RESUMO
BACKGROUND: The cost of medical care is continuing to rise and cost containment measures need to focus on inappropriate hospitalization. Armed Forces Medical Services ensure universal access to its consumers but continuous increase in patient load is stretching the capability of service hospitals. The present study was undertaken to determine the rate of inappropriate hospitalization in a large tertiary care service hospital. METHODS: Appropriateness Evaluation Protocol (AEP) was used to assess the appropriateness of hospital days, the study being carried out in the acute medical and acute surgical wards of the hospital on randomly selected days over a period of three months. RESULTS: Inappropriate patient days were found to be 29.48% during the study period, with 34% of acute surgical patient days and 24.4% of acute medical patient days found to be inappropriate. No statistically significant difference was observed in the rate of inappropriate hospital stay between serving personnel and ex-servicemen. 31.25% non local patients as compared to 25.81% of local patients were found to have inappropriate hospital stays, though the difference was not found to be statistically significant. 60.71% of inappropriate stays were found in the initial period of admission (1-5 days), the phenomenon being observed both in the acute surgical and acute medical wards. CONCLUSION: The study shows that the rate of inappropriate patient days is quite high among the study population and regular utilization reviews need to be carried out to conserve health care resources available with the service hospitals.
RESUMO
Hospitals are by nature complex organisations and the complexity is compounded in service hospitals with perceived notion of service deficiencies. Quality has emerged as a major issue in health care sector and TQM has been accepted as a major long-term strategic initiative towards continuously improving quality of health care. Key concepts of TQM start with top management leadership with emphasis on process and customer focus. Implementation of TQM in service hospitals will require Quality Management awareness, training and framework development as well as development of customer awareness. TQM has been widely applied in clinical field with successful outcome. TQM is not a short-term solution, it has to be understood and practised as a long-term strategic commitment.
RESUMO
Costing a service product is a challenging but important tool for cost control. Different methods used for costing may provide varying costs and the choice of the method used becomes important. Use of absorption costing and marginal costing method and treatment of labour cost as variable and fixed cost provided different results in the present study of the cost of below knee patellar tendon bearing prosthesis. The study shows that marginal costing should also be done along with the absorption cost as it provides better indicator for cost control.
RESUMO
Patient satisfaction is an important outcome measure independent of other outcomes. Its measurement is important to assess the effectiveness of a programme and to gain insight into the patients' perception of the programme. In this study conducted in a large rehabilitation centre it was found that majority of patients express satisfaction with care inspite of perceived discomfort. Various demographic factors, severity or duration of the disability or the level of rehabilitation do not influence patient satisfaction. Patients express more concern with aspects such as delay in issue of the prosthesis, or hotel component of the hospital services. Patients did not appear too concerned about the level of information provided. Patient satisfaction is an individual reaction to the overall care process and is influenced by the initial expectation level of the patient. Emotional response of the patient appears to be more important determinant of patient satisfaction than the cognitive evaluation. Periodical assessment of patient satisfaction should be an important component of any programme evaluation exercise.
