). The collective KAP score of all the participants is good (85%) which indicates that average levels of knowledge are balanced by good attitude and very good practices. However, good knowledge is crucial for ensuring expected levels of infection control practices, and hence ensures patient safety.

Conclusion: To achieve an environment of patient safety, it is essential that the healthcare staff should have sound knowledge and positive attitude. The study shows the need for further improvement of the existing infection control training programs to address the gaps in KAP.

Keywords: Attitude, Healthcare-associated infections Infection control, Knowledge, Practice, Standard precautions.

Key message: Good knowledge and positive attitude are essential for attaining expected levels of infection control practices among critical care nurses.

How to cite this article: Kaushal G, Doke P, Shah A, Verma V. An Analysis of Knowledge, Attitude and Practices regarding Standard Precautions of Infection Control and Impact of Knowledge and Attitude of ICU Nurses on Self-reported Practices of Infection Control. Int J Res Foundation Hosp Healthc Adm 2015;3(2):79-85.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Feroz Ikbal

Beyond Accreditation: Issues in Healthcare Quality

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:56] [Pages No:1-4][No of Hits : 1844]


ABSTRACT

In the last few years, there is an increased interest among Indian Healthcare institutions to get accredited from bodies, such as national accreditation board for hospitals and healthcare providers (NABH), Joint Commission International (JCI), Australian Council on Healthcare Standards (ACHS), and college of american pathologists Laboratory accreditation programme (CAP), etc. Hospital administrators, clinicians, academicians, promoters of the hospitals, policy makers and even government feel that accreditation is a panacea for all the problems associated with healthcare quality. But with the incidence of fire in one of the NABH accredited hospital in a metropolitan city, questions began to be asked on the correlation between quality and accreditation. Most of the hospitals use accreditation as a promotional tool, rather than a tool for continuous quality improvement. Often the entire focus of quality in a hospital is confined to the process of accreditation and re-accreditation. Time has come to think on the entire process of accreditation of hospitals in India, though it has a history of less than a decade. This paper intends to discuss various issues of quality in hospitals, outside the realms of accreditation. Need for strengthening and re-engineering the accreditation is also discussed. Accreditation essentially identifies the capability of the hospital to deliver quality care. It does not assure that hospitals delivers quality care. This aspect of accreditation has been often forgotten by the various stakeholders in healthcare. In this paper, an attempt is made to discuss other issues of quality, such as spurious drugs, quality of biomaterials, such as stents and biomedical equipments, quality of human resources, etc. which are often neglected by health institutions in its obsession to accreditation.

Keywords: Quality, Healthcare institution, Obsession, Accreditation.

How to cite this article: Ikbal F. Beyond Accreditation: Issues in Healthcare Quality. Int J Res Foundation Hosp Healthc Adm 2015;3(1):1-4.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
K Shweta, Shakti Kumar Gupta, R Chandrashekhar, S Kant

Planning and Designing an Isolation Facility in Hospitals: Need of the Hour

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:56] [Pages No:48-56][No of Hits : 1654]


ABSTRACT

Emerging infectious diseases represent an ongoing threat to the health and livelihoods of people globally. Over the past decade, numerous infectious diseases have shown up in the United States including SARS in 2003, H1N1 or ‘swine flu’ in 2009, and now, the Ebola virus.
Isolation of a patient is essentially an escalation of the core healthcare process. Best practice demands that isolation rooms be provided where care for the underlying medical condition is optimal. As uncontroversial as infection control may seem, the infrastructure required (such as washbasins and isolation rooms) is often lacking in hospitals. And if isolation rooms are available, proper maintenance of pressure gradients is an issue. In normal circumstances no purpose is served by routine cleaning of ventilation ducts. During replacement, dust is shed from old filters. All extract grilles and some types of supply grilles accumulate dust. These represent an infection risk. The dust reflects the air-borne flora at the time of deposition with organism death taking place at a rate determined by microbial, environmental and other factors.
It is vital that regular monitoring and maintenance of the ventilation system is in place. The physical design of a hospital is an essential component of its infection control measures to minimize the risk of transmission of any infectious disease. Today, with a more progressive outlook, it is the fundamental requirement to adopt a holistic view of the design and management of hospitals. This document will not only help in making strategy for planning or renovating an isolation room and also helps in cleaning or maintenance of ventilation.

Keywords: Infection control, Isolation room design, Ventilation system.

How to cite this article: Shweta K, Gupta SK, Chandrashekhar R, Kant S. Planning and Designing an Isolation Facility in Hospitals: Need of the Hour. Int J Res Foundation Hosp Healthc Adm 2015;3(1):48-56.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
AP Pandit, Neha Bhagatkar, Mallika Ramachandran

Personal Protective Equipment used for Infection Control in Dental Practices

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:56] [Pages No:10-12][No of Hits : 1565]


ABSTRACT

The potential size of India’s dental market is vast and is expected to become one of the largest single country markets for overseas dental products and materials. The total market for the dental equipment and materials is estimated to be around US$ 90 million annually. There are more than 1, 80,000 dental professionals in India, 297 dental institutes and over 5,000 dental laboratories. Thus, there is a huge potential for the market of personal protective equipment (PPE) used for infection control in dentistry. India’s market for dental products is extremely dynamic, with a current estimated growth rate of between 25 and 30%. Overall, the dental market is expected to grow by 20%.1
The personal protective equipment used in the practice of dentistry in India. Since dentistry is predominantly a surgical discipline, it leads to exposure to the pathogenic microorganisms harbored in blood, body fluids and other potentially infectious material. Thus, the use of adequate and good quality PPE is imperative for infection control in dental practice. With the growing potential of India’s dental market, the growth of the market for PPE is inevitable. But, it is equally important to raise the awareness among dental community about good quality products adhering to required standards to prevent the usage of low-cost, uncertified and sub-standard products that decrease the safety levels of personnel.
The present study is conducted with a view to observe the personal protective equipment used for infection control in dental practices.

Keywords: Personal protective equipments, Infection control, AAMI standard, Dental practice.

How to cite this article: Pandit AP, Bhagatkar N, Ramachandran M. Personal Protective Equipment used for Infection Control in Dental Practices. Int J Res Foundation Hosp Healthc Adm 2015;3(1):10-12.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sanjeev Singh, Murali Chakravarthy, Sharmila Sengupta, Neeta Munshi, Tency Jose, Vatsal Chhaya

Incidence Rates of Healthcare-associated Infections in Hospitals: A Multicenter, Pooled Patient Data Analysis in India

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:86-90][No of Hits : 1506]


Abstract

Aims: The aim of this study was to collect the multicenter data of healthcare-associated infections (HAIs) to assess the infection control scenario in India in context with CDC/NHSN and INICC database.

Materials and methods: Four National Accreditation Board for Hospitals and Health Care Providers (NABH) accredited hospitals were selected on random basis and raw data on healthcare-associated infections—number of days and number of infections in all intensive care patients was obtained as per the CDC-NHSN definitions and formula. Three major device related infections were considered for analysis based on the prevalence of HAIs and discussions with subject matter experts. All nodal champions from each hospital were trained and common data collection sheet for surveillance in accordance to CDC-NHSN was formed. The pooled means for HAI rates and average of the pooled means for all were calculated using data from four hospitals and were compared with CDC/NHSN and international nosocomial infection control consortium (INICC) percentiles of HAIs rates.

Results: The Indian pooled mean HAI rates for all infections were above CDC/NHSN percentile threshold but below INICC percentile. Ventilator-associated pneumonia (VAP) was considered as matter of prime concern, crossing P90 line of CDC/NHSN threshold. However, no HAI rate was in limit of P25.

Conclusion: Indian HAI rates were higher when mapped with CDC threshold. This promotes the need for more standardized and evidence-based protocols been adhered to so as to bring HAI within CDC/NHSN thresholds. However, the four hospitals have better HAI rates as compared to pooled INICC database.

Keywords: HAI, Multicentric, Patient data analysis, Retrospective.

How to cite this article: Singh S, Chakravarthy M, Sengupta S, Munshi N, Jose T, Chhaya V. Incidence Rates of Healthcare-associated Infections in Hospitals: A Multicenter, Pooled Patient Data Analysis in India. Int J Res Foundation Hosp Healthc Adm 2015;3(2):86-90.

Source of support: Children’s Heart Link, US supported the project of multi-centric pooled HAI data collection and analysis.

Conflict of interest: None


 
ORIGINAL ARTICLE
S Singh, Shakti Kumar Gupta, S Arya, DK Sharma, V Aggarwal

Adverse Drug Reaction Policy in a Tertiary Care Hospital

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:56] [Pages No:41-47][No of Hits : 1367]


ABSTRACT

Adverse drug reactions (ADRs) are a significant cause of morbidity and mortality and contribute to the incidence of adverse events, resulting in increased healthcare costs. Healthcare providers need to understand their role and responsibility in the detection, management, documentation, and reporting of ADRs. The purpose of this study is to provide guidelines regarding the procedure of reporting ADRs to hospital authority. It was a descriptive cross-sectional study carried out between April and August 2013. The study population included doctors, nursing personnel, paramedical staff and quality managers of tertiary care hospital from one public and two private hospitals. Interaction was done with study population against the back drop of the checklist and ADR policy was formulated.

Keywords: Adverse drug reactions, Adverse drug event, Medication error, Near-miss, Drug-related side effects.

How to cite this article: Singh S, Gupta SK, Arya S, Sharma DK, Aggarwal V. Adverse Drug Reaction Policy in a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2015; 3(1):41-47.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sanjeev Davey, Anuradha Davey, S Vivek Adhish, Rajni Bagga

Impact of Nutritional Services of Anganwadi Workers in Improving Nutritional Status of Infants in Delhi: A Study by Mixed Method Technique

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:57-64][No of Hits : 1232]


Abstract

Background: Despite the presence of integrated child development services (ICDS) program in rural area of Delhi, the real impact of nutritional services of ICDS program on nutritional status of infants is not very clear, therefore, studying this area may provide new insights in this field.

Materials and methods: This study was carried out from 1st January 2015 to 31st March 2015 (3 months). All children up to 1 year of age (in AWC 1 and 2 area of a one rural ICDS block) were examined for their nutritional status by weight for age criteria. The registered infants of both these Anganwadi centers (AWCs) and their mothers were simultaneously observed for all kind of nutritional services they received from Anganwadi workers (AWWs) by way of key informants interviews and this was further confirmed by applying secret customer technique.

Results: The prevalence of mild to moderate malnutrition among infants in both the AWC area (AWC 1 area—6 months to 1 year category—52.9%, AWC 2 area (from 0–6 months and 6 months–1 year—69.3%) was higher. The key feeding factors identified for such scenario were: Improper colostrums feeding, wrong age of initiation of semisolid feeding, exclusive breast-feeding not done for 6 months, etc. [especially for AWC 2 area (p < 0.05) and AWC 1 area (p > 0.05)] among the AWCs. These factors were further confirmed by poor efforts of both AWWs in providing nutritional services toward mother and infants.

Conclusion: Anganwadi workers need to focus on quality of nutritional services provided toward mothers of infants and this area needs regular monitoring and supervision from ICDS and health system meticulously.

Keywords: Anganwadi center, Anganwadi worker, Impact, Infant, Integrated child development services, Mixed methods, Nutrition.

How to cite this article: Davey S, Davey A, Adhish SV, Bagga R. Impact of Nutritional Services of Anganwadi Workers in Improving Nutritional Status of Infants in Delhi: A Study by Mixed Method Technique. Int J Res Foundation Hosp Healthc Adm 2015;3(2):57-64.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Nikita Sabherwal, Ashok Mittal, NK Pandey, Ginny Kaushal, Paul Kaustav

A Study of Patient-Physician Communication and Barriers in Communication

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:71-78][No of Hits : 1046]


Abstract

Context: Effective doctor-patient communication is the basic requirement in building a good doctor-patient relationship. Safe practices and effective, patient-centered communication is key to quality care. Good doctor-patient communication has the potential to help regulate patients’ emotions, facilitate comprehension of medical information and allow for better identification of patients’ needs, perceptions and expectations. Doctors with better communication and interpersonal skills are able to detect problems earlier, can prevent medical crisis and expensive intervention, and provide better support to their patients.

Current research indicates that ineffective communication among healthcare professionals is one of the leading causes of medical errors and patient harm. There are many barriers to good communication in the doctor-patient relationship, including patients’ anxiety and fear, doctors’ burden of work, fear of litigation, fear of physical or verbal abuse, and unrealistic patient expectations. National accreditation board for hospitals and healthcare providers (NABH) standards and international patient safety goals focus on the importance of effective communication in healthcare settings and how it leads to patient safety.

This study is an attempt to identify gaps in patient physician communication in the current healthcare settings, find the barriers in communication and give recommendation to enhance good practices in the future.

Aims: The aim of the study is to analyze the current levels of effective patient communication in a tertiary care hospital in Delhi-NCR with help of a self-administered questionnaire. The study will assess the level of information shared with the patient.

Settings and design: The design of our proposed study is a descriptive study where we will use a self-administered questionnaire to assess the level of patient-physician communication in the selected study setting.

Materials and methods: The NABH standard were used as a guideline for preparing the self-administered questionnaire. All admitted vulnerable patients of the selected study area will consist of the population for the study. Simple random sampling technique will be used to derive the sample out of the population.

Statistical analysis used: Correlation and analysis of variance (ANOVA) were used to establish associations between the independent and dependent variables.

Results: The study shows that 48% of the respondents were of opinion that they were given partial information, while 20% of the respondents alleged that they were not given any information about the explanation of their disease, its prognosis and the treatment option that were available, i.e. a total of 62% of the patients said that they had partial information to complete lack of information that would have made them aware of their diseases, its prognosis and the treatments options available to cure it, while only 32% of the patients agreed that they were supplied with thorough information during their interaction with the physicians.

Conclusion: The majority of the patients were not well-informed about their disease, its prognosis, treatment plan and continuity of care. There was a significant positive correlation between the communication made at initial stages of hospital stay and during the end stages of stay of patient. The main barrier to patient physician communication was time.

Keywords: Barriers in communication, IPSG, NABH, Patient-physician communication.

Key message: To ensure patient safety, it is imperative to inform patients about all the important aspects starting from admission till discharge.

How to cite this article: Sabherwal N, Mittal A, Pandey NK, Kaushal G, Kaustav P. A Study of Patient-Physician Communication and Barriers in Communication. Int J Res Foundation Hosp Healthc Adm 2015;3(2):71-78.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Jharna Bajpai

Employee Satisfaction and the Role of Motivation: A Study of a Super-specialty Hospital

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:65-68][No of Hits : 885]


Abstract

Employee satisfaction plays a role in motivation and ultimately, overall productivity and bottomline results. Employees who are more satisfied in their positions have more reasons to work hard and contribute to a shared work ethic that encourages others to do the same. Likewise, drops in productivity may stem from low levels of worker satisfaction. This paper throws light on the role of motivation and employee satisfaction in a super specialty hospital. A questionnaire pertaining to various motivations related questions was distributed to various employees. The sample size was 118 and a combination of descriptive and exploratory research methodology was used. Nominal scale and likert five points scaling was used for measuring the satisfaction level. Data were analyzed using the Statistical Package for the Social Science (SPSS) software program version-16 and conclusions were drawn. Approximately 53% of the employees were satisfied with the promotion policy. Sixty percent of respondents were satisfied with the working atmosphere of the organization and 32% were satisfied with the remuneration they are receiving. This paper discusses such more aspects which play a role in motivation and suggest solutions to make employees satisfied with their job.

Keywords: Employee satisfaction, Hospital, Human resource management, Job satisfaction, Motivation.

How to cite this article: Bajpai J. Employee Satisfaction and the Role of Motivation: A Study of a Super-specialty Hospital. Int J Res Foundation Hosp Healthc Adm 2015;3(2):65-68.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Parmeshwar Kumar, V Jithesh, Aarti Vij, Shakti Kumar Gupta

Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:56] [Pages No:33-40][No of Hits : 864]


ABSTRACT

Background: Standardized handovers have been known to improve outcome, reduce error and enhance communication. Few, if any, comparative studies on clinical handovers have been conducted in the India.

Objective: To study clinical handover practices among nurses and doctors in a neurosciences center in India.

Design and setting: This descriptive and cross-sectional study was conducted over 4 months in a 200 bedded public sector tertiary care facility in New Delhi, India.

Materials and methods: The handover practices of nurses and resident doctors in a neurology ward were assessed across shifts, weekdays and weekends using a pretested checklist. Ten elements were observed under the categories of time, place, record, process, staff interaction and patient communication. Outcomes were analyzed using z-test, analysis of variance (ANOVA) and Spearman’s correlation coefficient.

Results: Three hundred and eighty-two handovers each of nurses and doctors revealed varying adherence for time (44%), place (63%), documentation (50%), process (78%), staff interaction (50%) and patient communication (45%) related elements with overall compliance being 55%. Doctors fared better only in process elements and bedside handovers; however, only nurses had a statistically significant fall in levels over weekends and in night shifts. Staff interaction and patient communication were positively correlated and bedside handover was negatively related to handover duration in both groups. No statistically significant difference was found between the two groups when assessed as categories.

Conclusion: Study revealed a need for a system change and standardization of clinical handovers. Greater administrative commitment, use of technology, customized training and leadership development will aid in continuity of care, promote patient safety and ensure better outcomes.

Keywords: Clinical handovers, Shifts, Standardization.

How to cite this article: Kumar P, Jithesh V, Vij A, Gupta SK. Who is More Hands on with Hand-offs? A Comparative Study of Clinical Handovers among Doctors and Nurses in a Tertiary Care Center in India. Int J Res Foundation Hosp Healthc Adm 2015;3(1):33-40.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Kasturi Shukla, Priyadarshini Chandrashekhar, Nirmal Kumar, Pradnya K Devade

A Descriptive Study of Length of Stay at an Intensive Care Unit

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:56] [Pages No:29-32][No of Hits : 848]


ABSTRACT

Background and aims: As intensive care units (ICUs) are very resource intensive, length of stay (LOS) is of prime importance. This study was done to analyze the LOS in different ICUs and analyze it against a set benchmark.

Materials and methods: This retrospective study was conducted from April to June 2013 on patients admitted during January to March 2013 in the neurosurgery ICU (NICU), medical ICU (MICU), high dependency unit (HDU) and isolation ICU of a large multispecialty hospital in Pune (India). As per the quality manual of the hospital, benchmark LOS was considered as 3.08 days for ICU. Mean and median LOS was analyzed through Student’s t and Chi-square test; proportion of short (<2 days) and long stay (>4 days) patients was also computed.

Results: Out of 835 patients admitted to the NICU, MICU, HDU and Isolation ICU, the overall mean LOS was 3.37 ± 5.54 days which was statistically significant at a p-value <0.001 (t = 17.58, 95% CI 3-3.75). The overall mean LOS was higher than the benchmarked 3.08 days but still within the optimal range of 2 to 4 days. Mean LOS was statistically significant when tested for department-wise variations with a Chi-value of 173.56 (p-value < 0.001, LR = 113.75). Highest mean LOS was observed for isolation ICU and lowest for MICU. 360 (43.1%) were short stay, 141(16.8%) were long stay and remaining were optimal stay patients.

Conclusion: The mean LOS for the ICUs varied significantly across the type of ICUs which needs to be continuously monitored. Mean LOS variation across ICU type indicates need for separate benchmarks.

Keywords: Benchmark, Hospital, ICU, Length of stay.

How to cite this article: Shukla K, Chandrashekhar P, Kumar N, Devade PK. A Descriptive Study of Length of Stay at an Intensive Care Unit. Int J Res Foundation Hosp Healthc Adm 2015;3(1):29-32.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLES
Vijaydeep Siddharth, S Kant, R Chandrashekhar, Shakti Kumar Gupta

Integration in Operation Theater: Need of the Hour

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:123-128][No of Hits : 798]


Abstract

Integration in operation theater (OT) usually refers to systems integration, which means functionally connecting the OT environment. It includes integration of patient information system, audio, video, surgical lights and room lights, building automation (HVAC), medical equipment, telemedicine, video-onferencing, etc. When integrated, all technology can be manipulated from a central command console by single operator. Integration in OT holds the key for effective application of minimally invasive surgery, robotic surgery and functioning of hybrid OT. Apart from the conventional planning team for an OT, bringing on board an IT professional is a must for planning IT requirements. Integration in OT requires 15% more space than the conventional OT in order to accommodate the IT gadgets, i.e. walk-in technology room that would house teleconferencing and A/V equipment, blade-server computers, fiberoptic network electronics, teleconferencing and video conferencing equipment, audio-visual racks, etc. the level of integration can vary within an OT depending upon the user requirement. Space requirement for a general I-OT is about 60 m2, a cardiovascular I-OT or one that includes robotics may come up to 80 m2 or more, and I-OT with in-room imaging equipment requires at least 100 m2. Integration in OT not only increases the efficiency and patient safety in delivery of healthcare but can significantly increase efficiency and effectiveness both in teaching and research.

Keywords: Integrated OT, Operation theater, Planning and designing, Surgery.

How to cite this article: Siddharth V, Kant S, Chandrashekhar R, Gupta SK. Integration in Operation Theater: Need of the Hour. Int J Res Foundation Hosp Healthc Adm 2015;3(2):123-128.

Source of support: Nil

Conflict of interest: None


 
EXPERT VIEW
Surinder Singh, Akanksha Bisht

Regulation of Biologicals: Indian Perspective

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:135-136][No of Hits : 758]


Abstract

How to cite this article: Singh S, Bisht A. Regulation of Biologicals: Indian Perspective. Int J Res Foundation Hosp Healthc Adm 2015;3(2):135-136.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Hem Chandra, Nitin Dutt Bhardwaj, Faiyaz Mansoor, Rimma Mandal, Dinesh Chandra Srivastava, Rajesh Harsvardhan

Optimal Utilization of Government Assisted Financing for Poor Patients: Facilitation by a Hospital

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:56] [Pages No:25-28][No of Hits : 589]


ABSTRACT

Introduction: Sole objective of healthcare financing is that rich and poor should be treated equally as poverty is not a disability and wealth is not an advantage. Approximately, 78% of Indian population spends for healthcare from out of pocket expenditure, remaining by salary, agriculture, business, etc. Only 3% population is covered by health insurance. Prime minister (PM) fund is one of the methods to offset the treatment cost from poor.

Objective: Present paper is aimed to highlight the contribution of PM fund for patients getting treatment at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) hospital and efforts made by hospital for its optimal utilization.

Materials and methods: Retrospective studies were carried out in 2010 and July 2013 for contribution received form PM fund for indoor poor patients treatment during last 5 years, number of patient availed/not availed financial assistance, reasons for not availing, on the line of problem solving process. Efforts made by SGPGIMS for its optimal utilization were also highlighted.

Result: During financial year 2007-2008 to 2009-2010, total 1246 patients received the fund of worth USD 1.30 million (Rs 78792750.00) and only USD 1.09 million (Rs 65569869.00) was utilized by 1110 (89%) patients. One hundred and thirtysix (10.91%) patients did not utilize. Hospital administration made efforts for optimal utilization by minimizing the barriers, consequently it improved the utilization by 8.20%. During financial year 2010-11 to 2011-12, USD 1.85 million (Rs 111081789.00) was received for 1450 patients, out of which 730 patients have already utilized and 682 are still using the fund (total 1412/97.40%) and 38 patients (2.60%) did not use it.

Conclusion: Simple efforts made by hospital improved the utilization of PM fund by 8.20% and poor were really benefited. Hospitals should also fulfill the social responsibility by facilitating the patients.

Keywords: Healthcare financing, Developing country, Out of pocket expenditure, Below poverty line, Prime minister fund.

How to cite this article: Chandra H, Bhardwaj ND, Mansoor F, Mandal R, Srivastava DC, Harsvardhan R. Optimal Utilization of Government Assisted Financing for Poor Patients: Facilitation by a Hospital. Int J Res Foundation Hosp Healthc Adm 2015;3(1):25-28.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sheetal Singh, Shakti Kumar Gupta, Sanjay Arya, Vijay Aggarwal, T Thuilephy

Hand Hygiene Policy for a Tertiary Care Hospital

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:103-109][No of Hits : 566]


Abstract

Hand hygiene diminishes the carriage of potential pathogens on the hands. It results in reduction in patient morbidity and mortality from nosocomial infection. Eighty percent of nosocomial disease transmission is thought to be via hands. The purpose of this study is to provide policy with regard to hand hygiene which can be followed in tertiary care hospitals. It was a descriptive cross-sectional study carried out between April and August 2013. The study population included doctors, nursing personnel, paramedical staff and quality managers of tertiary care hospital from public and private hospitals. Checklist was made after an exhaustive review of literature which was then improvised. Validation of the checklist was done by experts in infection control in various private and public hospitals. Subsequently, interaction was done with study population against the back drop of the checklist and hand hygiene policy was formulated.

Keywords: Hand hygiene agents, Hand hygiene practices, Hand washing Techniques.

How to cite this article: Singh S, Gupta SK, Arya S, Aggarwal V, Thuilephy T. Hand Hygiene Policy for a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2015;3(2):103-109.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Amit Lathwal, Sanjay Kumar Arya, IB Singh, Ravinder Ahlawat, Kanika Jain

A Study of the Awareness Levels of Universal Precautions in High-risk Areas of a Super-specialty Tertiary Care Hospital

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:98-102][No of Hits : 565]


Abstract

Centers for disease control and prevention (CDC), Atlanta, in 1987, defined universal precautions and recommended that blood and body fluid precautions be consistently used for all patients. Although universal precautions have been in existence for a long period of time and the risk of transmission of blood borne infections to healthcare workers (HCWs) is very real, the awareness levels among HCWs to these precautions is still far from satisfactory.

This study was conceived to study the knowledge of universal precautions in high-risk areas of a super-specialty tertiary care hospital in India among different categories of HCWs.

A pretested structured questionnaire common to all the categories of HCWs was used to study the awareness levels of universal precautions. Each question was assigned a unit score. Seventy-five percent score in the questionnaire was taken as cut-off for adequate knowledge.

The findings of the study reveal that the HCWs who had adequate knowledge of universal precautions were 29 (30%) out of 96 HCWs. These included 17 (53%) doctors, 8 (36%) nurses, 3 (31%) technical staffs and 1 (5%) housekeeping staff.

Keywords: Blood-borne infections, Healthcare workers, Tertiary care hospital, Universal precautions.

How to cite this article: Lathwal A, Arya SK, Singh IB, Ahlawat R, Jain K. A Study of the Awareness Levels of Universal Precautions in High-risk Areas of a Super-specialty Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2015;3(2):98-102.

Source of support: Nil

Conflict of interest: None


 
Editorial
Shakti Kumar Gupta, Brig Sunil Kant

Smart Hospitals … Gen Next

[Year:2015] [Month:January-June] [Volumn:3 ] [Number:1] [Pages:56] [Pages No:v-vi][No of Hits : 539]


ABSTRACT

Smart Hospitals … Gen Next

Healthcare in India is undergoing paradigm shift. Globalization and shrinking of the world has necessitated the way to rethink and re-engineer how healthcare is delivered. Today the need is of instant updates and quick solutions. Technology is surging ahead by leaps and bounds and hospitals are also metamorphosing into technology embedded organizations. Facing increased competition, tighter spaces, staff retention and reduced reimbursement, today’s hospitals are looking at strategic ways to use technology to manage their deliverables.


 
RESEARCH ARTICLE
Gaurav Mahindra, Hamendra Kumar Dangi

Brain Drain: Migration of Healthcare Professionals in a Globalized World

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:63-72][No of Hits : 9630]


ABSTRACT

Social, economic and technological developments due to globalization have led to a surge in international demand for skilled workforce. Developed economies have made concerted efforts in not only attracting but also in retaining such human capital. Healthcare sector has been no exception. With limited career opportunities within their own country and a host of pull factors in developed countries, India and other developing countries have seen an exodus of medical and other professionals, what is known as ‘Brain Drain’. Shortages thus resulting from migration of health workers have even mitigated the effects of increased domestic healthcare spending. The health workers hold strategic importance in a nation’s health systems and disease control initiatives. The resulting imbalances could have a detrimental effect on the social as well as economic fabric of such sending countries. This study is an effort in understanding the factors encouraging human capital flight and thus seeking short-term and long-term measures in dealing with it. This research brings forth strategies to deal with brain drain by forming mutually beneficial relationships with the diasporas. This reciprocity will lead to circulation of skills between source and receiving countries. Formulating suitable policies would ensure correcting the human resource imbalances within countries on a sustainable basis.

Keywords: Brain drain, Human capital flight, Migration of health workers.

How to cite this article: Mahindra G, Dangi HK. Brain Drain: Migration of Healthcare Professionals in a Globalized World. Int J Res Foundation Hosp Healthc Adm 2014;2(2):63-72.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
P Naveen Kumar, Anil Jacob, Smruthi Thota

Impact of Healthcare Marketing and Branding on Hospital Services

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:19-24][No of Hits : 8328]


ABSTRACT

Healthcare is one of the many human-centered services offered, the other being legal services, hospitality services, transport services, etc. The healthcare is also the foremost in all of these personal services. Every section of the healthcare experience must embody and convey the message that the hospital is the center of health and wellness in the community. The connection between healthcare provider and patient needs to be developed to improve the delivery model.
However with the rise of healthcare costs to providers, increase in operating costs, informative and knowledgeable customers; hospitals need branding to drive strategies, convey their expanding range of services, make an emotional connection with customers and create lasting relationships thereby generating profits.
Companies are losing out because there is often little or no integration between Corporate Social Responsibility (CSR) and marketing departments and their respective strategies. This misses brand building opportunities and may also confuse as well as disenfranchise company stakeholders.
Unless CSR becomes central to the marketing director’s agenda, it will not have the desired effect and can potentially create a backlash. The nature of the business - category, customers, competitors - should dictate how much and in which ways, a company should promote its CSR-related activities.
Here, it lies the importance of developing a more strategic, distinct, sustainable and well defined brand platform. It is ultimately the hospital’s brand and the customers’ ability to trust that will aid in the decision-making process between competitive healthcare hospitals. Patient expectations and desires are changing, altering the competitive landscape. Employees are a hospital’s most vital force and communication medium. Thus, the brand is the greatest asset for uniting employees around a singular culture and mission. This study highlights a conceptual framework that can be used for healthcare organizations to develop the revenues based on branding.

Keywords:Healthcare branding, Brand image, Corporate social responsibility, Integrated marketing communication, Customer satisfaction index.

How to cite this article: Kumar PN, Jacob A, Thota S. Impact of Healthcare Marketing and Branding on Hospital Services. Int J Res Foundation Hosp Healthc Adm 2014;2(1):19-24.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Madhav Madhusudan Singh, Saroj Patnaik, Pawan Kapoor, Manu Chaturvedi, Pradeep Srivastava

The Consumer Protection Act: A Review of Legal Perspective

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:121-129][No of Hits : 5893]


ABSTRACT

The fast pace of commercialization and globalization is affecting all spheres of life, the medical profession is also affected by this socioeconomic phenomena. The consumer protection act (CPA) enacted in 1986 intended to provide effective and efficient safeguards to the consumers against various types of exploitations and unfair practices. This review article aims to augment awareness of medical practitioners regarding CPA and how to prevent litigations.

Keywords: Consumer protection act (CPA), Professional negligence, Complainant, Complaint, Consumer, Service.

How to cite this article: Singh MM, Patnaik S, Kapoor P, Chaturvedi M, Srivastava P. The Consumer Protection Act: A Review of Legal Perspective. Int J Res Foundation Hosp Healthc Adm 2014;2(2):121-129.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
V Siddharth, Sunil Kant, R Chandrashekhar, Shakti Kumar Gupta

Planning Premises and Design Considerations for Hybrid Operating Room

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:50-56][No of Hits : 4561]


ABSTRACT

The hybrid operating room can be defined as the combination of imaging system and operating table installed in an operating theater room for, e.g. use of an angiography imaging system and operation table in an operation theatre or use of an operating table in angiography room. Shorter patient recovery time, decreased length of stay, streamlined care delivery, improvement in cross-specialty communication, minimized risk for communication-related errors across clinical specialties and lower overall cost of care are some of the advantages of the hybrid operating room. Although no/limited data exists in the literature, the potential disadvantages of hybrid operating suite are cost, infection, prolonged anesthesia and radiation exposure. The primary components of a hybrid operating suite are an imaging system and imaging compatible operation table. Area required for hybrid operating suite varies from 80 to 150 m2. The most common configuration of hybrid operating suite includes a flat panel angiographic X-ray imaging system and surgical equipment for cardiac surgery.

Keywords: Operating room, Hybrid operation room, Intraoperative imaging.

How to cite this article: Siddharth V, Kant S, Chandrashekhar R, Gupta SK. Planning Premises and Design Considerations for Hybrid Operating Room. Int J Res Foundation Hosp Healthc Adm 2014;2(1):50-56.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
AK Gadpayle, HK Dangi, Debopriya

Study of Unit Cost of Medical Intensive Care Unit at Tertiary Care Hospital in Government Set up in New Delhi

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:10-14][No of Hits : 3525]


ABSTRACT

Aim: The cost incurred on delivery of Medical Intensive Care Service to the patient varies from type of Intensive Care Unit (ICU). The present study was conducted to assess the cost of per patient per day in Medical Intensive Care Unit (MICU).

Materials and methods: It was a prospective study which was carried out at tertiary care hospital, in Government setup, Delhi from 01st January 2014 to 31st January 2014. All the Adult patients admitted in Medical ICU were taken for study. Various costs like fixed, variable, Direct and Indirect were calculate for the study period by step down approach. The unit cost was calculated.

Results:Total 32 patients were admitted in Medical ICU during the study period. The average days of admissions calculated to 171 days. The average length of stay was estimated at 5.343. The salary component amounts to 42.44% of the total cost. The equipment cost amounts to 37.00% of the total cost. The total fixed cost amounts to 81.62% and variable cost amounts to 18.38%. Out of variable cost the investigation radiology amounts to 6.35% followed by medicine 4.81% and Investigation 3.83%. The unit cost calculated amounts to Rs.1133.29.

Conclusion: The fixed cost is a major share of the total cost incurred in Medical ICU. Out of which equipment cost stands first. The unit cost amounts to Rs.1133.29 which is relatively less than the other studies probably due to close type of ICU and patients admitted in Medical ICU are coming from outside.

Keywords: Medical ICU, Unit cost, Tertiary care hospital.

How to cite this article: Gadpayle AK, Dangi HK, Debopriya. Study of Unit Cost of Medical Intensive Care Unit at Tertiary Care Hospital in Government Set up in New Delhi. Int J Res Foundation Hosp Healthc Adm 2014;2(1):10-14.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
V Siddharth, S Arya, Shakti Kumar Gupta

A Study of Prescribing Practices in Outpatient Department of an Apex Tertiary Care Institute of India

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:31-35][No of Hits : 3469]


ABSTRACT

Introduction: Poor quality prescriptions, besides affecting patient safety, have a deleterious impact on the restricted purse of sick persons, especially those belonging to lower socioeconomic strata.

Objective: To study the prescribing practices in outpatient departments of an apex tertiary care institute of India.

Methodology: Descriptive and observational study of randomly taken sample of 300 prescriptions from pharmacy was carried out. Parameters for analysis were selected based on review of literature.

Observations: Of the total samples analyzed, OPD registration number, date of registration, patients name, gender and department were mentioned in 99.3% of prescriptions. Patient name was mentioned in all the prescriptions and gender was present in 99% prescriptions. Address of the patient was present in only 64.7% (194) prescriptions. 93.7% of the prescriptions were legible. Ninety-seven percent of the prescriptions carried diagnosis or presenting complaints. An average of 2.82 ± 1.77 (median - 3) drugs were prescribed per patient. Only 1.63% (14) prescribed drugs were generic. In our study, antacids (26.33%) followed by the vitamins (24%), analgesics (23.3%), antibiotics (22.8%) and antipyretics (18%) were the most commonly prescribed drugs. Drug strength, drug frequency and drug administration route was mentioned in only 62, 89 and 89% of the total prescriptions. Fifty percent did not carry the duration and mean duration of prescription was 17.75 ± 24.18 days. Signature, name, designation, address, stamp and medical registration number of the physician was mentioned only in 96.7, 7.3, 6.7, 2.7, 0.7 and 0% of the prescriptions respectively.

Conclusion: The study has brought out the need for sensitization and awareness programes for doctors to improve the quality of prescription-writing and periodic review of prescriptions.

Keywords: Prescription, Prescribing practices, Audit, Outpatient department.

How to cite this article: Siddharth V, Arya S, Gupta SK. A Study of Prescribing Practices in Outpatient Department of an Apex Tertiary Care Institute of India. Int J Res Foundation Hosp Healthc Adm 2014;2(1):31-35.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Gadelha Socorro Nunes, Miranda González Francisco Javier

Hospital Information System Satisfaction in Brazil: Background and Moderating Effects

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:1-9][No of Hits : 3096]


ABSTRACT

In the last years, hospitals in Brazil have made significant investments in adopting and implementing new hospital information system (HIS). Whether these investments will prove beneficial for these organizations depends on the support that will be provided to ensure the effective use of the information systems (IS) implemented and also on the satisfaction of its users.
The purpose of this study is to propose a conceptual model, appropriate for the intention to use HIS, by adopting the system, service, and information qualities covered in the Information System Success Model proposed by DeLone and Mclean.
In the present study, structural analysis applied to data from a sample of 393 HIS users showed the variables service quality, information quality, system quality and satisfaction to act as antecedents of HIS success. A novel finding of the study was the importance of the user’s aptitude with respect to computer moderating the relationships of the model.
Managerial implications are provided accordingly. Suggestions for introducing healthcare information system are then provided as well.

Keywords: Health information management, Management information system, Hospital, Brazil.

How to cite this article: Nunes GS, Javier MGF. Hospital Information System Satisfaction in Brazil: Background and Moderating Effects. Int J Res Foundation Hosp Healthc Adm 2014;2(1):1-9.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Poonam Chaudhary, Pankaj Kaul

An Assessment of Diagnostic Equipment Utilization in a Tertiary Healthcare Setup: A Key to Economical Patient Management

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:111-116][No of Hits : 2945]


ABSTRACT

Equipment utilization management is the evaluation of the medical equipment necessity, appropriateness, and efficiency of the use in the healthcare services or procedures. The investment on an equipment is said to be a good one if it shows a utilization coefficient of 50% or above.
The study was descriptive observational in nature and was conducted in the Histopathology Department, PGIMER, Chandigarh. The data for the entire year of 2012 was collected by studying various records of the department including purchase files, inventory registers, log books and service records of medical equipments.
The results indicated that the Utilization Coefficients of various diagnostic equipments in the department of Histopathology, PGIMER, Chandigarh for the year 2012 were in the order of 58.1, 62.1 and 60.4% for high cost, medium cost and low cost equipments respectively.
On an average, the utilization coefficient of medical equipments under study (Year 2012) of the Histopathology Department, PGIMER, Chandigarh, was found to be 60.2% (above 50%). This figure reflects that the budget spent on average medical diagnostic equipment in this department is very much justifiable. The study also showed that the cost incurred on various cost categories of diagnostic equipments, i.e. the low, medium and high cost equipments was also equally important.

Keywords: Low, Medium and high cost diagnostic equipments, Utilization coefficient, Break down, Equipment down time and daily work load.

How to cite this article: Chaudhary P, Kaul P. An Assessment of Diagnostic Equipment Utilization in a Tertiary Healthcare Setup: A Key to Economical Patient Management. Int J Res Foundation Hosp Healthc Adm 2014;2(2):111-116.

Source of support: Nil

Conflict of interest: None declared


 
ORIGINAL ARTICLE
Saroj Kumar Patnaik, Shakti Kumar Gupta, Sunil Kant, R Chandrasekhar, Madhav Madhusudan Singh

Planning and Designing of a Sleep Center

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:117-120][No of Hits : 2892]


ABSTRACT

Sleep disorders have become very common in today’s world. The various sleep related disorders are increasing at an alarming proportion. The first sleep clinics in the United States were established in the 1970s by interested doctors and technicians; sleep centers are specialized centers where an individual is provided home like environment and surroundings and his sleep cycle is monitored. Active therapeutic and diagnostic interventions are also done here. This article discusses various planning and designing issues of sleep center.

Keywords: Sleep disorders, Obstructive sleep apnea, Sleep medicine, Room acoustics.

How to cite this article: Patnaik SK, Gupta SK, Kant S, Chandrasekhar R, Singh MM. Planning and Designing of a Sleep Center. Int J Res Foundation Hosp Healthc Adm 2014; 2(2):117-120.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Shibu John, Komal Dabas, Iffat Naseem

Economic Evaluation of an Eye Hospital in Terms of Net Present Value and Profitability Index

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:36-40][No of Hits : 2836]


ABSTRACT

Introduction: Hospital projects are highly cost intensive and therefore, it takes few years to become a profit oriented entity. The success of these hospital projects can be measured through various economic evaluation methods. Economic evaluation can also be called as an effort to analyze inputs and outputs together and logically help decision makers evaluate whether a certain level of output is worth the amount of resources expended to produce it.

Method of the study: The present study was planned to do the economic evaluation of an Eye hospital, in Haryana state. Two parameters were considered for evaluating the project, i.e. Net Present Value (NPV) and Profitability Index (PI). The data used in the study was from 2010-2011 to 2016-2017. This includes actual and projected data.

Result and conclusion: A positive NPV explain the project is worthwhile and making profits, with current cost and revenue projections. PI for this center is found out to be 3.47 which also emphasize that the project is a value for money proposition.

Keywords: Economic evaluation, Net present value, Profitability index.

How to cite this article: John S, Dabas K, Naseem I. Economic Evaluation of an Eye Hospital in Terms of Net Present Value and Profitability Index. Int J Res Foundation Hosp Healthc Adm 2014;2(1):36-40.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Parmeshwar Kumar, Shakti Kumar Gupta, Arti Kapil, Aarti Vij, IB Singh

A Comparative Study of Hand Hygiene Practices in Operation Theaters in Tertiary Level Hospitals in Delhi, India

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:87-93][No of Hits : 2771]


ABSTRACT

Background: Healthcare associated infections (HCAIs) are directly related to the hand hygiene practices. Differences in implementation of practices may exist among hospitals despite standard guidelines.

Objective: To compare the hand hygiene practices in the operation theaters of tertiary care hospitals in Delhi.

Design and setting: A 6-months descriptive and cross-sectional study conducted in operation theaters of tertiary level, referral public and private sector hospitals in Delhi.

Materials and methods: Six leading multispecialty hospitals, three each from the private and public sectors were selected through purposive sampling. The sample comprised of cases from one major operation theater (OT) from each hospital conducting general surgery cases (10% of all cases).
A performa with 24 parameters was designed using the Center for Disease Control Guidelines for hand hygiene. Hospitals were analysed in categories and also independently.

Results: One thousand nine hundred and twenty observations were analyzed from six hospitals. The level of compliance was higher among the private sector and the autonomous hospital. Statistically significant differences were observed with groups of hand hygiene parameters namely hand washing, selection of hand hygiene agent, skin care, and educational programs and surgical scrub, but not regarding hand hygiene policy or technique. Comparison of five hand hygiene practices strongly recommended by CDC practices revealed significant differences. Adherence to hand washing practices was 76%,surgical scrub practice was 85% and overall compliance of hand hygiene practice was 80.5%.

Conclusion: The study revealed gaps in implementation of hand hygiene practices despite standard guidelines. In future, post interventional studies may reflect the extent of improvement of these practices through reduction in HCAIs.

Keywords: Hand hygiene practices, Operation theater, Surgical scrub.

How to cite this article: Kumar P, Gupta SK, Kapil A, Vij A, Singh IB. A Comparative Study of Hand Hygiene Practices in Operation Theaters in Tertiary Level Hospitals in Delhi, India. Int J Res Foundation Hosp Healthc Adm 2014;2(2):87-93.

Source of support: Nil

Conflict of interest: None declared


 
REVIEW ARTICLE
Madhav Madhusudan Singh, Saroj Kumar Patnaik, Deepak Prabhakaran, Pradeep Srivastva, Pranav K Choudhary

Sexual Harassment: A Growing Concern for Women in Indian Healthcare Industry

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:41-49][No of Hits : 2741]


ABSTRACT

Centuries of development in the field of medicine, has been one among the many indispensable major factors behind India’s sky-high growth and overall prosperity. Medicine has evolved itself from being just a subject of applied sciences at clinical level to become an industry occupied in constantly increasing the life-expectancy of the man kind. The Indian healthcare industry has been making an immense contribution in improving the quality of healthcare and ancillary services to the second largest populous country in the world, which shall continue only if every employee is secured from work-place crimes like sexual harassment. An employee is considered to be a victim of sexual harassment when he or she is mentally or/and physically pressurized against his or her will to get sexually exploited by a co-employee or a superior at his or her work-place. The Indian Penal Code along with several legislations governing the Indian healthcare industry have recognized the seriousness of ‘sexual harassment at work-place’, calling for an immediate attention from both legal and medical fraternity.

Keywords: Worker, Hospital, Patient, Sexual harassment.

How to cite this article: Singh MM, Patnaik SK, Prabhakaran D, Srivastva P, Choudhary PK. Sexual Harassment: A Growing Concern for Women in Indian Healthcare Industry. Int J Res Foundation Hosp Healthc Adm 2014;2(1):41-49.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Neeraj Garg, Shakti Kumar Gupta, R Mahesh

Patient Satisfaction Survey at a Tertiary Care Speciality Hospital

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:79-83][No of Hits : 2711]


ABSTRACT

Introduction: Patient satisfaction is one of the most important parameters of quality. The measurement of patient satisfaction is an important tool for research, administration, and planning. Client satisfaction is a crucial index for determining the quality services and the way in which they are provided by medical staff. The patient satisfaction is of paramount importance in ensuring better quality on the way to total quality management. Patient satisfaction survey are important from the view of improvement of quality of services and to attain the maximum satisfaction of the in-patients.

Aims and objectives: The aim of the study is to assess the level of satisfaction of in-patients at Tertiary care speciality hospital and to find out the causes for dissatisfaction. The objectives set were, to study the level of satisfaction of in-patients in private and General wards at Tertiary care speciality hospital and to find the causes for dissatisfaction, if any and suggest remedial measures.

Methodology: A questionnaire based study where views of inpatient were taken regarding various clinical and support services. The data were collected from different patient care areas over a period of 2 months, and analyzed to determine the biggest dissatisfying factors among the patients.

Observations: More than 88% of the patients have rated the services as Excellent/Good. The areas where the satisfaction level is low is the cleanliness specially in the toilets and the quality of food served to the patients. As far as clinical care is concerned 95% of the patients are satisfied with the level and expertise of professional care but suggested for development of soft skills in doctors and paramedics.

Conclusion: The study suggests that a majority of in-patients are highly satisfied with the services of the Hospital. The study recommends for the need to develop soft skills among Doctor and paramedics and to improve upon the level of cleanliness and quality of dietary services.

Keywords: Patient satisfaction, Soft skills, Cleanliness in toilets, Dietary services.

How to cite this article: Garg N, Gupta SK, Mahesh R. Patient Satisfaction Survey at a Tertiary Care Speciality Hospital. Int J Res Foundation Hosp Healthc Adm 2014;2(2):79-83.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Rajesh Harsvardhan, SK Arya, IB Singh, DK Sharma

A Cost Analysis Study of Inpatient Care Services at a Large Tertiary Care Teaching Institute at New Delhi, India

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:15-18][No of Hits : 2606]


ABSTRACT

A study was carried out at a large tertiary care teaching institute at Delhi to estimate the cost of medicines and surgical consumables to the hospital and the out of cost to in-patients, during the course of their stay at the hospital.
The study was conducted in the year 2007 and a total of 174 cases were included in the study fulfilling the selection criteria. The total length of stay of all the patients under study was 2235 days.
Total average cost incurred on patient care in the indoor unit under study thus calculated came out to be Rs. 1861.31 per bed per day.
The final average figure arrived at for cost to the hospital/ bed/day in this study is Rs. 834.74 and cost to the patient/day came to Rs. 1026.57 on account of the Medicines, Surgical consumables and Crystalloids.
The maximum total cost toward patient care came to Rs. 10958.84 for ICU. Whereas the lowest cost of Rs. 175.46 was for the psychiatry.
This study helped us to know that how much it costs in terms of cost per bed per day to treat in-patients in selected specialties and in a general ICU as well.

Keywords: Costing, Inpatients, Cost per bed per day, Cost to hospital, Cost to patient.

How to cite this article: Harsvardhan R, Arya SK, Singh IB, Sharma DK. A Cost Analysis Study of Inpatient Care Services at a Large Tertiary Care Teaching Institute at New Delhi, India. Int J Res Foundation Hosp Healthc Adm 2014;2(1):15-18.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Jharna Bajpai, Nirmal K Gurbani

Gap Analysis between Patients’ Expectations and Services Provided by Pharmacy Store of a Tertiary Care Hospital

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:73-78][No of Hits : 2482]


ABSTRACT

Pharmacy store of hospital is among one the major revenue generating area of hospital. Its performance can be a vital element in the success of any upcoming hospital. Nowadays, not only the availability of prescribed drugs matters but explanation of dose, frequency and duration of drugs to be taken, behavior of pharmacist and waiting time to get drugs play an important role in satisfaction of patients. The pharmacy store of the hospital provides more specialized and more time-saving services for patients. It also eases the financial burden on pharmacy users via drug discounts. A cross-sectional comparative study was conducted on 90 respondents. A self administered predesigned, pretested, structured questionnaire was given to selected respondents on first contact to the pharmacy store of the hospital with the aim to study the perception of patients and hospital on various parameters. Seventy-one percent respondents appreciated the accessibility to pharmacy. When segregated by sociodemographic characteristics females showed greater level of satisfaction than males, respondents above 50 years of age, respondents who were unmarried, those who had came for a follow-up were most satisfied with services. Eighty-six percent respondents appreciated the politeness in communication by pharmacists. There was some discordance between the perception of patients and the perception of hospital in accessibility to pharmacy. A large number of respondents were satisfied with clarity and brevity of information given by pharmacy staff, the presence of pharmacist, and availability of prescribed drugs.

Keywords: Patient satisfaction, Pharmacy store, Tertiary care hospital, Perception of patients, Perception of hospital management. workers.

How to cite this article:Bajpai J, Gurbani NK. Gap Analysis between Patients’ Expectations and Services Provided by Pharmacy Store of a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2014;2(2):73-78.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Alphonsa B Fernandes, Sweta D’Cunha, Sucharita Suresh

Patient Rights: Awareness and Practice in a Tertiary Care Indian Hospital

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:25-30][No of Hits : 2069]


ABSTRACT

Aim and objectives: To study the awareness and practice of Patient rights and to compare the same between general and private ward hospitalized patients of a selected hospital.

Materials and methods: Descriptive research approach was adopted wherein data was collected from 120 hospitalized patients, i.e. 60 from general and 60 from private ward using a structured questionnaire. It was then analyzed by frequency, percentage and significance test to interpret the awareness and practice of patient rights in the hospital.

Results: The study reveals that awareness of patient rights was high in most of the cases. There was 71% awareness about the right to confidentiality, 67% awareness of the right to grievance redressal, 65% awareness about the right to be informed, 58% awareness of the right of access to healthcare and 55% awareness about the patient’s right to choice of care and decision making. But low (39%) awareness was noted in case of patient’s right to informed consent.
With regards to practice of patient rights, it was seen that certain rights were well-practiced like 95% practice of the right of access to healthcare, 89% practice of the right to confidentiality and 64% practice of the right to choice of care and decision making. But relatively lower percentage of practice was observed for right to be informed (49%), right to informed consent (44%) and the right to grievance redressal (21%). There was significant difference in the level of awareness and practice of patient rights among private and general ward patients in most of the rights.

Conclusion: The study was vital in finding that most respondents were aware of patient rights. So also, most of the patient rights were practiced in the hospital in varying degrees, while a few needed immediate rectification and management action.

Keywords: Patient rights, Awareness, Practice, Informed consent, Confidentiality.

How to cite this article: Fernandes AB, D’Cunha S, Suresh S. Patient Rights: Awareness and Practice in a Tertiary Care Indian Hospital. Int J Res Foundation Hosp Healthc Adm 2014;2(1):25-30.

Source of support: Nil

Conflict of interest: None


 
CASE STUDY
Jitender Mehta, Sanjay Arya, Sunil Kant, Shakti Kumar Gupta

A Study of Hospital Infection Control Program against Normative Weighted Criteria at a Large Public Hospital

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:130-132][No of Hits : 1878]


ABSTRACT

Hospital infection control programs are important for prevention and control of hospital acquired infection in a healthcare facility. An evaluatory study was done to measure the quality dimensions of hospital infection control program in a public hospital to compare the program implementation in different speciality centers against the normative weighted criteria developed by Gupta and Kant (2002). Result showed variations in infection control program activities in various speciality centers. A centralized administration of infection control program and emphasis on more training and education is recommended.

Keywords: Hospital infection control program, Normative weighted criteria, Healthcare associated (nosocomial) infections.

How to cite this article: Mehta J, Arya S, Kant S, Gupta SK. A Study of Hospital Infection Control Program against Normative Weighted Criteria at a Large Public Hospital. Int J Res Foundation Hosp Healthc Adm 2014;2(2):130-132.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Shweta Prabhakar, AK Singhal, Shikha Vardhan

Technical Specification and Bid Evaluation: Major Bottlenecks in Equipment Procurement in a Public Sector Tertiary Care Hospital

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:103-110][No of Hits : 1805]


ABSTRACT

Introduction: The innovation of modern medical equipment with wide diversity has contributed immensely in improving the quality of healthcare and state of health profile of nations. For effective and efficient control on procurement of medical equipment, it is required to control the lead time (internal) as limited scope exists in case of external lead time.

Objectives: The study was conducted to analyze the lead time with an aim to identify the issues/bottlenecks and to suggest the appropriate remedial measures in a public sector Tertiary care Hospital.

Materials and methods: A retrospective exploratory study was undertaken. A total of 50 such capital equipment was procured in this hospital during March 2007 to 2010 (3 years) were included in this study.

Results: It was observed that the procurement procedure in public sector tertiary care hospital is as per the standard guidelines prescribed by Government of India in General Financial Rules and guidelines issued by MOHFW and DGHS in this regard. The lead time analysis showed that there is a variation in the total lead time, internal lead time (ILT), external lead time (ELT) and their components. It was observed that ILT2 and ILT4 component constituted around 70% of the total ILT for almost all the equipments under study. In case of ELT, 75% time was consumed by ELT1, i.e. the delivery time and receipt of equipment.

Conclusion: Since activities in both ILT2 and ILT4, i.e. laying down the technical specification and bid evaluation are the responsibility of the individual department, the overall delay can also be attributed to the individual departments. This is in contrast to the general impression that there is delay on the part of purchase department. On an analysis of lead time as per VED category, it has been concluded that no concept of VED analysis is applied in the procurement of equipment. On further analysis of lead time analysis, it was concluded that the shortest time was taken by proprietary purchase followed by open tender and maximum time in open tender where approval from higher authority was required.

Keywords: Capital equipment, Procurement, Internal lead time, External lead time, VED, Public sector tertiary care hospital.

How to cite this article: Prabhakar S, Singhal AK, Vardhan S. Technical Specification and Bid Evaluation: Major Bottlenecks in Equipment Procurement in a Public Sector Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2014;2(2): 103-110.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Amrita Patel, Kasturi Shukla, Uday Uttekar, Mahesh Mane, Rekha Dubey, Hem Chandra

Need for Asset Management Systems to Improve Efficiency of Biomedical Engineering Department in Hospital

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:84-86][No of Hits : 1461]


ABSTRACT

Introduction: With advanced medical equipments being developed everyday, hospitals have assets that need expert maintenance in order to ensure their proper functioning. This study was undertaken to understand the problems related to asset management faced by the biomedical engineering department (BMED) at a 390 bedded tertiary hospital in Pune, Maharashtra.

Materials and methods: The cross-sectional study was conducted at a 390 bedded tertiary care hospital in Pune, India during May 2013. The BMED staff was interviewed to identify the problems faced by them in the current manual system of equipment record maintenance and the need for a computerized BMED record system. Data from January to April 2013 were analyzed to measure total number of entries/month, time required/entry and related errors.

Results: An average of 16 hours per month were spent on manual data entry of equipment maintenance and errors due to manual system led to problems like inaccurate reports to calculate breakdown time of equipments.

Conclusion: Computerized system software is the need of the hour for managing biomedical equipments. This will save many man-hours and also make the system more efficient.

Keywords: Asset, Biomedical equipment, Manual errors.

How to cite this article: Patel A, Shukla K, Uttekar U, Mane M, Dubey R, Chandra H. Need for Asset Management Systems to Improve Efficiency of Biomedical Engineering Department in Hospital. Int J Res Foundation Hosp Healthc Adm 2014;2(2): 84-86.

Source of support: Nil

Conflict of interest: None declared


 
Guest Editorial
Lt. Gen. Surendra Singh Panwar

Leadership in Healthcare

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:vii-ix][No of Hits : 1168]


ABSTRACT

Leadership in Healthcare

Good leadership is important for the success of any organization. Harold Knootz, Cyril O’Donnell and Heinz Weihrich have called the leadership is the ‘art or process of influencing people so that they will survive willingly toward the achievement of group goal’. Actually, it is the process by which people are directed, guided and influenced to achieve stated objectives by successfully implementing a plan of action. In a healthcare organization, good leadership is more than just important-it is absolutely critical to the organization’s success. For a healthcare organization, the primary goal is to provide high-quality safe care to those who seek its help, whether they are patients, residents, clients or recipients of care. So, how does leadership influence organizational delivery? Leadership has been described as the behavior of an individual when directing the activities of a group toward a shared goal. Thus, it is important that the leader is extremely clear of the end objectives and the path to be taken to achieve the same. The competency level of healthcare leader should be very high as that will help him to handle complex issues and lead from front.


 
Editorial
Narottam Puri

Quality and Accreditation

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:v-vii][No of Hits : 1024]


ABSTRACT

Quality and Accreditation

India is known for the size of its population - a large country with a huge population. Till lately, India’s identification was for quantity not quality. But, the quality movement in India has begun.


 
CASE STUDY
Shakti Kumar Gupta, Jitendar Sharma, Vikas Varma, BS Anand

Designing and Application of a Renewable Energy Model for a Tertiary Care Research Hospital

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:57-61][No of Hits : 998]


ABSTRACT

Renewable energy can be harnessed from Solar and Wind energy to augment and substitute for the conventional energy for Healthcare institutes. This is economical and plentily available. This case study aims to design a Renewable energy model. Here various structural data and available expenditure has been utilized from a tertiary care hospital.

Keywords: Solar energy, Renewable energy, Wind energy, Sun hours.

How to cite this article: Gupta SK, Sharma J, Varma V, Anand BS. Designing and Application of a Renewable Energy Model for a Tertiary Care Research Hospital. Int J Res Foundation Hosp Healthc Adm 2014;2(1):57-61.

Source of support: Nil

Conflict of interest: None


 
Editorial
Editors

Lessons from Obama Care

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:v-vi][No of Hits : 938]


ABSTRACT

Lessons from Obama Care

The United States of America (USA) has tried to revolutionize healthcare delivery to its citizens by ushering in Obama care (The Patient Protection and Affordable Care Act). It is important to analyze and understand why a seemingly populist scheme with all noble intentions is facing so much of hurdle in implementation. The understanding of the nuances will provide insight to the planners of healthcare policy to deliberate extensively before deciding on any similar policy.


 
ORIGINAL ARTICLE
S Singh, Shakti Kumar Gupta, S Arya, V Aggarwal

To Formulate a Selective Patient Safety-related Policy for a Tertiary Care Hospital

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:94-102][No of Hits : 920]


ABSTRACT

Patient safety is the absence of preventable harm to a patient during the process of healthcare (WHO). Accuracy of patient identification remains a priority focus of healthcare organization. Identifying patients accurately presents many unique challenges in today’s healthcare settings. We need to understand how human factors can be used to reduce adverse events. Using a human factor approach, the human system interface can be improved by providing better designed system and processes. This involves simplifying processes, standardizing procedures, providing back up when human fails, improving communication, redesigning equipment and engendering a consciousness of behavioral organization and technological limitation that lead to error. The above study was an initiative toward simplifying processes and standardizing procedures. It was a descriptive cross-sectional study carried out between April to August 2013. The tool used was a check list made after an exhaustive review of literature and validated by experts in quality assurance from NABH accredited private hospitals. The study population of 100 people which included doctors, nurses, paramedical staff and quality managers of tertiary care public and private hospitals were approached for interaction against the back drop of the check list. Response rate was 61%. Policy was framed after incorporating inputs from responses received against the back drop of the check list.

Keywords: Patient identification policy, Patient safety.

How to cite this article: Singh S, Gupta SK, Arya S, Aggarwal V. To Formulate a Selective Patient Safety-related Policy for a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2014;2(2):94-102.

Source of support: Nil

Conflict of interest: None


 
JRFHHA

The Research Foundation of Hospital and Healthcare Administration

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:][No of Hits : 881]


ABSTRACT

INTRODUCTION

The Research Foundation of Hospital and Healthcare Administration has been founded with the aim to function as a scientific body encouraging and assisting research as well as all such activities that are likely to benefit art and science of Hospital Administration and Management in Indian subcontinent.


 
Upcoming Event
Narottam Puri

‘RFHHA MDP on ‘Best Practices in Hospital Logistics, Inventory and Stores Management’

[Year:2014] [Month:July-December] [Volumn:2 ] [Number:2] [Pages:70] [Pages No:][No of Hits : 826]


ABSTRACT

‘RFHHA MDP on ‘Best Practices in Hospital Logistics, Inventory and Stores Management’

Date: 21st and 22nd February, 2015
Place: Army College of Medical Sciences, Base Hospital, Delhi Cantt, Ring Road, New Delhi, India
The program offers an opportunity to sensitize leaders, administrators, managers, decision makers and students of hospital management about the latest trends in purchase and stores management, and offers interesting insights into the intricacies of procurement and the interpretation of guidelines through a case based, problem-solving approach, supplemented with dedicated sessions for discussion.


 
Upcoming Events

2nd Middle East Forum on Quality and Safety in Healthcare 2014

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:][No of Hits : 647]


ABSTRACT

2nd Middle East Forum on Quality and Safety in Healthcare 2014

Date: 25 Apr 2014 to 27 Apr 2014
Place: Doha, Qatar

This event will help to focus on how you can be empowered on the science of improvement and how to implement the safest and best healthcare practices to benefit patients. Participants will learn about the latest developments in Quality and Patient safety.


 
Book Review
Neeraj Garg

The Successful Leadership Development Program: How to Build It and How to Keep It Going

[Year:2014] [Month:January-June] [Volumn:2 ] [Number:1] [Pages:61] [Pages No:][No of Hits : 504]


ABSTRACT

INTRODUCTION

There are many books on the market claiming to have the answers for developing the leadership potential in the reader. Some of these books do a better job than others, but still, reading a book is not all that it takes to develop the particular skills necessary for a specific job or profession. Jo-Ann Byrne and Richard Rees have created a process that will help companies and organizations develop a leadership development program rooted in their mission, vision and strategic goals. This program will be built upon the individual needs of employees and will be endorsed by senior-level management. This algorithm that Byrne and Rees have developed is the center of their book, The Successful Leadership Development Program. The book outlines the steps one should take in implementing a leadership development program in the workplace. This process is lengthy, but if done correctly can help implement a program that will be sustainable. Byrne and Rees have written a book that is easy to read and is well organized, so that the algorithm is easy to follow and steps are clear.


 
LEGAL AND ETHICAL ISSUES
Madhav Madhusudan Singh, Uma Shankar Garg, Pankaj Arora

Laws Applicable to Medical Practice and Hospitals in India

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:19-24][No of Hits : 79299]


ABSTRACT

Healthcare in India features a universal healthcare care system run by the constituent states and territories. Law is an obligation on the part of society imposed by the competent authority, and noncompliance may lead to punishment in the form of monetary fine or imprisonment or both. The earliest known code of laws called the code of Hammurabi governed the various aspects of health practices including the fees payable to physician for satisfactory services. The first ever code of medical ethics called the Hippocratic oath was laid down 2500 years ago, in the 5th century BC, by Hippocrates-the Greek physician. The modern version of Hippocratic Oath (called the declaration of Geneva), devised by the WHO after the second world war and is accepted by international medical fraternity. The process of establishment of healthcare system during the colonial rule also necessitated creation of legislative framework for practitioners of medicine. As the number of doctors qualified in Indian medical colleges increased, creation of laws for them became necessary. The medical council of India, a national level statutory body for the doctors of modern medicine, was constituted after the enactment of Indian Medical Council Act 1933. The first legal recognition and registration for the Indian systems of medicine came when the Bombay Medical Practitioner' Act was passed in 1938.
Laws governing the commissioning of hospital are the laws to ensure that the hospital facilities are created after due process of registration, the facilities created are safe for the public using them, have at least the minimum essential infrastructure for the type and volume of workload anticipated and are subject to periodic inspections to ensure compliance. There are other laws pertaining to governing to the qualification/practice and conduct of professionals, sale, storage of drugs and safe medication, management of patients, environmental safety, employment and management of manpower, medicolegal aspects and laws pertaining to safety of patients, public and staff within the hospital premises. There are laws governing professional training and research, business aspects, licences/certifications required for hospitals, etc. A hospital administrator should be aware about all these laws, regulations, policies, procedures, reports and returns and keep abreast with the latest amendments to be on the safe side of law and provide quality care to the patients.

Keywords: Healthcare, Law, Act, Code, Health practices, Medical ethics, Hippocratic, Declaration of Geneva, Medical council of India, Statutory body, Indian systems of medicine, Commissioning of hospital, Conduct of professionals, Environmental safety, Employment and management of manpower, Medicolegal aspects, Patient safety, Professional training, Research.

How to cite this article: Singh MM, Garg US, Arora P. Laws Applicable to Medical Practice and Hospitals in India. Int J Res Foundation Hosp Healthc Adm 2013;1(1):19-24.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Pranav Kumar Choudhary, Saroj Kumar Patnaik, Madhav Madhusudan Singh, Ginny Kaushal

Break-Even Analysis in Healthcare Setup

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:29-32][No of Hits : 33754]


ABSTRACT

Keywords: Break-even analysis, Cost-volume profit analysis, Multiproduct/service organization, Total fixed expenses, Weighted average selling price, Weighted average variable expenses, Total revenues, Total costs.

How to cite this article: Choudhary PK, Patnaik SK, Singh MM, Kaushal G. Break-Even Analysis in Healthcare Setup. Int J Res Foundation Hosp Healthc Adm 2013;1(1):29-32.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Shibu John, Rasika Sharma, Manoj Kumar Dhingra

Role of Employee Satisfaction in Influencing Patient Satisfaction

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:13-18][No of Hits : 5398]


ABSTRACT

The proposed study is an attempt to understand the link between Outpatient Department (OPD) patient satisfaction and job satisfaction among front office executives of the OPD. The study was conducted in a 300 bedded multispecialty hospital in Delhi. The study is very important as the OPD is considered to be the mirror of any hospital, which reflects the functioning of the hospital being the first point of contact between the patient and the hospital staff. A structured questionnaire was used in conducting the study. Total 158 patients were interviewed during 2 months period. Stratified random sampling technique used in selecting the samples. Both type of patients, first timers and old patient participated in the study. As second part of the study, all 22 front office executives from the above-mentioned three concerned departments were participated. The age group of the employees ranged from 20 to 50 years.

Keywords: OPD, Front office, Patient satisfaction, Employee satisfaction, Third party administrator.

How to cite this article: John S, Sharma R, Dhingra MK. Role of Employee Satisfaction in Influencing Patient Satisfaction. Int J Res Foundation Hosp Healthc Adm 2013;1(1):13-18.

Source of support: Nil

Conflict of interest: None


 
MCQs

MCQs in Management and Healthcare Administration

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:][No of Hits : 4935]



 
RESEARCH ARTICLE
Rakesh Verma, Shakti Kumar Gupta, Sidhartha Satpathy, Sunil Kant, Sunil Chumber, RC Deka

Determination of the Cost of Training of Undergraduate Medical (MBBS) Student at All India Institute of Medical Sciences, New Delhi, India

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:1-7][No of Hits : 3229]


ABSTRACT

Keywords: Costing, Undergraduate study, AIIMS, Computation of academics.

How to cite this article: Verma R, Gupta SK, Satpathy S, Kant S, Chumber S, Deka RC. Determination of the Cost of Training of Undergraduate Medical (MBBS) Student at All India Institute of Medical Sciences, New Delhi, India. Int J Res Foundation Hosp Healthc Adm 2013;1(1):1-7.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Pankaj Arora

Quality Assurance Program in Radiodiagnosis in a Tertiary Care Hospital in India

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:8-12][No of Hits : 2864]


ABSTRACT

Context: The specialty of radiodiagnosis has been revolutionized by the advent of technology. This has put additional onus on the practitioners to maintain strict quality control to improve efficiency, lower exposure as well as cost.

Aims: The aim of the study is to determine quality assurance program in radiodiagnosis in order to identify the gaps and possible avenues of improvement.

Settings and design: The cross-sectional study was conducted in a tertiary care hospital in India in the second half of calendar year 2008.

Materials and methods: The department did not have a defined and documented quality assurance program. Hence, the factors which are part of such a QAP were identified and the practices in the department against those factors were compared. The scoring was done based on the degree of compliance; complete, partial or no compliance.

Results: A total of 23 parameters/subparameters were evaluated to find out the extent of quality assurance program being implemented in the study setting. Out of maximum 230, a score of 135 was achieved by the department.

Conclusion: The department of radiodiagnosis in the tertiary care institute need to institute a QAP for improving the quality and efficiency for better utilization of resources.

Keywords: Radiodiagnosis, Quality, Quality assurance program.

Key messages: Quality Assurance Program must be instituted in different departments, Radio diagnosis in the instant case, for efficient utilization, quality output and effective cost control. All these will contribute to patient safety practices.

How to cite this article: Arora P. Quality Assurance Program in Radiodiagnosis in a Tertiary Care Hospital in India. Int J Res Foundation Hosp Healthc Adm 2013;1(1):8-12.

Source of support: Nil

Conflict of interest: None


 
QUALITY AND PATIENT SAFETY
Jatin Kumar, Akash Sud

Use of Checklist Prevents Errors during Surgeries

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:25-28][No of Hits : 1809]


ABSTRACT

‘Hospitals do most of the right things, on most patients,
most of the time.
The checklist helps them to do all the right things, on all
patients, all the time.’

According to International Patient Safety Goal-4 (IPSG-4), the hospitals need to ensure the correct patient, correct site, correct procedure and correct surgery. WHO launched Safe Surgery Saves Lives program in 2009 to reduce the number of surgical deaths across the globe. In the complex setting of an operating room, any of the steps may be overlooked during the fast-paced preoperative, intraoperative, or postoperative preparations. So a customized checklist was introduced after sensitization and training of all OT users to reinforce accepted safety practices and foster better communication and team work between clinical disciplines. The aim of the checklist is to reduce the number of errors during surgery and to reduce postoperative complications. The use of the checklist reduced the rate of deaths and complications by more than one-third. The rate of major inpatient complications dropped from 11 to 7%, and the inpatient death rate following major operations fell from 1.5 to 0.8% after implementation of the checklist. Audit tool printed at the backside of the checklist is analyzed every month, to observe the shortcomings.

Keywords: Surgery, Patient safety, Safe surgery checklist, IPSG 4.

How to cite this article: Kumar J, Sud A. Use of Checklist Prevents Errors during Surgeries. Int J Res Foundation Hosp Healthc Adm 2013;1(1):25-28.

Source of support: Nil

Conflict of interest: None


 
Editorial
Shakti Kumar Gupta, Sunil Kant

From the desk of Editors-in-Chief

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:iv][No of Hits : 1644]


ABSTRACT

Healthcare sector in India is undergoing a paradigm shift in terms of technology dominance, changing disease pattern, changing urban rural health scenario and growing wrath of lifestyle diseases. The changing geopolitical scenario and the upsurge of chronic ailments is redefining the delivery of healthcare in the world. There are also issues of medical errors and adverse events. It has been estimated that there are 5.2 million injuries each year due to medical errors and adverse events. The local health sector is metamorphosing, keeping in sync with the global needs and clientele demand. Thus, the health sector is more glocal than ever. New trends and developments in health sector have to be customised to the local health needs of the populace. There are no set models to be replicated in health sector which adds up to the challenge of being constantly innovative and vibrant.


 
Recent Updates

Recent Updates (News in Healthcare Sector)

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:][No of Hits : 1186]


ABSTRACT

Philips released Two New DICOM Compliant Clinical Review Displays at InfoComm 2013 in June

Designed for everyday clinical environments, the 24- and 27-inch LCD monitors offer anti-microbial housing to inhibit bacterial growth, a medical grade power supply to ensure safety and low emission, and D-image preset for consistent DICOM grayscale medical images. Designed to complement clinical environments, the Philips 24-inch and 27-inch clinical review displays help ensure that medical images are shown consistently with high quality to achieve reliable interpretations. The rendering of medical grayscale images on standard monitors is mostly inconsistent at best, making them unsuitable for usage in a clinical environment. Philips clinical review displays with clinical D-image preset are factory calibrated to give DICOM part 14 compatible grayscale standard display performance. By using high quality LCD panels with LED technology, Philips aims to offer consistent and reliable performance at an affordable price point. Priced at $899 and $1,099, the Philips Brilliance LCD Monitors with Clinical D-image will be available soon to enterprise buyers through CDW and other resellers.


 
Book Review
Peter M Ginter, WJ Dunkun, Linda E Swayne

THE STRATEGIC MANAGEMENT OF HEALTH CARE ORGANIZATIONS

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:][No of Hits : 890]


ABSTRACT

THE STRATEGIC MANAGEMENT OF HEALTH CARE ORGANIZATIONS

The book ‘The Strategic Management of Health Care Organizations’ aims to provide a structured strategic management approach is what's needed to tackle the revolutionary change the healthcare system has been experiencing. Today, health-care organizations have almost universally embraced the strategic perspective first developed in the business sector and now have developed strategic management processes that are uniquely their own. Healthcare leaders have found that strategic thinking, planning and managing strategic momentum are essential for coping with the dynamics of the healthcare industry. Strategic management has become the single clearest manifestation of effective leadership of healthcare organizations. It is a multiauthored and multidisciplinary integrated book on the subject.


 
Guest Editorial
Rubin Pillay

Creativity, Innovation and Entrepreneurship...A New Prescription for Healthcare

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:v-vi][No of Hits : 747]


ABSTRACT

Creativity, Innovation and Entrepreneurship...A New Prescription for Healthcare

We are living through what is arguably the most challenging time for the healthcare industry. Globally, healthcare appears to be on a collision course with patient needs and economic reality. No one is happy with the current system and the combination of rising costs, poor access, inequitable care and diminishing quality and safety has created anxiety and frustration for all. Decades of interventions have failed to improve the situation; if anything, things have become worse. Current approaches tend to focus on a single issue or problem-the price of drugs, rising numbers without medical aids, provider incentives to overtreat but an overarching solution has remained elusive.


 
Forthcoming Events

Creating Excellence in the Healthcare Sector

[Year:2013] [Month:July-December] [Volumn:1 ] [Number:1] [Pages:32] [Pages No:][No of Hits : 725]


ABSTRACT

Creating Excellence in the Healthcare Sector

4th edition of Hospital Management Conference on 18th, 19th and 20th July 2014 . Alongside the exhibition is the HBI Middle East Congress, consisting of four conferences. The Healthcare Management, Leaders in Healthcare, Architects’ Congress and Hospitals of the Future are the conferences planned for next year. To enquire about a conference or suggest any new topics for the future.


 
ORIGINAL ARTICLE
Alexander Thomas, Subramanyam Raghunath, Bhupendra K Rana, Somil Nagpal

An Exploratory Study on the Benefits of Quality Accreditation: Financial Impact and Chief Executive Officer Perspectives

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:39] [Pages No:60-67][No of Hits : 463]


ABSTRACT

Little systematic evidence exists in published literature about the net financial impact of the process of quality accreditation on hospitals that have undergone the process. This exploratory study aims to explore the financial impact of undergoing National Accreditation Board for Hospitals & Health Care Providers (NABH) accreditation in Indian hospitals, based on chief executive officers (CEOs’) perspectives and the financial outcomes perceived by them. The attempt has been to provide a qualitative assessment of the costs and benefits of NABH accreditation on the financial health of the organization. As there were no leading studies to reference that could emulate the data available in the Indian context, the study team developed a set of financial indicators that could be collected from NABH-accredited hospitals. A total of 14 hospitals in Delhi, Ahmedabad, Mumbai, Bengaluru, Mysuru, Surat, and Chennai were included in the study. The CEOs of participating hospitals perceived that the NABH accreditation has been beneficial to their organization and that the overall quality of care for patients within their organizations has improved. In addition, they also confirmed improved awareness of statutory compliances, and of staff responses to emergencies, such as fire and cardiopulmonary resuscitation, and that data and evidencebased decision-making have helped in managing the facility better. The study suggests that the delivery of health care was positively influenced by NABH accreditation. The exploratory study also highlights the factors that may contribute to positive financial outcomes for hospitals. Specifically in terms of financial outcomes, the study has found that the income per used bed shows an increasing trend after the accreditation period. This may suggest medium- to long-term financial benefits to hospitals undergoing NABH accreditation.

Keywords: Chief executive officer perspective, Economic impact, Financial impact, Financial outcomes, Health care in India, National Accreditation Board for Hospitals & Health Care Providers accreditation.

How to cite this article: Thomas A, Raghunath S, Rana BK, Nagpal S. An Exploratory Study on the Benefits of Quality Accreditation: Financial Impact and Chief Executive Officer Perspectives. Int J Res Foundation Hosp Healthc Adm 2017;5(2):60-67.

Source of support: This study was funded by World Bank.

Conflict of interest: None


 
ORIGINAL ARTICLE
Md Mofazzal Hossain, Papia Sultana, M Shahjahan

Cross-sectional Study on Utilization of Radiology and Imaging Equipment in the District Hospitals of Bangladesh

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:53] [Pages No:21-28][No of Hits : 370]


ABSTRACT

A quality diagnosis mostly depends on the availability and proper utilization of radiology and imaging equipments in the modern medical technology. Every year, huge amount of revenue is spent to purchase costly and sophisticated radiology and imaging equipments for the district hospitals of Bangladesh. But radiology and imaging equipments are underutilized in most of the developing Asian and African countries, including Bangladesh. This descriptive cross-sectional study was conducted to find the functional status, workload, utilization, and factors affecting the utilization of radiology and imaging equipments in the district hospitals of Bangladesh. Interviewer-administered questionnaire was used to take interview of relevant human resources. Work time study method was applied where multiple checklists were used to measure consumed time for each procedure and daily actual work time of radiology and imaging equipments. In this study, 46.9% radiology and imaging equipments were found functional, 40.6% radiology and imaging equipments nonfunctional, and 12.5% radiology and imaging equipments functional but not in use. This study revealed that 53% of total radiology and imaging equipments of district hospitals were nonfunctional, and functional but not in use, where 8 equipments became nonfunctional before 10 years due to unavailability of spare parts and inadequate maintenance fund. Work time in radiography identified 83.51% and in ultrasonography (USG) 71.08% among the respondents of radiology and imaging department in the district hospitals. Utilization rate of general radiography equipments was found to be 67.01%, portable radiography equipments 16.5%, and USG equipments 71.08%. Average utilization rate of radiology and imaging equipments was found to be 51.53% in the district hospitals of Bangladesh. Utilization rate of radiology and imaging equipments more than 50% is considered as standard utilization. Current status of utilization rate needs to accelerate to get maximum turnover of the equipments among the district hospitals of Bangladesh. Important factors affecting the utilization of radiology and imaging equipments were observed - shortage of manpower, inadequate physical infrastructure, and less incorporation of advanced technology with existing facility.

Keywords: District hospital, Functional status, Radiology and imaging equipments, Utilization, Workload.

How to cite this article: Hossain MM, Sultana P, Shahjahan M. Cross-sectional Study on Utilization of Radiology and Imaging Equipment in the District Hospitals of Bangladesh. Int J Res Foundation Hosp Healthc Adm 2017;5(1):21-28.

Source of support: Nil

Conflict of interest: None


 
Editorial
Shakti Kumar Gupta, Sunil Kant

Legal and Ethical Challenges in Healthcare Ecosystem

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:53] [Pages No:iv][No of Hits : 316]


ABSTRACT

In recent times the print and social media is galore with adverse news regarding health sector such as doctor-pharma nexus, violence against doctors, medical negligence, cost of drugs/stents, kidney marriages, surrogacy and so on. Prime issues such as doctor-patient ratio, availability of health infrastructure, funding of healthcare system, etc. are generally not addressed. Healthcare industry is growing rapidly, however, some core ingredients such as care, compassion, empathy, trustworthiness and ethical considerations are losing their position of priority.


 
ORIGINAL ARTICLE
Serkan Deniz, Mesut Cimen, Seyit Kaya

Determining Organizational Learning Capability: A Study in Private Health Care Organizations

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:53] [Pages No:1-7][No of Hits : 302]


ABSTRACT

Introduction: Due to the fast-changing and developing business environment, knowledge has become a very important resource for organizations. However, reaching and obtaining knowledge is difficult, the level of organizational learning capability (OLC) perception within the organization is a key for this. This is also true for health organizations. If health care organizations can increase their OLC levels, they might achieve an increase in organizational performance, patient satisfaction, competitive advantage, and employee satisfaction.

Objective: In this study, it is aimed to determine the level of OLC perception of employees working in private health care organizations. It is also aimed to examine whether this perception level shows variance according to demographic differences.

Materials and methods: Research was done between January 2017 and March 2017 in private health care organizations operating in Turkey. The population of the study includes both administrative staff and health staff working in these organizations. Survey method was used to collect data, and 111 valid questionnaires were collected at the end of data collection period.

Results and conclusion: According to the findings, employees perceive their organizations’ OLC level positively both for general OLC and for OLC subdimensions. However, it is also concluded that this perception level could be increased as well. In order to achieve this, health care organizations are required to encourage their employees toward learning, investigating, communication, risk taking, and participation.

Keywords: Health care organizations, Organizational learning, Organizational learning capability.

How to cite this article: Deniz S, Cimen M, Kaya S. Determining Organizational Learning Capability: A Study in Private Health Care Organizations. Int J Res Foundation Hosp Healthc Adm 2017;5(1):1-7.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Sanjeev Davey, Pradeep K Kapoor, Meenu Bala, Jai V Singh, Santosh K Raghav, Nirankar Singh

Community-oriented Primary Care Services Model: Can it improve Morbidity Status in India? An Impact Evaluation Study

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:53] [Pages No:8-14][No of Hits : 302]


ABSTRACT

Introduction: The community-oriented primary care (COPC) services model is an approach prescribed by the Medical Council of India for existing medical colleges in India from their respective urban and rural health training centers (RHTCs). However, the evidence of whether it is better as compared with pure primary health care approach in the Indian context is lacking in the literature. Therefore, it becomes imperative to study this area for its further expansion.

Materials and methods: The study was done in the catchment area of RHTC and neighboring primary health center (PHC; Makhiyali) attached to the medical college in the district of Western Uttar Pradesh in India. Three surveyed villages out of six villages from July 1, 2016, to December 31, 2016, were taken in this study. Finally, the COPC vs primary health care approach comparison was done on four outcome parameters.

Results: The utilization of COPC services from RHTC area as compared with primary health care services from PHC area was significantly better for all diseases combined (p < 0.005) and also in the category of management of upper respiratory tract infections (p < 0.0001) and nutritional deficiencies (p < 0.05). On further applying COPC services model, it was also found that RHTC services were significantly better as compared with PHC services in terms of socioeconomic impact on health from services (p < 0.0000), identification of health needs from services (p < 0.0000), and participation in health care services (p < 0.05).

Conclusion: The COPC services model appears to be successful in the delivery of health care services from RHTC of a medical college as compared with pure primary health care approach delivered from a PHC. However, authors suggest more in-depth multicentric studies on this issue before generalization of COPD model usage across the world.

Keywords: Community-oriented primary care, Primary health care, Primary health center, Rural area, Rural health training center.

How to cite this article: Davey S, Kapoor PK, Bala M, Singh JV, Raghav SK, Singh N. Community-oriented Primary Care Services Model: Can it improve Morbidity Status in India? An Impact Evaluation Study. Int J Res Foundation Hosp Healthc Adm 2017;5(1):8-14.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Ankit Singh

Home Health Care: The Missing Link in Health Delivery System for Indian Elderly Population—A Narrative Review

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:39] [Pages No:89-94][No of Hits : 283]


ABSTRACT

Elderly population in India is at a disadvantageous position in comparison to other countries in matters of dedicated health facilities, health insurance, and geriatric specialist. Health issues of the elderly can be summarized as geriatric syndromes, cognitive decline, immobility, falls, and incontinence. These peculiar health characteristics of old age population can be better dealt with home health care, which is of recent origin in India and is limited to only metro cities in the private sector. Whereas home health care in the USA is present from over a century, in Europe it is present in most of the countries. This study presents the status of existing private home health care industry of India and advocates about the benefits of home health care for the elderly and supports that Indian policymaking bodies should incorporate home health care in its policy for improving access and quality of health care to elderly population.

Keywords: Aging, Home health care, Old age dependency ratio, Silver tsunami.

How to cite this article: Singh A. Home Health Care: The Missing Link in Health Delivery System for Indian Elderly Population—A Narrative Review. Int J Res Foundation Hosp Healthc Adm 2017;5(2):89-94.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Madhav M Singh, Saroj Patnaik, Bhandaru Sridhar

Medical Audit of Documentation of Inpatient Medical Record in a Multispecialty Hospital in India

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:39] [Pages No:77-83][No of Hits : 273]


ABSTRACT

Introduction: A medical record enables healthcare professionals to plan and evaluate a patient’s treatment and ensures continuity of care among multiple providers. A study was conducted to do medical audit of documentation of inpatient medical record in a multispecialty hospital to assess whether the existing documentation procedure is as per laid-down policy.

Study design: Retrospective, descriptive study.

Study area: A 545 bed multispecialty hospital in medical ward, gynecology and obstetrics ward, surgical ward, ear, nose, and throat (ENT) ward, eye ward, pediatric ward, skin ward, and psychiatry ward.

Sample size: Systematic random sample of all inpatient medical records of select ward of last 12 months was done. Sample size was 320 case sheets, 40 from each department. The data collected were primary and the source was the discharge case files of the last 12 months available in the medical record section. The approach used for data collection was quantitative. The techniques applied were survey and observation. A structured checklist (audit tool) with 26 checklist points was developed keeping few of the quality indicators as the benchmark.

Findings: Gynecology and pediatric department records were not found appropriate. Psychiatry and dermatology dept record keeping was found appropriate as per laid-down policy. Planned care was not planned as per standard protocol in surgery department.

Recommendation: Sensitizing the clinical staff regarding the importance of proper documentation of the forms and hospital-wide standardization of the medical record keeping including admission and discharge summary. Rewarding the best performing department/unit and educating and training the responsible staff to make a complete record of every patient should be emphasized in the hospital. There should be monthly audit of the documentation procedure.

Conclusion: Medical records are technically valid health records that must provide an overall correct description of each patient’s details of care or contact with hospital personnel. Medical records form a very important and critical document in hospital. These records are vital for legal purposes and for future planning of the hospital medical care.

Keywords: Checklist, Documentation, Inpatient medical record, Medical audit.

How to cite this article: Singh MM, Patnaik S, Sridhar B. Medical Audit of Documentation of Inpatient Medical Record in a Multispecialty Hospital in India. Int J Res Foundation Hosp Healthc Adm 2017;5(2):77-83.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Libert A Gomes

Role of Standard Radiation Safety Practices in Public Health: An Experience of a Tertiary Care Teaching Hospital

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:39] [Pages No:73-76][No of Hits : 250]


ABSTRACT

Ionizing radiation is employed for diagnostic and therapeutic purposes round the clock in hospitals. Hence, it is the prime responsibility of the hospital management to ensure the safety of the patients, staff, visitors, public, and the environment. Patient relatives and the public/visitors who are not concerned with medical use of radiation can become vulnerable to stochastic effects of scattered radiation close to therapeutic or diagnostic radiological facilities. This article highlights radiation safety measures that have public health relevance in hospitals having both diagnostic and therapeutic radiological facilities.

Keywords: As low as reasonably achievable, Optimum dose limits, Radiation, Radiation safety officer, Radioactive waste, Shielding.

How to cite this article: Gomes LA. Role of Standard Radiation Safety Practices in Public Health: An Experience of a Tertiary Care Teaching Hospital. Int J Res Foundation Hosp Healthc Adm 2017;5(2):73-76.

Source of support: Nil

Conflict of interest: None


 
Guest Editorial
Sharon Kleefield

Relections on Quality and Patient Safety at 2015: Progress and Opportunities

[Year:2017] [Month:January-June] [Volumn:5 ] [Number:1] [Pages:53] [Pages No:v-vii][No of Hits : 221]


ABSTRACT

It is a great privilege for me to share my personal and professional reflections on the current efforts to improve the quality and safety of patient care across borders. After completing my position as Director of Clinical Quality Improvement at an 800-bed tertiary care hospital affiliated with Harvard Medical School, in 2002, I was afforded the opportunity to collaborate with some Indian hospitals for designing quality management standards into their operating plan.


 
Editorial
Shakti Kumar Gupta, Sunil Kant

Artificial Intelligence in Health Care

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:39] [Pages No:iv-v][No of Hits : 220]


ABSTRACT

Artificial intelligence (AI) is the latest in the field of information technology which has influenced all sectors of society with its enabling power of being a facilitator and proactive tool for various activities. Artificial intelligence has been actively utilized in selective defence and space applications wherein its success in solving problems for specific areas like risk assessment and predictability has been acclaimed globally. Artificial intelligence is exploding in popularity and is being sought by various sectors for its precision and scientific might. Growth in the AI health market is expected to reach $6.6 billion by 2021—that’s a compound annual growth rate of 40%, which will be a major deciding factor for adoption of this technology.


 
ORIGINAL ARTICLE
Vijaydeep Siddharth, Vipin K Koushal, Vineet Goyal

Patient Safety is the Need of the Hour: A Study in Nursing Department of a Tertiary Care Teaching Hospital

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:39] [Pages No:55-59][No of Hits : 192]


ABSTRACT

Introduction: Patient safety is an important aspect of health care and is an issue of high concern globally. It was aimed to study the patient safety behavior among the nursing personnel of a tertiary care teaching hospital of North India.

Materials and methods: A descriptive, cross-sectional study was conducted over a period of 6 months in a tertiary care teaching hospital of North India. Study population included the 200 nursing officers, both clinical and administrative (very few). The data were collected using structured questionnaire using Hospital Patient Safety Survey Questionnaire of Agency for Health Research and Quality, USA. The questions were predominantly close-ended with very few open-ended questions and used five-item Likert scale. It had approximately 45 items on various aspects of patient safety, viz., teamwork across hospital units, patient safety during handoffs and transition of care, staff perception about patient safety, reporting of adverse events, etc. Overall patient safety grade for hospital was taken as outcome variable. The questionnaires were distributed in sealed envelopes in the work areas of the study population and collected after a period of 2 weeks.

Results: The questionnaire yielded a response rate of only 66.5%. There was no patient safety committee in the hospital; however, two-thirds (63.9%) of respondents believed that the hospital provides a work environment that promotes patient safety. Almost half (54.83%) of the respondents agreed that their supervisor/managers’ actions/behavior promotes patient safety. Nursing department promotes continuous learning that was agreed by 82.6%. Majority (72.5%) of the nursing staff are afraid to ask questions or speak up if they see something that negatively affects patient care. Only 66% staff agreed that they communicate and discuss errors/adverse events. Most (80.4%) of the staff believe that punitive action would be taken against them if they commit any error. Majority (90%) of the staff believe that they do not have enough staff to handle workload. Two-thirds of the nursing staff think that actions of hospital management promote patient safety. Only 59.2% of staff agreed that there is good cooperation/teamwork across different hospital departments. Almost half of the nursing staff believe that patient safety is compromised during hospital handoffs and transition. Only 26% of the nursing staff rated overall hospital safety as very good and above. Only 9.1% reported any errors/adverse events happening in the unit. By analyzing the data, prevalence of patient safety behavior in the nursing department is found to be 52.6%.

Conclusion: Structured system for implementation of patient safety measures is missing and hospital has to work a lot when it comes to delivering the patient care services in a safe environment.

Keywords: Nursing department, Patient safety, Safe care.

How to cite this article: Siddharth V, Koushal VK, Goyal V. Patient Safety is the Need of the Hour: A Study in Nursing Department of a Tertiary Care Teaching Hospital. Int J Res Foundation Hosp Healthc Adm 2017;5(2):55-59.

Source of support: Nil

Conflict of interest: None


 
Guest Editorial
R Guleria

Universal Health Coverage: Key To ‘Well India’

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:39] [Pages No:vi-vii][No of Hits : 165]


ABSTRACT

Universal health coverage is an extremely futuristic vision encompassing the basic pillars of affordability, accessibility and with the primary thrust on the equitable distribution of resources across all strata of society.The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. This requires a strong, efficient, well-run health system; a system for financing health services; access to essential medicines and technologies; ability to train and retain the manpower and motivate them with attainable objectives and awards thereon.


 
ORIGINAL ARTICLE
Sujeet K Sinha, Kanika Jain, Anant K Verma

Assessment of the Level of Anxiety and Associated Factors among Heart Patients Waiting for Cardiac Procedure at a Tertiary Care Hospital in North India

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:39] [Pages No:68-72][No of Hits : 159]


ABSTRACT

Introduction: The anxiety experienced among patients may have various causes, including not feeling cared about as an individual, not explained by physician regarding plan of treatment, too much waiting time before the procedure begins, and the physical discomfort like not getting proper bed by the hospital authority.
Anxiety can cause behavioral and cognitive changes which can result in increased tension, apprehension, nervousness, and aggression. Some patients may become so nervous and apprehensive that they are unable to understand or follow simple instructions. Some patients may be so aggressive and demanding that they require constant attention of the nursing staff and may end up fighting with the health care provider.

Need of this study: With few public-run cardiac centers, it was always a difficult task of managing the huge patient load on limited beds by the management. Nonavailability of beds forced the clinicians to keep the patients waiting for admission on trolley or postpone the surgery. In addition, it was also noticed that the doctors did not adequately counsel the patients regarding their plan and procedure of treatment. As a result, there is always disgruntlement among the patients, resulting in increased anxiety, apprehension, and aggression.

Objective: To assess the level of anxiety of patients before the cardiac procedure as per the Hamilton Anxiety Rating Scale (HAM-A) and to analyze whether adequate time is being given by the treating physicians in counseling of the patients about the treatment plan.

Materials and methods: This is a cross-sectional study done on patients waiting for cardiac procedure in a cardiac center of a tertiary care hospital. Patients admitted on daycare basis for the procedure were also included. All the patients waiting for the procedure were assessed at the time of admission. Participants were assessed using a performa containing two parts. Part one of the performa was used to capture the demographic profile of the patients and questions related with their disease condition. The second part consisted validated HAM-A. The HAM-A is a widely used scale in both clinical and research settings. The scale consists of 14 items. Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0 to 56, where <17 indicates mild severity, 18 to 24 mild to moderate severity, and 25 to 30 moderate to severe. These patients were then grouped as having mild, moderate, and severe anxiety based on HAM-A score.

Results: The study was carried out to find out the severity of anxiety of the patients waiting for the cardiac procedure. Total 110 patients were enrolled in the study. It was found that 63 (70.8%) male and 9 (42.9%) female patients had mild anxiety. In contrast, 4 (19%) male and 5 (5.6%) female participants had severe anxiety. There was statistically significant relationship (p < 0.05) in the anxiety level between male and female patients. Patients who were not adequately counseled by the physician were found to be suffering more moderate (33.3%) and severe (16.7%) anxiety in comparison with other groups.

Conclusion: There is no doubt that anxiety is very much relevant before any cardiac procedure. Counseling of the patients before any procedure plays a significant role in reducing the severity of the anxiety level.

Keywords: Anxiety, Cardiac procedure, Teaching hospital. How to cite this article: Sinha SK, Jain K, Verma AK. Assessment of the Level of Anxiety and Associated Factors among Heart Patients Waiting for Cardiac Procedure at a Tertiary Care Hospital in North India. Int J Res Foundation Hosp Healthc Adm 2017;5(2):68-72.

Source of support: Nil

Conflict of interest: None


 
POLICY AND PRACTICE
Shibu John, Prerna Singh

Female Education and Health: Effects of Social Determinants on Economic Growth and Development.

[Year:2017] [Month:July-December] [Volumn:5 ] [Number:2] [Pages:39] [Pages No:84-88][No of Hits : 139]


ABSTRACT

This study aims to discuss about girl’s education and health’s direct impact on economic growth. Education leads to higher social standing, independence, and greater autonomy in the decision-making process. Educated women will have greater control over family finances as they are more likely to spend discretionary resources on investments in human capital, such as health, education, and food. Desired millennium development goals cannot be achieved unless women are educated and are strengthened to take decisions about their own health in a suitable and conducive environment. This can only be attained by community-based demand side interventions for better education and maternal health. This study suggests that educated women were more likely to contribute to strengthen the economic growth of the nation than uneducated women. Female education level improves the health status of the family, which ultimately leads the economic growth and achievement of social development goals.

Keywords: Development, Economic growth, Education, Health indicators, Maternal health.

How to cite this article: John S, Singh P. Female Education and Health: Effects of Social Determinants on Economic Growth and Development. Int J Res Foundation Hosp Healthc Adm 2017;5(2):84-88.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
AP Pandit, Tanima Debmallik, Meenal Kulkarni

A Study on the Utilization of Hospital Information System (Ward and Physician) Modules in a Tertiary Care Hospital

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:66] [Pages No:51-60][No of Hits : 476]


ABSTRACT

Introduction: Hospital information system (HIS) is a key managerial tool for any hospital administrator. It gives him all requisite information online, wherever he is and whatever he is doing, so that he can apply timely interventions and set the things right and thereby take care of patient safety, quality improvement, and also minimize litigation problems in the hospitals.
After the initial introduction of HIS into the organization, the key findings were that the entire hospital operations are HIS driven. From the registration and admission of the patient, to the discharge summary generation of an inpatient, the entire process is guided by the HIS. It was found that the HIS is billing-centric, i.e., the HIS use pathway begins only when the registration fee is billed and the unique health identification number (UHID) of a patient is generated.
The main HIS modules under study are the Ward module and the Physician module. After conducting a utilization study using a structured questionnaire, it is found that the level of utilization of the Ward module is 36.4% and that of the Physician module is 6.66%. Using a Fishbone analysis, the causes of reduced HIS utilization have been identified and using a Pareto analysis the main causes have been found to be Work culture and Lack of mobile handheld devices. Various recommendations have been made to increase the HIS usage.

Keywords: Health care workers, Hospital information system, Physician module, Ward module.

How to cite this article: Pandit AP, Debmallik T, Kulkarni M. A Study on the Utilization of Hospital Information System (Ward and Physician) Modules in a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2016;4(2):51-60.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Deepti Jain, Kanika Jain, Gurvinder Kaur, Viney Kapur

Mergers by a Private Hospital: One Script Two Different Endings!

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:66] [Pages No:107-113][No of Hits : 413]


ABSTRACT

Introduction: A comparative study of a failed and a successful merger in health care was conducted in an attempt to explore the reasons for success or failure of mergers.

Materials and methods: This was a retrospective exploratory study of two mergers with the primary hospital being common. A detailed study of the existing policies and procedures, hospital records, financial data, and hospital statistics was conducted. Trends were analyzed and compared with the observed value.

Results: Reasons for the successful mergers can be attributed to managerial commitment and coordination, communication, as well as proximity of consultants of the two merging entities. Adequate strategic planning, a professional approach, and incremental implementation of necessary changes are also essential. No redressal of staff and stakeholder apprehension and poor communication are reasons for failure of mergers.

Conclusion: A merger in the Indian hospital scenario is a fairly recent phenomenon. Factors, and their interplay that result in successful or failed mergers in Indian context, are an unexplored field of research. Mergers are capital and resourceintensive, and the consequences of a failed alliance are huge. Thus, a careful, holistic feasibility study is essential before embarking on a merger.

Keywords: Alliances, Health care, Mergers, Success.

How to cite this article: Jain D, Jain K, Kaur G, Kapur V. Mergers by a Private Hospital: One Script Two Different Endings! Int J Res Foundation Hosp Healthc Adm 2016;4(2):107-113.

Source of support: Nil

Conflict of interest: None


 
Editorial
Shakti Kumar Gupta, Sunil Kant

National Ambulance Code: Toward Safe Roads and Saving Lives

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:66] [Pages No:iv-v][No of Hits : 397]


ABSTRACT

India records more number of deaths from road traffic accidents than most other countries in the world. In addition, with one of the highest motorization growth rate in the world accompanied by rapid expansion in road network and urbanization over the years, our country is faced with serious impacts on road safety levels.


 
EXPERT VIEW
R Chandrashekhar

In Pursuit of Holistic Green Health Care Facilities

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:66] [Pages No:114-117][No of Hits : 349]


ABSTRACT

Of late, rapid advancements in the health care industry have made recovery and recuperation of patients faster and precise, thanks to the prowess and skills of the medical fraternity.

How to cite this article: Chandrashekhar R. In Pursuit of Holistic Green Health Care Facilities. Int J Res Foundation Hosp Healthc Adm 2016;4(2):114-117.

Source of support: Nil

Conflict of interest: None


 
RESEARCH ARTICLE
Akash A Shrivastava, G Somu, M Dayananda

Good Clinical Practices toward Safe Blood Transfusion: A Study of Blood Transfusion Process and providing Suggestions for streamlining the Same

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:50] [Pages No:1-4][No of Hits : 348]


ABSTRACT

Introduction: Wrong blood transfusion (BT) is a medical negligence. Every hospital must have a strong policy to check incorrect BT and see to it that these policies are strictly implemented at the time of transfusion.

Wrong BT can occur due to carelessness of the staff and shortcomings in verification of the blood bag. The reasons can be avoided and wrong BT can be prevented by the formation of a checklist consisting of the important details to be verified before initiating transfusion. The checklist should not be very long and time-consuming, but very comprehensive and consists of only absolutely essential things to be checked.

Aim: To study the BT process and providing suggestions for streamlining the process of BT.

Objectives:

  • To analyze the nears miss incidents during BT.
  • To identify the errors in the process of transfusion.
  • To streamline the process by introducing checklist/work instructions for reducing errors.

Materials and methods:

  • Analysis of safety reports regarding BT.
  • Process-based root cause analysis was done at the time of issue and at ward level.
  • Feedback regarding BT was taken from the staff working at blood bank and nursing professionals.
    The study was divided into two phases: Phase 1: January-April 2014
    Phase 2: May-August 2014

All the reports from phase 1 of the study were analyzed. Based on the observations, interventions in the form of checklist and work instructions to the nursing staff were implemented in the hospital in the month of April and then the safety reports for the next 4 months were analyzed.

Interventions done: A “4C” checklist was created with just four elements that could be orally or mentally reviewed before beginning transfusion. Specific work instructions were also issued to the nursing staff at the ward level to prevent any errors during labeling of the samples being sent for cross match and blood grouping before BT.

Results: The number of BT-related safety incidents observed in phase 1 reduced in phase 2 though the workload in terms of samples received remained comparable for the two phases. However, a declining trend for the reporting of incidents was also seen through the phases.

Keywords: Blood transfusion, Checklist, Process reengineering, Work instructions.

How to cite this article: Shrivastava AA, Somu G, Dayananda M. Good Clinical Practices toward Safe Blood Transfusion: A Study of Blood Transfusion Process and providing Suggestions for streamlining the Same. Int J Res Foundation Hosp Healthc Adm 2016;4(1):1-4.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Deepti Sahran, Vijay K Tadia, SK Arya

Streamlining the Process of Communicating and Recording the Gender of the Newborn Child in the Labor Room

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:66] [Pages No:66-69][No of Hits : 276]


ABSTRACT

Purpose: The article tries to streamline the process of communicating and recording the gender of newborn in the birth certificate in the labor room.

Design: Descriptive.

Materials and methods: Redesigning of the process of recording gender in hospital information system (HIS) module/ e-birth module using process mapping and feedback from stakeholders.

Results: There were instances of discrepancy in verbally communicating the gender of newborn soon after the birth and the gender being recorded in the birth certificate issued in the labor room. Soon after these instances were reported, the process was examined and redesigned. After implementation of the redesigned process, follow-up was done and it was noted that there had been no further instances of discrepancies in communication of sex of the newborn child and recording of gender in the birth certificate. However, to institutionalize the change and to prevent any further mishaps in future and to eliminate chances of all possible human errors, it was decided that the whole process will be retested and all possible loopholes will be identified, with the aim to create a process which achieves the objective of elimination of all possible human errors (mistakeproofing). Initially, the process mapping was done. Later, the new process of recording birth-related information including gender was codified and implemented. The follow-up was again done post this intervention. It was found that systemic changes had streamlined the process. This had resulted not only in right gender recording and elimination of possibility of any errors, but also in reduction of number of visits by patients to labor room to get birth certificate.

Conclusion: Investigation of errors and redesigning of processes help in rooting out various defects in the system. Therefore, all the acts of omission/commission resulting in undesirable outcomes should be used as opportunities for overall improvement rather than to find fault of erring employees. As in this case, the overall approach was to improve the existing system leading to elimination of chances of any mistake and streamlining operations leading to desired outcomes.

Keywords: Electronic module, Quality improvement, Root cause.

How to cite this article: Sahran D, Tadia VK, Arya SK. Streamlining the Process of Communicating and Recording the Gender of the Newborn Child in the Labor Room. Int J Res Foundation Hosp Healthc Adm 2016;4(2):66-69.

Source of support: Nil

Conflict of interest: None


 
Editorial
Shakti Kumar Gupta, Brig (Dr) Sunil Kant

Editorial

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:50] [Pages No:iv-vi][No of Hits : 242]


ABSTRACT

Professional Management of Health Care Institutions

INTRODUCTION

Health care sector is the most dynamic and evolving field in the country today. Health care organizations are gradually expanding in both public as well as private sector. Indian health care delivery system is categorized into two major components-public and private. The government, i.e., public health care system comprises of primary, secondary, and tertiary care institutions. The private sector also augments the facilities by providing health care facilities at various strata of Indian society.


 
Guest Editorial
Sangita Reddy

Smart Health for Smart Cities

[Year:2016] [Month:July-December] [Volumn:4 ] [Number:2] [Pages:66] [Pages No:vi-vii][No of Hits : 233]


ABSTRACT

Most discussions on Indian health care invariably journey to the topic of dichotomy; the reality of two India’s is not new - it is an undeniable truth that pervades most aspects of life in our nation. Illiteracy coexists with several brilliant academics in the world; abundance is contrasted by abject poverty.


 
Guest Editorial
P Venugopal

Guest Editorial

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:50] [Pages No:vii-viii][No of Hits : 192]


ABSTRACT

Organ Donation: Lighting Lives of Needy

Organ donation is an extremely noble deed that all of us are empowered to carry out irrespective of the social, academic, and religious strata that we are from and this single act of benevolence can lead to adding years of life to many. Imagine this step forward can be the decisive change for so many lives around us who are yearning to spend few more productive years.


 
ORIGINAL ARTICLE
Bonnie Chien, Khumukcham I Singh, Laksmi S Hashimoto-Govindasamy, Meena N Cherian, Manish Mehrotra, Paul Francis, Natela Menabde

Emergency and Essential Surgical Care Capacity across Primary, Secondary, and Tertiary Institutions in Meghalaya, India: A Cross-sectional Study

[Year:2016] [Month:January-June] [Volumn:4 ] [Number:1] [Pages:50] [Pages No:35-44][No of Hits : 180]


ABSTRACT

Aim: This study aims to evaluate surgical care systems across tertiary, secondary, and primary health institutions in the state of Meghalaya, India.

Materials and methods: The government of Meghalaya conducted the first comprehensive assessment of surgical capacity at three levels of care: Tertiary hospitals, community health centers (CHCs), and primary health centers (PHCs).
This cross-sectional survey utilized World Health Organization (WHO) tool for situational analysis to assess emergency and essential surgical care (EESC) to capture health facilities- capacity to perform life-saving and disabilitypreventing surgical interventions, such as resuscitation, surgical, trauma, obstetric, and anesthetic care. Data were collected across four categories: Infrastructure, human resources, surgical procedures, and equipment.

Results: The 55 facilities surveyed comprised 8 tertiary hospitals, 26 CHCs, and 21 PHCs. A total of 107,962 surgical presentations were reported across all facilities per year, with the greatest number presenting to PHC. No specialist doctors worked at PHC level; there were 1 anesthesiologist and 2 obstetricians at the CHC level. All of the PHCs or CHCs referred do not provide key emergency and essential surgical procedures, including resuscitation, cesarean section, general anesthesia, laparotomy, and closed and open treatment of fractures. At the tertiary level, only 50% provide cesarean section and laparotomy procedures.

Conclusion: The results of this WHO state survey demonstrate significant gaps, notably in resuscitation, at all lower level health facilities and the absence of obstetric procedures at some tertiary hospitals, in essential and emergency surgical capacity, including human resources, equipment, and infrastructure, across all levels of health institutions in Meghalaya.

Clinical significance: This study is an effort to identify the strengths and limitations of surgical capacity in the state of Meghalaya. The method of the study are simple and results can be extrapolated to other states of the country or any third world state which can translate into enhancement and redirection of resources for an optimum outcome.

Strengths of the study

  • This study is driven by the motivation of the government of Meghalaya to address the issue of surgical care capacity.
  • The study identifies concrete areas of need in surgical care capacity in a collaborative effort with the government of Meghalaya.
  • Given the wealth of information on different levels of care centers provided by the government, specific recommendations for improvement can be made.

Limitations of the study

  • Although detailed, the situation analysis survey tool is not fully comprehensive and cannot be used exclusively for program planning.
  • Not all care centers were able to be surveyed; thus, the results may be representative of only those surveyed.

Keywords: India, Meghalaya, Surgical capacity, World Health Organization study.

How to cite this article: Chien BY, Singh KI, Hashimoto- Govindasamy LS, Cherian MN, Mehrotra M, Francis PP, Menabde N. Emergency and Essential Surgical Care Capacity across Primary, Secondary, and Tertiary Institutions in Meghalaya, India: A Cross-sectional Study. Int J Res Foundation Hospc Health Adm 2016;4(1):35-44.

Source of support: Nil

Conflict of interest: The authors include WHO staff. The views expressed in this publication reflect their views and not necessarily that of WHO.


 
ORIGINAL ARTICLE
Akanksha Bisht, Shakti Kumar Gupta, Surinder Singh

Transfusion Reaction Reporting Culture in Hemovigilance Program of India since Its Inception

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:69-70][No of Hits : 435]


Abstract

Hemovigilance Program of India (HvPI) at the national level was launched on 10th December 2012 by National Institute of Biologicals (NIB), Noida, Ministry of Health and Family Welfare, Government of India as the National Coordinating Centre (NCC). Awareness about the program, its objectives and its nonpunitive implications are being generated through organizing continuing medical educations (CMEs) on HvPI in different regions of the country from time to time. A total of 24 CMEs on HvPI have been organized all across the country. The study shows that creating awareness about this progam among healthcare professionals has resulted in substantial increase in number of center enrolled under HvPI as well as number of reporting of transfusion reactions under HvPI since the inception of this program.

Keywords: Clinicians and nurses, Continuing medical education, Hemovigilance, Reporting culture, Transfusion reactions.

How to cite this article: Bisht A, Gupta SK, Singh S. Transfusion Reaction Reporting Culture in Hemovigilance Program of India since Its Inception. Int J Res Foundation Hosp Healthc Adm 2015;3(2):69-70.

Source of support: Nil

Conflict of interest: None


 
Editorial
Pieter Stepaniak

Editorial

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:v-vi][No of Hits : 399]


Abstract

Need for Managing Variability of Healthcare Processes

Hospitals have scarce capacity. Almost always the demand for care is higher than the supply provided. Managing a hospital organization in an efficient, patient-centered, and timely way is easier said than done.
Let us try to understand the fundamentals of this problem. Imagine an ‘ideal’ world where a typical hospital provides services to patients. This hospital has 800 beds, 25 operating rooms (ORs), 50 intensive care unit (ICU) beds. Everyday exactly 80 patients are admitted and the length of stay (LOS) is exactly 10 days. All patients admitted are equal and all patients undergo the same procedure in the ORs.


 
ORIGINAL ARTICLE
Mukunda Chandra Sahoo, Shakti Kumar Gupta, DK Sharma, Sanjay Kumar Arya, Amit Lathwal

Study of the Traffic Management System at an Apex Tertiary Care Teaching Hospital and Recommendations for Improvement

[Year:2015] [Month:July-December] [Volumn:3 ] [Number:2] [Pages:79] [Pages No:110-113][No of Hits : 293]


Abstract

Introduction: Hospital parking services often represent the very first contact patients and visitors have with our hospital and to make a positive perception of our hospital, we need ample patient and visitor parking. Over last decade, there has been a quantum increase in workload by 6 to 7 times and a corresponding increase in the number of vehicles entering the tertiary care teaching hospital premises. Aim of traffic management at tertiary care hospital is to decongest, improve and smoothen traffic by advocating lane discipline, platooning, signal lights, parking, footpaths, reducing the number of private vehicles, efficient public transport, car pooling, etc.

Aims and objective: To study vehicular traffic management system at a Apex Tertiary Care Teaching Hospital.

Methodology: This was done by survey of the area and observation of traffic flow and its measurement. The data, thus, collected were analyzed and based on the analysis an action plan was drawn.

Conclusion: As regards parking arrangements at the tertiary care teaching hospital are concerned, there is a need to create integrated parking lots on surface as well as basement of the buildings for parking of approximately 7600 vehicles which will also take into account the future needs. These parking lots should also include multilevel intelligent parking system with a computerized system of lifts stacking each car in a berth, and thus reducing the need for parking and service personnel.

Keywords: Intelligent parking, Parking lots, Traffic management, Valet system, Vehicles.

How to cite this article: Sahoo MC, Gupta SK, Sharma DK, Arya SK, Lathwal A. Study of the Traffic Management System at an Apex Tertiary Care Teaching Hospital and Recommendations for Improvement. Int J Res Foundation Hosp Healthc Adm 2015;3(2):110-113.

Source of support: Nil

Conflict of interest: None