Rajiv Gandhi University of Health Sciences s108

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR SYNOPSIS

a. Name of the Candidate Dr.M. KUSUMA 1.

C-158,PWD Quarters ,Jeevan Beema Nagar

b. Postal Address Near JB Nagar Traffic police station

Bangalore- Karnataka

Vydehi Institute of Medical Sciences &

2. Name of the Institution Research Centre,

#82, EPIP Area, Nallurahalli, Whitefield,

Bangalore- 560066, Karnataka.

M.D HOSPITAL ADMINISTRATION 3. Course of Study and Subject

30-07-2013 4. Date of Admission to Course

“ A STUDY OF PATIENT CARE AND UTILIZATION OF 5. Title of the Topic FACILITIES IN THE OPERATION THEATRE AT TERTIARY CARE HOSPITAL”

6. Brief resume of the intended work 6.1 Need for study

OT is that specialized facility of the hospital where life saving or life improving procedures are carried out on the human body by invasive methods under strict aseptic conditions in a controlled environment by specially trained personnel to promote healing and cure with maximum safety, comfort and economy1

At the present time, about 50% of the hospital beds are surgical beds and about 50% to 60% of the inpatients require surgical treatment.2 Surgical facilities therefore represent a central life saving activity. Its performance is also dramatic and its successes and failures are highly visible. The activities carried out in this department can make or break the reputation of the hospital.1 Designing of an operation theatre complex is a major exercise and is mainly intended to benefit the patient. The need for safety, convenience and economy will guide the planning of a modern operation theatre complex, whatever the size, number or the speciality 3

Optimum utilization of the OT time has always been a priority area for Hospital administrators. The accurate records, weekly analysis of recorded data, establishment of operating room rules and regulations and strict adherence to and enforcement of approved policies and procedures are essential ingredients for an efficient operating of an operating room.4

The hospital can get accreditated by the joint commission on accreditation of health care organization(JCAHO).A professionally sponsored programme that stimulates a high quality of patient care in health Care facilities, In the present era of evidence based medicine, it becomes Imperative to give maximum importance to planning operation theatre complex, subject to the limitations of finance and space. The study will help us to suggest the necessary changes for improving the patient care and utilization of facilities of operation theatres. R eview of literature The managerial aspect of providing health services to patients in hospitals is becoming increasingly important. Hospitals want to reduce costs and improve their financial assets, on the hand, while they want to maximize the level of patient satisfaction, on the other hand. One unit that is of particular interest is the operating theater. Since this facility is the hospital's largest Cost and revenue centre 5 Wullink et al., for instance, examined whether it is preferred to reserve a dedicated operating room or to reserve some capacity in all elective operating rooms in order to improve the responsiveness to emergencies.6 Denton et al., for instance, examine how case sequencing affects patient waiting time, operating room idling time (i.e. surgeon waiting time) and operating room overtime. They formulate a two- stage stochastic mixed integer program (MIP) and propose a set of effective solution heuristics that are furthermore easy to implement. Note that patient waiting time may also be interpreted as the stay on a surgery waiting list.7 Dexter et al. , evaluate procedures based on the OR efficiency, which is a measure that incorporates both the underutilization and the overutilization of the operating room.8 A wide range of solution methodologies that are retrieved from the domains of operations management and operations research. Cardoen et al describe, next to a MIP model, a dedicated branch-and-bound procedure to solve a multi-objective case sequencing problem that is also addressed .9 According to American pattern 1 operating suite is required for every 25 surgical beds, while European authorities recommend 1 operating suite for every 50 surgical beds10

According to revised Indian public health standards IPHS 2012 guidelines to district hospitals of 101 to 500 beds .one OT for every 50 general inpatient beds and one OT for every 25 surgical beds11

Woloszyn M, Virgone J, Mélen St al , Experimental Study of an Air Distribution System for Operating Room Applications. Ventilation should be on the principle that the direction of air flow is from the operation theatre towards the main entrance. Efficient ventilation will control temperature and humidity in OT, dilute the contamination by microorganisms and anaesthetic agents Ultra clean laminar air flow – the filtered air delivery must be 90% efficient in removing particles more than 0.5mm. Positive air pressure system in operation theatre: It should ensure a positive pressure of 5 cm H2O from ceiling of operation theatre downwards and outwards, to push out air from operation theatre12.

1. Relative humidity of 40-60% to be maintained.

2. Temperature between 20-24degree Celsius to be maintained.

Each operation theatre should be equipped with three central pipelines, air conditioners of 1.5 tons power,5 to 6 electrical power points, anesthetic equipment and monitors.

According to Vanoostrum view, starting from a list of recurring procedure types.ie types that are frequently performed and hence have to be scheduled in each planning cycle, they decide what mix of procedures will be performed on what day and in which operating room. They aim at the minimization of the number of operating rooms in use and leveling of the hospital bed requirements13

6.3 Objectives of the study

1. To assess the physical facilities, organization structure and staffing pattern, equipment and functions of operation theatres.

2. To Evaluate optimum utilization of operation theatres

3. To discuss factors responsible for rescheduling the operative procedure and to avoid factors responsible for the same.

4. To evaluate quality assurance of activity against accreditation norms of operation theatres. 7. Materials and methods:

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 operation theatre.

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 OT complex (study for one month each specialty for 6 days a week; it involves number of operations performed per day, then cause for cancellation,late start,policy on anaesthesia etc.)  Informal interviews with the surgical team: Head of the unit, the Asst. professors, residents and nurses  Review of documents and files maintained in the unit to assess the compliance with NABH standards.

Retrospective study

A Retrospective study will be done on basis of past records and analysis of department statistics of 1 year, to study the utilization of the OT COMPLEX with the help of above indices: INCLUSION CRITERIA: Includes study of all OPERATION THEATRES(Ent,Opthal,Ortho,Surgery,Obg,Plastic Surgery,Paediatric Surgery,Urology,Ctvs,Neurosurgery,Oncosurgery,Gastroenterology.) EXCLUSION CRITERIA: Study excludes emergency OT services

B. Study design- Observational Study and interview C. Study period-

Retrospective study (Jan2013 to dec2013),

Prospective study (Jan 2014 to dec2014)

D. Place of study-VIMS & RC 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. Gupta Shakti, Kant Sunil, Chandrasekhar, satpathy, Modern trends in planning and designing of hospitals Principles and practices , Pg no 50-51, First edition 2007.

2. Olbricht. The architecture of the surgical department. Minim Invasive the Allied Technol. 12(6):300-303, 2003 Nov.

3.S S Harsoor, Bala Bhaskar, Special article designing an ideal operating room complex , Indian Journal of Anaesthesia, 51 (3): 193-199, 2007.

4. Reena Kumar, R.K. Sarma,Operation Room Utilization at AIIMS, a Prospective Study, Indian journal of hospital administration Vol. 15, 2006 .

5. A. Macario, T.S. Vitez, B. Dunn, and T. McDonald.et al,Health Care Financial Management Association. Achieving operating room efficiency through process integration, Technical report, 2005.

6. G. Wullink, M. Van Houdenhoven, E.W. Hans, J.M. van Oostrum, M. van der Lans, and G. Kazemier. Closing emergency operating rooms improves efficiency. Journal of Medical Systems, 31:543{546, 2007. 7. B. Denton, J. Viapiano, and A. Vogl. Optimization of surgery sequencing and scheduling decisions under uncertainty. Health Care Management Science, 10:13{24, 2007. 8. F. Dexter, A. Willemsen-Dunlap, and J.D. Lee. Operating room managerial decision- making on the day of surgery with and without computer recommendations and status Displays. Anesthesia and Analgesia, 105:419{429, 2007. 9. B. Cardoen, E. Demeulemeester, and J. BeliÄen. Optimizing a multiple objective surgical case scheduling problem. Working paper, Katholieke Universities Leuven, Belgium, 2006. 10. Geldner G, Eberhart LH, Trunk S et al. Efficient OP management. Suggestion for optimization of organization and administration as a basis for establishing statutes for operating theaters. Anesthetist ,sept; 51(9):760-767 2002.

11. Indian public health standards revised 2012 guideline for 101 to 500 bedded district hospitals, 2013 12.Woloszyn M, Virgone J, Mélen S et al. Experimental Study of an Air Distribution System for Operating Room Applications. The International journal of ventilation, June; Paper 1: Volume 4,2004

13.J.M.Van oostrum.M.Vanhoudenhoven.J.L.Hurinik,E.W.Hans,G.Wullink and G.kazemier. a master surgery scheduling approach for cyclic scheduling in operating room departments, OR Spectrum-2008

9. Signature of candidate

10. Remarks of the Guide It is relevant to have quality operating theatre, infrastructure and logistics by which we can provide surgeon friendly, patient friendly and other supportive staffs a quality ambience.

11. Name and Designation

11.1 Guide DR.ANIL KUMAR HEGDE M

Professor and Head

Department of Hospital Administration,

Vydehi Institute Medical Sciences &

Research Centre, Bangalore- 560066

11.2 Signature of Guide

11.3 Co-Guide(if any)

11.4 Remarks and

Signature

DR.ANIL KUMAR HEGDE M 11.5 Head of Department Professor and Head

Department of Hospital Administration,

Vydehi Institute Medical Sciences &

Research Centre, Bangalore- 560066

11.6 Remarks and PROFORMA: OPINION REGARDING DELAY IN START OF OT AND THE REASONS FOR THE DELAY

Consultant Resident Nurses OT functioning

OT starts on time

Delay is due to staff nurses

Delay is due to other staff

Delay is due to lack of sterile supplies

Delay is in the readiness of other equipment

Delay in shifting of patients