Tuesday, 7 March 2017

#PatientSafety is the key in the era of #DigitalHealth by @Drvikram

India has just seven registered allopathy doctors per 1,000 people; Indian healthcare was ranked 112th in the world by WHO; It takes almost 133 people to take care of 1 patient in a tertiary care hospital; There are now 133 touch points where patient safety can be compromised; Our healthcare system is unable to measure Patient safety, a very important parameter, mostly due to lack of longitudinal records;

India has just seven registered allopathy doctors per 1,000 people. Indian healthcare was ranked 112th in the world in a survey by the WHO. It is therefore unsurprising that most discussions in the healthcare sector today are focused around ways and means to build more infrastructure and increase access to care. 


Many startups have sprung up in the healthcare space promoting better health and preventive care. Investments are pouring into the country and new state of the art hospitals are being set up. But one must wonder are we doing the best we can with the existing system of doctors, hospitals, clinics and processes? How efficient is our system of care and what are the current outcomes we are seeing? Does a patient come out healthier and better than when he went in? Or was it just a case of good fortune that nothing untoward happened to him? What exactly are our priorities for safer care?

As per the Indian Confederation for Healthcare Accreditation (ICHA) it takes almost 133 people to take care of 1 patient in a tertiary care hospital. This is right from the time the patient decides to access healthcare in the hospital and till the time (s) he is discharged. Though the numbers seem interesting but it also gives us an idea about the complexity of the current healthcare system. Digital transformation, Modern technology and techniques might have made healthcare more effective but it has also made care more complex and unsafe - There are now 133 touch points where patient safety can be compromised.

Patient safety is a very important parameter. Somehow our healthcare system is unable to measure it, mostly due to lack of longitudinal records, as India has still not really adopted electronic medical records. Also key contributory factors are over diagnosis and reducing Hospital Acquired Infections (HAIs)

The solution to this issue could be in changing the approach to quality or excellence in healthcare. The traditional approach is to set rigid and stringent specifications against which service providers are benchmarked to see the extent of conformance. This “Outside – In” approach works well where the variables are mechanical and predictable. Unfortunately, healthcare is a sector where uncertainty is high and compounded by each patient’s unique condition and his/ her ability to respond to treatment. In such circumstances, the “Inside – Out” approach that begins with the patient’s needs and requirements may be a better fit.

“Optimum quality of healthcare delivery can be ensured by working backwards to align processes in tandem to meet these requirements” Says Dr Akhil Sangal, CEO of ICHA. “Healthcare has processes that have some predictable and many uncertain variables, and thus a mixed need based customized approach may be desirable,”

One example of the “inside-out” approach is the new infusion system introduced at the Virinchi Hospitals in Hyderabad. Patients going through invasive procedures and surgeries are more prone to infections. The risk of HAIs, including catheter associated infections, is common in patients due to various reasons, mostly the use of plastic or glass bottles in infusion therapy. 

The normal practice, which the nurses follow with these bottles, is to get a needle into the plastic bottle or open the air inlet of the IV sets with glass bottles for the fluid to flow into the patient’s body. This may lead to infection from the micro-organisms, that enter the bottle & may cause severe infection to the patients.

Dr. Srinivas Samavedam, Head of Critical Care Medicine, Virinchi Hospitals, Banjara Hills, Hyderabad added that “To prevent this type of infections from the infected air going inside the bottle, some medical institutions & hospitals have started to use the new-state- of the art German technology for IV solutions. These new IV containers are very advanced and do not require any needle prick for collapsibility thus ensuring high patient safety.”

No venting is necessary with this closed infusion system made by German Technology, as this collapses completely when emptying and therefore there is no need of needles to allow entry of air and hence any external infection.

International bodies like CDC & NIOSH also recommend risk free drug admixture, which reduces potential microbiological contamination. Accurate fluid delivery to the patient is also very important. The latest technology design of Closed Infusion System should facilitate dosage accuracy & should also be compatible with all pharmaceutical drugs.

Another example of the inside – out approach, is the launch of the Azurion from Philips. Philips’s new-generation image guided therapy platform is developed in collaboration with leading global hospitals allowing clinicians to easily perform a wide range of routine and complex procedures, helping them to optimize interventional lab performance and provide superior care. Azurion is built upon Philip’s redesigned operating system ConnectOS, which provided a real-time multi-workspot technology and a user-friendly interface for Physicians, Radiologists and Technicians. The Azurion platform also features over 1,000 new components, including an enhanced flat-panel detector, which provides a functionality to seamlessly integrate advanced interventional tools into the Azurion platform to support the clinical workflow.

It is clear that using the new infusion technology and using image guided therapy platforms like the Azurion there is a greater chance of improving patient safety. 

As always we would love to hear your views on the topic. Comments, suggestions and questions are welcome.

The article is authored by Dr. Vikram, it is reproduced here with the authors permission
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Dr. Vikram Venkateswaran
Dr Vikram Venkateswaran is a healthcare thought leader who writes and speaks about the emerging healthcare models in India and the role technology plays in them.
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