Published on : May 06, 2011

Hospital Challenges in the Millennium

Hospital Challenges in the Millennium

Since times immemorial hospitals are considered as temples of healing and people all over the world literally worship the doctors. However rapid industrialization and advancement in technologies have made hospitals more commercial in their outlook and more business oriented. Health insurance coverage is increasing and with better awareness and more funds at their disposal people have a wider and better choice of health care providers.

 

Healthcare is Competitive

In the metropolitan city of Mumbai there is a chain of corporate hospitals delivering quality healthcare at competitive rates. With the advent of medical tourism and health insurance it is imperative that the hospitals deliver standard care at competitive rates.

High quality healthcare is only   possible with the latest state of the art technology backed by the best medical brains. Healthcare technology is undergoing a rapid metamorphosis. What was latest yesterday could become redundant today.

Hence, the need for acquiring the best available technology. Some of the corporate hospitals of Mumbai have the latest state of the art technology backed by some of the best brains in the business, with the latest state of the art interiors. Some of them are so well designed that one does not feel it is a hospital. Within hospitals, the unnecessary use or overuse of antibiotics encourages the selection and proliferation of resistant and multiply resistant strains of bacteria. Once selected, resistant strains are favored by antibiotic usage and spread by cross-infection. Where resistance is encoded on transmissible plasmids, resistance can also spread between bacterial species.

There is a link between antibiotic use (or abuse) and the emergence of antibiotic resistant bacteria causing hospital-acquired infections. It is not possible to completely eliminate this evolutionary phenomenon, but it can be slowed or modified by prudent antibiotic use. This requires the inclusion of an antibiotic policy in the infection control program.

 

An Antibiotic Policy Will:

  • Improve patient care by promoting the best practice in antibiotic prophylaxis and therapy.
  • Make better use of resources by using cheaper drugs where possible
  • Retard the emergence and spread of multiple antibiotic-resistant bacteria.
  • Improve education of junior doctors by providing guidelines for appropriate therapy
  • Eliminate the use of unnecessary or ineffective antibiotics and restrict the use of expensive or unnecessarily powerful ones

 

Hospital Antibiotic Committee

The medical director and hospital administrator should ensure that the hospital plan for prevention and control of nosocomial infection includes an official committee that has responsibility for the formulation and supervision of an antibiotic policy. This might be a subcommittee of the hospital Drugs and Therapeutics Committee or of the Infection Control Committee. The Antibiotic Committee should have the support of the Medical Director and the authority to ensure that its policies are implemented throughout the hospital. Membership of an antibiotic committee may vary according to local conditions and needs. The committee should be responsible for producing general guidelines and policies for the healthcare areas after wide consultation with the users. The following key persons should be included in the committee:

  • The Pharmacist who will report back to the Antibiotic Committee at each meeting on drug utilization and cost.
  • The Microbiologist who will report on antibiotic susceptibility patterns of bacteria isolated from major infections.
  • Clinical doctors and nurses responsible for direct patient care who provide a link between clinical practice and the Antibiotic Committee.
  • Managers that will ensure the resources are available for implementation of the antibiotic policy.
  • Reciprocal Membership between the Infection Control Committee and the Drugs Committee should be ensured.

 

The Antibiotic Committee will have to make rational choices amongst "equivalent drugs" and classes of drugs in order to select the least expensive, most effective agents. Cost should determine the selection, when microbiological, pharmacological, and other relevant properties are similar. A major task of the Antibiotic Committee will be to establish guidelines for antibiotic use. This will lead to production of a formulary that restricts agents available to the minimum number needed for most effective therapy. The guidelines should:

  • Contain guidance on antibiotic prophylaxis (e.g. in surgery with details of timing, route, dosage and frequency)
  • Contain guidance on the choice of antibiotics for empirical and targeted therapy of major infections
  • Indicate first and second line therapy for common infections (might limit the use of certain second line drugs to consultant prescription only)

 

Good Practices

  • Consider whether or not the patient actually requires an antibiotic.
  • Avoid treating colonized patients who are not actually infected.
  • In general do not change antibiotic therapy if the clinical condition is improving.
  • If there is no clinical response within 72 hours, the clinical diagnosis, the choice of antibiotic and/or the possibility of a secondary infection should be reconsidered.
  • Give the antibiotic for the minimum length of time that is effective.
  • Consider the use of pharmacy ‘stop' policies, where drugs are written up for a specified period and are then only continued if a new prescription is issued.
  • For surgical prophylaxis start the antibiotic with the induction of anesthesia and continue for a maximum of 24 hours only.

 

The clinician should receive reports of antibiotic susceptibility based on the drugs available in the agreed formulary. The testing should be performed with a limited number of antibiotics selected to optimize patient care and cost effectiveness. The report should also indicate where organisms are invariably resistant. An effective antibiotic policy also provides and ensures education on the use of antibiotics at undergraduate and postgraduate level for medical and nursing staff.

 

Future Developments

In a fast moving city like Mumbai healthcare is a booming business and the competition is fierce and sometimes cut –throat. People want the best possible care at the most competitive prices.  It is therefore imperative for healthcare providers to be aware of the latest trends in the healthcare segment.

 

Future technological developments will continue to have a major impact on design. As technology advances and new care models emerge, it will be increasingly important for architects and interior designers to be specialized in the needs of healthcare. Technological advances also have a clear impact on healthcare engineering and information systems. Development of Integrated Electronic Medical Records will help physicians make better, faster decisions. And it will assist in public health efforts, making it easy to identify and contact, for example, patients who were prescribed a certain drug.

 

Radio-frequency identification (RFID) as an important part of such data-gathering systems because RFID tags can collect information automatically without giving busy hospital staff another task to complete. Hospital environments are going to be created around the patient, rather than the patient being taken to specific locations for services. This will entail rooms with “substantially more intense” infrastructure systems, along with the engineering design challenge of turning those systems on and off as needed.

 

Designing integrated technology systems will result in enhanced patient care. Technology applications are no longer self-contained silos. In the past, we installed individual applications, such as pharmacy, lab and radiology. Today, we track the information flow from one system or application to another to know how the care team will use that data. Such collaboration by the IT staff will continue on all aspects of the systems development life cycle, from identification of needs to post-implementation needs.  A pro-active management coupled with a positive approach can play a major role in establishing a world class center of excellence.

 

Dr. Balasubramanianhas been in charge of the Medical Administration at both Saifee and Bhatia Hospitals. At Saifee Hospital he was in charge of the Renal Transplant Program and developing various Health Checkup Packages. He has ensured proper Infection Control Practices and regular meetings of Drugs and Therapeutics Committee and Infection Control Committee. He may be reached at mbalas2001@hotmail.com