International journal of contemporary medical research, Aug 1, 2018
Introduction: NABH defines discharge as a process by which a patient is shifted out from the hosp... more Introduction: NABH defines discharge as a process by which a patient is shifted out from the hospital with all concerned medical summaries ensuring stability. The discharge process is deemed to have started when the consultant formally approves discharge and ends with the patient leaving the clinical unit. The study aimed to view the discharge process of SKIMS, compare it with NABH criteria AAC 13 and 14 and look for any bottlenecks. Material and Methods: The study was carried out in General medicine and General Surgery wards of inpatient department of SKIMS. It was an observational type of study where in all the patients who got discharged in the said wards from 10am to 4pm daily (Except Sundays) were observed for Discharge process including average time taken and the existing Discharge Process in SKIMS was compared with National board of Hospitals and health care organization (NABH) standards and objective elements. Results: A total of 710 Discharged patients were observed during the study period which includes 417 patients from General surgery department and 293 patients from General medicine side. The results show that the average time taken for discharge process was 240 minutes for those who had a planned discharge and had to pay out of pocket (Self-Payment). It was 255 minutes for those who had been discharged against medical advice (DAMA) while it was 270 minutes for below poverty line (BPL) patients who had to exempt hospital charges. The discharge time for all types of discharges was higher when compared to NABH criteria's. Conclusion: The results clearly indicate that average time taken for all types of discharges in SKIMS is more than prescribed NABH criteria. SKIMS as per the observations is following many objective elements of standards AAC 13 and 14 but discharge process and time needs to be defined and documented. The SKIMS should formulate a policy regarding a discharge process of a hospital wherein steps and time taken should be clearly defined and all measures should be taken in order to adhere to NABH standards.
International Journal of Contemporary Medical Research [IJCMR], 2018
Introduction: Older adults comprise majority of people receiving hospital services in many region... more Introduction: Older adults comprise majority of people receiving hospital services in many regions of our country. The Present Research was carried out to see physical facilities and problems faced by Geriatric patients in a tertiary care hospital. Material and Methods: It was a prospective type of study undertaken on elderly people based on Questionnaire. Cases were selected by Systematic Random sampling method by picking every 5th patient of the target population after checking the admission files in all wards. A total of 421 cases selected through systematic random sampling were studied. The questionnaire was developed and validated by a pilot study. The study population in the study were elderly (Geriatric) group of people with age = or > 60years as per their medical record. All those patients who do not agree to participate in the study and those patients who were comatose or on ventilator were excluded from the study. Results: Various parameters studied were Waiting time, availability of wheel chair / stretcher, separate counters at admission, nursing aides; difficulties in locating admission office, in getting the investigations done; 'Respect for age' and privacy, Routine cleanliness,pattern of toilets, Quality/ Quantity of food served, Information given at discharge about the management at home. Conclusion: The study on conclusion establishes that hospitals need to be made Geriatric friendly and Hospital management needs to introduce practicum in order to train and retrain the hospital patient care staff including doctors and nurses to improve their behaviour and skills to deal with the elderly patients so that their stay in the hospital is facilitated.
Introduction: Poisoning is a common medico-social problem. It is a significant contributor to mor... more Introduction: Poisoning is a common medico-social problem. It is a significant contributor to morbidity and mortality. Knowledge of the epidemiology of poisoning and its changes is important to both emergency physicians and public health practitioners. Our study was to determine the socio-demographic profile, pattern and outcome of the poisoning cases reported to the Emergency Department of a tertiary care hospital. Methods: The study was a Retrospective observational type of study conducted at Sheri-Kashmir Institute of medical sciences, Srinagar J&K. The patients with acute poisonings presenting to and managed in the Emergency Medicine department between February 2016 to February 2018 were reviewed for inclusion. Data was collected by reviewing records . Using a pre-structured format, case records of poisoning cases were reviewed for gender, age, residence, type of poison, route of poison and outcome of treatment. The collected data was analyzed using descriptive statistical anal...
BACKGROUND: Amarnathji cave, situated at an altitude of 3,888 m, about 141 km from Srinagar, is o... more BACKGROUND: Amarnathji cave, situated at an altitude of 3,888 m, about 141 km from Srinagar, is one of the holiest shrines in Hinduism. The annual pilgrimage to Amarnathji is a very demanding endeavor requiring strenuous physical efforts, and poses many health hazards to the pilgrims, especially elderly and those with chronic illnesses. OBJECTIVE: To study the pattern and outcome of illness in Yatris attending SKIMS during Amarnathji Yatra 2011. METHODS: This prospective study was carried during 45 day Yatra period, from July 2011 to August 2011. All the patients referred to SKIMS were recruited for the study. RESULTS: Of the 185 patients received in SKIMS during the mentioned yatra period, 100 were discharged on emergency-OPD card on the same day, and the remaining 85 patients (48 men) were admitted. Age of the patients ranged from 15 to 85 years with a mean of 51.49 ±15.49 (median, 53 years) with majority in the age group of 45 to 65 years. AMI was the main diagnosis at arrival (i...
Lead time is one of the most important factors that drive procurement cycle and buffer stock, and... more Lead time is one of the most important factors that drive procurement cycle and buffer stock, and tremendous gains can be realized by focusing on reducing lead times. Materials and methods: The present study was a retrospective one. A standardized proforma was used to collect the data. The internal lead time was calculated from the time the requisition is sent to purchase department up to placement of supply order. The external lead time included the time from placement of supply order up to receipt of supplies. Results: It was observed that for majority of drugs internal lead time was 20 to 30 days viz. 40%. It was observed that majority of drugs/items were received within forty days viz. 74% from date, the order was placed against the supplier. Average Internal lead time calculated was 27 days. The average total lead time calculated was around 61 days. Conclusion: The aim should be to provide right item, at right price at right time. The purchase process has to be streamlined by removing various bottlenecks.
BACKGROUND: The unique role of the Emergency Department (ED) has prompted some to call it the saf... more BACKGROUND: The unique role of the Emergency Department (ED) has prompted some to call it the safety net of the health care system. Unfortunately the increasing problem of crowding has strained this safety net to the breaking point according to some recent reports. OBJECTIVE: To study the patient flow at Emergency Department of a tertiary care centre. METHODS: This prospective study was carried over a period of two weeks at SKIMS in the month of December 2011. RESULTS: Of 175 patients attending on an average within twenty four hours to SKIMS emergency department, 22.3% of patients were admitted. 50 patients on an average were being treated at ED reception, the space which is meant for maximum of 16 patients. The hospital crowding was primarily regarded as a consequence of inadequate medical resources. Patients were seen more likely to leave without being seen when ED occupancy exceeded 100% of the total capacity. The shifting of admitted patients from ED depended on throughput facto...
International Journal of Research in Medical Sciences, 2016
Preventable harm to patients resulting from their healthcare is unacceptable at any time. Patient... more Preventable harm to patients resulting from their healthcare is unacceptable at any time. Patient safety is first and foremost a clinical problem, but it is also an important cause of wasted resources. 1 One of the key features of the patient safety 'movement' is the belief that safety can be improved by learning from incidents and near misses, rather than pretending they have not happened. 2 A good quality report should lend itself for detailed analysis of the chain of events that lead to the incident. This knowledge can then be used to consider what interventions, and at what level in the chain, can prevent the incident from occurring again. 3 The objective is to study the occurrence of adverse events on the basis of incident reporting.
International Journal of Research in Medical Sciences, 2016
Every second week there was a mortality meet held in the auditorium of Sheri Kashmir Institute of... more Every second week there was a mortality meet held in the auditorium of Sheri Kashmir Institute of Medical Sciences (SKIMS), discussing the preventable deaths of the patients in the hospital. The cases for the presentation were selected by the mortality meet committee comprising of various head of departments. The researcher attended the mortality meets from 1 st January 2013 to 31 st December 2013 for the period of one year to note down the details of the patients and the adverse events discussed in the meet. The patients who were ABSTRACT Background: There is an increasing belief that an institution's ability to avoid patient harm will be realized when it creates a culture of safety among its staff members. Aims to study the cases discussed in mortality meets. Methods: Critical analysis of cases discussed in mortality and morbidity meet were done for one year by using WHO Structured questionnaire on patient safety (RF-1 & RF-2 forms) along with their record review and interview to the concerned staff. Results: 62 mortality and morbidity meetings were conducted during the study period of one year. Cardiac/ Respiratory arrest was the most common adverse event studied (67.7%) followed by unexpected death (48.4%). 52.7% of studied adverse events showed signs of healthcare team responsible for causing adverse events, mainly related to the therapeutic care (64.8%). 47% of adverse events were categorized preventable. Conclusions: Mortality and Morbidity Meets should be made mandatory in all hospitals.
The clean bedding and clean clothes installs psychological confidence in the patients and the pub... more The clean bedding and clean clothes installs psychological confidence in the patients and the public and enhances their faith in the services rendered by the hospital. Being an important Component in the management of the patients, a study was carried out to find out the current quality status and its conformity with the known standards and identify the areas of intervention in order to further increase the patient and staff satisfaction regarding the services provided by linen and laundry department Quality control practised in the Linen and Laundry Service was studied by conducting a prospective study on the concept of Donabedian model of structure, process and outcome. Study was done by pre-designed Proforma along with observation / Interviews / Questionnaire and study of records. The input studied included physical facilities, manpower, materials, equipments and environmental factors. The various elements of manpower studied consisted of number of staff working, their qualificat...
A “near miss” is an unpleasant event that did not result in injury, illness, or damage but had th... more A “near miss” is an unpleasant event that did not result in injury, illness, or damage but had the potential to do so, but for a fortunate break in the chain of events. We present a near-miss case which occurred in the MR suite of a tertiary care hospital. Although the MR is considered a very safe procedure, if MR safety guidelines are not adhered to, adverse and catastrophic events to the extent of patient deaths are known to have occurred. It is hoped that this incident will prompt hospitals to document and follow MR safety protocols for patient and staff safety. Although MRI is an extremely safe procedure rarely MR adverse incidents have resulted in serious physical injury or even death. The incident is an eye opener regarding potential adverse events lurking in the relatively safe MR environment and provides an opportunity to rectify the inadequacies in MR safety.
International journal of contemporary medical research, Aug 1, 2018
Introduction: NABH defines discharge as a process by which a patient is shifted out from the hosp... more Introduction: NABH defines discharge as a process by which a patient is shifted out from the hospital with all concerned medical summaries ensuring stability. The discharge process is deemed to have started when the consultant formally approves discharge and ends with the patient leaving the clinical unit. The study aimed to view the discharge process of SKIMS, compare it with NABH criteria AAC 13 and 14 and look for any bottlenecks. Material and Methods: The study was carried out in General medicine and General Surgery wards of inpatient department of SKIMS. It was an observational type of study where in all the patients who got discharged in the said wards from 10am to 4pm daily (Except Sundays) were observed for Discharge process including average time taken and the existing Discharge Process in SKIMS was compared with National board of Hospitals and health care organization (NABH) standards and objective elements. Results: A total of 710 Discharged patients were observed during the study period which includes 417 patients from General surgery department and 293 patients from General medicine side. The results show that the average time taken for discharge process was 240 minutes for those who had a planned discharge and had to pay out of pocket (Self-Payment). It was 255 minutes for those who had been discharged against medical advice (DAMA) while it was 270 minutes for below poverty line (BPL) patients who had to exempt hospital charges. The discharge time for all types of discharges was higher when compared to NABH criteria's. Conclusion: The results clearly indicate that average time taken for all types of discharges in SKIMS is more than prescribed NABH criteria. SKIMS as per the observations is following many objective elements of standards AAC 13 and 14 but discharge process and time needs to be defined and documented. The SKIMS should formulate a policy regarding a discharge process of a hospital wherein steps and time taken should be clearly defined and all measures should be taken in order to adhere to NABH standards.
International Journal of Contemporary Medical Research [IJCMR], 2018
Introduction: Older adults comprise majority of people receiving hospital services in many region... more Introduction: Older adults comprise majority of people receiving hospital services in many regions of our country. The Present Research was carried out to see physical facilities and problems faced by Geriatric patients in a tertiary care hospital. Material and Methods: It was a prospective type of study undertaken on elderly people based on Questionnaire. Cases were selected by Systematic Random sampling method by picking every 5th patient of the target population after checking the admission files in all wards. A total of 421 cases selected through systematic random sampling were studied. The questionnaire was developed and validated by a pilot study. The study population in the study were elderly (Geriatric) group of people with age = or > 60years as per their medical record. All those patients who do not agree to participate in the study and those patients who were comatose or on ventilator were excluded from the study. Results: Various parameters studied were Waiting time, availability of wheel chair / stretcher, separate counters at admission, nursing aides; difficulties in locating admission office, in getting the investigations done; 'Respect for age' and privacy, Routine cleanliness,pattern of toilets, Quality/ Quantity of food served, Information given at discharge about the management at home. Conclusion: The study on conclusion establishes that hospitals need to be made Geriatric friendly and Hospital management needs to introduce practicum in order to train and retrain the hospital patient care staff including doctors and nurses to improve their behaviour and skills to deal with the elderly patients so that their stay in the hospital is facilitated.
Introduction: Poisoning is a common medico-social problem. It is a significant contributor to mor... more Introduction: Poisoning is a common medico-social problem. It is a significant contributor to morbidity and mortality. Knowledge of the epidemiology of poisoning and its changes is important to both emergency physicians and public health practitioners. Our study was to determine the socio-demographic profile, pattern and outcome of the poisoning cases reported to the Emergency Department of a tertiary care hospital. Methods: The study was a Retrospective observational type of study conducted at Sheri-Kashmir Institute of medical sciences, Srinagar J&K. The patients with acute poisonings presenting to and managed in the Emergency Medicine department between February 2016 to February 2018 were reviewed for inclusion. Data was collected by reviewing records . Using a pre-structured format, case records of poisoning cases were reviewed for gender, age, residence, type of poison, route of poison and outcome of treatment. The collected data was analyzed using descriptive statistical anal...
BACKGROUND: Amarnathji cave, situated at an altitude of 3,888 m, about 141 km from Srinagar, is o... more BACKGROUND: Amarnathji cave, situated at an altitude of 3,888 m, about 141 km from Srinagar, is one of the holiest shrines in Hinduism. The annual pilgrimage to Amarnathji is a very demanding endeavor requiring strenuous physical efforts, and poses many health hazards to the pilgrims, especially elderly and those with chronic illnesses. OBJECTIVE: To study the pattern and outcome of illness in Yatris attending SKIMS during Amarnathji Yatra 2011. METHODS: This prospective study was carried during 45 day Yatra period, from July 2011 to August 2011. All the patients referred to SKIMS were recruited for the study. RESULTS: Of the 185 patients received in SKIMS during the mentioned yatra period, 100 were discharged on emergency-OPD card on the same day, and the remaining 85 patients (48 men) were admitted. Age of the patients ranged from 15 to 85 years with a mean of 51.49 ±15.49 (median, 53 years) with majority in the age group of 45 to 65 years. AMI was the main diagnosis at arrival (i...
Lead time is one of the most important factors that drive procurement cycle and buffer stock, and... more Lead time is one of the most important factors that drive procurement cycle and buffer stock, and tremendous gains can be realized by focusing on reducing lead times. Materials and methods: The present study was a retrospective one. A standardized proforma was used to collect the data. The internal lead time was calculated from the time the requisition is sent to purchase department up to placement of supply order. The external lead time included the time from placement of supply order up to receipt of supplies. Results: It was observed that for majority of drugs internal lead time was 20 to 30 days viz. 40%. It was observed that majority of drugs/items were received within forty days viz. 74% from date, the order was placed against the supplier. Average Internal lead time calculated was 27 days. The average total lead time calculated was around 61 days. Conclusion: The aim should be to provide right item, at right price at right time. The purchase process has to be streamlined by removing various bottlenecks.
BACKGROUND: The unique role of the Emergency Department (ED) has prompted some to call it the saf... more BACKGROUND: The unique role of the Emergency Department (ED) has prompted some to call it the safety net of the health care system. Unfortunately the increasing problem of crowding has strained this safety net to the breaking point according to some recent reports. OBJECTIVE: To study the patient flow at Emergency Department of a tertiary care centre. METHODS: This prospective study was carried over a period of two weeks at SKIMS in the month of December 2011. RESULTS: Of 175 patients attending on an average within twenty four hours to SKIMS emergency department, 22.3% of patients were admitted. 50 patients on an average were being treated at ED reception, the space which is meant for maximum of 16 patients. The hospital crowding was primarily regarded as a consequence of inadequate medical resources. Patients were seen more likely to leave without being seen when ED occupancy exceeded 100% of the total capacity. The shifting of admitted patients from ED depended on throughput facto...
International Journal of Research in Medical Sciences, 2016
Preventable harm to patients resulting from their healthcare is unacceptable at any time. Patient... more Preventable harm to patients resulting from their healthcare is unacceptable at any time. Patient safety is first and foremost a clinical problem, but it is also an important cause of wasted resources. 1 One of the key features of the patient safety 'movement' is the belief that safety can be improved by learning from incidents and near misses, rather than pretending they have not happened. 2 A good quality report should lend itself for detailed analysis of the chain of events that lead to the incident. This knowledge can then be used to consider what interventions, and at what level in the chain, can prevent the incident from occurring again. 3 The objective is to study the occurrence of adverse events on the basis of incident reporting.
International Journal of Research in Medical Sciences, 2016
Every second week there was a mortality meet held in the auditorium of Sheri Kashmir Institute of... more Every second week there was a mortality meet held in the auditorium of Sheri Kashmir Institute of Medical Sciences (SKIMS), discussing the preventable deaths of the patients in the hospital. The cases for the presentation were selected by the mortality meet committee comprising of various head of departments. The researcher attended the mortality meets from 1 st January 2013 to 31 st December 2013 for the period of one year to note down the details of the patients and the adverse events discussed in the meet. The patients who were ABSTRACT Background: There is an increasing belief that an institution's ability to avoid patient harm will be realized when it creates a culture of safety among its staff members. Aims to study the cases discussed in mortality meets. Methods: Critical analysis of cases discussed in mortality and morbidity meet were done for one year by using WHO Structured questionnaire on patient safety (RF-1 & RF-2 forms) along with their record review and interview to the concerned staff. Results: 62 mortality and morbidity meetings were conducted during the study period of one year. Cardiac/ Respiratory arrest was the most common adverse event studied (67.7%) followed by unexpected death (48.4%). 52.7% of studied adverse events showed signs of healthcare team responsible for causing adverse events, mainly related to the therapeutic care (64.8%). 47% of adverse events were categorized preventable. Conclusions: Mortality and Morbidity Meets should be made mandatory in all hospitals.
The clean bedding and clean clothes installs psychological confidence in the patients and the pub... more The clean bedding and clean clothes installs psychological confidence in the patients and the public and enhances their faith in the services rendered by the hospital. Being an important Component in the management of the patients, a study was carried out to find out the current quality status and its conformity with the known standards and identify the areas of intervention in order to further increase the patient and staff satisfaction regarding the services provided by linen and laundry department Quality control practised in the Linen and Laundry Service was studied by conducting a prospective study on the concept of Donabedian model of structure, process and outcome. Study was done by pre-designed Proforma along with observation / Interviews / Questionnaire and study of records. The input studied included physical facilities, manpower, materials, equipments and environmental factors. The various elements of manpower studied consisted of number of staff working, their qualificat...
A “near miss” is an unpleasant event that did not result in injury, illness, or damage but had th... more A “near miss” is an unpleasant event that did not result in injury, illness, or damage but had the potential to do so, but for a fortunate break in the chain of events. We present a near-miss case which occurred in the MR suite of a tertiary care hospital. Although the MR is considered a very safe procedure, if MR safety guidelines are not adhered to, adverse and catastrophic events to the extent of patient deaths are known to have occurred. It is hoped that this incident will prompt hospitals to document and follow MR safety protocols for patient and staff safety. Although MRI is an extremely safe procedure rarely MR adverse incidents have resulted in serious physical injury or even death. The incident is an eye opener regarding potential adverse events lurking in the relatively safe MR environment and provides an opportunity to rectify the inadequacies in MR safety.
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