International Journal of Research Foundation of Hospital and Healthcare Administration

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2019 | July-December | Volume 7 | Issue 2

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Maj Gen Sunil Kant


[Year:2019] [Month:July-December] [Volume:7] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/jrfhha-7-2-iv  |  Open Access |  How to cite  | 


Original Article

Mukunda Chandra Sahoo, Susmita Dora, Yatin Talwar

Determinants of Hospital Discharge Process: Experience from an Apex Tertiary Care Autonomous Institute of National Importance of Eastern India

[Year:2019] [Month:July-December] [Volume:7] [Number:2] [Pages:3] [Pages No:55 - 57]

Keywords: Discharge process, Discharge at tertiary care institute, Patient discharge, Patient satisfaction, Time taken for the discharge

   DOI: 10.5005/jp-journals-10035-1112  |  Open Access |  How to cite  | 


Background: The discharge of a patient is a time-consuming process comprising of clinical, financial, legal, and administrative and record-keeping aspects that require proper execution. The discharge process is considered as an important quality indicator of the healthcare services of a hospital. Every hospital has its own discharge policy. Objectives: To study the steps in the discharge process in a tertiary care teaching hospital and identify the causes of delays in in-patient discharges in major clinical wards. Materials and methods: The study was conducted in four major clinical wards of AIIMS, Bhubaneswar. The discharge process was recorded using a structured format that was distributed in all the wards. The patient satisfaction and impression regarding the discharged process were recorded using a questionnaire. Results: The various steps identified in the discharge process were discharge summary writing, billing clearance, and patient leaving the hospital. Billing clearance contributed the maximum time from the total time taken for discharge followed by the discharge summary writing. Most of the patients rated their discharge process experience as above average and opined that the discharge process in the hospital was well organized. Conclusion: Discharging patients on time is a challenging task. With adequate manpower and proper patient counseling, the time taken for the process can be reduced. Improving the time taken for a discharge can improve the patient's satisfaction as well as effective bed management for the hospital.


Original Article

Neha Dang

Reduction in Needle Stick Injury Rate among the Healthcare Workers in a Tertiary Care Hospital

[Year:2019] [Month:July-December] [Volume:7] [Number:2] [Pages:5] [Pages No:58 - 62]

Keywords: Biomedical waste, Healthcare workers, Needle stick injury, Occupational hazards

   DOI: 10.5005/jp-journals-10035-1110  |  Open Access |  How to cite  | 


Introduction: Needle stick injuries (NSIs) are a commonly encountered underreported occupational hazard faced by healthcare workers (HCWs). Aim: The aim of the study was to determine the causes of the NSI and reduce the NSI rate among all HCWs (doctors, nurses, technicians, general duty assistants/housekeeping staff) at a tertiary care hospital. Objectives: • To determine the rate of NSI among various categories of HCWs at a tertiary care hospital. • To study the causal factors and circumstances for NSIs. • To implement corrective actions and prevent these through improvement in training, usage of safety devices, and providing a safe environment. • To reduce the NSI rate per healthcare worker per year. • To reduce the NSI rate below the set benchmark of the hospital, i.e., one NSI per 1,000 in-patient days. Materials and methods: The causes for NSI were identified by collating the data from January 2016 to May 2017 and the Pareto analysis was used to find out the main factors leading to NSI. Continuous and scheduled training for nurses, doctors, phlebotomists, housekeeping staff, and general duty assistants (GDAs) on waste segregation [biomedical waste (BMW) management], handling of sharps/sharps container, and PPE usage was provided and the same was monitored by the infection control nurse and quality team during rounds. The NSI rates were presented to the clinical department heads and awareness was created among doctors to segregate the waste. Needles with safety device were made available for the nursing team for sample collection. The corrective action was implemented in the month of June 2017 and data for 3 months, i.e., June, July, and August 2017, were continuously monitored. Results: In the study, the main reasons for NSI were improper segregation of sharps in trained HCWs (38.46%), unavoidable accidents (30.77%), and improper handling of sharps (11.54%), followed by untrained person (6.41%), recapping of the needle (5.13%), and the safety device not being used at the time of sample collection (3.85%). After training and awareness of HCWs and promoting use of safety devices, data were collected and analyzed. Needle stick injury per HCW per year was reduced to 0.03 (June 2017–October 2017) from 0.05 (Jan 2016–May2017). Similarly, there was reduction in the NSI rate per thousand patient days to 0.63 (June 2017–Oct 2017) from 1.19 (Jan 2016–May2017). Conclusion: Needle stick injuries can be reduced by identifying the causative factors and implementing corrective measures like use of a safety device for sample collection, creating awareness about segregation of waste, and handling of sharps among all the HCWs including doctors.


Original Article

Jenyz M Mundodan, KS Sarala, V Narendranath

A Study to Assess the Factors Contributing to Delay in Discharge Process in a Teaching Hospital

[Year:2019] [Month:July-December] [Volume:7] [Number:2] [Pages:4] [Pages No:63 - 66]

Keywords: Delay, Patient discharge, Patient waiting time, Teaching hospital, Time and motion studies

   DOI: 10.5005/jp-journals-10035-1113  |  Open Access |  How to cite  | 


Background: Delay in obtaining discharge is often a reason for dissatisfaction for patients, even for those who may have had a comparatively uneventful stay in the hospital. Aim: To study the factors contributing to delay in discharge process in a teaching hospital. Materials and methods: A time motion study was conducted in a teaching hospital wherein the time taken for discharge was measured for 69 patients. The outcome variable in the study was the time needed for the discharge process in total as well as for each individual step. Mean time at each step was identified and compared between groups using t test and analysis of variance (ANOVA). Results: The mean time for discharge process was 5 hours 41 minutes. The mean time between advice of discharge and physically leaving the ward varied from 6.62 hours in urology to 3.01 hours in ear, nose and throat (ENT). Only 13 patients (18.8%) were discharged within the National Accreditation Board for Hospitals and Healthcare Providers (NABH) prescribed time limit of 180 minutes. The maximum delay occurred during time taken for discharge summary completion. Conclusion: Very few patients were discharged within the prescribed time limit, with considerable delay in the time taken for discharge summary completion.


Original Article

PD Koggalage, Sunil De Alwis

A Project to Improve Management of Biomedical Equipment in Selected Units of District General Hospital, Gampaha, Sri Lanka

[Year:2019] [Month:July-December] [Volume:7] [Number:2] [Pages:8] [Pages No:67 - 74]

Keywords: Biomedical equipment, Biomedical equipment inventory management, Health technology management, Inventory management system, Medical equipment management

   DOI: 10.5005/jp-journals-10035-1109  |  Open Access |  How to cite  | 


Introduction: It is vital to manage biomedical equipment efficiently in planning, acquisition, maintenance, repair, and disposal stages. It was observed and experienced that there were issues in management of biomedical equipment in District General Hospital (DGH), Gampaha, which is a provincial tertiary care hospital in Sri Lanka. Aim: To identify the gaps and improve the existing system for management of biomedical equipment in the Operation Theaters (OTs) A and B, Medical Intensive Care Unit (MICU), and Ward No. 1 of DGH, Gampaha. Materials and methods: This interventional research project was conducted in three phases in three randomly selected units: MICU, OTs A and B, and Ward No. 1. The preinterventional phase identified the gaps in the existing system through key informant interviews, desk review of documents, and surveys. Based on the findings, interventions were designed and implemented in the second phase. The postinterventional phase assessed the effectiveness of the interventions using the same techniques in phase I. Results: Lack of a systematic mechanism to record and quickly access information required for equipment management and incompleteness of information was found. A central-level computer-based Biomedical Equipment Inventory Management System (BEIMS) was implemented along with a personal record keeping system at the unit level. The postinterventional evaluation revealed that the interventions made the vital information available and significantly improved quick accessibility to necessary information about biomedical equipment (p < 0.05). Also, there was a significant improvement in the level of convenience (p < 0.05) and satisfaction (p < 0.05) of the stakeholders with the new mechanism. Conclusion: The BEIMS was effective in improving the management of biomedical equipment. It is recommended to link the BEIMS online with the respective units to improve accessibility to information and also to replicate this project in other units of the hospital.



Vijay K Tadia, Shakti Gupta

Awareness amongst Different Strata of Society Regarding the “Good Samaritan Law”

[Year:2019] [Month:July-December] [Volume:7] [Number:2] [Pages:10] [Pages No:75 - 84]

Keywords: Accident victim, Good Samaritan Law, Road safety

   DOI: 10.5005/jp-journals-10035-1108  |  Open Access |  How to cite  | 


Introduction: The current annual death toll on Indian roads is over 140,000. Over 70,000 lives can be potentially saved if bystanders come forward to help the victims. According to the World Health Organization (WHO), in the absence of established emergency medical services, bystanders can play a crucial role in saving lives. The Law Commission of India report says that 50% of the victims who died of preventable injuries could have been saved had they received the medical care on time. A Good Samaritan can save a life in many emergent situations. Aim and objective: A study on awareness among different strata of society regarding the “Good Samaritan Law” (GSL). Materials and methods: The study involved a qualitative research design using in-depth semistructured questionnaires to elicit participant perspectives on the rescue principles in relation to their awareness of the law. A simple random sampling method was used to arrive at the representative sample. A pilot study was conducted, and a sample size of 60 responses each was required from seven groups representing different strata of society. The survey was conducted in Delhi NCR region, India. It included doctors and nurses from six hospitals (three government and three private), police, general public, lawyers, media personnel, and teachers. The study was conducted from January 2017 to August 2017. A questionnaire- and interview-based study was conducted taking into account representative sample of various representatives from different strata of society. The method of simple random sampling was used to arrive at representative sample size. Data was collected after instituting questionnaires and interviewing 420 participants from different occupations over a period of 8 months. Doctors and nurses were interviewed from over six different hospitals (three public and three private) of Delhi/NCR region in India. The questionnaires were given to police personnel, lawyers, media personnel, teachers, and general public. Results: The study revealed that people from different strata of society in India hesitated to come forward to help road accident victims. In total, 85% of them had attributed this hesitation to fear of legal and procedural hassles. These hassles include intimidation by police, unnecessary detention at hospitals, and prolonged legal formalities. Conclusion: Many people die in road crashes with treatable injuries but no one helps out of fear of getting into trouble. On March 30, 2016, the Supreme Court of India gave “force of law” to the guidelines for the protection of Good Samaritans issued by the Ministry of Road Transport and Highways. The purpose of a Good Samaritan law is to provide legal protection to bystanders who come to the aid and rescue of victims of road crashes. Enforcement of Good Samaritan Law may motivate the people to help the road accident victims in the hour of need.



CH Mallawarachchi, KCS Dalpatadu

A Project to Improve the Process and Practices of Provision of Diet to Inward Patients in a Government Hospital, Sri Lanka

[Year:2019] [Month:July-December] [Volume:7] [Number:2] [Pages:6] [Pages No:85 - 90]

Keywords: Diet, Diet ordering form, Food wastage, Government hospital, Inward patients, Menu, Patients’ satisfaction

   DOI: 10.5005/jp-journals-10035-1111  |  Open Access |  How to cite  | 


Aim: The research project was implemented in Base Hospital Warakapola (BHW) with the aim of improving provision of diet for inward patients in BHW. Materials and methods: The process of providing diet to inward patients in BHW was mapped and gaps were assessed. A patients’ survey, a checklist to assess consumption of hospital food, desk review of records, and key informant interviews (KIIs) were used. Results: The menus were not appealing, the patients were unaware of the menu till the food was served, and their preferences were never considered when ordering diet. Tea and soup were served too close to times of main meals. It was found that the diet requirements were estimated assuming the patient who has requested diet for a given day would need all three meals. But it was noted that only 11.64% (39/335) inward patients expected all three meals from the hospital. The food wastage, calculated by the number of diets not consumed, was 24.26% in the preintervention phase. Existing diet menus were modified by offering a diet with appealing variety in texture and color. The schedule of diet menu for each day was displayed in all wards. Estimation of diet requirement was improved by introducing a form to record diet requirements attached to the bed head ticket (BHT) of each patient to be filled by the nursing officer (NO) every morning. Post-interventional KIIs and survey of patients showed that satisfaction of staff and patients regarding the process and practices had increased. Wastage of food had been reduced significantly to 9.47%. Conclusion: The process and practices of providing diet to hospitalized patients were assessed and it was found that there were gaps in patients’ satisfaction on the menu, timeliness, and appearance of food and there was a significant waste of food. The project improved the issues identified.



Satish Kumar Saginela, Arun Kanth Madri, Rama Mohan Desu, Venkata Ramya Bola

Assessment of Satisfaction Levels of the Outpatients Attending Outpatient Departments in a Quaternary Care Hospital

[Year:2019] [Month:July-December] [Volume:7] [Number:2] [Pages:8] [Pages No:91 - 98]

Keywords: Consultation time, Patient satisfaction, PSQ-18, Quaternary care hospital

   DOI: 10.5005/jp-journals-10035-1114  |  Open Access |  How to cite  | 


Background: The quality of service (QOS) needs to be assessed at regular intervals by hospitals in the form of patient satisfaction. The outpatient department (OPD) is a “shop window” of a hospital and measurement in this area is a key determinant of health care. This study aims to assess the level of satisfaction among outpatients attending the superspecialty departments of a quaternary care teaching hospital. Materials and methods: Our study was conducted in the OPDs of Narayana Medical College Hospital, Nellore, India, from July 2017 to August 2017. The consent was obtained from 205 patients and were enrolled randomly. The short-form patient satisfaction questionnaire (PSQ-18) was used to collect the data and analyzed using the SPSS (19) statistical software. Results: Out of 205, 146 (71%) were males, 59 (29%) females. The mean scores for subscales, general satisfaction, communication, interpersonal manner, technical quality, financial aspects, and consultation time spent during the visit, accessibility, and convenience, were 4.03 ± 0.79, 4.39 ± 0.66, 4.60 ± 0.55, 3.86 ± 0.67, 3.37 ± 0.83, 3.77 ± 0.89, and 3.77 ± 0.67, respectively. Subscale scores for interpersonal relation and communication are high for the patients. The scores for interpersonal relation and financial aspects were statistically significant. Conclusion: The subscales general satisfaction, communication, interpersonal relation, technical quality were rated better to good with mean ± SD as 4.13 ± 0.66 and consultation time and finance aspects were rated good with mean ± SD as 3.57 ± 0.86. The variables affecting are age, socioeconomic status, expectations and clinical quality of doctor. Feedback surveys and training of staff are recommended.


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