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Hospital Observation Services

November 30, 2011 Leave a comment

By: Ahmed Afaal, MD

In hospitals, observation services are mainly referred to as

The use of a bed and periodic monitoring and/or short term treatment by a hospital’s nursing or other staff  (BCBSNC)

Observation is a reasonable and necessary process to evaluate a patient’s condition to determine whether there is a need for the patient to be admitted hence is recognized as an alternative method of evaluation and treatment to inpatient hospitalization. It can even be classified as an outpatient service rather than a hospitalization.

The allocated length of stay at observation services may not be the same in different institutions. Ideally, the earlier a patient is discharged from an observation service, the better. The time allowed at an observation service may vary from few hours to a maximum of about 48 hours. Observations services, in some hospitals may even be developed separately with separate policies for different conditions, while in others common policies with common observations services are also provided. In the Maldives, it is mainly the latter that is practiced.

Different categories of patients can be put under observation for the reasons specified below.

  • Patients who arrive in the hospital in an unstable medical condition would be placed for observation till a definitive care plan can be determined.
  • Patients who develop unusual reactions to procedures and or medicines after minor outpatient surgical procedures are also placed for observation for further assessment and treatment.
  • Diagnostic testing that require a specific preparation or an invasive procedure maybe placed at observation before and after the intervention.
  • Some patients are also placed in observation for planed routine therapeutic services that require the patient to be observed after the treatment.

Given the above categories, patients who utilize the observation services should mainly be discharged after observation. Hospitalization an inpatient should be very low from the observation room.

Observation services utilization rates, Jul - Oct, 2011

At ADK Hospital, the observation services are utilized heavily. As a result the demand for increased observation beds have been almost consistent. In august 2011, the hospital expanded its observation services from 3 beds to 6 beds, a 100% expansion. However, expansion alone is not enough. It is important to assess the utilization of these services. In this regard, an analysis of observation service utilization was assessed.

From July to October, observation service utilization has increased by almost 58% with 184 patients in July to 320 in October. This obviously is a sign of the expansion in beds and hence more patients have benefited from this intervention.

Also, it can be said that the observation service has been managed efficiently. On average, 95% of the patients utilizing observation services were discharged home and only about 5% required an admission. This is a clear sign of proper determination by the clinical staff on who actually requires observation services. The graph shows the utilization of the observation services at ADK Hospital.

In order to keep this service further efficient, a lot needs to be done. Some actions that can be implemented in the near future could be as follows.

  • Improve the current observation service policy by reviewing and strengthening it.
  • Attempt to provide slightly more complex services at observation so that more people can be treated without full hospitalization.
  • Start to take statistics on return rates to observation services or for hospitalization after being released from observation services.

Continuous monitoring and assessment of the service would still be crucial to continuous maintenance of quality of service provided in observation.

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Categories: Issue 21: Dec 11

New labour room commissioned

November 30, 2011 Leave a comment

On average, over a 1000 births are given at ADK Hospital. Over the years the demand for gynaecological services has grown. In the Maldives, ADK Hospital is where one of the largest numbers of births takes place every year. Hence, the hospital has found it increasingly challenging to meet up with the required demand. With the recent redevelopment of the Hospital, emphasis was given to this particular area and hence Obstetrics and Gynaecology has become the largest department of the Hospital.

The new delivery cabin

Currently there are four full time gynaecologists working in the department and more are yet to join. On an average, the outpatient consultation per consultant in the Department stands at about 25. In addition the load of attending emergencies, deliveries and caesarean sections as well as other related surgeries pose a huge demand on the professionals.

From June to October 2011, a total of 575 deliveries were taken at ADK Hospital. Of these deliveries, 63% were vaginal deliveries and 37% caesarean sections. Among the vaginal deliveries, 88% were normal, 9% and 3% were vacuum and forceps deliveries respectively. Among the caesareans, 56% were emergency and 44% elective. The figure shows the number of deliveries per month by type for this period.

Number of deliveries by type, June to october 2011

Given the increase in deliveries, the need for better-equipped and sophisticated delivery services was increasingly demanded from both the service seekers and professionals. Hence, on November 8, 2011 a new labour room was commissioned at the Hospital. From a 3-bedded labour room, to a more sophisticated 7-bedded labour facility has brought increased satisfaction to the mothers as well as the staff.

This, new labour room has 5 state of the art delivery beds with continuous monitoring of which one bed is equipped with more advanced monitoring for high-risk mothers. Two beds are allocated for pre-delivery mothers, which was a service previously unavailable.

In addition to the labour beds, a more spacious new-born resuscitation area is also attached to the labour room. Efforts are being to further improve the resuscitation service by equipping it with more modern and additional stations for the service.

Building on the strong Obstetrics and Gynecology services currently available, the Hospital’s aim is to continuously develop this service and introduce new services, including infertility treatment eventually leading to artificial reproduction therapy (ART) as well.

Categories: Issue 21: Dec 11

Five-in-one

November 30, 2011 Leave a comment

By: Gerard van Mourik, UNICEF Consultant to Maldives

‘The Government of the Maldives’, says UNICEF consultant Gerard van Mourik, ‘is playing with fire’.  Van Mourik is working with the Ministry of Health & Family and helps drafting their communications strategy for the introduction of the pentavalent vaccine. The vaccine is already used in over 70 countries around the World and now about to be included in the country’s national immunization program. Pentavalent is also called ‘easy5’ as it combines 5 vaccines in one vaccine and protects against diphtheria, pertussis, tetanus, hepatitis b and Hib.

Pentalvalent vaccine combines five vaccines in one

Gerard van Mourik clarifies: ‘Pentavalent vaccine is extremely cost-effective, reduces the number of pricks to a child, and provides adequate and efficient protection from all five diseases. Also, it reduces the number of visits to the health center, so mums and dads have more time for other things, and obviously reduces the amount of admin work required by the vaccination health worker’.

‘The critical part of the introduction however’, says Van Mourik, ‘is that health care is currently severely being decentralized and restructured’. Van Mourik clarifies: ‘Community health workers who used to be the vaccination practitioners have a wealth of experience, but are placed in the local Councils, while nurses and doctors at Health Corporations are now responsible for vaccination, and they have significantly less experience’.

During his recent trip to Gadhdhoo, Fiori, Rathafandhoo and Thinadhoo, Van Mourik observed strong emotional reservations amongst health practitioners, community health workers, family planning specialists, nurses and doctors alike. ‘New standard operating procedures have been dropped like parachutes without follow up’, adds Van Mourik, ‘and there is a painful absence of proper guidance and coaching of health staff with their new responsibilities’. ‘I strongly recommend improving communications between councils, health corporations, and ministries of health and finance, which needs be very carefully and tactfully managed’.

Van Mourik says he heard from various health practitioners that for example life saving deworming and vitamin A programs are already beginning to fall apart. ‘We may subsequently assume that other immunization program components are at serious risk as well’, Van Mourik says.

Van Mourik recommends mandatory training of all nurses in all islands before the new vaccine is becoming available in the Maldives, while UNICEF could continue to facilitate procurement of the new pentavalent vaccine, hence ensuring quality of vaccine.  ‘Procurement of vaccines has to remain the primary responsibility of the Government in Male’ and should not be decentralized’, says Van Mourik. It is expected that the vaccine will be made available in June 2012.

A Frequently Asked Questions pentavelent vaccine guide for health workers, parents, media, Imams and policy makers is available on the PentaCommunity Facebook site.

Categories: Issue 21: Dec 11

How to become and outstanding receptionist!

November 30, 2011 Leave a comment

By: Ziyaadha, CRM.

Face of the organization

Getting an opportunity to participate in the training program on “how to become an outstanding receptionist” which was held in Colombo on 20th October 2011, I gained knowledge in different areas in giving quality customer service. The training program was mainly focused on the following:

  • Steps to exceed customer expectation
  • How to deal with angry customers
  • Effective communication
  • Professional ways of handling customer queries

As we all know that public face and voice of an organization is the Receptionist. From the moment a customer walks into an organization what they usually notice is not the building but the friendly smiling face of the receptionist. The first impression is always important when meeting with customers. So have a friendly smile on your face and always dress up decently!

Dealing with angry customers are hard even though it may not even be our fault, we still need to know how to recover from a crisis situation as it’s our responsibility if the customer came to you or if it was you who has answered the phone on behalf of the company. Effective communication, both verbal and non-verbal plays an essential role in conveying what you really want to say without creating further problems.

During this training program I also got an opportunity to work at Nawaloka Hospital in Sri Lanka. Though it was hard to get along with their language, it was a great experience working there. I learnt valuable information, which I could apply in my daily work here in ADK. Also share some of the knowledge I have gained with my colleagues.

I would like to thank management for giving me such a great opportunity to enhance my career and look forward to get more training opportunity in customer service skills.

Categories: Issue 21: Dec 11

Partnerships in healthcare

November 30, 2011 Leave a comment

Dr. Habeeb and Mr. Afaal signed the MOU on behalf of the respective parties

On November 14, 2011, The Clinic, one of the leading private clinics in Maldives and ADK Hospital signed an MOU for collaboration is patient services.

This could be the first time in Maldives where two private healthcare providers have come to a written understanding on patient referral and service. It is only natural that as health systems evolve, innovation in providing healthcare does not only limit to care alone, but partnerships between providers to optimize the availability and access to services.

The MOU signed between ADK Hospitals and The Clinic include exclusivity in referral for MRI, CT, Digital X-ray, Bone Densometry, Echo Cardiography, Dental X-rays in the imaging field. Other diagnostic and investigative services such as laboratory, dental laboratory, TMT and physiotherapy services are also included for referral.

In addition to this, the MOU also agrees to collaborate in visiting specialist services where there is a high demand and/or shortages. In this regard radiology is one field of emphasis where there would be visiting collaboration.

ADK Hospital hopes to come to similar understandings with other clinics in future to provide easier access and options to patients to seek services not available in the clinics.

Categories: Issue 21: Dec 11