RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR SYNOPSIS
1. / a. Name of the Candidate/ DR. VISHNU SUNIL
b. Postal Address / P.G BOYS HOSTEL, ROOM NO. 3,
2nd FLOOR, EPIP AREA, #82, WHITEFIELD, NALLURHALLI
VYDEHI INSTITUTE OF MEDICAL SCIENCES,
BANGALORE- 560066
2. / Name of the Institution / VYDEHI INSTITUTE OF MEDICAL SCIENCES,
EPIP AREA, #82, NALLURHALLI, WHITEFIELD
BANGALORE- 560066
3. / Course of Study and Subject / M.D HOSPITAL ADMINISTRATION
4. / Date of Admission to Course / 4th June,2013
5. / Title of the Topic / “PLANNING, ORGANIZATION AND INFRASTRUCTURE UTILIZATION OF A MULTIDISCIPLINARY INTENSIVE CARE UNIT (MICU) AT 2 TERTIARY CARE HOSPITALS”
6. Brief resume of the intended work
6.1 Need for study
ICU is highly specified and sophisticated area of a hospital which is specifically designed, staffed, located, furnished and equipped, dedicated to management of critically sick patient, injuries or complications requiring constant observation. It is a department with dedicated medical, nursing and allied staff. It operates with defined policies; protocols and procedures should have its own quality control, education, training and research programmes. It is emerging as a separate specialty and can no longer be regarded purely as part of anaesthesia, Medicine, surgery or any other specialty. It has to have its own separate team in terms of doctors, nursing personnel and other staff who are tuned to the requirement of the specialty .[1]
Before planning the ICU department in detail, its location in the hospital has to be determined using the intensities of communications with other hospital departments; important are the links with the operation theatre, emergency, lab areas and radiology departments. [2]
In 1978 the Hospital Review Committee for Delhi Hospitals suggested 2% as ICU beds. In UK one ICU bed for every 100 acute beds is recommended. In USA up to 4 times this proportion is followed and in Germany 5%of total hospital beds are for ICU. It is estimated that a 10 bed multidisciplinary ICU should meet the requirement of up to 300 bed district hospital. However, every hospital above 100 beds should have a fully equipped and staffed ICU. Intensive care units of less than 4 beds with less than 200 admissions annually, is uneconomical. On average, an 8 bedded ICU should admit about 600 cases in a year. [3]
Classification of the ICU:
Level I adult ICU: it has a role in small district hospitals. It provides resuscitation and short term cardio respiratory support of critically ill patients and monitors and prevents complications in “at risk” medical and surgical patients. There should be an intensive care specialist.
Level II adult ICU: it’s located in larger general hospitals. It provides a high standard of general intensive care, including multisystem life support, in accordance with the role of its hospital. It has a medical officer on site access to pharmacy, pathology and radiological facilities at all times. There should be an intensive care specialist and a consultant.
Level III adult ICU: it is located in a major tertiary referral hospital. It should provide all aspects of intensive care required by a referral role for indefinite period. The unit is staffed by specialist intensivists with trainees, critical care nurses, allied health professionals and clerical and scientific staff. Complex investigations and imaging and support by specialist of all disciplines required by the referral role of the hospital are available at all terms.[4]
Nosocomial infections constitute an important worldwide health problem with high morbidity and mortality rates as well as economic consequences. Nosocomial infections has become especially prominent in intensive care units (ICU’S) where the incidence is 2 to 5 times greater than general inpatient population. The cause of the increased risk for nosocomial infections in ICU’s have been reported to include the growing complexity of ICU’s,the impaired host defences of patients, invasive monitoring and procedures, exposure to multiple antibiotics and colonization by resistant microorganisms.
In hospitals with effective programme for nosocomial surveillance, infection rates can be reduced by approximately one-third.(5)
6.2 Review of literature
ICUs developed from the post-operative recovery rooms and respiratory units of the 1920s 1930s and 1940s when it became clear that concentrating the sickest patients in one area was beneficial.
The 1970s saw heightened interest in intensive care medicine, with research into the pathophysiological processes, treatment regimen and outcomes of critically ill and the founding of specialty journals, training programs and qualifications dedicated to intensive care. Intensive care today is a separate specialty and while some period of training in an ICU is a valuable to all specialties, it can no longer be regarded as the part of anesthesia, medicine, surgery or any acute discipline.[4]
India is a diverse country with different levels of healthcare: primary, secondary and tertiary. The first coronary care unit in India was started in 1968 at the King Edward VII Memorial Hospital, Mumbai. This unit was followed by one at Breach Candy hospital in Mumbai, and later in other large private hospitals of Mumbai and in other large cities of India.2 Critical care units in the early 1970s, though centralized, were designed and equipped chiefly to offer intensive care to patients with acute myocardial infarction and other manifestations of ischaemic heart disease. There was a poor concept of overall critical care or intensive respiratory care. Ventilator support was primitive and was generally offered as a terminal therapeutic approach. Many of the ICUs were deficient in good monitoring facilities and were initially offered in few designated rooms within a general ward of the hospital. The number of critical care units caring for life-threatening illnesses other than coronary heart disease slowly increased. In mid-1980s there was a significant improvement in the standard of care, particularly evident in the larger teaching and private hospitals in the cities of India. As a related professional development, in 1993 the Indian Society of Critical Care medicine was formed. (6)
A study by R.B.Patwardhan, P.K.Dhakhephalka et al, showed that Antimicrobial resistance in nosocomial infections is increasing with both morbidity and mortality greater when infection is caused by a drug resistant organisms. This increase is due to overuse and misuse of antimicrobial agents, immunosuppressed patients and exogenous transmission of bacteria, usually by hospital personnel. Nosocomial infect ions are typically exogenous, the source being any part of the hospital ecosystem, including people, objects, food, water and air in the hospital. These infections are opportunistic and microorganisms of low virulence can cause disease in hospital patients whose immune mechanisms are impaired. The outcome is that many antibiotics can no longer be used for treatment of infections caused by such organisms and the threat to the usage of other drugs increases.[7]
Hospitals can sharply reduce the spread of the drug-resistant bacteria in their intensive care units by decontaminating all patients rather than screening them and focusing only on those found to be infected already.
According to Susan S. Huang M.D et al. A study involving more than 74,000 patients in 74 intensive care units nationwide found that cleaningallICU patients with a special soap and ointment reduced all infections, including MRSA, by 44 percent. For the patients in group that got disinfected no matter what, there were 3.6 infections per 1,000 days in the hospital. That result compared with a baseline of 6.1 infections per 1,000 days beforehand [8]
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6.3 Objectives of the study
1 To study the physical facilities, organizational structure, staffing pattern and equipments.
2 To study the policies, procedures and functioning.
3 To assess the utilization of beds.
4 To evaluate the infection control measures.
5 To evaluate quality assurance of activity against accreditation norms in MICU.
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7. Materials and methods
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7.1 Source of data
Data will be collected from secondary sources, (e.g. hospital statistics, bed census etc.); and focus group discussions will be held with the doctors and nurses of Multidisciplinary intensive care unit (MICU) and with specialists involved in the organization of infrastructure of MICU.
7.2 Method of collection of data (including sampling procedure, if any)
A. Methodology and type of data collected
Prospective study
An observational study will be done for 1 year time to appraise the existing physical facilities, organizational structure, and staffing. The study will be done by-
· Direct observation of activities in the Multidisciplinary intensive care unit (MICU) to look for any kind of deviation from standard operating procedures (e.g. monitoring vitals and immediate therapies) by nursing personnel as guided.
· Informal interviews with the Head of the unit, the Asst. professors, residents and nurses regarding workloads, educational qualification, shift timings, experience of diagnosing and handling the acute cases and others.
· Review of documents and files maintained in the unit regarding mortality and morbidity indicators
· feedback from patients(e.g. if he was examined sensitively, was he made feel at ease, was he given enough time and others)
· Bed turnover rate (B T R), Bed occupancy rate (B O R), Bed turnover interval (B T I).
· Statistics of admission, discharges, deaths, Average length of stay of discharged patients and bed utilization.
Retrospective study
A retrospective study will done on basis of past records and analysis of department statistics of 1 year, to study the utilization of Multidisciplinary intensive care unit (MICU) with the help of following indices:
· Bed turnover rate (B.T.R), Bed occupancy rate (B.O.R), Bed turnover interval (B.T.I).
· Statistics of admission, discharges, deaths, Average length of stay (ALOS) of discharged patients and bed utilization.
Inclusion criteria- MICU
Exclusion criteria- All other ICU’s (PICU, SICU, NICU etc)
B. Study design- Observational Study and interview
C. Study period- Retrospective study will be done from 1st January 2013 to 31st December 2013, Prospective study will be done from 1st January 2014 to 31st December 2014.
D. Place of study-VIMS &RC, Bangalore. MALLYA HOSPITAL, Bangalore.
E. Statistical methods involved- The data collected in this study will be analyzed statistically using descriptive statistics like mean, standard deviation and percentages.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
It does not require any investigations or interventions.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
yes
8 list of References
1.Dr.Narendra rungta, Dr.Deepak govil, Dr.sheila nainan, Dr.manish munjal, Dr.j Divaita, Dr.C K jani,ICU planning and designing,guidelines-2010;http://www.isccm.org/PDFfiles/Section1.pdf ,Accessed on 25th September 2013
2. Erwin Putsep .Modern hospital- international planning practices ,critical care units ,Lloyd-luke ltd 49 newman street London,2nd edition,1981,pg no-354.
3. B M Sakharkar, Principles of hospital administration and planning, jaypee publications,
2nd edition,2009, pg. no 86.
4. Andrew.D.Bersten, Neil Soni-Oh’s intensive care manual, design and organization of intensive care units, Butterworth Heinemann, Elsevier, 6th edition,2009,pg no-3.
5.Meliha meric, Ayse willke, Cigdem caglayan,Kamil toker; intensive care unit-acquired infections:incidence,risk factors and associated mortality in a Turkish university hospital; Japanese journal of infectious diseases ,2005;58:297-302.
6. M.E.Yeolekar,S.Mehta. ICU care in india. Status and challenges,Journal of association of physicians of india,april 2008 vol-56,pg no 219-222.
7. R.B.Patwardhan,P.K.Dhakhephalkar,K.B.Niphadkar,B.A.Chopade A study on nosocomial pathogens in ICU with special reference to multiresistant Acinetobacter baummanni harbouring multiple plasmids.
Indian Journal of medicine, august 2008, pg 178-187.
8. Susan S. Huang, M.D., M.P.H., Edward Septimus, M.D., Ken Kleinman, Sc.D. Targeted versus Universal Decolonization to Prevent ICU Infection,The New England journal of medicine, June 2013;pg no 79-84.
9. / Signature of candidate10. / Remarks of the Guide / This study will throw light on the utilization of ICU’s as well as the importance given to quality assurance aspects in ICU’s by two different multispecialty hospitals.
11. / Name and Designation
11.1 Guide
11.2 Signature of Guide
11.3 Co-Guide(if any)
11.4 Remarks and Signature
11.5 Head of Department
11.6 Remarks and
Signature / Dr.K RAVI BABU
Associate Professor
Department of Hospital Administration
Vydehi Institute Of Medical Sciences &
Research Centre, Bangalore-560066
DR. ANIL KUMAR HEGDE M
Professor & HOD
Department of Hospital Administration,
Vydehi Institute Medical Sciences &
Research Centre, Bangalore- 560066
12. / 12.1 Principal
12.2 Remarks and
Signature / Dr. GURUMURTHY
Principal,
Vydehi Institute of Medical Sciences &
Research Centre, Bangalore- 560066
PATIENT SATISFACTION SURVEY
Q.No. / Questionnaire / StronglyAgree / Agree / Neutral / Disagree / Strongly
Disagree
1. Q1. / The MICU is neat and clean
2. / The facilities provided in the waiting area are adequate
3. Q2. / The MICU environment feels safe and comfortable
4. Q3. / I felt the MICU staffs are caring and compassionate
5. Q4. / The MICU nurses who took care of the patient were easy to talk and all my questions were answered
6. Q5. / The doctors in the MICU answered my questions thoroughly
7. / The MICU caregivers were positive, courteous and respectful throughout the patient’s stay in the MICU
8. Q6. / I am informed why procedures were done, and why special equipment was used on the patient while in MICU
9. Q7. / If the patient received any medications, they were explained to me
10. Q8. / The MICU caregivers were consistent in informing regarding condition of the patient.
11. / If the patient was uncomfortable or had a painful procedure I felt his/her pain was managed well
12. Q9. / I am informed about results of tests and procedures
13. Q10. / I am informed about the visiting hours for family members
14. Q11. / The noise in the MICU is too loud for the patient to rest
15. Q12. / Hand-washing and/ or hand gels were easy to access and encouraged
16. Q13 / The MICU caregivers encouraged me in decision making in care and treatment of the patient
17. Q14. / The discharge process is explained to me properly and all my queries were addressed well
18. Q15. / The support provided by the MICU staff during the patients care was satisfactory
19. Q18. / I am satisfied with the care the patient has received in the MICU
Suggestions:
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