PGDHHM - Case Study 2PESIT - HOSMAC

Observe, Study, and Analyze the Accident and Emergency Department at BGS Global Hospitals and find the level of efficiency at which it is presently working.

The study on will mainly focus on the department’s Infrastructure, Human resource, Technology and the prevailing Systems and Procedures.

Depending on the efficiency levels, we will then broadly categorize them as Excellent, Good, Moderate, Bad, Very Bad.

After the study, recommendations can be placed if any to improve the present efficiency level and the functioning of this department.

Global Hospitals is today India's fastest growing chain of facilities offering tertiary level super specialty care and multi organ transplantation services.

With hospitals already functioning in Hyderabad, Bangalore and Chennai, the group is all set to foray into Mumbai, Kolkata, Delhi and Bhubaneswar.

Founded in 1998 by Dr. K. Ravindranath, an internationally renowned Surgical Gastroenterologist, and his associates, Global Hospitals has today become a synonym for outstanding and compassionate health care.

Offers world-class care at affordable cost  Employs personnel with rich experience and

impeccable credentials  Deploys state-of the-art equipment and

technologies Believes in multi-disciplinary teamwork  Produces results on par with the best in the West  Sets benchmarks in quality, safety and innovation Exceeds patient expectations by going the extra

mile in service

 Vision  To be a world –class medical services provider turning

distant possibilities into today’s realities.  Mission  To achieve our dream of a healthy world through

continuous innovation, dedication to quality, and provision of compassionate and affordable medical services.

Deploying State-of-the art facilities and equipments Attracting the most talented medical, scientific and

support staff. Providing affordable health care of unsurpassed quality. Exceeding service expectations. Adhering to professional and scientific integrity. Embracing change and encouraging innovation.

BGS Global Hospital is a 500-bed health care centre offering multi-speciality care through global standard medical technology.  

500-bed Tertiary Care Centre 14 major/specialty Operating rooms Over 120 Intensive Care beds Comprehensive Emergency & Trauma Care

units ‘Best-in-class’ Radiology/Imaging facility &

Laboratory, with transfusion medicine

Aim Analysis of efficiency level of Casualty Management

at BGS Global Hospitals, Kengeri, Bangalore

Objectives of the Study To understand the overall functioning of the

Casualty department at BGS Global Hospitals. To study the infrastructure and resource availability

in the department. To study the systems and processes adopted in the

department. To study the technology used. To provide recommendations or suggestions if any.

Study was conducted over period from 01.06.09 to 15.06.09 between 1.30 pm and 5.00 pm at the Accident and Emergency department of BGS Global Hospital, Near Kengeri, Bangalore.

The study included head of department, supervisors, nurses, support staff and ambulance staff from the Hospital’s side and discussions with patient attenders on the client side.

Primary data Interview method – Nursing staff, Doctors,

Class 4 employees Observation method- against checklistSecondary data Registers Protocols

Here since the department is small enough, sampling was not required in call cases. For the general feedback, census was carried our covering all the staff.

But for specific information on the management of various functions, the respective heads or in-charge was interviewed.

There is a fully equipped Operation Theatre setup within the A &E department. It is excluded from the study as presently the theatre is being used for non A&E cases also. It can handle minor surgical procedures.

The 12 bedded transit / observation ward is presently being used as day care also. Functioning of this ward is not included

Also the housekeeping department and ambulance department is excluded.

The study is done and the findings are recorded under 3 main heads

Infrastructure Human Resource, Systems and

Processes Technology

Hospital is located 1.5 km inside from the main Bangalore-Mysore state Highway.

The access road from the highway till the entrance of BGS Global Health City is good, however the small stretch connecting the hospital entrance and the main road is presently in a very bad shape.

There are several large pot holes and also hardened concrete that was spilled over from concrete trucks at the time of construction which makes smooth entrance into the hospital difficult.

In a heavy rain this only access to the hospital gets flooded and cuts the hospital off from the main road temporarily.

The entrance to the Accident and Emergency department is located at one side of the hospital near to the entrance.

The entrance area has sufficient area for an ambulance to easily maneuver and also the area stays clear from any kind of external vehicle parking.

There is an ambulance bay at the entrance where the hospital ambulances stay parked.

Since the ambulance bay is close to the entrance, it is very easy to dispatch it when there is an emergency call.

The Total area allocated for Accident and emergency department is roughly about 6500 to 7000 Sft.

Triage area - 3 beds Shock Room - 1 bed Trauma bay – 4 beds Full emergency OT –

1bed Transit ward/

Observation – 12 beds

Store

Doctors Room Nurses Room Managers Room Public Washrooms Staff wash rooms. Attender lounge Staff Resting and

changing area

All the 21 beds in this department have got standard monitors of GE make. The head side panel for all beds has provisions for connecting monitors, medical gases, suction etc.,

The department has its own portable X-Ray machine and Ultrasonography machine.

Biomedical engineers come to rounds every day to check whether the equipments are working fine or if there is any problem.

Even the gadgets used for intubation are checked for battery life by the engineers or the nurses. Spare batteries are provided to be stocked in the department to use when required.

Since the hospital has been commissioned newly all the equipment are new and also since the equipment are from GE, there are no major cases of Equipment breakdown reported from the A&E till date.

The Biomedical engineering department is also very responsive to the A&E department because they immediately attend to any call from that department.

The hospital has deployed pneumatic shoot system where in they can just load the samples into the case and send it to the lab in the touch of a button.

This saves considerable amount of time and human resource wasted to transport lab samples from the department to the labs.

Organizational StructureIn the Organizational Structure of the Accident and Emergency department we have the following broad levels,

Head of the A&E Department Casualty Medical Officers Casualty managers Nursing in-charge Nurses House Keeping Shifting Boys

Dr. Prashanth Patil is the head of the Accident and Emergency Department.

He is a senior consultant with over eight years of overall experience and about five years of experience in the casualty alone.

He has a team of who are junior doctors four casualty medical officers with some basic experience in casualty.

Coordination between Departments Coordination with Consultants Patient Counseling Management of Essential Supplies Coordinating Housekeeping Staff Duty

There are 15 nurses posted in the A&E department. This includes the nurses in the transit ward of the A&E also.

There are two nursing in-charge to manage the two shifts.

Mr.Bogesh and Mrs Sheela, both highly experienced in handling nursing care specially in the A&E departments.

The Nursing in-charge prepares the Duty Roster. It is sent to the Nursing Supervisor for approval.

HOD and HR are additional signatories for Duty Roster processing.

Leave Book for Nurses is maintained in the A&E Department and needs to be entered in case of planned leaves.

Then the assistant from nursing office brings the leave card from the HR department.

Duty Roster of Nursing staff for accident and Emergency for the month of June 2009 is attached in the next slide.

If you can observer carefully, at any given point of time the average nurses available in this department is three.

Due to adjustments in duty so as to complete 208 hrs of service per month there would be some additional allocation seen.

However the intended nursing staff allocation to this department is three.

EMP CODE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Tot hr

N016 EL EL EL EL EL EL EL G G G G G G D/O G G G G G G D/o G G G G G G D/o G G 208

N0108 E E E E E D/o N N N N N N N N N/o E E M D/o CL CL CL E M M D/o N N N N 228

N075 N N/o M M M E E E D/o m M M E D/O N N N N N N N N N/o E/4 E E E M M M 208

N079 G G G G G G G D/O G G G G G D/O G G G G G D/O G G G G G G G D/o G G 208

N084 N N N N N N N N/O E E E E D/O E E M M CL M E E M D/O N N N N N/O E E/4 216

N021 M M M/8 M M/8 D/o M E M D/O M M M M D/O N N N N N N N N N/O E E E E M M 208

N0116 E E E E/8 E E/8 D/O N N N N N N N N N/O E M E E E D/O M E M M M E D/O M 208

N211 E/8 E/O E E D/O M M M M D/O M M M M M D/O N N N N N N N N N/O E M M E E 208

TRN19 D/O N N N N N N N N/O E E E E E E E E D/O M M M M M M M M D/O N N N 216

TRN08 C/O C/O CL CL D/O M E M N N N N N N N N N/O E E M M E E E D/O M M/4 M D/O N 208

TRN21 M/E M M N N N N/O E E E E E D/O M/8 M M M M/8 E E D/o E N N N N N/O E E E 208

  N N N N/O E E E/8 M/8 E m D/O E E E E E D/O E M M E E CL CL N N N N N N/O 208

N060 G G G G G G D/O G G G G G G D/O G G G G G G D/o G G G G G G D/o G G 208

Morning 3 3 4 3 3 3 3 4 4 4 5 5 4 3 4 4 4 4 4 4 3 3 3 3 4 4 4 3 3 4  

Evening 3 3 3 3 3 3 3 3 3 3 3 4 3 3 3 3 3 3 4 3 3 4 3 4 3 4 3 3 4 4  

Night 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3  

Duty Roster for the month of June 09

Morning: 7.30am to 1.30 pm Evening : 1.30 pm to 7.30p pm Night: 7.30 pm to 7.30 am

General: 7.30 am to 4.00 pm – all in-charges

The statistics of the number of patients attended to in the month of May 2009 is recorded in the next slide.

It provides an idea about the cases received date wise and how they are moved to the different types of wards.

BGS Global Hospitals

Department of Accident and Emergency

No of Patients Received @ A&E for the month of May 09

                                                                 

Date 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 G.T

TICU 4 0 0 1 1 1 2 0 2 1 2 1 2 2 1 1 1 0 0 1 1 2 0 1 1 3 1 1 1 0 34

CCU 1 0 2 1 1 0 1 1 0 0 1 0 0 1 0 1 0 0 1 1 1 3 1 1 0 0 0 1 2 1 22

MICU 0 3 0 0 1 2 1 0 2 0 1 0 0 0 0 0 1 2 1 0 0 1 4 0 0 0 1 0 0 2 22

NICU 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 2 1 1 2 0 1 3 3 2 0 0 17

OT 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1

Gen.ward 3 1 1 5 3 4 2 1 1 1 0 0 2 2 0 2 2 2 3 2 1 1 6 3 3 1 2 0 4 6 64

Semipvt 1 0 0 1 0 0 0 0 0 0 2 0 2 1 0 3 1 1 2 3 4 0 0 1 1 0 0 4 0 1 28

Pvt 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 1 1 0 1 1 0 1 0 0 10

OPD 6 6 1 4 0 2 6 5 10 4 0 5 2 4 4 3 6 1 1 8 3 7 8 8 4 2 3 1 5 11 130

Transit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Brought dead 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 2

Total 15 11 5 12 7 9 12 7 15 6 7 6 9 12 5 10 12 6 8 18 11 16 22 14 11 11 10 10 12 21 330

                                                               

MLC 0 1 0 1 2 1 0 0 0 1 2 0 5 3 0 3 9 1 1 3 3 1 4 1 3 7 3 2 3 8 68

CTC/108 0 0 0 1 1 0 0 0 1 1 1 1 2 0 1 0 1 0 1 2 0 0 2 0 0 3 1 0 1 0 20

DAMA 0 0 0 1 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 6

Sl NoShifted from

A&E toNo. of

PatientsPercentage

1 TICU 34 10.30303

2 CCU 22 6.666667

3 MICU 22 6.666667

4 NICU 17 5.151515

5 OT 1 0.30303

6 Gen.ward 64 19.39394

7 Spvt 28 8.484848

8 Pvt 10 3.030303

9 OPD 130 39.39394

10 Transit 0 0

11 Brought dead 2 0.606061

12Number of

Patients attended

320 100

The hospital has the most cutting edge technology to cater to the new generation healthcare requirements.

It is adequately equipped with mostly GE and other premium branded diagnostic equipment.

Biomedical Equipment - The A&E department also has a very tech monitors and other ER Gadgets to provide quality care for its patients.

Diagnostic Services - It is in close proximity to very sophisticated diagnostic imaging systems like MRI, CR, PET, installed in other departments.

Pneumatic Shoot System - The A&E department has a terminal of pneumatic shoot system, which saved considerable amount of time in transporting lab samples and get the reports.

Information System - The hospital has an average HIS system and employs partial electronic documentation of healthcare records and full electronic billing system. The hospital has been completely networked for LAN and has wired internet connectivity on most computers. Presently there is no wireless internet facility available.

Telecommunication – the whole hospital has been networked with EPABX system and has simple and easy connectivity. Paging systems were not observed.

Fire Safety – there are fire protection systems installed. Primary observation makes us feel the systems are adequate.

Infrastructure The access road connecting the main

hospital building with the main road needs to be immediately repaired and re-graded so that water doesn’t flood in the low area of the road.

Also care has to be taken to remodel the road so that the rain water doesn’t carry the silt and deposit in the middle of the low lying curve of the road which again can turn dangerous for pedestrians and two wheelers.

Human Resource and Systems and Processes

The department presently is just optimally staffed with respect to nurses and doctors.

If there is an arrival of mass casualty of more than three people, then the department is not prepared to take that work load with its presently available work force.

So keeping this factor in mind and as the statistics of average number of patients per day increases, more nursing staff and doctors needs to be added into the department.

Technology Telecommunication : Addition of paging system needs to me

included into the hospital’s communication system. Strengthening of mobile phone signals also needs to be taken

care to improve communication efficiency. Case Observed: Since in the hospital, the mobile phone signals

are very bad, there had been a situation where the A&E consultant was trying to locate an Urologist on rounds, but there was no way to reach him as his mobile was inaccessible and there was no paging system in the hospital.

Atlast, with great deal of inter communication to various desks, the doctor could be located. This happened when there was an emergency case which required the specific attention of the urologist. If this had happened in case of a cardiac patient, then things would have been fatal. Even then the patient had to suffer till the doctor could be located.

IT :data security and virus protection systems needs to be put in place. Wifi internet and other facilities would benefit patients and students like us.

After doing my study in the A&E department of BGS Global Hospital, Kengeri Bangalore, I have come to a conclusion that the department is presently working good.  

It is able to satisfactorily cater to the present work load it is receiving daily. The infrastructure and the human resource aspects of the department are also adequate to perform efficiently under the present conditions.  

There is lot of technology concentration in the department and some of the modern gadgets are presently underutilized.  

The hospital should aim at going paperless and work in this regard with respect to their technology. Presently the information system in the hospital is only average.  

The diagnostic facilities available in the hospital are very good. 

The space planning in the hospital is very good.

Rijo Stephen Cletus