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Gowda NR, Khare A, Vikas H, Singh AR, Sharma DK, Poulose R, John DC. More from less: Study on increasing throughput of COVID-19 screening and testing facility at an apex tertiary care hospital in New Delhi using discrete-event simulation software. Digit Health 2021; 7:20552076211040987. [PMID: 34868613 PMCID: PMC8642042 DOI: 10.1177/20552076211040987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/05/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background One of the challenges has been coping with an increasing need for COVID-19
testing. A COVID-19 screening and testing facility was created. There was a
need for increasing throughput of the facility within the existing space and
limited resources. Discrete event simulation was used to address this
challenge. Methodology A cross-sectional interventional study was done from September 2020 to
October 2020. Detailed process mapping with all micro-processes was done.
Patient arrival patterns and time taken at each step were measured by two
independent observers at random intervals over two weeks. The existing
system was simulated and a bottleneck was identified. Two possible
alternatives to the problem were simulated and evaluated. Results Scenario 1 showed a maximum throughput of 316. The average milestone times of
all the processes after the step of “Preparation of sampling kits” jumped
62%; from 82 to 133 min. Staff state times also showed that staff at this
step was stretched and medical lab technicians were underutilized. Scenario
2 simulated the alternative with lesser time spent on sampling kit
preparation with a 22.4% increase in throughput, but could have led to
impaired quality check. Scenario 3 simulated with increased manpower at the
stage of bottleneck with 26.5% increase in throughput and was implemented
on-ground. Conclusion Discrete event simulation helped to identify the bottleneck, simulate
possible alternative solutions without disturbing the ongoing work, and
finally choose the most suitable intervention to increase throughput,
without the need for additional space allocation. It therefore helped to
optimally utilize resources and get “more from less.”
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Affiliation(s)
- Naveen R Gowda
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), India
| | - Amitesh Khare
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), India
| | - H Vikas
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), India
| | - Angel R Singh
- Department of Hospital Administration, All India Institute of Medical Sciences (AIIMS), India
| | - D K Sharma
- All India Institute of Medical Sciences (AIIMS), India
| | - Ramya Poulose
- All India Institute of Medical Sciences (AIIMS), India
| | - Dhayal C John
- All India Institute of Medical Sciences (AIIMS), India
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Chandra A, Sarda R, Kumar A, Bir M, Parija PP, Pal A, Sinha S, Vikas H, Naveet W. Impact of COVID-19 on the patients' income and work in Delhi, India. J Family Med Prim Care 2021; 10:3047-3050. [PMID: 34660445 PMCID: PMC8483079 DOI: 10.4103/jfmpc.jfmpc_2582_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 11/04/2022] Open
Abstract
Background Currently, there is no data on the impact of COVID-19 on patients' income and work in India. Methods We conducted a cross-sectional study at a tertiary hospital in New Delhi. We included all the patients who were ≥18 years of age and consecutively diagnosed with COVID-19 between the 1st of May 2020 to 31st July 2020. Patients were interviewed by a physician using a semi-structure questionnaire. Data were collected on socio-economic status, occupation, income loss, leaves taken, decrease in work efficiency (self-perceived) and about-facing any stigma/discrimination at the workplace. Results Out of 245 patients, 190 patients were employed. A total of 126 patients (66.3%) self-reported their work was affected due to COVID-19 disease. A total of 30.5% of patients (n = 58/190) reported deduction in their salary. The median amount of salary loss was INR 10,000 (IQR 9000-25000). Decrease in income and work efficiency (self-perceived) was found to be 37.3% (n = 71) and 12.1% (n = 23), respectively. A total of 47 patients (37.3%) took personal leaves (median number - 17 days (IQR 14-25), and discrimination/stigma related to the COVID-19 at the workplace was faced by 22.6% of patients. Conclusion Income and work of a substantial number of patients was affected due to COVID-19, as there was a decrease in income and work efficiency. Patients also had to take personal leaves and face stigma in the workplace. This will inform the policymakers to formulate strategies to mitigate the impact of COVID-19.
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Affiliation(s)
- Ankit Chandra
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Radhika Sarda
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Megha Bir
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Pragyan Paramita Parija
- Centre for Community Medicine (CCM), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Aishee Pal
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - H Vikas
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Wig Naveet
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Gupta R, Dwivedi T, Gajendra S, Sahoo B, Gupta SK, Vikas H, Singh AR, Mohan A, Bhatnagar S, Singh S, Wundavalli L, Guleria R. Authors' response. Indian J Med Res 2021; 153:565-567. [PMID: 34643565 PMCID: PMC8555615 DOI: 10.4103/0971-5916.323967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ritu Gupta
- Department of Laboratory Oncology Unit, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Tanima Dwivedi
- Department of Laboratory Oncology Unit, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Smeeta Gajendra
- Department of Laboratory Oncology Unit, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Biswajeet Sahoo
- Department of Laboratory Oncology Unit, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Sanjeev Kumar Gupta
- Department of Laboratory Oncology Unit, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - H Vikas
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Angel Rajan Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia & Palliative Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Sheetal Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Laxmitej Wundavalli
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India
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Vikas H, Kini A, Sharma N, Gowda NR, Gupta A. How informed is the informed consent? J Family Med Prim Care 2021; 10:2299-2303. [PMID: 34322428 PMCID: PMC8284237 DOI: 10.4103/jfmpc.jfmpc_2393_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/21/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Informed consent is a cornerstone of the ethics of modern medical care. In an ideal world, informed consent is a process of education – a conversation between a surgeon and a patient or family that allows the patient or family to make the best possible decision regarding care. Objective: The study was conducted with objectives of assessing information given to the patient before taking consent for surgery and determining the compliance to various contents of the consent forms. Material and Methods: This was a prospective study over a period of 12 weeks in wards of various surgical departments of a 1000+ bedded tertiary care hospital. Patient interviews were conducted to assess their level of information and the consent forms were reviewed to assess the compliance. Observations: The overall level of information r4egarding various aspects among the participants was 75.14%. The level of information varied statistically with age, literacy level, annual income and the type of surgery. All the patients (100%) stated that they were informed about the current clinical condition/ problem, while only 34% were informed about risk and 26% about the alternative options. All the forms (100%) had a statement regarding the explanation of procedure to the patient/ guardian and none of the forms (0%) contained names of all practitioners performing the procedure. Conclusion: There is need to create awareness among doctors and also to educate patients regarding the importance of informed consent.
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Affiliation(s)
- H Vikas
- Department of Hospital Administration, AIIMS, New Delhi, India
| | | | - Nishant Sharma
- Department of Hospital Administration, AIIMS, New Delhi, India
| | - Naveen R Gowda
- Department of Hospital Administration, AIIMS, New Delhi, India
| | - Anant Gupta
- Department of Hospital Administration, AIIMS, New Delhi, India
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Gupta R, Dwivedi T, Gajendra S, Sahoo B, Gupta SK, Vikas H, Singh AR, Mohan A, Bhatnagar S, Singh S, Wundavalli L, Guleria R. Seroprevalence of antibodies to SARS-CoV-2 in healthcare workers & implications of infection control practice in India. Indian J Med Res 2021; 153:207-213. [PMID: 33642348 PMCID: PMC8184075 DOI: 10.4103/ijmr.ijmr_3911_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background & objectives: Healthcare workers (HCWs) are considered to be at a high risk of contracting COVID-19 infection. Besides, control of nosocomial infections transmitted from HCWs to the patients is also a cause of concern. This study was undertaken to investigate the seroprevalence of antibodies against the SARS-CoV-2 virus among the hospital staff of a tertiary care health facility in north India. Methods: The HCWs were tested for SARS-CoV-2 serology (IgG+IgM) using chemiluminescence immunoassay between June 22 and July 24, 2020. Venous blood (2 ml) was collected and tested for SARS-CoV-2 IgG and IgM antibodies. Results: Of the 3739 HCWs tested, 487 (13%) were positive for total SARS-CoV-2 antibodies. The highest seroprevalence was observed in administrative staff (19.6%) and least in physicians (5.4%). The staff who used public (20%) and hospital transportation (16.9%) showed higher seroprevalence compared to staff using personal transportation (12.4%). No difference was observed between HCWs posted in COVID versus non-COVID areas. All seropositive symptomatic HCWs in our study (53.6%) had mild symptoms, and the remaining 46.4 per cent were asymptomatic. The antibody positivity rate progressively increased from 7.0 per cent in the first week to 18.6 per cent in the fourth week during the study. Interpretation & conclusions: The presence of antibodies to SARS-CoV-2 in a significant number of asymptomatic HCWs, association with the use of public transport, relatively lower seroprevalence compared with the non-HCWs and rising trend during the period of the study highlight the need for serosurveillance, creating awareness for infection control practices including social distancing and study of infection dynamics in the community for effective control of an infectious pandemic.
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Affiliation(s)
- Ritu Gupta
- Laboratory Oncology Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Tanima Dwivedi
- Laboratory Oncology Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Smeeta Gajendra
- Laboratory Oncology Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Biswajeet Sahoo
- Laboratory Oncology Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Gupta
- Laboratory Oncology Unit, All India Institute of Medical Sciences, New Delhi, India
| | - H Vikas
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Angel Rajan Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sheetal Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Laxmitej Wundavalli
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Sahu A, Vikas H, Sharma N. Life cycle costing of MRI machine at a tertiary care teaching hospital. Indian J Radiol Imaging 2020; 30:190-194. [PMID: 33100688 PMCID: PMC7546299 DOI: 10.4103/ijri.ijri_54_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 09/04/2019] [Accepted: 03/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Life cycle costing (LCC) is an excellent decision-making tool that can assist a hospital administrator in seeking more cost-effective decisions to select the best course of action. LCC can be defined as “an economic assessment of competing design alternatives, considering all significant costs of ownership over the economic life of each alternative, expressed in equivalent rupees. Aim: To determine the LCC of magnetic resonance imaging (MRI) machine at a tertiary care teaching hospital. Settings and Design: A descriptive, observational study in MRI scan center of a tertiary care teaching hospital. Materials and Methods: LCC analysis (LCCA) was performed to ensure total cost visibility for the entire life span of the MRI scan equipment, which was assumed to be 10 years. Statistical Analysis: Data were analyzed using MS Excel. Results and Conclusions: The total cost per MRI scan was calculated to be Rs. 2944. It was estimated that the MRI scan center would reach the break-even point by the end of the third year.
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Affiliation(s)
| | - H Vikas
- Department of Hospital Administration, AIIMS, New Delhi, India
| | - Nishant Sharma
- Department of Hospital Administration, AIIMS, New Delhi, India
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Vikas H, Chowdri N, Parray F. Extralevator abdominoperineal excision: Surgical results. Apollo Medicine 2015. [DOI: 10.1016/j.apme.2015.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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