Improving clinical and patient outcomes in a Lions Hospital set-up

Dr Soumen Chakrabortydrschak05@rediffmail.com

Conclusion

Up gradation – both of perceptible and non perceptible aspects

Spectrum and variety of services should be widened

Quality of services must be ensured

Incoming technology must be assimilated

Establishing clinical practice parameters

Basis should be scientific information, clinical knowledge and professional consensus

Perspective is quality – cost notwithstanding

Should include variability of rural and urban locations

Shall need regular updating

Must be easily accessible to all staff concerned

Should be a guiding light and not a constraint

Changes in the out patients area

The eye OPD is different from outpatients’ department of other specialties because a lot of the daily work is completed in the OPD itself. This includes refraction, biometry, anterior and posterior segment lasers, perimetry and a host of other procedures.

A large fraction of the patients are elderly people or children- age groups who demand special attention

Self sufficient clinical exam rooms should contain basic equipments like S/L, I/O etc so that the patient is not un- necessarily shuttled around

Minor OT / procedure room should be on the same floor

Periodic patient satisfaction surveys –questionnaire based on weakness perception

Changes in the out patients area –patient flow chart

REGISTRATION REFRACTION IOP CHECK

CONSULTATIONSPECIAL PROCEDURES IF NEEDED

Changes indoors

Should be separate for aseptic and septic cases

Should have a general sense of cleanliness

Floor admission should be avoided. If at all, Head end should be opposite to the aisle Ward should be a bare foot zone

If over crowding is inevitable (as during camps) Ventilation should be ensured Smoking should be strictly prohibited Food should not be supplied on the bed Patients should be told not to cover operated

eye with blankets

Improvements in the OR

General structural guidelines to be followed

Size should be such which can be comfortably fumigated

Bare foot zone and separate attire should be ensured

Air conditioning Must ensure adequate air exchanges Periodic cleaning

Amoric environment HEPA filters Laminar air flow

Video recording of each surgical procedure for documentation & training

Issues regarding sterilization

Best to follow NPCB guidelines

Pre operative face wash & providone iodine prophylaxis is a must

Instruments Ultrasonic cleaners increase instrument longevity Flash autoclaves for quick sterilization in high volume situations

Post operative antibiotics in any form – topical, sub tenon or intra cameral - mandatory

Human resource issues: Continuous Professional Development

OPD should have two consultants One for the general clinic One for a special clinic like retina, oculoplasty etc- one on each day of

the week

Continuous Professional Development (CPD) Is a life long learning process which helps the individual reach his

complete potential, and is incomplete without institutional patronage

Periodic workshops, guest lectures symposia etc

Periodic aid to attend national and international conferences

Should always be oriented to deliver patient needs

Monitoring the quality of care

Ensure that patients and their families are treated with respect and dignity

Coordinate information to identify and evaluate problem patterns

Develop problem correction mechanisms so that problems do not recur

Assess patient care problems in terms of performance criteria that reflect clinically acceptable and attainable patient care practices.

Evaluation and annual review of quality assurance

The quality pyramid

QUALITY CONTROL TEAM AT THE HOSPITAL

QULAITY ADIVSOR OF A MD

QC COMMITTEE

Mandate of the quality control team

Monitoring patient and physician satisfaction status

Monitoring outcome and complication rates of commonly performed surgeries

Regular staff performance appraisals

Advise on procurement and upkeep of equipments

Advise on health professional appointments

Ensure continuing education and training of health professionals

Leadership – addressing any issue of concern

Critical incident / adverse event analysis

Prompt analysis and review of any event which has the potential of an adverse ophthalmological outcome.

These situations should be addressed by the concerned surgeon and if needed the entire quality control team and appropriate redressesal measures taken

Situations include operation on the wrong eye, endophthalmitis, expulsive hemorrhage, etc

Monitoring standards - EMR

Electronic Medical Records (EMR) is an important tool for self evaluation an development

All clinical notes including hand written ones in relation to a particular patient can be stored in .pdf format.

Video recording of operations performed on him can also be tagged in MPEG format

These records can be retrieved for statistical, academic and training purposes

Monitoring standards – clinical audit

Audits may retrospective, where data is collected about events that have already occurred or prospective, where data is collected about events as they happen

Prospective audit has the advantage of allowing all the relevant data to be collected, the disadvantage being that the knowledge of data being collected can influence people's behaviour

Retrospective audit eliminates this, but only routinely collected data is available of analysis – may induce bias

Random samples should be taken, and adequate sample size used

Changes needed should be identified and made accordingly

Conclusion

Improved clinical outcomes and delivery of quality eye care go hand in hand

Improvement of skill, technology and hospital environment

Changes made should be sustainable and on a long term basis

Thank you !