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Birla Institute of Technology & Science, Pilani WILPD, Second Semester 2011-2012 HSMM ZG629T Dissertation Outline

ID No Name E Mail Employing organization Supervisor Supervisor s Email Dissertation Title

2010HSMM001 Dr Narendra S Basarge narendra_basarge@yahoo.com Basarge Urology Hospital, Kolhapur. Dr Ismail Namazi, MD, Head Dept of Anesthesia, Dr DY Patil Medical College, Kolhapur.
drismailnamazi@gmail.com

Quality control in the Department of Urology, at tertiary care centre.

Background : The story of mankind from prehistoric days, through the medieval period, right up to the modern times, has been a long quest for quality. Quality may mean different things to different people. Quality : Definition (Chambers Twentieth Century Dictionary) That which makes a thing what it is : nature : character : kind : property : attribute : social status : high social status : persons of the upper class collectively : grade of goodness : excellence : manner. In its simplest form, quality is the degree of adherence of a product or service to the predetermined specification. It may be termed good or bad, high or low, depending upon the extent of conformity to the expected specified criteria. Quality of health services : Definition ( Joint Commission on Accreditation of Healthcare Organizations, JCAHO) : The degree to which health services for individuals and populations, increase the likelihood of the desired outcome and are consistent with the current professional knowledge. Definition ( International Organisation for Standardization, ISO) : The totality of the features and characteristics of a service that bear on its ability to satisfy the stated and implied needs of the patients. Dimension of quality in health care y y Equitable distribution of resources Judicious allocation of the resources to preventive, promotive, curative, rehabilitative and educative aspects so as to have the maximum impact in terms of reducing the morbidity and mortality among the entire population. To provide need based facilities. To ensure availability and accessibility of the Primary Health Care facilities to the entire population in terms of reasonable travel time. To bring the health care services within reach of a common man by reducing the cost of services so as to make them affordable. Availability of transportation and communication system for prompt and efficient treatment.

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The ultimate test of quality of hospital services is the satisfaction of users, i. e. the patients who are dependent on the hospital. The health care quality has three corner stones quality, access and cost. A quality service is one which available, accessible, affordable and effective. Quality is achieved when the needs and expctations of the patient are met with.

Quality control in the department of Urology, tertiary care centre : Urology is the largest superspeciality branch of surgery, 40% pediatric surgery is pediatric urology, 40% abdominal lumps in children arise from kidney, 40% of the hospital cross infections arise from urinary tract, urosepsis has 40% mortality if not treated effectively and promptly. All the external stake holders( patients, referring doctors, referring nursing homes, TPA s) have high expectation of the quality especially from the tertiary care centre. The tertiary care urology centre typically has Urology out patient department, Urodiagnostics laboratory and imaging Day care OPD urology procedures endoscopy and extra corporeal shock wave lithotripsy In door urology department general wards and special rooms Urology operation theatres endourology including lasers and intracoporeal lithotripsy, laparoscopic urology, open urosurgery and kidney transplant surgery. Objectives : The present study is undertaken to have quality control in the urology operation theatres. The aims and objectives of the present study being y y y To decide the objective quality control criteria for the working of the urology operation theatres. Urology operation theatre infrastructure. To assess the quality of the outcome of urology operations at tertiary care urology centre. To decide the line of action for the improvement of the quality of the urology operation theatre.

Plan of work : y To assess the present urology operation theatre infrastructure on following points o Building and construction o Patient flow, Doctors and operation theatre staff flow, and instruments and linen flow in and out of operation theatre o Air sterilization system o Utility services in the urology operation theatre -Uninterrupted electricity, water supply, drainage system. o Urological endoscopic and laparoscopic armamanterium o Operation theatre inventory control with quantitative analysis techniques o C arm image intensifier and Extra corporeal lithotripsy machine To assess the patient safety measures do no harm To assess the doctor and staff safety measures radiation, HIV, HBSAg etc.

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Plan of work : Prospective study carried out by analysing the outcome of urology opearion theatres at Basarge Urology Hospital, Kolhaur, Maharashtra, which is a tertiary care urology centre. To assess the present urology operation theatre infrastructure on following points o o Building and construction Patient flow, Doctors and operation theatre staff flow, and instruments and linen flow in and out of operation theatre Air sterilization system Utility services in the urology operation theatre -Uninterrupted electricity, water supply, drainage system. Urological endoscopic and laparoscopic armamanterium Operation theatre inventory control with quantitative analysis techniques C arm image intensifier and Extra corporeal lithotripsy machine

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To assess the patient safety measures do no harm To assess the doctor and operation theatre staff safety measures radiation, HIV, HBSAg etc. The following data will be collected prospectively from the hospital records by online filing of the proforma. Proforma : y y y y y y y y y y y y y y y y y Name of the patient and id No Whether relatives of the doctor, staff or doctor himself Name ofoperation performed Planned/semi emergency/emergency/dire emergency Primary/secondary/redo surgery ASA grade Type of anesthesia given Post anesthesia recovery ICU/ Anesthesia related complications Expcted surgical outcome and the actual outcome to note the discrepancy Infection related post op complications Post op stay in ICU expected v/s actual discrepancy Post op total hospital stay expected v/s actual discrepancy Total expenses incurred- budgeted v/s actual discrepancy Other morbidity and mortality specifiy Overall patient satisfaction feed back graded 1 to 5 in asceding order of satisfaction To objectivise the criteria in various issues of the quality in urlogy operation theatre.

Literature references : y y y 2005, Berwick, D. M. My Right Knee. Annals of Internal Medicine 142 (2): 121 25. 2007, Dalrymple, J. Lessons Learned from the iPhone Price Cuts. [Online article; retrieved 11/14/08.] www.pcworld.com/article/id,137046-c,iphone/article.html. 1985. Donabedian, A. Explorations in Quality Assessment and Monitoring: The Definition of Quality and Approaches to Its Assessment, Vol. Ill: The Methods and Findings of Quality Assessment Measurement and Monitoring. Chicago: Health Administration Press. 1982. Explorations in Quality Assessment and Monitoring: The Definition of Quality and Approaches to Its Assessment, Vol. II: The Criteria and Standards of Quality. Chicago: Health Administration Press. 1980. Explorations in Quality Assessment and Monitoring: The Definition of Quality and Approaches to Its Assessment, Vol. I. Chicago: Health Administration Press. 1966. Evaluating the Quality of Medical Care. Milbank Quarterly 44 (3): 166 206. 2001. Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press. 1990. Medicare: A Strategy for Quality Assurance: Volume I, edited by K. N. Lohr. Washington, DC: National Academies Press. 1962. Kennedy, J. F. Special Message to the Congress on Protecting the Consumer Interest, March 15,1962. [Online information; retrieved 2/20/09.] www.jfklink.com/speeches/jfk/piiblicpapers/i962/jfk93_62.html. 2007. Manner, P. L.. Practicing Defensive Medicine Not Good for Patients or Physicians. [Online article; retrieved 11/17/08.] www.aaos.org/news/bulletin/janfebo7/clinical2.asp. 1986. Walton, M. The Deming Management Method. New York: Putnam Publishing Group. 2009. Quality Management in Hospitals, SK Joshi, Jaypee Brothers Medical publishers 2009. Introduction to health care quality management, Patrice Spath, Health Administration Press 2010. Value based health care : Linking finance and quality, Yoseph D Duglacz, Jossey-Bass

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Particulars of the Supervisor : Dr Isamil Namazi, MBBS, MD (Anesthesia), Head, Senior Professor and PG Examiner, Dept of Anesthesia, Dr DY Patil Medical University, Kolhpaur, Maharashtra. The Supervisor has been actively involved in Uro Anesthesia for all the referral and complicated cases of urological surgery. He is also incharge of the day to day activities of the urological theatres at Basarge Urology Hospital, Kolhapur.

Remarks of the Supervisor : This has been the very important managerial issue in the tertiary referral superspeciality centre . The quality in the operation theatre is the major determinant of the overall outcome and success of treating the patient. I am involved in the uroanesthesia with this tertiary urology centre for last more than 15 years. This would be a land mark study which can be followed at other superspeciality centres worldwide.

Signature of the Student Date : 10th July 2011 Place Kolhapur

Signature of the Supervisor Date 13th July 2011 Place Kolhapur

13th July, 2011

To, The Coordinator, WILPD, Birla Institute of Technology & Sciences, Pilani, Rajasthan, India. Sub : Regarding submission of the dissertation outline. Dear Sir, Kindly find the dissertation outline for your perusal. Thanking you Sir,

Yours Sincerely,

Dr Narendra Basarge Bits ID : 2010HSMM001

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