When a health crisis strikes, one’s mind is generally too clouded to take a rational decision about choosing a hospital. So, it makes sense to select a hospital when one is in good health, says Sarita D’Souza

Charles was riding a bike with a bag strapped around its front when the strap broke and the bag landed in front of the bike. Charles fell from the bike, with excruciating pain in his leg, indicating a possible broken leg. His wife, Jenny, now had to deal with the question ‘Where should she take him for medical treatment…’

It is best to choose a hospital when you are healthy and do not need the services of one rather than wait for an emergency to arise, which necessitates hospital admission. If you want to decide which hospital to go to during an emergency, the best time to make that decision is when you are well.

CHOOSING HOSPITALS

What factors would you keep in mind when choosing a hospital? According to Dr Amit Dias of Goa Medical College, “Choosing a hospital may be a difficult task for most patients. It may be a good idea to consult your family doctor before choosing a hospital for any condition as it will be a balance between hospital cost, quality of services, expertise of the doctors, comfort available (private room/ general ward/AC rooms and other facilities), convenience of family members, insurance cover etc. A hospital with a good doctor is always the best bet. But everyone may think like you and you may get token number 100 at the OPD!”

Dr Dias adds, “One should be cautious of a hospital with several reports of nosocomial infections (hospital acquired infections) and irregular staff.

If the condition is not serious, like a common cold, the choice of the hospital may not matter much. However, for an emergency such as a stroke (brain attack), myocardial infarction (heart attack), trauma, it is necessary to shift the patient immediately to a hospital that has facilities for early intervention. This means that besides considering a good facility, one must also consider the distance and time taken for travel.”

Studies have indicated that patient preferences for hospitals are influenced by several factors, some of which are listed below:

NATURE OF CARE REQUIRED

Does the hospital have experience and successful outcomes with your condition? ‘General’ hospitals deal with routine conditions while ‘specialty’ hospitals focus on handling certain conditions (such as ‘heart conditions’) or certain groups (such as ‘children’ or ‘women’). If you have a chronic heart condition, you would do well to choose a hospital with more expertise in handling these cases than others.

PROXIMITY TO HOME

How accessible is the hospital? While the distance of the hospital from your home is an important consideration, you need to keep in mind the nature of care required. In case of an emergency at home, where it is critical to get the person admitted immediately, or in case of hospitalization for a longer period of time, nearness to your home is an important consideration. For planned treatment at a hospital, you would need to also consider other factors like the nature of care and whether the hospital is included in your insurance cover.

INFRASTRUCTURE

What is the kind and quality of physical and people infrastructure? Availability of the equipment and infrastructure required for medical treatment is another consideration that is to be kept in mind. While some hospitals do refer patients to other facilities for the specific infrastructure, the nature of your condition and the immediacy of access to the medical equipment would need to be kept in mind. Infrastructure would also include the levels of hygiene and processes in place to control infection at the hospital.

ATTENDING DOCTOR AND CARE

Is your doctor attached to the hospital? Sometimes the decision of which hospital to choose is driven by your doctor and whether he offers his/her services at the hospital. If your decision is influenced by the doctor who would be treating you, you would do well to check if your doctor attends to patients at the hospital. Sometimes, doctors offer their services at a large branded hospital as well as at the next best hospital. The choice between the two hospitals would be influenced by your cost considerations.

COSTS AND HEALTH INSURANCE COVERAGE

Does your health plan cover care at the hospital? In case of cashless facility, the hospital is required to be listed with the insurance company and the Third Party Administrator, to enable you to avail of the facility. If you are going in for a planned surgery, you would need to do your homework before deciding on the hospital.

The cost assessment is particularly important if you are paying from your pocket or in cases where you need to make the payment and obtain reimbursement from your insurance company.

If you choose a hospital well, you could make the most of the limited sum insured. If you choose a hospital that offers healthcare of equivalent quality at a reasonable rate, this claim of a lower amount would help keep the next year’s renewal premium under check, as your previous year’s claim is considered in determining your subsequent premium rate.

QUALITY AND ACCREDITATION

Does the hospital meet quality standards? How well does it check and improve on its own quality of care? Patient care involves clinical care and support activities like requisition of tests, medicines, nurse doctor coordination, infection control, training, etc. These need to run in a coordinated manner to provide the best experience to the patient and relatives. A quality-conscious hospital defines and documents all such activities and organises necessary staff training.

A good hospital would respect the rights of the patient and his family and have in place adequate processes to provide information about the proposed treatment, expected outcome, possible risks and estimated costs, and focus on quality in investigations, surgical services, medication, infection control and regular.

If you do not wait till an emergency to make the decision of the hospital you would like to go to, you would be better prepared to deal with the situation, should it ever arise.

[Sarita D’Souza is a faculty at the Marian Institute of Healthcare Management and can be contacted at sdsouza@marianinstitute.in]

Meena Parulekar and Sarita D’Souza - Gomantak Times – Weekender, 6 June 2010

As shocking as it may sound, blood test reports can sometimes be erroneous, the reasons for which are many.

Seeing his son with a high fever, Rahul took the boy to the doctor. On examining the boy, the doctor asked Rahul to get a blood test done to check for possible causes of the fever. Since it was late evening and he had to travel on work the next day, Rahul took his two-year-old son for a blood test to a laboratory attached to a hospital. The next day, his wife Gauri took the results to the doctor.

The doctor was shocked to see the blood test show the possibility of leukaemia. He waited till Rahul returned and asked him to take his son for another blood test — the results indicated an infection. One can only imagine the angst and turmoil that the parents would have experienced on seeing the initial test results.

As we can see from the above incident, a pathological laboratory plays a key role in diagnosing a health condition. Pathology is understood as the study and diagnosis of disease through examination of organs, tissues, body fluids. Decisions about diagnosis and treatment, hospital admission and discharge largely rest on these test results.

For a lab manager, a wrong blood report signals the need to review the lab’s working. He would do well to examine the process followed at the lab including:

• Entry of the patient and recording of his details
• Checking the tests to be conducted with the doctor’s written recommendation
• Conduct of the test and handling of the blood sample collected
• Labeling of the blood sample collected and storage conditions
• Processing of the blood sample
• Documentation of the blood report
• Handing over of the report to the patient and maintaining a copy for the record
• Timelines involved for all the above

INCORRECT REPORTS

A wrong report could be the result of the following reasons: insufficient blood for testing, wrong details on sample tube and form, wrong sample taken, no signatures, wrong type of tube, mismatch with information on lab records, tube compromised, clotting, ability of processing technician, lab equipment and so on. The lab manager could conduct a root cause analysis to find out the reason/s for the error in the report and then put in place processes to eliminate the cause of the error.

Dr P N Velingkar, who runs a lab in the heart of the city, cites quality of the reagent used, process followed and a possible error in test kit as possible reasons for errors. He suggests that labs examine standards of previous reagents used and track their performance, perform an EQAS (External Quality Assurance Services) regularly. He also opines that while sometimes a patient wants the results urgently, it is important that the lab ensures adequate time for confirmation of results.

This helps review decisions on which tests the lab can conduct, lab layout planning, quality and maintenance of equipment, putting in place proper standard operating procedure for consistent processes, proper storage facilities, training personnel and providing proper working conditions.

REDUCING ERRORS

Continuous improvement cannot rely on a single approach. An error could arise out of several individual causes working together with each other. In addition to putting in place barriers to reduce errors in test results, training initiatives create a sharp awareness of the impact and potential risk of errors in the entire process.

Pathological laboratories face issues like access to patients, availability of trained lab technicians, managing working capital and investment for equipment. Also, according to Dr J P Agarwal, director of a diagnostic centre in Hyderabad, “Some onus also rests on the doctor who does the initial diagnosis. Only when the initial diagnosis is in the right direction, the lab report will also be on the right path.” Thus, there are several operating constraints faced by path labs.

Despite having to deal with several constraints, laboratories would do well to review their working to enable consistent and accurate reports. This would form the basis for better diagnosis and effective treatment so that parents like Rahul and Gauri can rest assured about their son’s diagnosis and treatment.