Wrong blood transfusion (BT) is a medical negligence. Every hospital must have a strong policy to check incorrect BT and see to it that these policies are strictly implemented at the time of transfusion.

Wrong BT can occur due to carelessness of the staff and shortcomings in verification of the blood bag. The reasons can be avoided and wrong BT can be prevented by the formation of a checklist consisting of the important details to be verified before initiating transfusion. The checklist should not be very long and time-consuming, but very comprehensive and consists of only absolutely essential things to be checked.

To study the BT process and providing suggestions for streamlining the process of BT.

• To analyze the nears miss incidents during BT.

• To identify the errors in the process of transfusion.

• To streamline the process by introducing checklist/work instructions for reducing errors.

• Analysis of safety reports regarding BT.

• Process-based root cause analysis was done at the time of issue and at ward level.

• Feedback regarding BT was taken from the staff working at blood bank and nursing professionals.

The study was divided into two phases:

Phase 1: January—April 2014

Phase 2: May—August 2014

All the reports from phase 1 of the study were analyzed. Based on the observations, interventions in the form of checklist and work instructions to the nursing staff were implemented in the hospital in the month of April and then the safety reports for the next 4 months were analyzed.

Interventions done: A “4C” checklist was created with just four elements that could be orally or mentally reviewed before beginning transfusion. Specific work instructions were also issued to the nursing staff at the ward level to prevent any errors during labeling of the samples being sent for cross match and blood grouping before BT.

The number of BT-related safety incidents observed in phase 1 reduced in phase 2 though the workload in terms of samples received remained comparable for the two phases. However, a declining trend for the reporting of incidents was also seen through the phases.

Shrivastava AA, Somu G, Dayananda M. Good Clinical Practices toward Safe Blood Transfusion: A Study of Blood Transfusion Process and providing Suggestions for streamlining the Same. Int J Res Foundation Hosp Healthc Adm 2016;4(1):1-4.

This study is based on an approach employed by a medical college hospital for improving the adequacy of documentation in their medical records. The hospital utilized CRABEL scoring tool to screen and score their medical records and then used this information as a feedback to their clinical departments for encouraging them to improve their record documentation.

The study aims to determine whether the approach of the hospital resulted in any significant change in adequacy of their medical record documentation.

Baseline sample of 250 current medical records (stratified random) from four clinical departments were scored using CRABEL scoring method to determine baseline average score and number of files with high scores (score > 0.85). Feedbacks on scores were given to departments, along with the information on areas for improvement. Scoring and feedback were repeated every month for six consecutive months, with sample size of 230 to 271. Trends in average score and number of files with high scores were observed. Difference between average scores of baseline sample and sample at the end of 6 months was statistically tested. Number of files with high scores, in departments where approach was carried out was compared with number of files with high scores, in departments were approach was not carried out, to check statistically significant difference, if any

The trend showed a continuous monthly improvement in both average scores and number of files with high scores. Improvement was found in files of all clinical departments with minor variations. The chi-square test and Student's t test showed a significant difference at p < 0.05 (p for chi square — 0.001 and for t-test — 0.04).

The hospital's approach was found to be successful in improving the adequacy of documentation in medical records.

Medical record constitutes the most important record in a clinical setting. Completeness of medical record is essential for proper patient care, but is a challenge in most organization. The approach has proven successful in this study and can be replicated in other settings for improvement.

Raza A. Use of CRABEL Scores to improve Quality of Medical Records Documentation in Hospitals. Int J Res Foundation Hosp Healthc Adm 2016;4(1):5-10.

The quantum of waste generated from medical care and activities is a global matter of concern. Improper management of biomedical waste (BMW) has a grave health impact on the community, health care professionals, and the environment.1 It is mandatory by law that every medical organization that generates waste should have a system, process, and resources in place for segregating BMW within the organization for proper disposal. The present article deals with the understanding of various costs associated in BMW management process that will help the health care organization to prioritize their spending and focus on areas that require spending to achieve compliance in process of BMW management.

Descriptive cross-sectional study was carried out, to study the compliance of BMW management at three different hospitals with respect to Bio-Medical Waste (Management and Handling) Rules, 2011. A retrospective study was conducted to analyze cost data for a 1-year time period. Cost involved in BMW management was analyzed and classified as capital and recurring costs. The study was undertaken in Udupi taluk, and the taluk comprises 11 hospitals (1 Government and 10 private hospitals). The hospitals were selected using convenient sampling as taking permission to conduct the study was difficult. Only three hospitals were permitted to carry out the study.

Compliance was found to be better in accredited hospital than in nonaccredited hospital. This could be attributed to strict adherence to standard operating procedures and regular training of staff. Cost involved in BMW management was analyzed as capital and recurring costs. Since most of the hospital outsource final disposal, capital costs are significantly less compared to recurring costs. Among the recurring costs, maximum expenditure is on consumables like color-coded bags. Cost per bed per day for handling BMW was calculated and it was found to be higher in smaller hospitals.

Bryal D'souza, Arun MS, Johnson B. Comparative Analysis of Cost of Biomedical Waste Management in Rural India. Int J Res Foundation Hosp Healthc Adm 2016;4(1):11-15.

Anand H, Siddharth V, Goyal V, Koushal VK. Lead Time in Drug Procurement: A Study of Tertiary Care Teaching Hospital of North India. Int J Res Foundation Hosp Healthc Adm 2016;4(1):16-19.

In case of internal disasters, such as fire in hospitals, health services to the community are severely hampered with the additional morbidity of victims, such as employees and visitors present when the disaster strikes. Risk assessment and fire preparedness are most crucial proactive measures to prevent fire disasters and minimize the loss in a hospital; however, scanty studies are available on this topic.

This cross-sectional study was conducted at a multispecialty hospital in Mumbai, Maharashtra (India), during March. April 2014. Fire-Safety Preparedness Framework (FSPF) was designed with four domains (risk and vulnerability assessment, response mechanisms and strategies, preparedness plan and information management) for evaluation of fire safety preparedness of hospital employees. Baseline variables were summarized; instrument was tested for reliability using Cronbach's alpha and content validity through review by experts. The number of correct responses for each question was further analyzed across the type of employee.

The instrument showed high reliability (Cronbach's alpha = 0.89, p-value. 0.01) and content validity. A total of 207 employees (mean age 32) 8.3 years, 63% females) consented and participated in the study. Out of 20 questions, awareness was high (90%) only for three questions from Response mechanism and strategies-domain. For the remaining questions, awareness was moderate to low. The awareness varied highly with the type of employee.

The FSPF is a reliable tool for application in the Indian context for hospital employees. Disaster preparedness training and drill need to involve employees from all departments as awareness levels varied highly with type of employee.

Shukla K, Chandrashekhar P, Mehta S. How Prepared are Hospital Employees for Internal Fire Disasters? A Study of an Indian Hospital. Int J Res Foundation Hospc Health Adm 2016;4(1):20-24.

Health insurance is emerging fast as an important mechanism to finance health care needs of the people. Complexity of the health insurance industry has been much talked about and less understood in the Indian scenario. Hence, it is imperative to assess the level of awareness that the population has with respect to health insurance policies.

Cross-sectional prospective study conducted over a period of 6 months, at the third-party administrator (TPA) desk of the hospital. The data was collected using a preformed close-ended questionnaire after obtaining consent from all the participants. Only patients admitted in the hospital availing cashless hospitalization were included in the study. The study was undertaken with the objective to determine the level of awareness about insurance policies and procedures among those insured and identify the problems faced by those insured when availing cashless treatment. Responses to the variables in the questionnaire were compiled and tabulated using Excel 2010.

Response rate of 76% was observed. 56% of the study population were planned admissions and 44% were admitted through emergency department. The study showed that about 56% of the principal policy holders were between 30 and 50 years of age. The awareness regarding the terms and conditions of the health care insurance policy and the servicing TPA was found to be 70%. However, on interacting with patients it came to light that despite being appraised by their insurance agent, they faced challenges while availing health care benefits under health care insurance and were ignorant about the procedure involved.

For the current admission, in 78% of the cases, the TPA responded within 24 hours of intimation; however, in 22% cases there were delays in response from the TPA mostly attributed to communication gap between the Insurance Company and the TPA. Preexisting disease was not covered in 14% cases. 82% cases had to wait for more than 2 hours for the final clearance from the TPA. Over the years, as ascertained in 2016 also, the scenario of insurance has not undergone significant change.

Strategies to optimize claims by bringing about a uniformity in the rates being charged by the hospitals for different procedures are needed to increase coverage.

Jain K, Sinha SK, Jain D, Kumar R. Does Health Insurance give Us an Assurance? A Study on the Extent of Coverage of Health Insurance at a Tertiary Care Hospital in North India. Int J Res Foundation Hospc Health Adm 2016;4(1):25-30.

Tadia VK, Ahlawat R, Arya SK, Sharma DK. A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior. Int J Res Foundation Hosp Health Adm 2016;4(1):31-34.

This study aims to evaluate surgical care systems across tertiary, secondary, and primary health institutions in the state of Meghalaya, India.

The government of Meghalaya conducted the first comprehensive assessment of surgical capacity at three levels of care: Tertiary hospitals, community health centers (CHCs), and primary health centers (PHCs).

This cross-sectional survey utilized World Health Organization (WHO) tool for situational analysis to assess emergency and essential surgical care (EESC) to capture health facilities’ capacity to perform life-saving and disabilitypreventing surgical interventions, such as resuscitation, surgical, trauma, obstetric, and anesthetic care. Data were collected across four categories Infrastructure, human resources, surgical procedures, and equipment.

The 55 facilities surveyed comprised 8 tertiary hospitals, 26 CHCs, and 21 PHCs. A total of 107,962 surgical presentations were reported across all facilities per year, with the greatest number presenting to PHC. No specialist doctors worked at PHC level; there were 1 anesthesiologist and 2 obstetricians at the CHC level. All of the PHCs or CHCs referred do not provide key emergency and essential surgical procedures, including resuscitation, cesarean section, general anesthesia, laparotomy, and closed and open treatment of fractures. At the tertiary level, only 50% provide cesarean section and laparotomy procedures.

The results of this WHO state survey demonstrate significant gaps, notably in resuscitation, at all lower level health facilities and the absence of obstetric procedures at some tertiary hospitals, in essential and emergency surgical capacity, including human resources, equipment, and infrastructure, across all levels of health institutions in Meghalaya.

This study is an effort to identify the strengths and limitations of surgical capacity in the state of Meghalaya. The method of the study are simple and results can be extrapolated to other states of the country or any third world state which can translate into enhancement and redirection of resources for an optimum outcome.

• This study is driven by the motivation of the government of Meghalaya to address the issue of surgical care capacity.

• The study identifies concrete areas of need in surgical care capacity in a collaborative effort with the government of Meghalaya.

• Given the wealth of information on different levels of care centers provided by the government, specific recommendations for improvement can be made.

• Although detailed, the situation analysis survey tool is not fully comprehensive and cannot be used exclusively for program planning.

• Not all care centers were able to be surveyed; thus, the results may be representative of only those surveyed.

Chien BY, Singh KI, Hashimoto- Govindasamy LS, Cherian MN, Mehrotra M, Francis PP, Menabde N. Emergency and Essential Surgical Care Capacity across Primary, Secondary, and Tertiary Institutions in Meghalaya, India: A Cross-sectional Study. Int J Res Foundation Hospc Health Adm 2016;4(1):35-44.

An emergency department (ED), also known as accident and emergency (A8E), emergency room (ER), or casualty department, is a medical treatment facility specializing for acute care of patients who present without prior appointment, either by their own means or by ambulance. In spite of the emergency beds forming only a fraction of the hospital beds, they consume a relatively large proportion of the hospitals resources. There is a requirement to ascertain the cost incurred in providing emergency care treatment to the patients coming to an apex tertiary care center, whose principal mandate is to provide tertiary care treatment. The study will not only help in allocating funds to the ED in an apex tertiary care facility but will also be useful if the hospital authorities decide to outsource the emergency services to a third party.

To study the cost incurred in providing emergency care services in an apex tertiary care hospital. To identify the various cost centers pertaining to patient care in the emergency care department and to estimate the cost of rendering patient care in ED and the cost of running the emergency per day.

Six months’ retrospective data were collected from the ED, accounts section, engineering section, stores department, radiology department, emergency lab, computer facility, etc. The cost was apportioned to per patient as well per hour in rendering emergency care services.

The total cost incurred in providing emergency care services in the hospital under study was Rs 2034 per patient, while Rs 31,000 are spent per hour in running the emergency care facility.

Almost 40 to 50% of the total cost incurred on providing emergency care services goes to the salary head of the staff working in the ED. The next major sources of expenditure are the radiology and lab investigations.

The study suggests that a considerable amount of hospital funds are spent on providing emergency care services in the apex tertiary care facility, whose primary mandate is to provide tertiary care services. The possibility of complete outsourcing or partial outsourcing in the form of radiology investigations and hiring humanpower on a contract basis can be a viable solution, to reduce the cost on providing emergency care, which can better be utilized in providing high-end tertiary care facilities.

Garg N, Gupta SK, Lathwal A, Garg R. A Study of Cost incurred in providing Emergency Care Services in an Apex Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2016;4(1):45-50.