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2015| July-December | Volume 2 | Issue 2
January 19, 2016
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Criteria-based core privileging: Best form of privileging
July-December 2015, 2(2):61-68
Hospitals are accountable and responsible for all activities & services provided by the individual healthcare providers within their premises. The primary objective of Credentialing & Privileging process is to ensure that hospital and healthcare providers provide services, which are appropriate in scope and quality of their practice. While credentialing involves obtaining, scrutinizing and verifying the qualifications, experience & professional standing of medical practitioners, to judge their competence, privileging is the right of a medical practitioner to provide specific medical care consistent with his/her training, experience and competency. Of the various methods of privileging, Criteria-based core privileging incorporates predefined criteria in conjunction with clinically realistic, well-defined core privileges. This is a scientific approach to privileging in which the privileges for each specialty are predefined and divided into two categories: a) Core Privileges: Privileges that a fully trained, entry-level medical practitioner is qualified to do in a particularly specialty on completing an approved training program. b) Specific (Additional/Non-Core Privileges): Procedures that go beyond the core that would require additional training and/or experience are covered by additional specific privileges. Practitioners who meet predefined criteria are eligible to apply for core privileges, and those who can document additional training and experience may request special (or noncore) privileges. Advantages of Criteria Based Core Privileging are: scientific approach with clearly defined criteria, consistency, and practicality with ease of operationalization. High attrition rates & frequent hiring of medical staff also makes Criteria Based Core Privileging the most suitable form of privileging for Indian Healthcare scenario.
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Implementation of surgical safety checklist for all invasive procedures
Akanksha Patel, Vinay Sanghi, Vibhu Ranjan Gupta
July-December 2015, 2(2):41-46
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.
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.
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.
Implementation needs constant monitoring, retraining, and reinforcement until it becomes self-evident and accepted.
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Achieving quality in primary health care
Anil P Pandit, Meenal Kulkarni, Swati Sonik
July-December 2015, 2(2):37-40
This review article tries to provide an insight into how we can improve the quality of primary health-care services provided in a primary health center (PHC) setup. Primary health care is essential health care made universally accessible to individuals and acceptable to them through their full participation and at a cost that the community and the country can afford. Unlike the previous approaches (e.g. basic health services, integrated health care, and vertical health services) that depended upon taking health-care services to the doors of the people, primary health-care approach starts with the people themselves.
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Dropped calls, Turnaround time and Document Retention Time: Crucial parameters to monitor the effective implementation of laboratory Critical alert policy for critically ill patients
Manminder Singh, Vibha Gupta, Piyali M Mathavan, Harish Chandra, Dushyant Singh Gaur, Muthuvenkkataraman Muthu Mathavan
July-December 2015, 2(2):53-60
Critical alert policy adopted under laboratory accreditation guidelines
and under the National Patient Safety Goals (NPSGs) has prioritized safe and timely communication of critical alert
so that immediate treatment can be done as soon as the sample showing critical value is communicated by the laboratory. Laboratories are burdened with the analysis of samples not only from emergency and intensive care units but also from outdoor and wards; require to frame a policy, which meets the need of the critical patients. Most of the studies conducted to analyze the effective implementation of the critical alert policy look at the tip of iceberg as the percentage of critical alerts reported by laboratory and the turn- around time.
The present study was conducted to analyze the various components of critical alert policy framed by the laboratory under study.
Setting and Design:
Study was conducted at a tertiary care hospital in a NABL accreditation of laboratory running since 3 years. We assessed not only the policy and procedure documented and followed by the laboratory under study as laid down under the guidelines
but also certain issue (Dropped calls), which are encountered during implementation of the critical alert policy and procedure.
Study was a retrospective, cross-sectional.
The outcome of the study highlighted the hidden component of the iceberg causing obstacle in implementation of the critical alert policy as increased dropped calls, the turnaround time of which till the writing of the manuscript was infinite. Moreover, short storage time of the document maintained by a laboratory as evidence of communication of critical alert to the caretaker by the hospital-based laboratory leaves the hospital with no evidence if required later on.
Detecting and correcting hidden components of critical alert policy can lead to immediate attention and treatment of critical patients and prevent mortality and mortality on one hand and on the other hand the hospital that implements this system can be prevented from the burden of medico legal cases to an extent.
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Cost of postexposure management of occupational sharp injuries in an Indian tertiary health care facility: A prospective observational study in a tertiary care hospital
Murali Chakravarthy, Sukanya Rangaswamy, Chidananda Harivelam, Sumant Pargaonkar, Rajathadri Hosur, Leema Pushparaj, Thejasvini Anand, Priyadarshini Senthilkumar, Arul Suganya
July-December 2015, 2(2):47-52
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.
In an attempt to understand the direct cost of post exposure management, we carried out this prospective observational study.
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.
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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