Organising a Free Medical Camp/CME

 

HOW TO ORGANISE A FREE MEDICAL CAMP ?

Organising a free medical camp is no easy task as it requires ofcourse fund and lots of planning. However, if done correctly, it will be very helpful and an effective tool in increasing brand awareness and business for any hospital.

There has been a lot of debate on role of free camps and continuing medical education programmes (CMEs) as effective marketing tools for hospitals/ Nursing Homes. Its proven that a camp or a CME is a useful marketing tool only if its potential is tapped properly which again needs a statageically planned followup .

Though most hospitals organise free camps, in which sizeable number of patients turn up, but the tragic part is, that these patients do not make it to the hospital in the end. In other words they fail to get translated into business.

This leaves the hospital promoters wondering whether the whole exercise was worth it or not. Similarly, there may be a good number of people who attend a CME and then forget about the hospital which organised it within a week. The flight of fancy of the organising hospital ends up in despair as hardly any referrals get generated in spite of spending so much time and money.

Over the last few years while I have had the opportunity to organise a few camps and CMEs for my hospital , I have learned few facts which may help a hospital to gain maximum advantage from a camp or a CME.

I would, however, assert that these two are not the only ways of generating patient flow. Also, the hospitals in my opinion should use these as a long term brand building tool rather than a formula for instant patient generation. It would be useful to add that the guidelines being mentioned here are useful in many ways but they do not guarantee anything.

First of all, the hospital must always organise the CME and the camp together for a long lasting effect.

 

Few tips to make your camp a hit :

1. Organise the camp on a holiday or a weekend. This will allow more patient flow .

2. If you are organising a speciality camp for a particular disease, consider keeping a token fee because it will help to filter ?genuine patients? from the free camp buffs who grace all the camps in town with their presence

3. Take help of a local authority, or the local Club or some other NGO to impart some credibility to the camp. Use their facility for the camp. It is also a good idea to use the facility of a smaller nursing home or a clinic for the event

Just make sure that the clinic you are using enjoys a good reputation among the locals. In such a case, the clinic or the nursing home which is co-organising with you may also share the publicity expenditure with you. They would do so because you are boosting their image in the local market and they will also earn from the investigations or the medicines you might prescribe to the patients

4. Make sure you carry a lot of medicine samples to be distributed free to the patients

5. Always market a camp as a screening camp for the procedures which would be carried out at the hospital at a later date. Announce a discount for the ?selected? patients. The ideal thing would be to rope in the NGO or some local government body or politicians or businessmen or all of these to bear some percentage of expenses for the procedures you would carry out on ?selected? patients if they are poor.

This will help in making your camp a great hit. People will not get offended if you call them over to your place for the procedure since you have already admitted that the purpose of the camp is to screen eligible candidates for surgery or other procedures. Plus pitching in credible sponsors will instill confidence in people apart from reducing their monetary burden

6. Build a hype for the camp at least four days before the event.

Make your camp unique. Don?t make it sound as just another camp by some hospital. This can be done using myriad marketing tools. The most effective in my opinion are :

a. Pamphlets [if designed professionally], give it a catchy headline, use short sentences, mention free medicines, include a picture in the pamphlet to catch attention. These pamphlets can be used as inserts in the paper

b. A loud speaker mounted on the top of a vehicle and a person announcing the event date and other particulars. You could be innovative to have these announcements be made in an interesting way, like in form of a poem or a song. This helps to gain attention of people

c. Banners put at a decent height so as to be visible. Put these at places like bus stand or a busy crossing

d. Run an ad on the local cable TV channel. Highlight whatever is free and also tell them that the procedures will be performed at a discount rate on patients selected from the camp.

e. Give a pre-camp press note to all the leading newspapers of the area. Tell them you are arriving with something very relevant and unique

f. Always have a small opening ceremony for the camp. If a prominent figure from your locality / NGO/ CORPORATOR comes it will give you free press reviews/ publicity .Do not forget to have a cameraman be present there for clicking the photographs

7. During the camp manage the crowd in a systematic way. Make sure that people do not have to wait long hours and are taken care of. Always have a ?marketing guy? seated alongside you when examining people. This person will do the job of telling eligible patients how much discount they would get if they reach within 10 days for surgery. Who all are paying a part of their hospital bill, what is the best way to reach the hospital and what advantages they would get if they come to you in the next ten days.

Take care that all this is done in a subtle way. People are likely to get upset if they experience any hardshell. This guy must take the addresses and phone numbers of all the potential patients so that they are informed whenever you have another camp in the area.

8. Ensure that you are running audio visual clips in the OPD area while the camp is on. These clips may highlight your hospital services and may also contain testimonials from your previous patients. Also give brochures and other reading material to the patients generously.

9. Invariably follow a camp with a press conference. Have the local press and cable TV people be present at a nearby caf?. Give them photographs of the camp to be printed. Tell them something which is sensational enough to make headlines the next day. For instance tell them why Indians are more prone to heart disease or how women get gall stones so frequently these days or how the new technique available at your hospital has revolutionised the medical field, etc.

10. At the end of the day if you get the names and addresses of a few legitimate patients and if the press people send in a detailed report on your camp, you have done your job. Not to forget the ?sponsors? who chip in to help poor patients requiring surgery. As it turns out, organising a camp is not a joke. It requires a team of three-four people out of which at least one is a marketing professional with some exposure in this area.Iif done correctly, a camp will give you a good reason to have cheers at your face it always helps in increasing footfalls and business.

My next camp on Renal Diseases including dialysis and kidney transplant is due next will I will surely share my experinces by next to next week. More for next time

Ensuring safe Injectible

There is a need to facilitate a safe injection environment to improve the healthcare delivery system and elucidates on the means to enable it

Today injections are among the most common of all clinical procedures. Billions and Billions of injections are administered every year to facilitate preventive and curative care. Yet, in a majority of developing countries almost half of these injections are unsafe due to reuse of single-use syringes and/ or needles, faulty technique, and poor disposal methods.

These faulty handling issues expose patients, healthcare practitioners and the public, at large, to the risk of transmission of infections, which cause a significant drain on the health of individuals, the healthcare system and the community. Unsafe injection practices exert a very significant impact on the health of patients, caregivers (healthcare practitioners) as well as the entire healthcare system.

World Health Organisation says that a safe injection does not harm the recipient, expose the provider to any avoidable risks, or result in waste that is dangerous for the community. A safe injection environment must therefore take into account the patient, the caregiver, the community and the environment. Patient safety is seriously compromised by inappropriate use of injection devices. A 2005 study to assess injection practices in India showed that nationwide 62 per cent of all injections were unsafe due to improper sterilisation, reuse or faulty administration,1 making them a leading cause of healthcare associated infections (HAIs) – infections that a patient gets from the very healthcare facility and procedure that he visited to get well.

Hence, collaborative efforts of key stakeholders are imperative to promote a safe environment for parenteral medication delivery that reduces or eliminates unwanted disease outbreaks (e.g. Hepatitis B, C) by:

a ) Raising awareness to the issues

(b) Standardising clinical best practices and

(c) Embedding comprehensive solutions that protect patients, caregivers and community across the continuum of care delivery.

Historical perspective: Eliminating re-use of needles and syringes for immunisation

WHO, PATH and UNICEF worked with the industry through the 1990s and with pioneering auto disable (AD) syringe technologies developed by Becton Dickinson (BD), UNICEF and WHO promoted their adoption throughout the world to prevent reuse of syringes during immunisation campaigns.

India was using glass syringes for vaccinating children till as late as 2005. Indian Association of Paediatricians (IAP) and BD played a key role in advocating for safe injections. Evidence of unsafe injections was generated through a massive, nationwide Government of India (GOI) study by INCLEN, led by Dr NK Arora, across various healthcare settings from private to government curative to immunisation. Highlights of the INCLEN report on the magnitude of reuse are in Table 1.

In 2005, GOI mandated the use of AD syringes in its flagship Universal Immunisation Programme (UIP), covering a cohort of approximately 26 million children per year, who have since been safe from risk of infections through re-use of syringes.

However, vaccination related injections account for only 10-15 per cent of total injections. Approximately 85-90 per cent of injections are curative injections. Although it has been over seven years since the INCLEN study was disseminated, and there have been numerous deaths attributed to syringe reuse across the country, there is no comprehensive mandate for syringes with reuse prevention features.

Characteristics of unsafe injections (% of all injections) in India

The impact of unsafe injections

Compromising Patient Safety: In the past few years, deadly outbreaks of diseases have been caused due to unsafe injection practices in this country. One of India’s deadliest outbreaks of Hepatitis B occurred in February 2009 at Modasa in Gujarat’s Sabarkantha district. Within months, 94 people had died from 593 confirmed cases in the talukas of Modasa, Idar and Meghraj. Hepatitis B had broken out simply because some private practitioners kept reusing infected syringes.1 Other incidents have also been reported. As recent as February 2012, news regarding a Hepatitis C outbreak in Fatehabad area of Haryana was reported in the local papers. A comprehensive investigation by the Department of Community Medicine, Post Graduate Institute of Medical College, Rohtak, revealed that of 8000 suspected individuals investigated clinically, biochemically and microbiologically in and around Ratia town, 1605 have been confirmed to have Hepatitis C. 70 per cent of these cases are linked to the reuse of syringes. Further investigation by National Center for Disease Control has been recommended.

Reuse of syringes happens both ‘intentionally’ i.e. due to either a profit motive of practitioners who charge a fixed consultation fee including cost of drug and syringe, and/ or due to ignorance of risks of reusing a syringe which may not have visible blood, but only ‘invisible’ body fluids or due to ‘downstream’ re-use, through repacking and resale of syringes collected by the unorganised waste collection.

In the last 20 years, emerging diseases like Hepatitis B and C and HIV have made the risks from unsafe injections and unsafe waste disposal unacceptable. WHO estimates that globally about 1.3 million2 people die of infections caused by reuse of syringes, of which estimated 300,000 are in India. National AIDS Control Organization (NACO) estimates that reuse of syringes and needles is one of the causes of new HIV cases, after unsafe sex.3

Compromising community safety: Unsafe waste disposal is especially common in India’s highly fragmented healthcare delivery system, where used syringes are often not disposed through specialised bio-medical waste agencies, but are disposed along with kitchen waste from residence-cum-clinics, or as part of municipal waste. This leads not only to the risk of diversion of the syringes for repacking and resale by unscrupulous elements, but also to the risk of infection from needle-stick injuries to the people handling such waste – often rag pickers.

India’s Central Pollution Control Board (CPCB) has issued guidelines for injection waste management, but reports indicate the rules are not always followed. Of the 3,842 healthcare providers/ facilities participating in the 2005 study of Indian injection practices, it was pointed out that satisfactory disposal of plastic syringes and disposable needles was observed only at 61.3 per cent of the facilities. It was the lowest at immunisation clinics (50.9 per cent). Nationally, only 6.2 per cent of health facilities undertook waste segregation. Less than half the health facilities (44.8 per cent) ensured satisfactory terminal disposal of injection waste, which was lowest at private health facilities (41.5 per cent). Unlike urban health facilities, rural areas were more prone to unsatisfactory waste disposal. Direct observation also showed that used plastic syringes/needles were sold to scrap dealers more often from private health facilities (15.2 per cent) than government health facilities (3.2 per cent). With widespread use of plastic syringes in India, the study stressed the significance of properly disposing such waste.4

In India, device manufacturers, healthcare facilities and waste handlers can contribute to the reduction of overall sharps waste through programmes that collect sharps waste, treat it to remove potential biohazards, recycle and recover raw materials, and incorporate them into new products. A ‘safe injection environment’ approach requires continued innovation and commitment from stakeholders—from manufacture and use, to disposal and recovery—while maintaining a high standard of care at a reasonable cost4.

The solution: a collaborative approach by key stakeholders towards comprehensive safety

In order to improve injection safety in India, the 2005 INCLEN study made several recommendations, including the following:

• Encourage universal use of (single use) pre-sterilised syringe/ needles with a mechanism for prevention of reuse

• Ensure adequate quantities of syringes/needles according to requirement

• Adhere to guidelines for injection waste management

• Institutionalise the process of training of injection prescribers and administrators

• Increase communication and awareness among health professionals and the community

• Establish follow-up studies to assess and monitor economic and clinical aspects of injection safety interventions.

It is clear that improving injection safety in a comprehensive manner cannot be addressed by any one stakeholder — it would require a sustained and coordinated effort amongst various stakeholders — government, NGOs, doctor bodies, community outreach workers, manufacturers of injectable drugs and syringes. Opportunities for improvement exist across the spectrum of the lifecycle of the syringe – from source materials and manufacture, through use and disposal.

The Central and State governments can play a key role by mandating the use of devices with reuse prevention features and improving enforcement of biomedical waste handling norms. The fact that over 75 per cent of injections are delivered by the private sector, mostly in outpatient clinics of estimated one million practitioners spread across all towns and villages, makes the task of training and regulating even more difficult in the absence of enforceable policy around this issue.

Professional medical associations and NGOs can also be instrumental by increasing awareness of the risks of unsafe injection and disposal practices. Through their support, appropriate training and education modules can be developed for all healthcare workers. By adopting and promoting best clinical practices related to comprehensive injection safety, caregivers can embrace their responsibility to do no harm to those they serve.

Manufacturers must develop product solutions and services which address patient, caregiver and community safety, while also reducing their impact on the environment. New product and process technologies are enabling the reduction of source materials and elimination of materials of concern, such as plasticisers and halogenated plastics, in the design and manufacture of medical devices. Product designs for minimal consumption of raw materials may consume fewer non-renewable resources and require less fuel to ship. Such products can spare raw materials, and have a lower impact on disposal, while meeting the highest standards for performance, safety and local regulations.

Opportunities exist for new stakeholders as well. As in the US, collaborations between manufacturers, healthcare providers and waste handlers could enable the appropriate recovery and recycling of materials that would otherwise be part of the waste stream. US hospitals generate 5.9 million tonne of waste annually, and sharps (injections, needles, blades, broken glassware) comprise about one per cent of all hospital waste (59,000 tonne). To reduce the amount of waste that ends up in a landfill, the 442-bed Rady Children’s Hospital, San Diego, recycles 19 tonne of sharps per year through an innovative programme that safely turns injection-related waste into new products.

Indeed, cultivating a truly safe injection environment calls for collaboration by manufacturers, providers, waste handlers and other stakeholders to implement comprehensive solutions across the healthcare spectrum. When it comes to the safety and welfare of patients, caregivers, the community and the environment, there are truly no shortcut

Curing with Care



!Health Care System needs a good Doc!



Curing with Care _ Our Health Care System Challenges

India's healthcare system faces the important and often too hard challenges of expanding access, ensuring affordability and guaranteeing quality Health Care to all. Almost all Governmets since independence whether its state of Centre promised to improve it but very little or none progress is made. As matters stand, small private hospitals, clinics, pharmacists and quacks are the mainstays of healthcare provision in both urban and rural centers. The renewed focus and increased spending by the government to revamp the public sector health delivery system may tilt the balance back towards public sector healthcare, but a large structural shift in healthcare-seeking behaviour is usually very slow and cumbersome. Even at places where infrastructe is available the skill is not there and efficient hospital administratiors are missing altogether. The doctors are doing both administrative and clinical work which is irony for a sector which already have a huge issue of shortage of  qualified and experienced doctors and paramedics .

In theory, the private sector responds in more sensitive way (at least they pretend to be ) to patients' needs because it provides greater autonomy and flexibility to the healthcare provider. Multiple healthcare providers competing on quality and price allow the patient to choose the best quality of healthcare they can afford and the invisible hand of the market achieves system-wide efficiency.

In practice, however, greater flexibility without any regulatory oversight results in the quality of care provided falling short of even a basic minimum standard of quality. The scale of this quality problem is enormous even in high-end urban medical centers, leave alone rural health clinics. Inappropriate treatment, malpractice, excessive use of certain procedures and negligence are rampant.

The root cause of the problem is that the quality of healthcare (of course cost) is extremely difficult to measure and the consumer is unable to verify the quality. Attempts to objectively measure it always result in esoteric, multi-attribute healthcare quality metrics which are difficult to create and even more difficult for the patient or the caregiver to understand.

In choosing their hospital, clinic or quack, patients and their caregivers typically rely on 'perceived' quality which is often far removed from actual quality. In a market where unscrupulous low quality providers have a competitive advantage in both price and perceived quality, high quality providers find it extremely hard to recover the costs required to provide high quality healthcare.
Most developed countries, therefore, regulate the provision of healthcare and pharmaceutical products through central government-run agencies. In some ways, the clinical establishments registration and regulation Bill is attempting such a regulatory structure. However, the risks of well-designed but poorly executed healthcare regulation are extremely high in India. The national and state regulatory councils would lack trained and motivated personnel to enforce the regulations, especially in remote areas. And a slow and needlessly complex regulatory agency can choke the private sector and deny any kind of healthcare to some segments of the population. The risks of decentralised corruption within the regulatory agencies are even higher.

A voluntary accreditation programme for health providers is another way to improve quality. The National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a powerful attempt at this. But while NABH's accreditation efforts can help improve quality in larger private hospitals and clinics, they are unlikely to have a significant impact on the quality of care in small private clinics or rural healthcare establishments.

Accreditation results in high quality of care only if the patient cares about the accreditation, or accreditation becomes a precondition for healthcare providers to receive payments from insurance or third party payers. NABH has attempted this through preconditions for empanelment by the Central Government Health Scheme and other insurance companies, but with limited success. Healthcare in India is still largely paid out-of-pocket and the leverage of the insurance companies or payers is still relatively small.

A prime cause of our inability to ensure higher quality in healthcare provision is the excessive fragmentation of our healthcare provisioning system. This makes monitoring, regulating, or improving quality very costly. The infrastructure investment required for collecting quality performance data from small owner operated clinics is extremely high at present.

This does not, however, mean that quality can be achieved only when a few large hospital chains own all the clinics, or when there is a plethora of franchise clinics. It requires a few coordinating agencies, or orchestrators, who can guarantee higher compliance to quality standards and better reporting of clinical performance metrics.

One way to achieve this would be to couple the desired quality improvements with access to critical inputs - which the coordinating body can provide to hospitals, clinics and rural health establishments at a much cheaper cost than what they can otherwise obtain. Examples of such inputs would be very cheap sources of capital; heavily discounted medicines or hospital equipment; well-trained paramedical staff at subsidised rates.

The poor quality providers will not have access to these inputs at the same prices as their high quality counterparts and will not be able to compete unless they improve quality and can get access to these subsidised inputs. The coordinating agency needs to be organised as a public-private partnership; a for-profit or a government-run model will not be effective and sustainable for this role.One can never predict how complex systems such as healthcare will react to a new regulation, new information flows, or new incentive structures. Perhaps the regulatory Bill will work, or NABH programmes will achieve national scale, or doctors and the Medical Council of India will ensure better peer-review and thus self-regulation will emerge. What is critical, though, is that we end the gridlock on healthcare quality regulation and make some difficult choices - else we face an inevitable decline in our nation's health and Health care System will be a far cry for common people and in rural areas only Neem Hakeem will be available to milk money .

Which Masters Degree in Hospital Management is right for you: MHA vs MBA vs MS

Are you interested in a a career in hospital management?  If so, you have a number of options when looking at master’s degree programs. The three main types of master’s degrees in hospital management are the Master of Health Administration (MHA), the Master of Business Administration (MBA), and the Master of Science (MS). Each degree has its advantages to those hoping to become hospital administrators.

Master of Health Administration in Hospital Management

An MHA  in hospital management is perfect for students who already have experience in business or who are working in the healthcare field as a doctor or nurse. This type of program is the type of master’s degree most focused on the healthcare field. From day one, your classes will focus not just on administration, but on administration at a hospital. The classes you take will depend on the program you attend, but some that you could take include clinical administration, human resources management, government and public policy, healthcare ethics, operations, population health, marketing and communications, health informatics, and finance.

Most MHA in hospital management courses take about two years to complete. Many require that you have work experience in an administrative position or in the field of healthcare in a lower-level position before you enter and MPH in hospital management program, but requirements vary depending on the program you choose.

Master of Business Administration in Hospital Management

If you’re looking for a more flexible hospital management program, an MBA might be a better option for you. Where MHA programs as specific to students who want to work in healthcare, an MBA allows you work in a variety of fields. MBA programs allow you to specialize, so if you want to work in healthcare, you can take hospital management classes; however, your education will also include a number of more general business classes. The disadvantage here, of course, is that you’ll get less hospital-specific education, but the advantage is that you’ll be able to transition to other industries if your career path changes in the future.

Because an MBA in hospital management is less focused on the healthcare aspect and more focused on the business aspect, it is great for students who already have clinical experience or have otherwise worked in healthcare in the past. Most MBA programs have a strong focus on finance and accounting, which is not the emphasis of most MHA programs, which focus primarily on operations. Of course there is a lot of overlap here, so check out each individual program to determine which is best for you. Many colleges actually offer a duel MBA – MHA degree if you’re unsure which degree program makes more sense for your career goals and educational needs.

Like MHA programs, MBA programs typically take about two years to complete and most (but not all) require that you have prior experience working in either business or healthcare in some capacity. MBA programs almost always require you to submit standardized test scores, while not all MHA programs require this.

Master of Science in Hospital Management

MS in hospital management programs are similar to MHA programs in that they are specialized for those who want to work in leadership positions in the healthcare field. However, with an MS, you can specialize even further, focusing on a field like marketing or quality control. Where as an MHA prepares you for top leadership positions at a hospital, MS programs allow you work in a lower-level leadership field. It’s great for students who do not yet have work experience, since many MS programs accept students directly from bachelor’s degree programs.

MS programs also typically take two years to complete, though many colleges also offer part-time programs so you can choose to enter the workforce while you earn your graduate degree at the same time. MS programs are also often extremely flexible, so if you’re looking for an online program, you might find more MS options than MHA and MBA options – it depends on what you want most in a master’s degree.

Which Master’s Degree Should You Choose?

So which master’s degree program is best for you?

• MHA programs are great for students who have a strong desire to work in healthcare leadership and have prior business experience.
• MBA programs are great for students who want some career flexibility and have prior healthcare experience.
• MS programs are great for students who have little experience in the field and want to work in a specific type of administrative position (like human resources manager or quality control manager).

Keep in mind that there’s a lot of overlap with these type of programs, so consider individual programs to find the once that works for you.

Hospital administrators are responsible for the administration, leadership, and management of hospitals and hospital networks. A masters degree in healtcare or health administration is the standard credential for those in the field of hospital administration. Below are several accredited colleges that offer online degrees in health and hospital administration.

Infection Control Challenges

Infection control Committee (ICC) has to put the ring in order by arranging the beads.

Although much noise has been made already, in regard to setting up an Infection Control Committee (ICC) in every hospital, very little progress has been made in this line and many are still waiting to respond to the call. Health Pundits hope that this system will be accepted by all and the beads in the missing chain will be connected in the near future.

In one of the main ambitions of any hospital now a day’s Quality appears to play an increasingly important role not only from a clinical perspective, but also from a business perspective. In reality, hospitals are a setting where cutting-edge medical advances relieve suffering, and bring healing as well as provide a new life for patients who need absolute care. Focusing on the value of the service provided to patients, hospitals these days are coming up with value-enhancing strategies that include providing a rich patient experience, meeting infrastructural needs, working out on best interior designs, staying technological abreast, adopting systematic waste management strategies, reducing process variation so on and so forth. The list will go on. Indian hospitals especially, the elite institutes have been able to achieve the important components of the value chain in the Indian healthcare industry, producing services and recognised delivery segments, which are growing at an annual rate of 14 per cent. However, in all these positive endeavours to become a place of excellent healthcare delivery, the most important aspect that needs the highest priority- Infection Control level within a hospital is ignored perhaps always. Much has been highlighted and spoken about the unmet needs related to Infection Controls; nevertheless we still remain where we were ten years back.

Even after investing too much money and ho halla the studies prove that the cost of antibiotics to patients has not comedown rather has increased with a rapid pace. On one hand hospitals are claming that they are making huge % contribution in Infection control and on other hand patients are paying more and more for antibiotics.

Hospital Acquired Infections (HAI), Nosocomial

Many deaths or prolonged hospital stay are caused by unsanitary facilities, germ-laden instruments and unwashed hands. Recent reports indicate that at any time about 1.4 million people worldwide suffer from HAI. According to estimates the risk of HAI is nearly two to 20 times higher in developing countries where the overall incidence of HAI is about 10 per cent of hospitalized patients.

Experts say “Majority of infections are endogenous in origin, i.e. from the patient’s own micro-organisms. However, infection can spread to other patients through contact or hands of healthcare professionals, visitors and attendants. Some infections like measles, mumps, chicken pox, sputum positive lung tuberculosis etc. can spread through air. Other infections can spread through certain improperly disinfected or sterilised material or through water. Experts say the most high risk areas are ICU, OT, Nursery, Cancer ward, burn ward, kitchen etc.”

HAI and Infection Control

“Historically, infection control practices, in one form or another, have existed since great surgeons, like Lister, recognised the significance of bacteria in producing postoperative wound infections. John Bell, in 1801, remarked that hospital infection exists in every type of hospital. In the early 1970's, the first infection control nurse was appointed in the UK - this marked the beginning of an era: the recognition of infection control as a speciality in its own right.”

In today’s scenario “Statistics state, that in the developed nations the HAI rate is less than five per cent. Though few authentic studies have been conducted in India, and results of those studies reveal that in our country the HAI rate is more than 15 – 20 per cent.“In developing countries, the infection control programmes are nonexistent or, at best, in their infancy. Individual hospitals and physicians struggle to establish programmes despite financial constraints.”

India today is grappling with the emergence of diseases. Based on this evidence, several infection control policies are being constantly developed and revised, yet this issue remains a continuous process. Blame it on the great Indian divide, wherein, the country provides high quality medical care to elite and middle class Indians as well as to the medical tourists, or the country whose residents have limited or no access to quality care or the poor healthcare policies or blame it on the lack of awareness among healthcare providers. The fact is that HAIs are a serious cause of concern. “Lack of awareness about infection prevention and control practices amongst healthcare practitioners and absence of a formal education programme in Infection Prevention and Control in the country has contributed towards adding on the burden of HAIs.

Infection Control Committee (ICC)

The ICC is a team whose core responsibility is to make protocols to fight infections that can spread within the hospital set-up and to conduct surveillance subsequently. Every hospital should have an efficient ICC consisting of a member of a hospital staff preferably a senior medical microbiologist, epidemiologist or infectious disease physician, personnel from medical and nursing staff, support services like engineering and biomedical engineering, operations, housekeeping, F&B, operation theatre and sterile supply departments as well as the hospital administrator having an experience and training in infection control. The clinical microbiologists form the core Infection Control Practitioner in an ICC and generally chair or are member secretaries, by virtue of their closest involvement with micro-organisms and patients.

Role of ICC

The ICC acts as an advisory body to advice on the following subjects:

• Taking appropriate safety measures and making protocols in patient care so as to prevent infection in the patients and health care staff

• Conducting surveillance of healthcare associated infections, seeking trends and reviewing measures and changing them if required

• Educating the hospital staff on efficient and standardised use of antiseptics, disinfectants and products used for washing and disinfecting the hands

• Inspecting aspects such as quality control of the techniques used to sterilise equipment in the hospital; monitoring of sterilisation/disinfection cycle

• Recommending antimicrobial policy for the organisation

• Setting guidelines for training of different categories of staff in prevention of infection and control

Functions of the Committee

“Ideally, the infection control committee should meet monthly. For greater success, the meeting should be held on the same day and time each month. The meeting agenda should be well planned and circulated to committee members before the meeting,” informs Dr Pandey. Furthermore, the committee performs three principal functions:

• The first is to gather data. Each institution needs to know the microflora of its high risk areas such as operating theatres, adult- and neonatal- ICUs, dialysis units and oncology services. A good microbiology laboratory is essential to isolate organisms, to plot antibiotic resistance patterns and to indicate to clinicians' trends and changes in hospital flora. The laboratory is also best suited to identify outbreaks (three or more cases of infection with the same organism and antibiograms) and to alert clinicians accordingly.

• The second function is to carry out surveillance. Whole hospital surveillance is impractical and largely meaningless. Most hospitals should generally go for target surveillance to areas of the hospital where the highest rates of infection and antibiotic resistance are likely to be found.

• The third function of the committee is to enforce good infection control practices. For this certain concepts must be ingrained. Nosocomial pathogens have reservoirs and are transmitted by predictable routes to susceptible hosts.

Infection Control Programme

The most important objective of an ICC is to successfully plan and execute an infection control programme. The success of which facilitates to reduce the spread infection levels within patients, visitors and the hospital staff as well. “Infection Control Programme is conducted to prevent the infection occurring from the hospital environment by training health worker, patients and patient relatives and taking effective measures for proper use of antibiotics"

“An infection control programme is directed towards realisation of twin desired outcomes- decreasing preventable infections to minimum in patients and healthcare staff and decreasing antimicrobial resistance.” He further mentions that an ICC is incorporated to represent the Infection Control programme. ICC team looks after implementation of the programme and depiction of well defined roles and responsibilities of each component. It prepares an annual action plan with set targets, budgeting and review mechanisms. The team further creates a document in the form of a working infection control manual detailing policies, recommendations and guidelines including antimicrobial policy, infection control practices and protocols, activities carried out by infection control team with an infection control officer and infection control nurse(s), surveillance and monitoring activities, periodicity of ICC meetings and its occurrence at regular intervals to seek and review trends, deliberate on measures for implementation , a component of daily as and when required interaction between different departments of the organisation or healthcare institution, teaching training and awareness of all staff engaged in healthcare delivery in that institution- whether permanent or on contract and also patients and attendants.

Attention needed to control communicable disease by ICC

Experts are of the opinion that general monitoring of patients for development of HAIs and tracking these to improve upon processes associated in patient and staff health, specifically where devices are regularly used have to be conducted on a weekly basis. Monitoring for infections such as Ventilator Associated Pneumonia (VAP), central line associated blood stream infections and Catheter Related Urinary Tract Infections (CR-UTI) is vital. Antimicrobial usage monitoring with emphasis on certain restricted antimicrobials, antimicrobial susceptibility monitoring, monitoring of patients for development of surgical site infections, monitoring compliance of hand hygiene, monitoring of disinfectants and their usage, monitoring of

Sterile supply and Central Sterile Supply Department (CSSD) including bacteriological monitoring of -autoclaves, other sterilisation/disinfection processes etc is also of high priority. To look after safety of the staff members, needle stick and exposure inoculation injury monitoring, screening of food handlers , bacteriological analysis of water, monitoring specific infections in the staff, biomedical waste mangement should be also be conducted.

ICC and Indian Scenario

Microbiologists across the country believe that setting up an ICC within the hospital setting is a must for every hospital to provide quality care. However, in India very few hospitals have a complete and a functioning ICC. Stressing on the importance of an ICC Dr Sardana states, “Infection control programme which is effectively implemented and monitored with continuous improvement would grossly minimise the risk of development of healthcare associated infections. ICC is an integral part of infection control programme. However, heathcare associated infections cannot be totally eliminated. They would be there in one form or the other as micro-organisms (bacteria, viruses, fungi etc., as they are intimately present in and on human body and around us.” Moreover, studies show that nearly one-third of nosocomial infections can be prevented by a well- organised infection control programme.

Playing the Watch Dog

There are no specific polices that posses a compulsory binding on hospitals to set up a ICC within the hospital. This leads to a laid back attitude among caregivers on the respect of following stringent norms. Though statutory bodies such as ISO, NABH, HISI and JCI have set guidelines for formulation of ICC in every hospital, the success received is minimal.

NABH Norms

“According to the NABH standards, every hospital that seeks accreditation is bound to form an ICC within the hospital. These standards provide framework for quality assurance and quality improvement for hospitals. Chapter five of the NABH standards focus on Hospital Infection Control.

Challenges

Since we live in a country with limited resources, healthcare delivery providers are faced with umpteen numbers of challenges that restrict the successful implementation of an Infection Control programme. Heads of various hospitals are of the opinion that these challenges are a hindrance to the success of the ICC. “Ours is a country with vastly differing health care systems, hence the challenges are many. High bed occupancy, over worked staff, lack of sufficient funds to procure gloves, disposable syringes etc are some serious impediments to developing an adequate infection control programme in hospitals across the country. Hospitals need to perform antibiotic surveillance and develop antibiotic policies on a regular basis. Regular staff education is necessary. These activities need constant supervision by well trained infection control nurses,” says Dr Anjali Shetty, Consultant Microbiologist, P D Hinduja Hospital and Research Centre. Moreover, lack of coherent policies is the biggest set-back to the progress of infection control. Hospital infections are increased by invasive devices, and there must be a conscious effort to remove these at the earliest opportunity. Bacteraemia, pneumonias, urinary tract infections, line infections and surgical site infections are the major causes of morbidity and mortality. In India, this cost is more than what the Government spends on total healthcare.

Lastly...

There’s a lot to be done. Hospital administrators, microbiologists and policy makers need to gear-up together to develop various strategies to improve the quality of hospital care in the future. Formulation of stringent policies that will be binding on every hospital will also help reduce a decent amount of infection levels within the hospital. Moreover, infection control is a never ending struggle as medicine become more invasive and the proportion of ageing and immuno-compromised patients in our population continues to increase. Hospitals should come up with an in-house awareness programme where staff members, patients and their relatives can be educated on maintaining hygiene. All in all, experts believe creating a hygiene conscience society is the solution to reduce the infection menace.

Need of Change to Run the Business

Time For Change

ways to implement change
Possible challenges faced by the management that limit the ability to run the business better. Knowing where or what to change is only the first and simple step in the exercise. Just an analysis of the situation would be of no use. There is always a need to move towards making this change.

To quote Karl Marx -

"The philosophers have interpreted the world in several ways; the point though is to change it."

Facts
Before pondering upon several options that can be taken care, it is important to understand a few facts:

1. A majority of those among the management believe that problems are attributable to people in an organisation. The fact though is that over 90 per cent of all problems are due to the processes. Only 10 per cent is attributable to the people.

2. The person owning the process has the authority to change it, usually top management in an organisation.

3. It therefore obviates the necessity to work actively on processes and not people. Changing processes requires one to have a thorough understanding of its impact. It is also necessary to be responsible and accountable for it.

4. Changing a process requires every person responsible to be taken into confidence. This is probably the most difficult part of the process.

5. Keep in mind that about 10 per cent of the problem is attributable to people - it may, however, have a far greater impact on processes to be ignored. The fact therefore is that change management sometimes does require you to "change the management".

6. Making a change in your organisation is not a magic bullet. At no stage can one allow the current systems to stop working without an alternative one being put in place. In a hospital environment, therefore, change needs to be initiated without disrupting the present system. This requires one to follow a method of evolution or making one change at a time, and waiting for it to stabilise before making another. Any attempt at drastic change can only be doomed to failure. It must therefore, be evolutionary in nature.
There are essentially four questions we must ask before bringing about the change contemplated. Why is it necessary to change and what needs to be changed? And if change has to be implemented, what should it be changed to? Finally, how would one go about doing this?

Methodology
Way back in the early 1950s, a physicist and statistician, W Edwards Deming evolved a methodology for business process improvement that came to be known as the the Deming Cycle. His method was one of the continuous improvement process. This is also known as the PDSA cycle - plan, do, study and act. It seems quite simple and obvious until we look at the elements that go into each of these components.

Using the Deming Cycle
The components of the Deming cycle indicate the steps required to be taken in the process of making the change. Though it is not simple math, it is no rocket science either. The following paragraphs outline the steps involved in the PDSA cycle:

Plan - The first stage requires establishing objectives and processes that are required to deliver the desired end result; the focus of the entire plan. All specifications, policies, practices, procedures and other aspects that may need change must be formally listed. An exhaustive list and accuracy of detail should be a part of the plan.

Do - The second stage requires one to carry out changes taking small steps at a time to examine its impact on the results. Every aspect of the process will have to undergo change in line with the overall plan, and not be limited to individual functions, departments or activities. The correlation between each part of the plan and its implementation is extremely crucial to its success.

Study - The third stage requires one to formally study the impact this change would bring. Often, whenever change is put in place, there could be some volatile fluctuations in its results. Such impact of any change that one makes to the system is not abnormal. One of the most dangerous things to do when one observes such fluctuations is either to revert to the older system, or try to take immediate corrective action. But, it should be kept in mind that the results now seen are based on a small sample. Trying to correct a system at such a nascent stage often leads to changes that are even more abnormal than what one started with.
Therefore one should ensure that the process has stabilised before reviewing it or studying its impact. Depending on the magnitude, carry out the study every day, or over a one-year period. For instance, if the change is to impact patients' waiting time in a queue, it is best assessed every day. If, it is to impact the capital structure of the organisation, it is better to review it only after a significant time has elapsed; say six months to a year. It is also important to study the impact not merely as visible numbers of the results, but to try assess the non-measurable, qualitative changes that have resulted from the processes.

Act - In the final stage, one needs to understand with clarity the impact that should be made by using the new standard. It is worth taking a relook at the plan, the method by which it was acted upon, and the end results as seen by stakeholders. One may also need to guage the success and failure involved in the process.

Warning Signs and Mirages

The most important aspect that the management often misinterprets is in involving people in the change process. It is often understood to mean that they communicate with everyone through slogans, posters and notices. This is probably the worst form of communication. They seldom serve any purpose and often have no, or at best negligible impact, on the results in a coprporate setting. It is better to communicate the changes formally through short daily meetings, highlighting the achievements and progress.

The second aspect is not to go by visible figures alone as the basis of evaluating any change. It is often the invisible part of change that is far more important than the visible component.
The third aspect is never to reward or punish people based on short-term results. There have been numerous cases of people working their way around the system rather than working for the system. The biggest reward for individuals in such cases are rarely monetary. These are usually best offered in the nature of being duly recognised as a leader of the group, or appointment to a job suited to the person's aspirations. It could even be a small memento declaring the good work carried out.

And Finally we can conclude...

The journey of change has begun. As the clichéd proverb goes - the only constant is change. While embarking upon this journey, it is often not the destination, but the journey which is important. If you do things even reasonably right, it will lead you to your destination eventually. But, what you might find on this journey is that somewhere the gradient gets too steep or you are running into uncharted territory, and at this stage you may find it difficult to proceed.
I recollect a famous quote often used in rural India, which roughly translates as - "The first time is always a big issue, every subsequent time it is monkey business!" It is therefore necessary to look for help, the first time, but for that expert who has been through this several times before, it is monkey business. Would you be able to make it to the next stage of the journey? There are three facets to it - a Yes, a No and a Maybe. Yes, because failure may not be the only option and help is always available. No, because it is not a question of getting there eventually, but within a timeframe. Time and competition will not wait for you to catch up.
And the Maybe quotient; because you may be already far too deep in the water than you imagined. Getting out of the current mess may be far more difficult than thought. There may be a way out but the "cost" may be far too much to swallow. Henceforth, we should empower ourselves to l address the question of "What to do? When?"

Guide to NABH Accrediation

A brief guide for healthcare providers who wish to go for NABH accreditation.
Having gone through the rigorous assessors training for National Accreditation Board for Hospitals & Healthcare Providers (NABH), I understand how demanding the standards are. Moreover, as NABH is very recent, doubts persist over explanation and application of various objectives of the NABH standards. Here I am trying to elaborate few NABH standards.
.2.
Patient and family rights, support individual beliefs, values and involve the patient and family in decision making processes.
Objective Elements
2. A. Patient and family rights include respect for personal dignity and privacy during examination, procedures and treatment.
Explanation: To ensure that inappropriate (revealing/short/broken buttons etc) patient gowns are not in circulation. Right size of gown to be given to the patients. Dignity for the patient to be observed even when the patient is semi/unconscious, while shifting the patient, etc.
2. G. Patient and family rights include information on how to voice a complaint.
Explanation: There should be a mechanism for receiving verbal complaints from the patients/their relatives. Methods could include feedback forms, suggestion boxes etc.
2. H. Patient and family rights include information on the expected cost of the treatment.
Explanation: There should be evidence by way of patients'/admitting relatives' signature that he/she has understood the encumbrances and possible increase in costs depending on further care requirements of patient.
COP.2
Emergency services are guided by policies, procedures, applicable laws and regulations.
Objective Elements
COP.2 B. Policies also address handling of medico-legal cases.
Explanation: Local laws and guidelines also have to be considered while handling medico-legal cases. Medico-legal cases should be intimated to the local police station immediately.
COP.3
Ambulance services are commensurate with the scope of the services provided by the organisation.
Objective Elements
COP.3 A. There is adequate access and space for the ambulance(s).
Explanation: Easy turnaround of vehicle is a must, and ramp must not be steep to cause inconvenience.
COP.3 C. Ambulance(s) is manned by trained personnel.
Explanation: Only well-trained staff (nurses and technicians, etc.) should man the ambulance. And proper training record of the same should be maintained as evidence.
COP.3 G. The ambulance(s) has a proper communication system.
Explanation: A working method of communicating with the base to be made available. Mobile phones accepted as compliance.
COP.7
Policies and procedures guide the care of vulnerable patients (elderly, physically and/or mentally challenged and children).
Objective Elements
COP.7 A. Policies and procedures are documented and are in accordance with the prevailing laws and the national and international guidelines.
Explanation: Lunacy Act 1912 (now replaced by the Mental Health Act 1987) to be referred to for details.
COP.7 C. The organisation provides for a safe and secure environment for this vulnerable group.
Explanation: Hospital to ensure provision of railing, skid free tiles, easy access to wheel chair, nearness to call bell, easy to open doors, prevention for abduction of babies, baby swap, etc.
MOM.2
There is a hospital formulary.
Objective Elements
MOM.2 A list of medication appropriate for the patients and organisation's resources is developed.
Explanation: All medicines for all available and advertised specialities to be available. For instance, narcotics under NDPS Act to be available for pain elevation clinic etc. To ensure availability of all essential drugs, daily and common use drugs, etc.
MOM.2 C. There is a defined process for acquisition of these medications.
Explanation: To include vendor selection method/policy, lead time, cold chain concerns etc.
MOM.2 D. There is a process to obtain medications not listed in the formulary.
Explanation: Short purchase policy, policies for outside purchase, allowing patient to purchase, et., but in consonance to the above point MOM 2-A.
MOM.4 Policies and procedures guide the prescription of medications.
Objective Elements
MOM.4 B. The organisation determines who can write orders.
Explanation: Keeping in mind statuary requirements, the organisation has to outline who shall write orders apart from the treating consultants. This point is of importance in instances when the treating physician may not be available and the orders may be given by him on the phone etc to the nurse/RMO. Also refer point MOM 4 E below.
MOM.4 E. Policy on verbal orders is documented and implemented.
Explanation: The organisation needs to make a policy on accepting verbal orders, especially keeping in mind the potential communication errors which may lead to a wrong medication. A policy may be in place to not to accept verbal orders (preferably) or to get it doubly checked by a senior staff member or a senior resident etc. Apart from that, verbal orders have to be countersigned by the prescribing consultant within 24 hours.
MOM.5 Policies and procedures guide the safe dispensing of medications.
Objective Elements
MOM.5 B. The policies include a procedure for medication recall.
Explanation: Policies have to be in place to recall a particular batch or a lot of medicines/consumables. This is essential in case of identified defective batch or notice from Government regarding the same. The same should also be done when an instance of wrong prescription or wrong administration of medication is identified, to ensure that the same mistake is/was not duplicated for other patients.
MOM.7 Patients and family members are educated about safe medication and food-drug interactions.
Objective Elements
MOM.7 A. Patient and family are educated about safe and effective use of medication.
Explanation: The patient and family members should be explained clearly and in detail about the medication, specially in the OPD and at the time of discharge. This should be done to avoid incidences of over dosage, allergic reaction, etc.
MOM.7 B. Patient and family are educated about food-drug interactions.
Explanation: There is a need to educate the patients and their family members about the adverse reaction of certain food items on some drugs, and the necessity to avoid such food items during the medication period. Example, alcohol contradicted with metranidazole etc.
MOM.11 Policies and procedures govern usage of radioactive or investigational drugs.
Objective Elements
MOM.11 C. The policies and procedures include the safe storage, preparation, handling, distribution and disposal of radioactive and investigational drugs.
Explanation: There was a concern that some junk dealers may sell the nuclear portion/source for making a crude bomb. BARC can be notified to dispose this nuclear source prior to disposal. BARC disposes of the same in safe controlled methods.
HIC.7 There are documented procedures for sterilisation activities in the hospital.
Objective Elements
MOM.7 C. There is an established recall procedure when breakdown in the sterilisation system is identified.
Explanation: Example: Recall of entire CSSD load for a wet item found in the dry pack.
CQI.3
The organisation identifies key indicators to monitor the managerial structures, processes and outcomes.
Objective Elements
CQI.3 D. Monitoring includes utilisation of facilities.
Explanation: Monitoring of bed occupancy, average length of stay (ALOS), ICU utilisation etc. This indicates whether we are optimally utilising our resources and can also pinpoint a deviation in the quality of care if an ALOS varies from estimated for a particular case.
CQI.3 G. Monitoring includes adverse events.
Explanation: There should be a system in place to monitor and also minimise adverse events like bed falls, accidents, drug allergy, wrong drug, etc.
CQI.6 Sentinel events are intensively analysed. Monitoring of these events are essential as occurrence of these will only reflect poor processes and lack of training of staff, both reflecting poor patient care.
Objective Elements
CQI.6 A. The organisation has defined sentinel events. Sentinele even may include neonatal abduction, rape, murder, fall from staircase, electric shock, sparks, birds in AC ducts, bed falls, bed sore after admission, fall from window/balcony, suicide, discharge against medical advice.
ROM.5
Leaders ensure that patient safety aspects and risk management issues are an integral part of patient care and hospital management.
Objective Elements
ROM.5 D. Management provides resources for proactive risk assessment and risk reduction activities.
Explanation: Similar to preventive and corrective action of ISO 9001:2000. Confusion surrounds between the difference of preventive and corrective actions. A preventive action is one where an incidence has yet not occurred, but there is a potential hazard, while a corrective action is one when an incidence has occurred and necessary corrections are put in place for immediate reprieve and further prevention.
Examples of preventive action are naked electrical wires and a check on it to prevent any electric shock and; observing that there is lack of pest control and carrying an immediate pest control activity before infestation of insects and rodents, etc.
While example of corrective action is an electric shock has occurred due to a naked wire and now the naked wires are repaired to prevent such an incident from occurring again.
FMS.1
The organisation is aware of and complies with the relevant rules and regulations, laws and byelaws and requisite facility inspection requirements.
Objective Elements
FMS.1 D. There is a mechanism to regularly update licenses/ registrations/ certifications.
Explanation: SOP may be made with instructions as to how, when and where the licenses will be renewed and from which nodal agency. A list of licenses, consisting of renewal dates (including software package renewals) and trigger date for each, and responsible authority for renewal is a good practice.
HRM.6
The organisation has a well-documented disciplinary procedure.
Objective Elements
HRM.6 B. The disciplinary policy and procedure are based on the principles of natural justice.
Explanation: Both employee and employer shall be given enough opportunity to defend the case. Complainant cannot be the judge.
IMS.5
Policies and procedures are in place for maintaining confidentiality, integrity and security of information.
Explanation: To ensure that there is access only by authorised personnel and that processes exist to safeguard against unauthorised access, physical as well as digital, by way of lock and key, password protection etc. Protocols should be in place to disseminate the right information to the right person/patient and at the right time. Care also has to be taken while sharing data with external agencies where some tests are outsourced as the confidentiality of patients always needs to be maintained.

Effective Management of Medical Records is in our own interest

Effective Management of Medical Records is in our own interest In-patient as well as out-patient medical records generated in the hospital, in its own interest as well as for the patient are required to be stored for stipulated time depending on the relevance of the record. There is a lot of significance of good practices required in managing medical records.
Are medical records so important?
Medical records constitute a range of medical care documents, which include patient’s history, diagnostic investigations, consent documents, operative notes, nurses’ daily notes, intake / output sheet, treatment sheets, etc. Managing these records systematically is really important, as these records are the only way for the doctor to prove that the treatment was carried out properly. These records become the sole and critical evidence for the treating doctors to defend themselves from any claim of negligence and also for further treatment of patient whenever needed.
How Are Medical Records Stored?
Today in most hospitals, medical records are paper based and are stored manually in designated areas in the hospitals – some have a dedicated medical records room and officers looking after them. However, with increasing volumes of patients over the years, the physical records occupy more space and its more time consuming and difficult to retrieve the patient record. The paper based records are also prone to damage by weather, rodents, dust, etc. along with occupying hell lot of space and also the retrival becomes difficult and lengthy process.
Classification of Medical Records
There are two ways in which medical records can be relevantly classified: the extent to which they can be shared and the contents of the records.
The Extent to Which Records can be Shared
Must be given to the patient- certain records, viz. discharge summary, referral notes, etc., have to be shared with all patients including those who are discharged against medical advice irrespective if the bill payment has been made.
Can be given to the patient after formal application- records such as, indoor papers, operative notes, investigations, etc., requires a formal application from the patient. The copies of these records given to the patient are generally attested as true copies by the hospital.
Given only with direction of the court - some OPD and IPD records, especially those of medico-legal cases cannot be given to the patient without the direction of the Court.
On the other hand, medical records can be distinguished as per the constituent documents and each of them have its own significance, for example – discharge notes, are considered as a critical proof with respect to the in-hospital treatment provided to the patient, irrespective of the fact that the patient has been discharged with / against the advice of the doctor.
Preservation Period, Legal Aspect
There has been ambiguity with respect to clear regulations on how long a medical record must be preserved. Most hospitals follow their own set of policies in retaining records as per the relevance. The limitation period for filing a case paper is up to three years under the Limitation Act 1963 (two years under the Consumer Protection Act 1986). Nonetheless, the limitation period starts only after the patient becomes aware of the effect of the alleged negligence by the doctor.
The Maharashtra Government has issued a resolution (ref GR No. JJH-29 66/ 49733) which says that OPD paper should be kept for three years, indoor case papers for a period of five years and in case of a medico-legal case, 30 years. Usually medical records are summoned in a court of law in:
• Medico legal cases: where often the medical records are referred to establish medical history / treatment given, especially important in road traffic accidents, medical negligence, etc.
• Insurance cases: where the insurance company wants to review the medical records verify the claim
• Workmen’s compensation cases: In cases where an injury occurs to a workman out of and in the course of employment.
• Criminal cases – to prove the nature, timing and gravity of injuries.
MCI Guidelines
The Medical Council of India, has issued the (Professional Conduct, Etiquette and Ethics) Regulations, 2002, which mentions the following on Maintenance of Medical Records (Section 1.3)
• Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of three years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India (Section 1.3.1 and Appendix 3).
• If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours (Section 1.3.2)
• A registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued. When issuing a medical certificate he / she shall always enter the identification marks of the patient and keep a copy of the certificate. He / She shall not omit to record the signature and/or thumb mark, address and at least one identification mark of the patient on the medical certificates or report. The medical certificate shall be prepared as in Appendix 2. (Section 1.3.3 and Appendix 2).
• Efforts shall be made to computerise medical records for quick retrieval. (Section 1.3.4)
Role of Virtual Record Room (VRR) in Maintaining Medical Records
In my last article in June 2011 of Express Healthcare, I had introduced the concept of VRR. This time, I have outlined a practical case study of VRR implementation.
Quick recap; a VRR is like an online vault of patient records just like the MRD room – a secure online library containing Electronic Medical Records (EMR) of the patients – available for view / access to the authorised personnel as per their preferences. It’s a centralised repository of all patient records at one place, which can be securely accessed 24x7 from anywhere.
A VRR is not something that is important only for tax authorities or municipal corporations as we think of in India, but it is extremely important, critical and legally required in the context of medical care provided to patients. Following is the case study of BSES MG Hospital, Mumbai.
Example BSES MG Hospital, Mumbai
Since the time BSES MG Hospital has implemented the virtual record room; it has been empowered with 24x7 secure retrieval, enabling the admin to process queries regarding medical records substantially faster. Apart from the most evident improvement in time efficiencies, the EMR solution has made BSES MG Hospital’s medical record keeping more systematic. Each physical file has been scanned and fed in the software application. All scanned images can be easily identified intuitively. Ready reference information on the patient demographics (identification, emergency contact, doctor details, etc.) is instantly available from the patient profiles created.
BSES MG Hospital receives end-to-end service (from scanning till patient profiling) to achieve this in addition to the EMR application. The hospital staff doesn’t have to worry of records getting damaged or being misplaced. By using secure login, the authorised personnel can know at all times how many / which records belong to which patient; especially useful in medico-legal cases such as accidents, domestic violence, etc. The software also facilitates them with audit trails, telling them when and by whom the application was accessed.
Implementation of the EMR solution was a fairly simple affair for BSES MG Hospital. They outsourced the entire piece – including software, hardware and manpower. All they had to do is provide a small space for the scanning to happen and an internet connection for data transfer. In fact, they were also able to export all the patient registration details from their existing Hospital Information System (HIS) to the new application – rendering a high degree of accuracy of data entry of patient details. This made the EHR solution complimentary to the existing HIS.