Hospital information system (HIS) is a key managerial tool for any hospital administrator. It gives him all requisite information online, wherever he is and whatever he is doing, so that he can apply timely interventions and set the things right and thereby take care of patient safety, quality improvement, and also minimize litigation problems in the hospitals.

After the initial introduction of HIS into the organization, the key findings were that the entire hospital operations are HIS driven. From the registration and admission of the patient, to the discharge summary generation of an inpatient, the entire process is guided by the HIS. It was found that the HIS is billing-centric, i.e., the HIS use pathway begins only when the registration fee is billed and the unique health identification number (UHID) of a patient is generated.

The main HIS modules under study are the Ward module and the Physician module. After conducting a utilization study using a structured questionnaire, it is found that the level of utilization of the Ward module is 36.4% and that of the Physician module is 6.66%. Using a Fishbone analysis, the causes of reduced HIS utilization have been identified and using a Pareto analysis the main causes have been found to be Work culture and Lack of mobile handheld devices. Various recommendations have been made to increase the HIS usage.

Pandit AP, Debmallik T, Kulkarni M. A Study on the Utilization of Hospital Information System (Ward and Physician) Modules in a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2016;4(2):51-60.

To assess the level of knowledge of appropriate prescription of dental radiographs amongst Interns of two dental institutes of Belagavi city.

A cross-sectional study was conducted on 120 interns of 2 dental institutes of Belagavi city. The knowledge of appropriate prescription of dental radiographs was assessed using a structured, close ended and self-designed questionnaire.

Knowledge of appropriate prescription of dental radiographs was significantly lower in Institute 1 than Institute 2 (p=0.001*).Only a small % of 33.76 and 38.66 of interns of institutes 1,2 respectively had an above average knowledge. Thus, it is inferred that the awareness level of interns of correct prescription of radiographs is lower than expected.

The lack of awareness could be due to various factors such as a lack of previous knowledge, inadequate quality and quantity of educational courses and so on. Thus, students should receive the necessary education on correct prescription of radiographs to ensure their correct prescription, circumventing unnecessary exposure and their consequent detrimental effects.

Radiographic examination is an important diagnostic tool used by dentists leading to an increased exposure to radiation. However, unessential exposure may lead to detrimental effects such as mutations, genetic changes and so on. One efficient way of decreasing exposure is to avoid their application when not indicated. Thus, it is the professional duty of a dentist to have adequate and accurate knowledge of prescription of radiographs. The present study shows the necessity to optimize educational tools to increase the theoretical knowledge of students and consequently improve clinical application of the knowledge gained.

Tyagi P, Naik Z, De Piedade Sequeira MAKE. Knowledge of Appropriate Prescription of Dental Radiographs among Interns of Two Dental Institutes of Belagavi City: A Questionnaire Study. Int J Res Foundation Hosp Healthc Adm 2016;4(2):61-65.

The article tries to streamline the process of communicating and recording the gender of newborn in the birth certificate in the labor room.

Descriptive.

Redesigning of the process of recording gender in hospital information system (HIS) module/e-birth module using process mapping and feedback from stakeholders.

There were instances of discrepancy in verbally communicating the gender of newborn soon after the birth and the gender being recorded in the birth certificate issued in the labor room. Soon after these instances were reported, the process was examined and redesigned. After implementation of the redesigned process, follow-up was done and it was noted that there had been no further instances of discrepancies in communication of sex of the newborn child and recording of gender in the birth certificate. However, to institutionalize the change and to prevent any further mishaps in future and to eliminate chances of all possible human errors, it was decided that the whole process will be retested and all possible loopholes will be identified, with the aim to create a process which achieves the objective of elimination of all possible human errors (mistake-proofing). Initially, the process mapping was done. Later, the new process of recording birth-related information including gender was codified and implemented. The follow-up was again done post this intervention. It was found that systemic changes had streamlined the process. This had resulted not only in right gender recording and elimination of possibility of any errors, but also in reduction of number of visits by patients to labor room to get birth certificate.

Investigation of errors and redesigning of processes help in rooting out various defects in the system. Therefore, all the acts of omission/commission resulting in undesirable outcomes should be used as opportunities for overall improvement rather than to find fault of erring employees. As in this case, the overall approach was to improve the existing system leading to elimination of chances of any mistake and streamlining operations leading to desired outcomes.

Sahran D, Tadia VK, Arya SK. Streamlining the Process of Communicating and Recording the Gender of the Newborn Child in the Labor Room. Int J Res Foundation Hosp Healthc Adm 2016;4(2):66-69.

An unusual amount of brisk and continuous traffic of people as well as goods crisscrossing every zone of the theater was noticed at an operation theater (OT) of a cardiothoracic center. Many storage areas were filled with cartons of various sizes which are good media for fungi and bacteria. Interactions with the theater staff and a study of the stores revealed that the traffic of people and goods was interconnected, and improper stores management was the root cause of the increased traffic. The focus of this study was to identify possible reasons for unusual traffic in the OT and to arrive at solutions in an objective manner for optimizing it.

The aim was to assess the traffic flow in an OT with the purpose to devise and implement measures for optimal and even flow of traffic during surgery and to create an additional operating room (OR) and instrument room and to improve the overall indoor air quality (IAQ).

Scholarly articles regarding ventilation, traffic flow, and inventory management were reviewed along with information available onsite. The method of descriptive study was adopted. Data were collected after analyzing the traffic flow charts, prestudy questionnaire, nonstructured interview results, and nonparticipant observation study. Tools for the study included: (1) Anecdotal evidence, (2) checklists, and (3) rating scales of three different groups. Compliance levels of five different categories of people in the OT were assessed. Air efficiency microbial culture studies and wound swab cultures were carried out during and postimplementation.

The process also resulted in generation of optimal traffic of staff and goods inside the ORs and decreased air turbulence, collateral benefits, such as (1) creating space for an additional OR, (2) creating a sterile area for storage of instrument packs, (3) optimal space management by segregation of bulk stores, (4) organized inventory control and indenting, and (5) good ventilation in ORs. Changes made in administration and training program increased awareness and compliance levels among staff. No surgical site infection was reported during poststudy observation period.

The study has resulted in improvisations originally conceived, planned, and implemented by the author at the work station. This study facilitated optimizing traffic of people and goods in OT and stores and in improving IAQ. Excellent cooperation among staff, clean and pleasant ambience, peaceful work situation, laid out standard operating procedures, segregated stores, and well-designed work hours boosted the morale of the entire staff.

One of the main sources of airborne contamination in ORs is dead skin cells called “squames,” each around 15 μm or less in diameter shed by staff and patients. A proportion of these may carry harmful bacteria. The rate of shedding increases with movement. This study focused on optimizing traffic of people and goods in the OT and thereby resulted in improving overall IAQ.

Saraswati SV. An Evidence-based Study on Traffic Flow in Operation Theater. Int J Res Foundation Hosp Healthc Adm 2016;4(2):70-78.

Modern hospitals are matrix organizations with a high investment in terms of capital, labor, and resources. It is imperative for the hospital administration to provide right material of right quality at the right time. Hospitals that set up in-house laundry operations generally make the decision without thoroughly identifying and accounting for total linen and laundry costs. Now evidence has emerged that hospitals that outsource were seeing improved linen utilization rates. If proper and clean linen is not provided, this can result in patient dissatisfaction. Further, innovations in laundry equipment have led to tremendous increases in efficacy. So, there is a need to ascertain the cost incurred in providing linen and laundry services so as to gauge the plausibility of transitioning to outsourcing-based models.

To study the cost incurred in providing linen and laundry services at an apex tertiary care hospital and to evaluate outsourcing model based on rental linen management.

A descriptive, cross-sectional, retrospective, record-based study was conducted during a period of 1 month from March 1, 2016 to March 31, 2016.

The quantity of monthly linen washed in Dr Rajendra Prasad Centre was found to be 22,465 kg. The monthly laundry expenditure in Dr RP Centre was Rs. 1,415,295. The linen procurement expenditure per month at Dr RP Centre was Rs. 419,386. So total expenditure on linen and laundry per month at Dr RP Centre was Rs. 1,834,681. Thus, cost/kg (with inclusion of linen cost) was Rs. 82.

The rate quoted by a leading vendor to supply washed, sterilized linen to the hospital was Rs. 55 per kg. Since the expenditure incurred per kg at Dr RP Centre was Rs. 82, this amounted to a saving of around Rs. 27 per kg. It would mean saving of around Rs. 606,555 per month and Rs. 7,278,660 per annum. So, it was recommended that rental linen management services may be hired for Dr RP Centre after taking care of functional, operational, and strategic contingency.

Tadia VK, Gupta SK, Arya SK, Lathwal A, Jain K, Ahlawat R. Why switch to Rental? Costing of Laundry Services at an Apex Tertiary Care Hospital from the View of Outsourcing based on Rental Linen Management Services. Int J Res Foundation Hosp Healthc Adm 2016;4(2):79-88.

(1) To study compliance rate of prescriptions written in capital letters according to continual quality improvement (CQI) 3j indicator of National Accreditation Board of Hospital (NABH) (4th edition). (2) To study compliance to doctors and patient detail, legibility of prescriptions, strength and dose, frequency, route of administration, dosage form, abbreviation for drug, allergy detail, and leading zeros in the dose.

Convenient randomly selected Medication Administration Record (MAR) sheets from wards and intensive care units (ICUs) were studied. One hundred thirty-two prescriptions were identified for errors pertaining to doctor’s details, patient’s details, and medication details. Errors were captured on a prepared checklist for a period of 11 days. Results were analyzed by Microsoft Excel.

Results were expressed in percentages for wards and ICUs respectively. Six hundred twenty four and 652 drugs were observed in wards and ICUs respectively. Doctor’s name was present in 79.6 and 83.3%. Out of 55 prescriptions in both wards and ICUs, patient’s name compliance was 94.5 and 96.4% and patient’s weight was 83.6 and 81.8% respectively. Compliance for drugs in capital was 98 and 100% for wards and ICUs respectively. Details pertaining to medication were also found out subsequently on various parameters.

The study revealed that the level of completeness of handwritten prescriptions was low in terms of doctor’s details and patient’s weight, which indicates unsatisfactory commitment of the prescribers to follow the hospital guidelines of prescribing. Majority of prescriptions showed compliance to medication written in capital but still the compliance to clear and legible prescriptions is three-fourths of the total prescriptions.

Kaushik S, Chawla R, Bhalla S. Prescriptions Written in Capital Letters in Compliance with National Accreditation Board of Hospital Standards. Int J Res Foundation Hosp Healthc Adm 2016;4(2):89-99.

To identify the number of individuals for whom double identification check was done before administering medication and before procedure/intervention, as per Continual Quality Improvement 3j indicator of National Accreditation Board of Hospitals (4th edition) and hospital policy.

The study was a concurrent, observational recording of the study population which included doctors/surgeons, nurses, and/or technicians before administration of any medication and before beginning of any procedure/intervention. The observations were recorded on a prepared checklist to find the compliance of incidence of patients’ double identification.

A total of 34 observations were recorded before administering medication to a patient. In 18 cases, wristbands were not being used, and identification details were incorrect in 4 cases. Of 34 cases, identifiers were illegible in 6 cases. The major area where the error was high was noncompliance to verbal confirmation of identity (ID) and checking it from the patient’s file. Out of 34 observations before a procedure/intervention, 9 errors were identified in cases where the ID band was not used for verification, and identification details on the band were illegible in 5 cases. In six cases, the patient’s name was not verbally confirmed with the patient or carer. Furthermore, in 10 cases, verbally confirmed name was not checked with the patient’s file. Out of 34 cases, double identification was not done in 13 cases.

Many nurses, doctors, and technicians in clinical settings do not verify patient ID before performing a task, resulting in more than one-third of staff not conforming themselves with the double identification procedure. The study also showed that over three-fourths of the total invasive procedures are compliant to double identification. On the contrary, noninvasive procedures showed less than one-fourth compliance to double identification.

Chawla R, Kaushik S. Incidence of Patient Identification Errors observed before Medication and Procedure/Intervention. Int J Res Foundation Hosp Healthc Adm 2016;4(2):100-106.

A comparative study of a failed and a successful merger in health care was conducted in an attempt to explore the reasons for success or failure of mergers.

This was a retrospective exploratory study of two mergers with the primary hospital being common. A detailed study of the existing policies and procedures, hospital records, financial data, and hospital statistics was conducted. Trends were analyzed and compared with the observed value.

Reasons for the successful mergers can be attributed to managerial commitment and coordination, communication, as well as proximity of consultants of the two merging entities. Adequate strategic planning, a professional approach, and incremental implementation of necessary changes are also essential. No redressal of staff and stakeholder apprehension and poor communication are reasons for failure of mergers.

A merger in the Indian hospital scenario is a fairly recent phenomenon. Factors, and their interplay that result in successful or failed mergers in Indian context, are an unexplored field of research. Mergers are capital and resource-intensive, and the consequences of a failed alliance are huge. Thus, a careful, holistic feasibility study is essential before embarking on a merger.

Jain D, Jain K, Kaur G, Kapur V. Mergers by a Private Hospital: One Script Two Different Endings! Int J Res Foundation Hosp Healthc Adm 2016;4(2):107-113.

Chandrashekhar R. In Pursuit of Holistic Green Health Care Facilities. Int J Res Foundation Hosp Healthc Adm 2016;4(2):114-117.