Risk Assessment in Discharge Process using PFMEA Tool in a Multi-Specialty Hospital

Introduction: ‘Quality’ is an inseparable component of healthcare. It focuses not only on care parameters but also in identifying the potential failures/ risks associated with the care process; thereby addressing them pro-actively before the occurrence of the loss. There are several quality tools available such as Process Failure Mode Effect Analysis (PFMEA) that helps in analyzing a process for identification of possible failures. This helps to find ways to avoid the occurrence of the failure or have a strategy to eliminate or minimize the risk. Thus, the current study was undertaken on identifying the risks involved in the discharge process using PFMEA tool. Objectives: To identify the potential risks in patient discharge process and suggest measures to address the failures. Methodology: The study was conducted for a period of 2 months in a multi-specialty hospital. In-patient discharge process was observed in detail and potential failures in the process were identified with the help of a multidisciplinary team constituted for the same purpose. Brainstorming sessions were conducted with the team members to identify possible failures, its causes and effects. Basing on the severity, occurrence and detectability, failure was ranked on a scale of 1 to 10 and Risk Priority Numbers (RPN) were assigned to each of the potential risks in the process. Results: A total of 23 possible failures were identified which included inadequate explanation of discharge summary, missing diagnostic reports, delay in discharge medication initiation and unattended patient queries. RPN values have ranged from 60-320; depicting severity, occurrence and detectability of respective failures. Conclusion: Identifying the potential failures in the patient care process is very crucial for patient, provider and healthcare facility as it helps in the optimization of resources, adds value to patient care, leads to patient satisfaction thereby enhancing quality

Comparison of pocket pulse oximeter and standard pulse oximeter with ABG analysis in critically ill patients

Background: Pulse oximetry (SpO2) is a standard monitoring device in patients presenting to EMDs and intensive care units (ICUs). Pocket pulse oximeters (PPOs) are used widely in wards, EMDs, and small hospitals/clinics. These inexpensive PPOs also guide therapeutic interventions. Few studies have evaluated the accuracy of SpO2 in patients presenting to critical care areas vis-à-vis devices like PPO and standard pulse oximeter (SPO). This study becomes extremely relevant in view of the ongoing crisis of the COVID-19 pandemic wherein SpO2 monitoring is very important in hospitals, quarantine centers, small clinics, or even at home.Methods: Patients presenting to critical areas who underwent arterial blood gases (ABG) analysis on the recommendation of the treating physician between November 2016 and October 2018 were included in this study. Along with the ABG analysis, a simultaneous assessment of SpO2 was done with a single PPO and SPO and all values were noted. Statistical analysis was done using the SPSS v.21.0 for Windows.Results: The study included 300 patients. We compared the O2 saturations of ABG, SPO, and PPO with respect to sex, different age groups, and at different levels of ABG pCO2, HCO3, and pH in all patients. All parameters were compared using the Pearson’s correlation test; the results showed that ABG O2 saturations were closer to the SPO than the PPO but the differences were not statistically significant as the Pearson’s correlation values for all parameters were >0.8. We also compared the parameters by Bland Altman Plot and all observations were outside 95% CI (confidence interval), which means that there was a good agreement between O2 saturations by all three methods, that is, ABG, SPO, and PPO; however, ABG O2 saturations were closer to SPO than PPO but this difference was not statistically significant. Hence, we conclude that the PPO is a useful tool for reliable monitoring of O2 saturations.Conclusion: This study highlights that inexpensive and noninvasive PPO can be used as a standard monitoring device with reliability in critically ill patients presenting to EMDs, ICUs, and small hospitals/clinics, quarantine centers, and even at home

Comparison of Pocket Pulse Oximeter and Standard Pulse Oximeter With ABG Analysis in Critically Ill Patients

Background: Pulse oximetry (SpO2) is a standard monitoring device in patients presenting to EMDs and intensive care units (ICUs). Pocket pulse oximeters (PPOs) are used widely in wards, EMDs, and small hospitals/clinics. These inexpensive PPOs also guide therapeutic interventions. Few studies have evaluated the accuracy of SpO2 in patients presenting to critical care areas vis-à-vis devices like PPO and standard pulse oximeter (SPO). This study becomes extremely relevant in view of the ongoing crisis of the COVID-19 pandemic wherein SpO2 monitoring is very important in hospitals, quarantine centers, small clinics, or even at home.  Methods: Patients presenting to critical areas who underwent arterial blood gases (ABG) analysis on the recommendation of the treating physician between November 2016 and October 2018 were included in this study. Along with the ABG analysis, a simultaneous assessment of SpO2 was done with a single PPO and SPO and all values were noted. Statistical analysis was done using the SPSS v.21.0 for Windows.  Results: The study included 300 patients. We compared the O2 saturations of ABG, SPO, and PPO with respect to sex, different age groups, and at different levels of ABG pCO2, HCO3, and pH in all patients. All parameters were compared using the Pearson’s correlation test; the results showed that ABG O2 saturations were closer to the SPO than the PPO but the differences were not statistically significant as the Pearson’s correlation values for all parameters were >0.8. We also compared the parameters by Bland Altman Plot and all observations were outside 95% CI (confidence interval), which means that there was a good agreement between O2 saturations by all three methods, that is, ABG, SPO, and PPO; however, ABG O2 saturations were closer to SPO than PPO but this difference was not statistically significant. Hence, we conclude that the PPO is a useful tool for reliable monitoring of O2 saturations.  Conclusion: This study highlights that inexpensive and noninvasive PPO can be used as a standard monitoring device with reliability in critically ill patients presenting to EMDs, ICUs, and small hospitals/clinics, quarantine centers, and even at home

"DREEM" comes true - Students′ perceptions of educational environment in an Indian medical school

Background: The accomplishment and contentment of students depends upon their educational environment. Very few studies in India have looked at the impact of educational environment on students, there are few such studies in our country despite having a large number of medical schools. Objective: This study was performed to assess the undergraduate students′ perceptions of medical education in general and educational environment in our medical school in particular. Materials and Methods: The Dundee Ready Education Environment Measure (DREEM), a validated inventory was distributed among undergraduate students in final Bachelor of Medicine and Bachelor of Surgery (MBBS) (2010-2011) and students who were undergoing internship (2010-2011) and various scores were calculated and the means were compared using Mann-Whitney test. Results: The mean total DREEM score was found to be 121.5/200 for final MBBS students (n = 115) and 118.4/200 (n = 109) for the internship batch students. There was no statistically significant difference between the scores of the two batches. The overall DREEM score for our Medical School during the academic year 2010-2011 (for the final MBBS and internship batch) was 120/200 (n = 224), which showed that the students′ perceptions were more positive. Conclusion: The study showed that the students′ perception of the educational environment was positive. There was no statistically significant difference between the scores of the two batches (final MBBS and internship). This study helped us to introspect and identify remediable areas in the educational environment of our medical school and hence we could suggest some measures to modify them

Correlates of Process of Suicide Attempt and Perception of its Prevention

Objective: Suicide attempt may follow a process right from the inception of the first information about ‎suicide until the act itself. This study was conducted to determine the relationship between ‎perception of suicide prevention with the process of suicide attempt and demographic ‎variables following a suicidal attempt.‎ Method: In this hospital based cross-sectional study, 168 consecutive admitted participants with a ‎suicide attempt were screened, and 109 who met the study criteria were recruited to ‎participate in this study before discharge. They were assessed using the socio-demographic ‎and clinical proforma designed for this study as well as by the Pierce Suicide Intent Scale. To ‎assess the process of suicide attempt and perception of suicide prevention, a 17- item ‎questionnaire was developed and used after rigorous literature search. The Cronbach’s ‎alpha coefficient value of this questionnaire found to be 0.84 in the reliability analysis.‎ Results: Media was the first source of information, and the majority had short duration of ‎preoccupation and interval between making the decision and the actual attempt and the ‎control of emotion during the attempt. A significant positive correlation was observed ‎between the source of the first information and age (p<01), reason for the method used and ‎economic status (p<01), duration since the first information and family history of suicide (p<01). Psychiatric diagnosis had a statistically significant association with the method used (p<01), duration of preoccupation (p<01), preparedness (p<01) and emotional state during ‎the attempt (p<01). A statistically significant negative correlation was found between the ‎source of the first information and education (p<01), any psychiatric diagnosis and duration ‎since the first death wish (p<01). On the score of perception about suicide prevention, a ‎significant group difference was observed for marital status, occupation, medical diagnosis, ‎opinion about an attempt, duration since the decision to attempt, and emotional control ‎during the attempt.‎ Conclusion: Based on the findings, it can be concluded that perception of suicide prevention may vary ‎with the process of suicide attempts and demographic characteristics.

Level of paranormal beliefs and its relationship with explanatory models, treatment adherence and satisfaction

Abstract Background Paranormal beliefs are common among patients with mental illness. Such beliefs may mediate conceptualization of illness, treatment satisfaction and medication adherence. Objective To study the level of paranormal beliefs and its relationship with explanatory models, treatment adherence and satisfaction using standardized assessment tool. Methods Eighty nine patients with mental illness in remission were assessed with Sociodemographic proforma, Revised Paranormal Belief Scale (RPBS), Mental Distress Explanatory Model Questionnaire (MMAS), Morisky Medication Adherence Scale (MMAS) and Short Assessment of Patient Satisfaction (SAPS). Results Results revealed a high level of paranormal beliefs on RPBS (Mean 83.96, SD ± 23.91). Variables that had a statistically significant group difference on the score of RPBS were domicile status (p < 05), diagnosis (p < 001), method of treatment sought before (p < 001). In a linear regression analysis four variables explained 35.4% of the variance (R2 = .38, R2Adjusted = .35, F = 13.04, p < .001) in RPBS Score. These variables were total score of MDEMQ (Beta = .308, t = 3.435, p < .001), total score of MMAS (beta = .357, t = 3. 716, p < .001) and magico-religious treatment received earlier (beta = .306, t = 3.52, p < .001) and SAPS. Discussion Based on the finding of this study, it may be concluded that the level of paranormal beliefs may vary with some demographic variables. Levels of paranormal beliefs is positively associated with explanatory models and adherence in patients with mental illness in remission

Exocrine dysfunction correlates with endocrinal impairment of pancreas in Type 2 diabetes mellitus

Background: Diabetes mellitus (DM) is a chronic abnormal metabolic condition, which manifests elevated blood sugar level over a prolonged period. The pancreatic endocrine system generally gets affected during diabetes, but often abnormal exocrine functions are also manifested due to its proximity to the endocrine system. Fecal elastase-1 (FE-1) is found to be an ideal biomarker to reflect the exocrine insufficiency of the pancreas. Aim: The aim of this study was conducted to assess exocrine dysfunction of the pancreas in patients with type-2 DM (T2DM) by measuring FE levels and to associate the level of hyperglycemia with exocrine pancreatic dysfunction. Methodology: A prospective, cross-sectional comparative study was conducted on both T2DM patients and healthy nondiabetic volunteers. FE-1 levels were measured using a commercial kit (Human Pancreatic Elastase ELISA BS 86-01 from Bioserv Diagnostics). Data analysis was performed based on the important statistical parameters such as mean, standard deviation, standard error, t-test-independent samples, and Chi-square test/cross tabulation using SPSS for Windows version 20.0. Results: Statistically nonsignificant (P = 0.5051) relationship between FE-1 deficiency and age was obtained, which implied age as a noncontributing factor toward exocrine pancreatic insufficiency among diabetic patients. Statistically significant correlation (P = 0.003) between glycated hemoglobin and FE-1 levels was also noted. The association between retinopathy (P = 0.001) and peripheral pulses (P = 0.001) with FE-1 levels were found to be statistically significant. Conclusion: This study validates the benefit of FE-1 estimation, as a surrogate marker of exocrine pancreatic insufficiency, which remains unmanifest and subclinical