Shakti Kumar Gupta

Economics of head injuries.

Head injuries account for significant proportion of neurosurgical admissions and bed occupancy. Patients with head injuries also consume significant proportions of neurosurgical resources. A prospective 6-month study has been carried out to evaluate the expenditure incurred on head injury patients in a modern neurosurgical center equipped with state of the art infrastructure. Costing areas included wages / salaries of health care personnel, cost of medicines / surgical items / crystalloids, general store items, stationary, all investigation charges, equipment cost, overhead building cost, maintenance cost, electricity and water charges and cost of medical gases, air conditioning and operation theatre expenses. Expenditure in each area was calculated and apportioned to each bed. The statistical analysis was done using X2 test. The cost of stay in ward was found to be Rs. 1062 / bed / day and in neurosurgical ICU Rs. 3082 / bed / day. The operation theatre cost for each surgery was Rs. 11948. The cost of hospital stay per day for minor, moderate and severe head injury group was found to be Rs. 1921, Rs. 2569 and Rs. 2713 respectively. The patients who developed complications, the cost of stay per day in the hospital were Rs. 2867. In the operative group, the cost of hospital stay per day was Rs. 3804. The total expenditure in minor head injury was Rs. 7800 per patient, in moderate head injury was Rs. 22172 per patient, whereas in severe head injury, it was found to be Rs. 32852 per patient. Patients who underwent surgery, the total cost incurred was Rs. 33100 per operated patient.

Does a single specialty intensive care unit make better business sense than a multi-specialty intensive care unit? A costing study in a trauma center in India

Context: Though intensive care units (ICUs) only account for 10% of hospital beds, they consume nearly 22% of hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. Aim: To evaluate and compare the cost of intensive care delivery between multi-specialty and neurosurgery ICU in an apex trauma care facility in India. Materials and Methods: The study was conducted in a polytrauma and neurosurgery ICU at a 203 bedded level IV trauma care facility in New Delhi, India from May, 2012 to June 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical Analysis: Fisher′s two-tailed t-test. Results: Total cost/bed/day for the multi-specialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU was Rs. 14,306.7/-, manpower constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Conclusions: Quantification of expenditure in running an ICU in a trauma center would assist healthcare decision makers in better allocation of resources. Although multi-specialty ICUs are more expensive, other factors will also play a role in defining the kind of ICU that need to be designed.

Study of patient satisfaction in a surgical unit of a tertiary care teaching hospital

BACKGROUND The hospitals have evolved from being an isolated sanatorium to a place with five star facilities. Patients and their relatives coming to the hospital not only expect world-class treatment, but also other facilities to make their stay comfortable in the hospital. This change in expectation has come due to tremendous growth of media and its exposure, as well as commercialization and improvement in facilities. The aim of this study was to evaluate the level of patient/relatives satisfaction at tertiary care teaching hospital and feedback from them for improvement of the same. METHODS The study was conducted by 1. Review of available national and international literature on the subject. 2. Carrying out survey amongst 50 patients and their relatives at one of the surgical unit by using structured questionnaire. 3. By analyzing the data using appropriate statistical methods. RESULTS Eighty two percent people were satisfied with the service at admission counter while 81% were satisfied with room preparation at the time of admission. The nursing services satisfied 80% of people while 92% were satisfied with explanation about disease and treatment by doctor. The behavior of nurses, doctors and orderlies satisfied 92, 92 and 83% of people. The cleanliness of toilets satisfied only 49% while diet services satisfied 78% of people. CONCLUSION The five major satisfiers were behavior of doctors, explanation about disease and treatment, courtesy of staff at admission counter, behavior and cooperation of nurses. The five major dissatisfiers were cleanliness of toilets, quality of food, explanation about rules and regulation, behavior of orderlies and sanitary attendant and room preparedness.

Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs.

Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patients length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. Results: The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were 2,04,787 (US

A Study on Aftereffects of Holi: Color Injury, Ocular Trauma, and Assault at a Tertiary Care Ophthalmic Center in North India

3,413) and 56,587 (US

Determining Organizational Learning Capability: A Study in Private Health Care Organizations

943), respectively and the mean difference in the total cost between cases and controls was 1,48,200 (95% CI 55,716 to 2,40,685, P<0.01). Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

Accreditation is not a One-time Process: Quality Assessment of Intensive Care Unit during Post-NABH Accreditation Period in a Tertiary Care Hospital

Introduction: India is known for its diverse culture and religions which are indeed famous for their variety of festivals. The presented study deals with one such festival called Holi and its hazardous ocular effects at Tertiary Care Ophthalmic Center In North India. Aim: To study the demographic and clinical profile of patients visiting ophthalmologic emergency tertiary care ophthalmic center during Holi in New Delhi. Objectives: • To study the pattern of normal patient flow in the emergency department of RPC. • To study the demographic and clinical profile of patients visiting Emergency Department during Holi. • To study the trend of Holi cases over the years. Materials and methods: The data were collected by conducting direct interviews with patients and from medical records of the patients visiting the Emergency Department of RPC from March 1 to 5, 2018 (i.e., 5 days). These 5 days were chosen so that it could cover the pre-Holi day, Holi day and post-Holi day. Data of total 210 patients who visited the Emergency department of RPC, AIIMS, New Delhi, were taken. Statistical data were analyzed using Microsoft Excel. Results and discussion: An increase in awareness among people shows a substantial decline in number of color injury, complications, traumatic eye injuries, and assault cases from the year 2016. Men (20) were more affected than women (9), with most common being among the youth (21 years ± 10). No change in routine cases was recorded in normal patient flow to the casualty, but a sudden spike in cases of color injury (29) was observed during the study period. Sooner the patient reported, better was the prognosis.

Cross-sectional Study on Utilization of Radiology and Imaging Equipment in the District Hospitals of Bangladesh

Introduction: Due to the fast-changing and developing business environment, knowledge has become a very important resource for organizations. However, reaching and obtaining knowledge is difficult, the level of organizational learning capability (OLC) perception within the organization is a key for this. This is also true for health organizations. If health care organizations can increase their OLC levels, they might achieve an increase in organizational performance, patient satisfaction, competitive advantage, and employee satisfaction. Objective: In this study, it is aimed to determine the level of OLC perception of employees working in private health care organizations. It is also aimed to examine whether this perception level shows variance according to demographic differences. Materials and methods: Research was done between January 2017 and March 2017 in private health care organizations operating in Turkey. The population of the study includes both administrative staff and health staff working in these organizations. Survey method was used to collect data, and 111 valid questionnaires were collected at the end of data collection period. Results and conclusion: According to the findings, employees perceive their organizations’ OLC level positively both for general OLC and for OLC subdimensions. However, it is also concluded that this perception level could be increased as well. In order to achieve this, health care organizations are required to encourage their employees toward learning, investigating, communication, risk taking, and participation.

Community-oriented Primary Care Services Model: Can it improve Morbidity Status in India? An Impact Evaluation Study

Accreditation is an integral part of quality and it is not a onetime process. This study was done to know the extent to which hospitals maintain the standards after obtaining accreditation. This study tries to find out the gaps in standards during the postaccreditation period. The objective of the study was to assess the policies of the intensive care unit (ICU) with reference to standard protocols of the National Accreditation Board for Hospital and Health Care Providers (NABH) and measures taken by the management to maintain the standards. Data was collected from a 285-bedded NABH-accredited hospital that had five ICUs and four recovery rooms by means of nonparticipant observation, semistructured interviews. Data on indicators was collected by using the hospital management information system; the questionnaire on satisfaction was filled by 30 patients/relatives who were admitted in the ICU for more than a week. Quality team was interviewed to know the perception of the management toward quality and accreditation. To know the compliance of the staff to the NABH standards, a surprise check was done in three ICUs of the hospital. Data analysis showed that the organization was not able to maintain the standards, as it had done at the time of accreditation. The quality team strongly accepted that accreditation helps in maintaining and improving quality, whereas the data from ICUs showed a wide variation in compliance. Three ICUs from the same hospital were having different compliance rates for standards, which shows that staff was not aware about the standard protocol to be followed. The patient-satisfaction questionnaire also showed that the patients were not satisfied with the services given.

Cost analysis of a disaster facility at an apex tertiary care trauma center of India

A quality diagnosis mostly depends on the availability and proper utilization of radiology and imaging equipments in the modern medical technology. Every year, huge amount of revenue is spent to purchase costly and sophisticated radiology and imaging equipments for the district hospitals of Bangladesh. But radiology and imaging equipments are underutilized in most of the developing Asian and African countries, including Bangladesh. This descriptive cross-sectional study was conducted to find the functional status, workload, utilization, and factors affecting the utilization of radiology and imaging equipments in the district hospitals of Bangladesh. Interviewer-administered questionnaire was used to take interview of relevant human resources. Work time study method was applied where multiple checklists were used to measure consumed time for each procedure and daily actual work time of radiology and imaging equipments. In this study, 46.9% radiology and imaging equipments were found functional, 40.6% radiology and imaging equipments nonfunctional, and 12.5% radiology and imaging equipments functional but not in use. This study revealed that 53% of total radiology and imaging equipments of district hospitals were nonfunctional, and functional but not in use, where 8 equipments became nonfunctional before 10 years due to unavailability of spare parts and inadequate maintenance fund. Work time in radiography identified 83.51% and in ultrasonography (USG) 71.08% among the respondents of radiology and imaging department in the district hospitals. Utilization rate of general radiography equipments was found to be 67.01%, portable radiography equipments 16.5%, and USG equipments 71.08%. Average utilization rate of radiology and imaging equipments was found to be 51.53% in the district hospitals of Bangladesh. Utilization rate of radiology and imaging equipments more than 50% is considered as standard utilization. Current status of utilization rate needs to accelerate to get maximum turnover of the equipments among the district hospitals of Bangladesh. Important factors affecting the utilization of radiology and imaging equipments were observed – shortage of manpower, inadequate physical infrastructure, and less incorporation of advanced technology with existing facility. ORiginAl ARticle 1Senior Medical Technologist, 2Lecturer, 3Professor 1Department of Radiology, International Centre for Diarrhoeal Disease Research of Bangladesh, Dhaka, Bangladesh 2Department of Public Health, State University of Bangladesh Dhaka, Bangladesh 3Department of Public Health Administration & Hospital Management, State University of Bangladesh, Dhaka, Bangladesh Corresponding Author: Md Mofazzal Hossain, Senior Medical Technologist, Department of Radiology, International Centre for Diarrhoeal Diseases Research of Bangladesh, Dhaka Bangladesh, Phone: 8801710960825, e-mail:mhrt@icddrb.org 10.5005/jp-journ ls-10035-1072 Cross-sectional Study on Utilization of Radiology and Imaging Equipment in the District Hospitals of Bangladesh 1Md Mofazzal Hossain, 2Papia Sultana, 3M Shahjahan