The role of online medical direction in emergency medical services in India

Medical direction is a system of physician-directed quality assurance that provides professional and public accountability for medical care provided in the prehospital setting. In an Emergency Medical Services (EMS) system, medical direction provides the operational framework and authorization for EMTs and others to provide emergency treatment outside the hospital. While attending and transporting critical patients to a definitive care setting, there is a need for advanced interventions and administration of drugs to the patients, this will alleviate patient suffering and ultimately allow the patient to be delivered to a receiving hospital in an already improved clinical state whenever possible. The Emergency Medical Technician (EMT) in the ambulance is not licensed to administer drugs to the patient on his own. As EMTs are not aware of administering drugs to the patients in critical situation, there is an urgent need to increase the percentage of critical cases with ERCP advice handled by EMT. The current descriptive study has been conducted to identify the hurdles and gaps preventing communication among the EMT and ERCP among a sample of 40 Emergency Medicine staff through a structured questionnaire. The study showed that there are substantial hurdles when the EMT wants to talk to the emergency physician, which can be removed by a few changes like adopting a new method of enhancing skills and training activities, revision of policies and protocols and a few managerial activities

Study of determination of laboratory turnaround time in tertiary care hospital in India

Turnaround time (TAT) is commonly defined as the time from when a test is ordered until the result is reported. TAT is often considered the most significant measure of a laboratory’s service and is used by many clinicians to judge its quality. Timely reporting of laboratory test results is now considered an important aspect of the services provided by the clinical laboratory. It has also been shown that outcomes in certain situations such as operation theaters and in emergency departments have been affected by timely reporting of lab tests results. Rapid laboratory turnaround times are important both from a medical and commercial point of view. The study was conducted from 1 April 2013 to 31 May 2013. Out of total 232 samples, 183 samples (78.88%) were taken for analysis. 100 (54.65%) samples were within TAT time and 83 (45.35 %) samples were delayed. Out of total 83 samples which were delayed, 48 (57.83%) samples had TAT between 60 minutes to 90 minutes, 22 (26.51%) samples had TAT between 90 minutes to 120 minutes, 9 (10.84%) samples had TAT between 120 minutes to 180 minutes, and 4 (4.82%) samples had TAT over 180 minutes. Average time between sample collection and lab reach was observed to be 15 min. 38 sec. Transport delay was observed. Instrumentation failure was observed in biochemistry - 2 times and thyroid - 1 time. Hence this study aims to evaluate the delay and reason of delay of turnaround time (TAT) of stat tests in section of clinical chemistry of the clinical laboratory.

Case study on reimbursement process and settlement of bills of patients treated under package charges in super speciality public hospital

Background: In the Government hospitals, because of constraints of resources, patients are often asked to buy certain items required for their treatment procedure. There is an inadvertent delay in bill reimbursement process due to the cumbersome procedure, which causes dissatisfaction among patients. Thus, it was highly imperative to reduce the reimbursement time and improve the level of patient satisfaction by improving quality of services. The present study depicts modifications initiated to reduce causes of delay and improve patient satisfaction.Methods: Process mapping was done for different procedures which are carried out under package system at Cardio Neuroscience Centre. All the available documents were analysed from Operation theatre, Wards, ICU, Billing section, Account office, OPD area etc. and Interviews were taken from consultants, nursing staff, staff working at Billing section, Account office etc. to identify causes of delay.Results: The study helped in improvement in efficiency by 60% percent and reduces the number of resources by 10 percent.Conclusions: The study helped to increase productivity gains and improve accuracy

Clinical profile of patients with acute coronary syndrome with special reference to diabetes mellitus

Background: Ischemic heart disease is defined as inadequate blood flow resulting in decreased oxygenation to the myocardium due to severe narrowing and/or complete blockage of coronary arteries. Although a number of risk factors have been identified over the past several decades, the precise aetiology and mechanisms leading to the development of CAD are not fully understood. These includes abnormal levels of circulating cholesterols with elevated level of LDL-cholesterol and reduced level of HDL-cholesterol, hypertension, cigarette smoking, diabetes mellitus, male gender, post-menopausal state, advanced age, sedentary life style, obesity and a positive family history of premature cardiovascular disease female population.Methods: Our study was aimed to interrogate and to assess the patients presenting with acute coronary syndrome, for the presence of conventional risk factors with special eye on diabetes and to stratify patients with acute coronary syndrome according to their diabetic status (Diabetic vs. non diabetic) and also to study pattern of involvement of coronary arteries in diabetic and non-diabetic patients and to stratify patient according to treatment they received PTCA vs. CABG.Results: It was observed that out of 100 patients with diabetes mellitus, 71% patients were having diabetes mellitus. Among the diabetics in this study, STEMI (73.13%) was the commonest presentation of ACS. On the other hand amongst diabetics, 58.33% had STEMI.Conclusion: Patients with diabetes mellitus had more dyslipidemia, hypertension and smokers. This group of patients required maximum intervention in the form PTCA and CABG.

Case study on reimbursement process and settlement of bills of patients treated under package charges in super speciality public hospital

Background: In the Government hospitals, because of constraints of resources, patients are often asked to buy certain items required for their treatment procedure. There is an inadvertent delay in bill reimbursement process due to the cumbersome procedure, which causes dissatisfaction among patients. Thus, it was highly imperative to reduce the reimbursement time and improve the level of patient satisfaction by improving quality of services. The present study depicts modifications initiated to reduce causes of delay and improve patient satisfaction.Methods: Process mapping was done for different procedures which are carried out under package system at Cardio Neuroscience Centre. All the available documents were analysed from Operation theatre, Wards, ICU, Billing section, Account office, OPD area etc. and Interviews were taken from consultants, nursing staff, staff working at Billing section, Account office etc. to identify causes of delay.Results: The study helped in improvement in efficiency by 60% percent and reduces the number of resources by 10 percent.Conclusions: The study helped to increase productivity gains and improve accuracy