Saturday, March 15, 2014
Providing sustainable healthcare
The “Health for All” declaration
of the World Health Organization, brought out in 1978, envisions
securing the health and well being of people around the world that has
been popularized since the 1970s. It is the basis for WHO’s primary health care strategy to promote health, human dignity, and enhanced quality of life.
With the advent of
modern-day healthcare, healthcare costs have been going up
exponentially. Thus, the need for devising sustainable healthcare
systems is felt. In this backdrop, several low cost healthcare systems
such as the Vaatsalya Group, Glocal Healthcare etc, have come into
advent. They are focusing on the lower end of the affordability
spectrum, depending on volumes to drive business. Some of the key
strategies of low cost/ sustainable healthcare systems are:
1. Fixed salaries rather than bonuses or incentives for doctors
2. Innovative management of real estate, such as rental of building
3. Optimal use of technology and low cost of equipment, made possible by aggressive bargaining
4. Fixed
prices for common medical treatments , which keep costs down for
patients by preventing doctors from ordering unnecessary procedures
5. Innovations such as beating-heart procedure and manual excision for cataract procedure
With the extension of
modern healthcare into Tier II and Tier III cities, sustainable
healthcare is reaching out to the masses. This trend would hopefully
grow with time.
Friday, March 14, 2014
Building of a Quality
Management System
By Dr.Abhimanyu Bishnu; MBBS, MHA, CTQM,NABH Assessor
Today, most
hospitals are going in for systems of Quality management, such as ISO, NABH (National
Accreditation Board for Hospitals & Healthcare Providers), Joint Commission
International (JCI) etc. Quality Management System (QMS) is the backbone of
effective running of any hospital.. QMS is broadly defined as “all the
procedures explicitly designed to monitor, assess and improve the quality of
care. “ Accreditation is a form of self-evaluation and peer review, against
explicit standards, and is aimed to enhance quality improvement.
The QMS is the
backbone or framework, on which a system of accreditation can be built up. It
consists of documents, processes , training plans, Quality Indicators,
Committee structure, Incident Reporting System, Audit plan etc. All of these
add up and integrate into a common QMS, on which the system of accreditation
can be built up.
The essential qualities of a QMS
are that the parameters must be
-
Simple
-
Measurable
-
Achievable
-
Reasonable
-
Timeline
–bound
-
i.e. S.M.A.R.T.
The usual components of a QMS, are:
1.
Manuals
-
Quality Manual
-
Quality Policies Manual
-
Infection Control Manual
-
Safety
& Security Manual
-
Laboratory Quality & Safety Manual
-
Radiology Quality & Safety Manual
2.
Departmental
SOPs
3.
Quality
indicators
-
Structural
indicators
-
Process indicators
-
Outcome indicators
4.
Incident Reporting System
5.
Emergency and disaster management system
6.
Committees
-
Quality Steering Committee
-
Infection Control Committee
-
Facility
Management & Safety Committee
-
Pharmaceutical & Therapeutics Committee
-
Medical Audit Committee
-
Mortality & Morbidity Audit Committee
7.
Annual
training and retraining plan
8.
Internal Audit System
The steps of setting up a QMS,
are as follows:
1.
Management and stakeholder adoption of Quality
requirements, and Mission & Vision statement
2.
Documentation of Policies, Procedures, SOPs, Manuals
3.
Training of staff
4.
Internal audit and Reaudit
5.
Improvement of the system
Through this process, the QMS can
set up and sustained.
The focus of a modern –day QMS
should be on Continuous Quality
Improvement and Patient Safety. Essential
elements of patient safety, including a Patient Safety Plan, must be built into
the QMS System.
A QMS focuses on both Clinical and Non-clinical quality.
These include Patient assessments, Radiology investigations, Laboratory
investigations, Medication management, Infection control, Continuous Quality
Improvement, Facility Management, Human Resource Management, Information
Management Systems etc.
European countries have taken up
Quality management at a national level, aided by a broad policy framework. In
Finland, the recommendations for building up the QMS have been outlined as
under:
Ø
Customer participation in QMS
Ø
Leadership for the steering of quality;
Ø
Personnel as a prerequisite for high quality;
Ø
QMS for preventive as well other activities;
Ø
Management of processes as a basis for QM;
Ø
Information as a basis for the continuous
enhancement of quality;
Ø
Systematization of QM;
Ø
Detailed recommendations and quality criteria
support quality management.
In our country, the development
of QMS in hospitals has mainly been aided by the growth in demand for ISO, NABH
& JCI accreditation. Based on this, QMS systems have been developed, and
sustained. It is expected that with the further growth of accreditation in our
country, Quality Systems will continue to evolve and flourish, and lead to an
exponential improvement in Quality Improvement and Patient Safety.
Saturday, March 8, 2014
Sentinel Events in hospitals
A Sentinel Event is defined by the Joint Commission International (JCI) as any unanticipated
event in a healthcare setting resulting in death or serious physical or
psychological injury to a patient or patients, not related to the natural
course of the patient's illness. These
are usually the most serious events in hospitals, and include:
Ø Unexpected death
Ø Patient suicide
Ø Wrong patient, wrong side, wrong site surgery
Ø Infant abduction
Ø Sexual assault on patient
Ø Haemolytic blood transfusion reaction resulting
from incompatible bllopd transfusion
Ø Intrapartum maternal death
Ø Assault, homicide or other crime resulting in permanent
loss of function or death
Sentinel events are intensively monitored by the Joint
Commission International ( JCI) and the
National Accreditation Board for Hospitals & Healthcare Providers (NABH).Theses
events require a Root cause Analysis ( RCA) to detect the underlying causes,
and come up with solutions to prevent the recurrence of the event. At the same
time, potential measures of improvement, called an “ Action Plan”, are to be
implemented.
The Joint Commission disseminates "sentinel
event alerts" identifying specific sentinel events, their underlying
causes, and steps to prevent recurrence. For hospitals accredited by the
JCI, the RCA has to be done within 45 days of the event, and suitable advisory
issued accordingly.
Statistics of sentinel events are recorded and
published by the FDA's MedWatch program. The JCAHO publishes a great deal of information about
sentinel events on their website: www.jcaho.org. They also send out Sentinel Event Alerts that are
available to all health care providers and organizations as a means of
increasing the general knowledge about sentinel events.
Sentinel events usually point out a system or
process defect, rather than a defect related to any one individual. They have
to be taken in this context and analyzed thereof.
An example of a Sentinel Event in a hospital:
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ROOT CAUSE ANALYSIS
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S/ 01/ 11
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Type of event
|
Sentinel event
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Event
|
Inj.Vancomycin given by improper technique ( iv bolus instead of
infusion)
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What happened?
|
Patient was scheduled for OMC+ ASD closure.Doctor had prescribed
Inj. Vancomycin I gm iv bd without mentioning dilution. Nurse gave the
medication as iv bolus after dilution in 20 ml NS, whereas it should have
been diluted in 100 ml. Patient developed discolouration of hand- this
progressed to thrombophlebitis with left hand pain, burning and blackish discolouration.
The operation was cancelled due to this and patient was discharged. At the
time of discharge, patient was having discolouration and pain, with flexion
problems of the hand. Patient was later readmitted , having suffered deep
skin necrosis and underwent debridement and flap cover surgery.
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Analysis using the " 5 times why" technique
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Why did thrombophlebitis develop?
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Due to improper dilution and technique of administration
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Why was the improper technique followed?
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Since nurse was not aware
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Since doctor had not mentioned it in medication order
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Why was nurse not aware?
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Dilution guidelines not available at ward
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Knowledge and training was insufficient
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Why had doctor not mentioned in medication order?
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Due to oversight
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Factors
affecting this event ( Ishikawa Diagram)
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Friday, March 7, 2014
Use of Information, Communication & Technology ( ICT) in healthcare
Use of Information, Communication & Technology ( ICT) for enhancing
the access, quality and reliability
of healthcare, is a fairly well-entrenched concept now.
The following article shows how ICT has been radically used
by a corporate to enhance the quality of healthcare, in the state of Odisha in India.
Healthcare: a growing investment opportunity
Healthcare is today one of the few sectors with a stable revenue potential, marked by a steady EBIDTA margin and moderate growth. Healthcare caters to a basic healthcare need, and the industry is growing by leaps and bounds.
The following article presents a view on the growing investment potential of the healthcare sector:
http://healthcare.financialexpress.com/editorial/2418-a-healthy-bet
Launch of Urgicare Clinics in Delhi
Urgent
Care Centre, a pioneering model of pre-hospital care medical centres in
India launched its second centre in the capital, one month after coming
up with its first centre at Vikas Marg. The centre is located in
Kalkaji/ Nehru Enclave region of the capital and is plans to provide
critical and immediate attention for all medical urgencies. To achieve
the aim of providing timely, safe, effective, measurable and efficient
care, Urgent Care Centres will be accessible 24x7.
http://healthcare.financialexpress.com/latest-updates/1207-2nd-urgent-care-facility-at-kalkaji-in-delhi
http://healthcare.financialexpress.com/latest-updates/1207-2nd-urgent-care-facility-at-kalkaji-in-delhi
Friday, February 28, 2014
Mahajan Imaging, Delhi gets India’s first Silent MRI
GE’s revolutionary Silent Scan technology dials down MRI scanning down
to a Whisper for patient comfort & reduces the need for re-scans
Silence is golden for millions of patients who
find MRI scans loud and distressing. Patient comfort is one of the
leading factors in getting the most accurate diagnosis. GE Healthcare’s
Silent Scan*, a revolutionary technology addresses this significant
impediment to patient comfort – excessive sound generated during an MRI
scan. Mahajan Imaging, Delhi is the first healthcare facility in Asia to
install Silent MRI in India. GE’s exclusive Silent Scan technology is
designed to reduce MR scanner noise to near ambient (background) sound
levels and thus improve a patient’s MR exam experience. Conventional MR
scanners can generate noise in excess of 110 dBA (decibels) levels,
roughly equivalent to rock concerts.
“One drawback of MRI scans is that they are loud, generating as much
noise as a rock concert or an airplane engine. Noisy MRI scans can be
quite disturbing, especially brain scans in elderly and children, and
hence, since patient comfort is paramount for getting accurate,
high-quality images, sometimes we need to repeat scans to get high
quality images. With this new Silent MRI from GE, we are able to get
exceptionally high-quality images of the anatomy the
first time, since MRI noise is virtually inaudible and the patient is
relaxed. We are very proud and thrilled that we are the first diagnostic centre
to offer this benefit to patients in India. This is in-line with our
mission of bringing the latest and most-advanced medical technologies
into the country.”, said Dr. Harsh Mahajan, Director, Mahajan Imaging, a
Padmashri awardee.
Noise is one of the major complaints from patients who undergo a MRI
exam. Historically, medical manufacturers have addressed the noise issue
by muffling it using a combination of acoustic dampening material or
even degrading MRI machine performance in order to reduce the noise
level. Two years ago, GE engineers initiated their quest to reduce noise
during an MRI scan. They developed –Silent Scan Technology, a radical
new type of 3D MR acquisition methodology, a combination of proprietary
high-fidelity gradient and RF system electronics, by which the noise is
not merely dampened but is virtually eliminated at the source. The
Silent Scan Technology is co-developed in India by GE.
“Silent MRI puts patients first. It is part of our efforts to humanize
MRI systems and make them patient friendly and safe without compromising
on image quality. The Silent Scan technology is co-developed in India
by our engineers. While it is a boon for patients, it also potentially
allows a healthcare facility to see more patients with fewer repeat
scans or recalls.” Said Dr Karthik Kuppusamy, Senior Director, MRI
Imaging, GE Healthcare South Asia.
Silent Scan is available on new as well as existing Discovery MR750w with GEM and Optima MR450w with GEM systems.
- See more at: http://ehealth.eletsonline.com/2014/02/mahajan-imaging-delhi-gets-indias-first-silent-mri/#sthash.oK8ikmcg.dpuf
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