Student Dissertation

Agency : Quality Indicator, Operational Efficiency, Organizational Resources

Objective : To identify the indicators of quality assessment in the clinical departments of hospital, as per set NABH standards and guideline. To find out trends of functioning of clinical departments in last three months. To identify areas of potential improvements and develop recommendations in coordination with organizational resources for strengthening and enhancing the overall quality of Clinical departments.

Background : Quality orientation is an integral part of patient care. Quality indicators help in achieving these objectives. Health care is becoming transparent and customer focused. It is therefore becoming mandatory for the institution to monitor quality indicators/parameters and compare their performance level with the national standard or international bench marks. Quality indicators aim to detect sub-optimal care either in structure, process or outcome, and provide an opportunity to the individual institution to improve its quality of care through standardization of processes, procedures and treatment protocols.

Methodology : Place of study: 200 bedded super specialty hospital, in Jaipur; Study area: Departments taken into consideration for the study were Radiology Department, Operation theatre, Intensive Care Unit, MRD Department, Patient Care Wards, Laboratory, Blood Bank Department Study design: cross-sectional analytical study. Data type: Primary and Secondary data has been collected in 3-month period. Method of data collection: The data will be collected through the primary and secondary sources. Primary data source- Direct observation (day to day); Secondary Data Source-Checklist, Auditing patient records (MRD) and HIS, Inpatient files, Interaction with the consultant, doctors and supporting staff. Sample size: All the cases reported from 1st january’16 to 30 march’16 has been taken into consideration, except for the blood bank turnaround time calculation where our sample size is of 66 blood bag taken and sample size of 100 inpatient files per month taken for assessing inpatient indicators. Sampling method- simple random sampling method.

Findings : Percentage of blood bag component wastage is higher in February month i.e. 9.6% which is due to mishandling of blood, shorter storage time for RDP and haemolysed blood. Percentage of Re dos increased from January to March i.e. 0.06% to 0.5% in laboratory which is due to dilution, clotted sample and haemolysed sample. Adherence to safety precautions by employee working in diagnostics was 75% by residents and 73% by technician which was due to negligent behaviour. Percentage of unplanned return to OT increased in February month i.e. 3.23% which was due to re exploration, flap necrosis and emergency tracheostomy. Needle stick injury cases has occurred in March month which was 7 and reason was untrained new nursing, ward staff and recapping.

Recommendations : The results should however be interpreted within the wider context of delivery of care and used with the sole aim of improving quality of care, rather than simply making judgments about it. Non-conformance could be due to various reasons. Shortage of man power, deficiency of trained manpower, injudicious work pressure, inadequate infrastructural and equipment support, lack of protocol, and personal issues are the few important causes of errors. These factors should be addressed before blaming a person.