Background: Non Productive Time OT causes potential loss or deferment of revenue for the hospital and internal customer dissatisfaction. The quality tool Lean Six Sigma may help to reduce the non-productive time. Aim: To use elements of a six sigma model to reduce non-productive time in Gastro Intestine Surgery OT. It focuses on the reduction of NPT between Patient In time and Induction Begin time, Induction End time and Incision In time, Patient Out time and OT Readiness Time. Method: In a five phase study using DMAIC (Define. Measure, Analyze, Implement & Control) model, business case, value analysis, brain storming, FMEA (Failure Mode & Effect Analysis), RPN (Risk Priority Number) calculation identified causes and solutions. In six sigma analysis process sigma, target sigma and achieved sigma was calculated. Results: The null hypothesis of no difference in old and new Non Productive Time between Patient In time and Induction Begin time, between Induction End time and Incision and between Patient Out Time and OT Readiness Time was rejected using 2test since the p-value was below 0.05 at 95% confidence level. The process sigma was at 0.91, 0.96 and 0.67 which got improved to 2.55, 2.22 and 3.28 which was better than target Six sigma. Overall bottom line improvement was 4.8CR for the study period by bringing efficiency in the system. Conclusion: The six sigma project in OT resulted in reducing NPTs, helping to take more cases, patient discharge becoming more systematic, and reducing chaos regarding scheduling OT cases.

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Objective: Health being a subject of the state and Accreditation of Healthcare Organisations being a voluntary process, the Quality Council of India (QCI) through National Accreditation Board for Hospitals and Healthcare Providers is creating standards and promoting quality in healthcare. The Medical Laboratory Program, which is designed to improve the Quality of Medical Laboratories, is being implemented by both government and private Laboratories to ensure quality of test results. Materials and Methods: A small program Evaluation study was carried out over a period to understand the level of understanding, usefulness and feedback from the participating Laboratories regarding "QCI - Essential Standards for Medical Laboratories"1 Program. The data was collected and analysed from 55 participating laboratories. Results: The study findings indicated 100% strongly agree that, training programs conducted were really helpful, 98% stated that, this program was instrumental towards Patient Safety and improved the Quality Indicators of laboratory activities. Around 89% of the respondents strongly support the fact that "Educational Materials & technical Supports provided by Med-Lab Team were very useful & helpful to implement the standards" & this Program has helped to "achieve Quality Output with minimal effort & investment". Most of the respondents (4/5 ^th ) i.e. 80% of the respondents found that implementation of Med-Lab Program was easy & flexible. More than 80% of the respondents have felt either good, very good or excellent on all the parameters that have been spelt out regarding "Post-Implementation impact of Med-Lab Program on various quality Indicators. 53 labs (96%) are satisfied with results on post implementation of the Med-Lab Program and agreed to recommend this program to other labs as well. This is the first such study in India. The findings may be an eye opener for the labs and the state governments who haven't yet participated in the Med Lab Program.

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Background and Objective: The next decade shall see a great change in the health care sector and there is a need for standardization of health care delivery at all levels, which at the moment is lacking in India. The standardization can come if we adopt some sort of uniform accreditation. For proper deliverance of health care, the role of medical staff is significant. This asks for an assessment on the attitude of medical staff toward accreditation and then the knowledge on accrediting standards. This study is conducted with the objectives to identify the attitude level of medical staff on accreditation, as well as their knowledge level on NABH standards. Research Methodology: The study was conducted on 10 doctors and 40 nurses of the hospital before and 6 months after the start of accreditation process in the hospital. Samples were selected by simple random method. A questionnaire was used to collect the information about the attitude and knowledge of medical staff about NABH accreditation. Results: The study revealed that medical staff had a positive attitude and improved knowledge about accreditation after 6 months working in a hospital on the way to NABH. The attitude reflected in their positive approach in managing patients under better work atmosphere thus, indirectly reflecting on the benefit to the society as whole. Conclusion: The sound knowledge and a positive attitude toward NABH accreditation among the medical staff are very important. And the same can be accomplished with proper training and good hospital environment.

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Aim: The present cross-sectional questionnaire survey was conducted with an aim of assessing the knowledge, attitude, and practice (KAP) related to pharmacovigilance among the health-care professionals in a teaching hospital located in Central India region. Materials and Methods: To assess the demographic details of the health-care professionals, their KAPs toward pharmacovigilance and adverse drug reaction (ADR) reporting; a predesigned, structured, close-ended 18 item questionnaire was used. Results: A total of 392 questionnaires were distributed among the health-care professionals. It was found that only 38.01% health-care professionals comprising 54.43% medical, 38.01% nursing and 19.01% dental professionals were aware regarding the existence of pharmacovigilance program of India. While, only 40.56% health-care professionals felt that ADR monitoring center should be established in every hospital. Similarly, very few health-care professionals, that is, 6.12% have ever reported ADR to pharmacovigilance center. Conclusion: The results of our study indicate that the majority of the health-care professionals had a poor knowledge and attitude about pharmacovigilance. There was a huge gap between the ADR experienced, and ADR reported by the health-care professionals especially among dentist and nursing staff. It has been advised that the health-care professionals; especially dental and nursing, should be trained properly on ADR reporting to improve the current scenario in the pharmacovigilance program of the country.

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Introduction: The purpose of continuous quality improvement programs is to improve health care by identifying problems, implementing and monitoring corrective action, and studying its effectiveness. Aim: The present study aims to find out the present length of stay (LOS) of inpatients at a superspeciality hospital. Objectives: 1. To study the existing system of discharge process of patients, 2. to find out the reasons for the delays, 3. To recommend suitable suggestions to reduce length of stay. Mehodology and Results: By considering the LOS of 128 random patients, 32 from each ward A, B, C, and D. The average LOS (ALOS) was found to be 5.69. Factors have been identified by studying the delays through time and motion study in the discharge process. Recommendations: Recommendations have been made for appropriate changes to be considered to reduce ALOS and bring it to 5.0 so that proper resource utilization occurs, and at the same time, there is an improvement in bed turnover rate and thereby in bed occupancy rates.

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Background: This study was undertaken to assess the levels of job satisfaction and its correlate among nurses in Aminu Kano Teaching Hospital (AKTH); and to compare the levels of job satisfaction between senior and junior nurses. Materials and Methods: This was a cross-sectional study of senior and junior nurses working at various specialties in AKTH, Kano. Ethical clearance and informed consent were obtained. Questionnaires were used to obtain a response from 350 nurses in a five-point Likert scale. The data obtained were analyzed using SPSS version 16.0 statistical software. Descriptive statistics was used. Significant association of job satisfaction and sociodemographic variables was tested using the Chi-square test and Pearson' Coefficient of Correlation. Statistical significance was considered when P < 0.05. Result: The mean ages were 30.26 ± 4.76 and 40.19 ± 5.61 years for junior and senior nurses, respectively, and the difference was statistically significant, (P = 0.001). The mean number of dependents was higher (5 ± 2) for senior nurses compared to junior nurses (4 ± 2), but the difference was not statistically significant. Both age and number of dependents showed very weak positive correlations with job satisfaction. The average duration of service for senior nurses (9.45 ± 4.25 years) was higher than that of junior nurses (3.44 ± 2.00 years), and the difference was statistically significant (P = 0.0001). Most junior nurses had their promotion 4-7 years prior to the study (58.75%) compared to the senior nurses whose promotion was within the past 3 years (64.7%). Nurses in the two groups worked 7-9 h/day (84.3% and 85.3%). Duration of last promotion showed very weak positive correlation with job satisfaction. Conclusion: There are generally high levels of job satisfaction among nurses in AKTH compared with those report from other studies and this showed a very weak positive correlation with promotion. Job satisfaction may improve if nurses are promoted timely.

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Aim: The aim was to assess the knowledge and awareness of standard precautions among heath care workers that is, doctors, nurses, and technicians. Setting and Design: A cross-sectional survey was conducted in September and October 2013 at Nizam's institute of medical sciences, Hyderabad. Materials and Methods: A 40-item questionnaire was provided to 180 health care workers including doctors, medical technicians and nurses to assess their knowledge and awareness of standard precautions under seven divisions namely general information on standard precautions, care of skin and hand washing, personal protective equipment (PPE), procedure for the safe handling and disposal of sharps, postexposure prophylaxis, bio medical waste and linen disposal, knowledge on blood borne and other pathogens. Statistical Analysis: Chi-square test has been used to compare the relevant groups. Results: It was observed that 96 (53.3%) respondents are very knowledgeable and 84 (46.7%) were somewhat knowledgeable. In the very knowledgeable category, there were 38 doctors, 24 nurses and 34 technicians. 48 (57.1%) males and 48 (50%) female respondents were found to be very knowledgeable. With respect to length of service, 21 (53.8%) respondents in 0-5 years of service category, 18 (60%) in 5-10 years category and 57 (48.7%) in >10 years category were found to be very knowledgeable. Conclusions: Knowledge of standard precautions was highest among doctors (63.3%), followed by technicians (56.6%) and nurses (40.0%). There is a significant difference in knowledge and awareness of standard precautions among studied health care professionals (P = 0.031). Knowledge and awareness of standard precautions did not vary significantly between males and females (P > 0.05). There is no significant difference in knowledge and awareness of standard precautions among groups, with respect to length of service (P > 0.05). The studied population was not very knowledgeable in division's namely PPE, sharps disposal and bio-medical waste disposal.

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Aim: The aim of this study was to analyze the multi-center data of healthcare associated infections (HAIs) to assess the infection control (IC) scenario in India in context with Center for Disease Control (CDC)/National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC) database. Materials and Methods: Four National Accreditation Board for Hospitals accredited hospitals contributed their raw data on HAIs-number of days and number of infections in all intensive care patients were obtained as per the CDC-NHSN definitions and formulae. Three major device related infections were considered for analysis based on the prevalence of HAIs and discussions with subject experts. All nodal champions from each hospital were trained and common data collection sheet for surveillance in accordance to CDC-NHSN was formed. The pooled means for HAI rates and average of the pooled means for all were calculated using data from them and compared with CDC/NHSN and INICC percentiles. Results: The Indian pooled mean HAI rates for all infections were above CDC/NHSN percentile threshold but below INICC percentile. Ventilator associated pneumonia was considered as a matter of prime concern, crossing P90 line of CDC/NHSN threshold. However, no HAI rate was in the limit of P25. Conclusion: Indian HAI rates were higher when mapped with CDC threshold. This suggests the requirement for more standardized and evidence based protocols to tackle the HAIs with an aim to achieve the benchmark within CDC/NHSN thresholds. However, the 4 hospitals have better HAI rates as compared to pooled INICC database.

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Context: The purpose of this study was to analyze the implementation of the surgical safety checklist (SSCL) for all invasive procedures and compliance with the SSCL to determine further improvements. Aims: To implement the SSCL for all invasive procedures within 6 months and achieve 80% compliance. Settings and Design: Various invasive procedures selected that have comparatively risks of errors. Modified the SSCL based on essential requirements of the procedure. Materials and Methods: The implementation of the SSCL was observed for all identified invasive procedures. Checklists were piloted, rolled out, and monitored. Statistical Analysis Used: Plan-Do-Study-Act (PDSA) and Pareto principle were used for implementing the SSCL and analyzing the hurdles for implementation. Results: During this exercise, the checklist for the various invasive procedures was finalized after a brainstorming sessions with various stakeholders. All the checklists were developed with the help of the World Health Organization (WHO) surgical safety principle between March 2013 and May 2013. Sensitization and training for the checklist were done among all relevant staff. All the checklists were piloted for June 2013 and the compliance of checklist usage was monitored. The sample for audit was decided. The rates of compliance for various procedures during the pilot phase of the study were 50% for dental extractions, 60% for cataract surgeries, 35% for endoscopy, 20% for cystoscopy, 40% for cardiac catheterization procedures, and 0% for bronchoscopy procedures. Compliance reviewed and changes made based on feedback received from users for checklist finalization. After the intervention, compliance monitoring for the same sample size at a defined frequency is done and shared with relevant stakeholders when required. Conclusions: Implementation needs constant monitoring, retraining, and reinforcement until it becomes self-evident and accepted.

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Introduction: Sharp injuries are not uncommon among healthcare workers and costs of post ex-posure management go unmeasured, because a few aspects of it are potential costs due to medi-co-legal and psychological issues which indeed are unmeasurable.Many healthcare institutions even in India are obliged to carry out investigations and provide treatment in the event of sharp injury from an infected patient. These cost the healthcare facility. Aim: In an attempt to understand the direct cost of post exposure management, we carried out this prospective observational study. Results: There were two hundred and three sharp injuries at our institution from the year 2007 to 2014. In our study the total cost of post exposure management was INR 423,555/- and approxi-mate mean cost per sharp injury was INR 2100/-. Several workers from developed countries showed that it made economic sense to use safety engineered products rather than manage sharp injuries. This however might not be acceptable verbatim in developing countries counties such India. Conclusion: Time has come for governments and producers of safety engineered devices to arrive at a formula in making safety engineered devices are available to healthcare workers of India at cost lower than that of developed countries.

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Background: Clinical laboratories usually focus their attention on quality control methods and quality assessment programs in dealing with the analytical aspects of testing. However, quality in clinical laboratories cannot be assumed by merely focusing on analytical aspects only. Preanalytical processes are equally important for ensuring quality services since most of the laboratory errors occur in this phase thus influencing patient outcomes and cost. Objective: The aim of this study was to evaluate and compare the level of completion of request forms in blood bank (BB) and biochemistry (BC) laboratory of a teaching hospital in North India. Materials and Methods: A total of 3532 requisitions were received in BB and 18,410 in BC laboratory between November 2014 and April 2015. The information regarding incomplete/inappropriate requisitions and samples in both departments were recorded, compared, and analyzed. Results: The most common deficiency was the absence of clinical/provisional diagnosis among both the outpatient department (OPD) (50.7%) and inpatient department (IPD) (3.2%) request forms in BC. Doctor's name not mentioned in 1.1% of the OPD requisitions and platelet count not mentioned on 7.8% of platelet request forms in IPD requisitions were the most common deficiencies in BB. The only well-documented parameter was the patient's name. Maximum numbers of incomplete requests were received from medicine OPD's followed by Intensive Care Units, emergency and medicine wards. Conclusions: As laboratory data play a significant role in medical diagnosis, incorrect/incomplete data provided to the laboratory significantly affects the comments and successful outcome of the treatment that patient receives. Therefore, clinicians and paramedical staff should be trained to adequately fill all the required information into the request forms and appreciate its importance to patient's management. Furthermore, feedback/interpretation of significant results by the laboratory physicians to the clinicians should be emphasized.

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Introduction: Hand hygiene is one of the least expensive easy to train procedure which can sub substantially decrease hospital associated infections. Healthcare workers perhaps are the major contributors to health care associated infection by their non compliance to this simple practice. It is important that knowledge and training about this preventive measure be inculcated during the training of healthcare workers. Training of young medical students is undoubtedly an important pivot to ensure reduction in hospital associated infections. Aim: A survey regarding hand hygiene practices among medical students was conducted with an aim to find out the knowledge and practices of the students regarding hand hygiene during their interaction with patients and their routine hospital visits. Methods: An electronic survey using 'survey monkey' was conducted in a medical college in the city of Bengaluru to assess the knowledge levels of medical students. Medical students of all the years of education were included. Full fledged doctors were excluded from participation. Results: Our results suggest that knowledge regarding hand hygiene is sub-optimal among the students (40%) and the compliance is low (63%) as a consequence of non availability of hand rubs at various locations. Theoretical knowledge among the medical students was high. More than 70% knew that the gloves cannot be replacement of hand hygiene. But the other details of the procedure of hand hygiene, were not known to them. Only 44% of the respondents an-swered that 10 seconds contact time with an alcohol, 29% answered it as 20 seconds, 23% an-swered as 1 minute and 4% answered 3 seconds. These data suggest that the medical institu-tions must taken upon themselves to train the prospective doctors in this vital, life saving simple. Conclusion: The knowledge levels of medical students about hand hygiene is far below expecta-tions; the administrators should take upon themselves to include this topic in the educational curriculum.

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There is an increasing focus on having quality systems in place during the planning stages of clinical trials. Such systems require the development and implementation of standards for each step. Although this is not imposing something totally new on clinical research, a systematic approach will produce a more reliable and useful end product-high-quality data obtained without compromising the protection of human subjects' rights and welfare. A suggested quality system with standards for each step is addressed in this article. The organization measures and improves when necessary, compliance with organizational policies, procedures, and applicable laws; regulations, codes, and guidance. The organization also measures and improves when necessary, the quality, effectiveness, and efficiency of the clinical trial process to protect the research participant.

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