Crisis Management In Hospital

Healthcare institutions of today are complex matrix organizations.
Crisis is bound to occur in any complex human endeavour, and healthcare is no exception.
We often encounter crisis while delivering health care. Crisis is more common in area of emergency, critical care and operation theater. Crises are ubiquitous and the costs (human and financial) are substantial.

A "crisis" has been defined as "a turning point" and, in the context of health care, "the point in the course of a disease at which a decisive change occurs, leading either to recovery or to death“

The problem facing the clinician is to detect that a crisis is at hand, to diagnose its underlying cause, and to take the necessary steps to divert the course of the patient’s condition from impending disaster towards recovery. This problem is not always managed adequately, and the consequences of this inadequacy are sometimes tragic.
Why crisis is common in Hospital? :
ØUncertain, dynamic environments.
ØMultiple sources of concurrent information.
ØShifting, ill-defined, or competing goals.
ØIll-structured problems.
ØActions having immediate and multiple consequences.
ØMoments of intense time stress interleaved with long periods of routine activity.
ØSophisticated technologies with many redundancies.
ØComplex and sometimes confusing human-machine interfaces.
ØHigh stakes.
ØMultiple players with differing priorities.
ØA working environment highly influenced by group norms and organisational culture.
ROOT CAUSE ANALYSIS:


MAN RELATED:
Examples-
Air embolisation during withdrawal of central line.
Oesophageal intubation followed by paralysis.
MACHINE RELATED:
Examples-
Massive haematemasis ,aspiration due to non functioning suction machine.
Malfunctioning laryngoscope during intubation.
MATERIAL RELATED:
Example-
Empty oxygen cylinder
Drugs causing life threatening complication
METHODS RELATED:
Example-
Mismatched blood transfusion.
Inadequate management of hypotension/hypoxia.

• Quality Indicators are a set of measures that provide a perspective on hospital quality of care using hospital administrative data. These indicators reflect quality of care inside hospitals and include inpatient mortality for certain procedures and medical conditions; utilization of procedures for which there are questions of overuse, underuse, and misuse; and volume of procedures for which there is some evidence that a higher volume of procedures is associated with lower mortality.
  Although quality assessments based on administrative data cannot be definitive, they can be used to flag potential quality problems and success stories, which can then be further investigated and studied. Hospital associations, individual hospitals, purchasers, regulators, and policymakers at the local, State, and central levels can use readily available hospital administrative data to begin the assessment of quality of care.
  1. Hospital-level Patient Safety Indicators
  · Complications of anesthesia
  · Death in low mortality DRGs
  · Decubitus ulcer
  · Failure to rescue
  · Foreign body left in during procedure
  · Iatrogenic pneumothorax
  · Selected infections due to medical care
  · Postoperative hip fracture
  · Postoperative hemorrhage or hematoma
  · Postoperative physiologic and metabolic derangements
  · Postoperative respiratory failure
  · Postoperative pulmonary embolism or deep vein thrombosis
  · Postoperative sepsis
  · Postoperative wound dehiscence in abdominopelvic surgical patients
  · Accidental puncture and laceration
  · Transfusion reaction
  · Birth trauma -- injury to neonate
  · Obstetric trauma -- vaginal delivery with instrument
  · Obstetric trauma -- vaginal delivery without instrument
  · Obstetric trauma -- cesarean delivery
  · Foreign body left in during procedure
  2. Hospital-level Procedure Utilization Rates
  · Cesarean section delivery
  · Primary Cesarean delivery
  · Vaginal Birth After Cesarean (VBAC), Uncomplicated
  · VBAC, All
  · Laparoscopic cholecystectomy
  · Incidental appendectomy in the elderly
  · Bi-lateral cardiac catheterization
  · Coronary artery bypass graft
  · Percutaneous transluminal coronary angioplasty
  · Hysterectomy
  · Laminectomy or spinal fusion
  · Esophageal resection
  · Pancreatic resection
  · Abdominal aortic aneurysm repair
  · Carotid endarterectomy
  
  3.Mortality indicators
  
  a.Mortality Rates for Medical Conditions
  Acute myocardial infarction
  Congestive heart failure
  Stroke
  Gastrointestinal hemorrhage
  Hip fracture
  Pneumonia
  b.Mortality Rates for Surgical Procedures
  Esophageal resection
  Pancreatic resection
  Abdominal aortic aneurysm repair
  Coronary artery bypass graft
  Percutaneous transluminal coronary angioplasty
  Carotid endarterectomy
  Craniotomy
  Hip replacement
  
  ADMINISTRATIVE INDICATORS
  Patient satisfaction score
  Employees satisfaction score
  Employees turnover
  Admission rate
  Cost effectiveness of services
  
  Utilization rate of services
  Equipment Down time
  
  Patient fall rate
  Sentinel events rate
  Hospital infection
  Bed occupancy
  Waiting Time in OPD
  
  
  Importance of Quality Indicators:
  These are used to help hospitals identify potential problem areas that might need further study.
  Provide the opportunity to assess quality of care inside the hospital using administrative data found in the typical discharge record.
  
  These are used to support accountability, regulation and accreditation
  
  These are used for Benchmarking and marketing purposes
  
  
  These allow the organization to see how it is performing relative to its strategic plans for improvement.

The Doctor patient relationship in our country has undergone a sea change in the last decade and a half. The lucky doctors of the past were treated like God and people revered and respected them. Aryans embodied the rule that, Vaidyo narayano harihi (which means doctors are equivalent to Lord Vishnu). We witness today a fast pace of commercialization and globalization on all spheres of life and the medical CPA, Consumer awareness and Commercialization has changed the scenario. All these 3C has adverse effects on DOCTOR AND PATIENT RELATIONSHIP.
It's a common observation that medical practitioners, hospitals are being attacked by family members of patient for alleged medical negligenceprofession is no exception to these phenomena.
Section 304-A of IPC is a sword hanging above the doctor, working both in government hospitals and in the private sectors. Doctors are considered as soft targets by the law enforcing
agencies and being harassed by unsatisfied patients. Moreover complainants often use criminal cases to pressurize medical professionals and to extract unjust compensation

Allegations of rashness or negligence are often raised against doctors by persons without adequate medical knowledge, to extract unjust compensation.
This results in serious embarrassment and harassment to doctors who are forced to seek bail to escape arrest. If bail is not granted, they will have to suffer incarceration.
They may be exonerated of the charges at the end; but in the meantime they would have suffered a loss of reputation .
Public awareness of medical negligence in India is growing. Hospital managements are increasingly facing complaints regarding the acilities, Standards of professional competence, and
The appropriateness of their therapeutic and diagnostic methods.

Currently, approximately 10,000-15,000 medico-legal cases are pending in various courts of our country, a rise of almost 25 per cent in the last five years. Worldwide and in India, gynaecologists and obstetricians top the chart when it comes to the number of cases filed
against medicos. Anaesthesiologists and ophthalmologists follow.

The severity of the punishment depends on whether the case is civil or criminal.
Compensation range from a meagre Rs 10,000 to several lakhs. The average compensation ranges from Rs 4 lakh to Rs 5 lakh. If it's a civil case, which most are, then if proven
guilty the State Commission might debar the doctor from practice. Around 10 per cent of cases are based on very 'gross' negligence More than 20 to 30 per cent of cases fall into
mild or moderate category. Ratio of relevant cases to the number of frivolous cases is 50:50.
RECOMMENDATIONs FOR DEALING WITH COMPLAINT OF NEGLIGENCE :
A- AWARENES OF NEGLIGENCY
B-BUILD STRONG STRUCTURE, PROCESS,
C- COMMUNICATION
D-DOCUMENTATION
E-EMPHATHETIC ATTITUDE