Study of compliance of crash carts to standards in the emergency of a tertiary care teaching hospital

Background: The successful management of cardiopulmonary emergencies revolves around the optimum utilization of the golden hour, so that the patient gets the best possible advantage at survival. Aim of the study was to perform gap analysis of crash carts in the emergency of a tertiary care teaching hospital by comparing the salient parameters with standards listed by Resuscitation Council UK (for equipment) and National Accreditation Board of Hospitals and health care providers (for management of medication). Further, to assess the improvement in compliance with the simple intervention of educating staff regarding protocols.Methods: A descriptive, quantitative, observational study, supplemented in the second phase by an intervention to increase awareness of staff in achieving standardization, followed further by assessing the level of improvement in compliance to standards in terms of content, labeling, documentation and functionality of the contents of the carts.Results: The root causes of non-adherence to standardization were design of the area and of the cart, amount of workload which led to neglect of labelling, documentation protocols resulting in decreased accountability and inefficient monitoring. This impacted the adequate provision of content and functionality of the items in the crash carts. Human factor engineering in the form of customization of crash carts for cognitive ergonomic design, clarity and awareness of guidelines among the nursing staff i.e. ‘first responder’ went a long way in improving compliance to standards.Conclusions: Human factor engineering supplemented by usage of sub-trolleys, along with increasing sensitivity and awareness to standard protocols, can help achieve maximum compliance in terms of the effective functioning of crash carts in the emergency

To study the impact of design considerations on customer satisfaction in a dialysis facility of a super-specialty tertiary care hospital in Delhi, India

Background: In recent times, patient focused hospital architecture is gaining attention. The current scenario demands to provide living spaces for families rather than ware houses for the sick. Attitudes, aspiration and values of the society must be clearly understood while planning a facility.Methods: This prospective cross sectional observational study was carried out over a period of one year at the Dialysis unit of a tertiary care, super specialty hospital in North India with the objective to establish that minor structural changes can enhance customer delight which includes patients and their attendants of a chronic disease patient population visiting a health care facility and satisfaction of the staff of the facility. The tool used was a structured 5 point Likert scaled questionnaire including unstructured interviews. These were held with 200 patients availing treatment in the old and new dialysis unit each and who have at least had three dialysis treatments within 6 months in the both the units. Also, for staff satisfaction, 25 staff working for at least one month in the old unit and new unit each. Data was analysed using SPSS 17.0 software.Results: Good design and quality of care were regarded important for patient experience. For patients, overall functioning and efficiency of the processes in the facility dependent on the design of the building was most important. Just over half of all surveyed patients felt that design impacted their relationship with their doctor and the quality of the care received. For attendants, waiting area including billing facility fetched the highest parameter for satisfaction. For staff the importance of access to support services, safety and provision of basic facilities resonated with the patient views presented above. Privacy, confidentiality and patient safety through careful design of waiting room, reception and consulting room were high staff priorities. Design that facilitated communication between team members also emerged as an important area although the change in design did not make much difference in emotional wellbeing and work life balance of the staff.Conclusions: This study did not yield sufficient data to confirm or refute either concept, though clearly this merit further investigation. Some unexpected findings were reported. Specifically, the survey data rated privacy and the availability of comfortable physical conditions as the highest priority for both staff and patients

Always, better and control - vital, essential, desirable matrix analysis of the drug store of a tertiary care teaching hospital of North India

Background: Substantial improvement can be brought about in the hospital inventory and drug expenditure by inventory control techniques. These include ABC (always, better and control), VED (vital, essential and desirable) and ABC-VED matrix analysis. The objective of the study was to categorize the drugs based on cost and criticality and identify those which require stringent managerial control.Methods: ABC analysis according to drug expenditure, VED analysis according to criticality of the drugs,  ABC-VED matrix analysis to classify drugs into category I, II and III was done for drug store of a tertiary care teaching hospital of North India for the period of April, 2018 to March, 2019.Results: The total number of the drug items used by the drug store was 315. The total drug expenditure was Rs. 9,61,29,859. By ABC analysis, it was found that 15.24%, 22.54% and 62.22% items belonged to A, B and C category respectively, accounting for 70%, 20% and 10% of Annual Drug Expenditure (ADE). VED analysis showed that 31.11%, 60.32% and 8.57% were V, E, and D category items respectively, accounting for 30.44%, 57.12% and 12.44% of ADE. By ABC-VED matrix analysis, 42.86%, 52.38% and 4.76% items were category I, II and III items respectively, accounting for 78.91%, 20.15% and 0.94% of ADE.Conclusions: The study depicted the items belonging to category I which requires top managerial control, also the items belonging to categories II and III which require control by middle and lower managerial level respectively

COVID-19 disease and comorbidity: an outcome? A study on Indian population in a COVID care hospital

Background: The world has been severely affected by the novel coronavirus disease (Covid-19). Continuously rising number of cases has put a significant strain on healthcare resources of all countries of the world. Preliminary studies show that people suffering from comorbid conditions are at a relatively higher risk of severe disease and poor outcome.Methods: We studied the risk of ICU admission in 152 Covid-19 positive patients with comorbidity compared to those without comorbid conditions. We studied effect of old age (>65 years), male sex, presence of at least one comorbidity, presence of multiple comorbidities, diabetes mellitus, hypertension, CAD, respiratory disease, neurological disease, skin disease, and hypothyroidism on outcome of coronavirus disease with two tailed Student’s t-test, odds ratio, Chi-square test was used to test significance of results at 95% confidence interval 95% (95% CI). Fisher’s test was also used if one expected value (row total × column total/grand total) was less than 5.Results: In this study, 23 (15.13%) required ICU care. We found higher odds of ICU admission in Covid-19 patients in case of presence of comorbid condition (OR=7.3, 95% CI=2.674, 20.038), diabetes mellitus (OR=2.8, 95% CI=1.035, 8.028), hypertension (OR=1.3, 95% CI=0.396, 4.258), coronary artery disease (OR=2.3, 95% CI=0.430, 12.978) and malignancy (OR=6.5, 95% CI=1.516, 28.54). Case fatality rate (CFR) of those with comorbid conditions was higher (7.55) compared to those without comorbidity (3.03).Conclusions: This study shows that presence of comorbid conditions in Covid-19 positive patients results in significantly higher risk of ICU admission and poor outcome

An Analysis of the Economic Burden of the Trauma Services at a Level 1 Public Sector Trauma Center in South Asia

Background: Incidence of road traffic injuries (RTIs) is increasing and accounting for country's 3% gross domestic product. It is crucial to perform a cost analysis of trauma systems to allocate resources judiciously. Aim and Objectives: To study the economic burden of trauma care on the patient attending a level I trauma center including stratification of costs according to injury. Materials and Methods: This is a prospective study, with patients of polytrauma (Injury Severity Score >16) admitted in the center. Cost analysis (cost descriptive study) was done by calculating direct costs to hospital by bottom-up microcosting considering fixed and recurrent costs including reference unit prices (RUPs). According to the anatomical site of injuries, major injury groups (MIGs) costs were also analyzed. Results: The demographics including mode of injury were similar to other studies. The RUP's and MIG's were defined which represented majority of the sample size. Due to highly subsidized nature of services in this Government institute, the cost to patient is less compared to other countries. Still, the total expenditure incurred by the low-income group was higher than the minimum wages at that time. The creation of plausible RUP's and the grouping of MIG's can help in reducing the costs by targeting and implementing strategic cost reduction measures. Conclusion: The study has shown that microcosting is feasible. Considering the low-income population demanding trauma services, further efforts are required to reduce costs substantially

Supplementary_table - Patient Involvement in Decision-Making: An Important Parameter for Better Patient Experience—An Observational Study (STROBE Compliant)

<p>Supplementary_table for Patient Involvement in Decision-Making: An Important Parameter for Better Patient Experience—An Observational Study (STROBE Compliant) by Namrata Makkar, Kanika Jain, Vijaydeep Siddharth, and Siddharth Sarkar in Journal of Patient Experience</p