End of Internship Presentation

Embed Size (px)

DESCRIPTION

Presentation of master's thesis internship at the MSMC

Citation preview

  • Bed Management and Discharge Processes at the MSMC

    Internship Report

    April 8 July 4, 2014

    Brendan Drew, B.S.

    M.Sc. Healthcare Policy, Innovation and Management Programme

    Maastricht University

  • Project 1: Bed Allocation by Clinical Department Goal: Allocate a fixed number of beds to each clinical department

    Rationale: Facilitate admission and bed allocation processes

    Facilitate nursing specialization

    Aggregated data from 6 months of inpatient admissions reports

    Calculated average (with stddeviation), maximum and

    minimum daily bed use by clinical department

    Calculated the number of general, private and semi-private beds to be allocated to each department

  • Project 1 Conclusion

    Variability was too great to allow for fixed bed allocation

    Medical superintendent advised against proceeding with project

    0

    5

    10

    15

    20

    25

    30

    35

    40

    45

    50

    1 6

    11

    16

    21

    26

    31

    36

    41

    46

    51

    56

    61

    66

    71

    76

    81

    86

    91

    96

    10

    1

    10

    6

    11

    1

    11

    6

    12

    1

    12

    6

    13

    1

    13

    6

    14

    1

    14

    6

    15

    1

    15

    6

    16

    1

    16

    6

    17

    1

    17

    6

    18

    1

    Nu

    mb

    er o

    f B

    eds

    Allo

    cate

    d

    Days

    Neuro Surgery Department Bed Use

  • Project 2: Mapping the Discharge Process

    Collaborated with NH interns to map the discharge process, focusing on identifying non-value-added steps

    Conducted on-the-floor observations and interviews with staff

    Developed ideal process flows for cash, corporate, scheme and ESI patients

    Proposed IT and non-IT solutions to address identified inefficiencies

  • Project 2: Discharge Summary Preparation

    Discharge summary was consistently identified as a bottleneck (only 8% completed in under 40 min.)

    Developed an ideal process flow that improves coordination by use of SMS and email communication

    ADVISE DISCHARGE ONE DAY PRIOR

    RESIDENT DOCTOR WRITES COURSE IN HOSPITAL

    ON A DISTINCT SHEET WITH CORRECT DIAGNOSIS,

    CORRECTED HISTORY & MEDICATION ADVICE (WITHN 2 HRS)

    FILE SENT TO DISCHARGE DEPARTMENT

    (WITH 30 MIN.)

    DRAFT OF DISCHARGE MAILED TO RES. DR.

    / ADMITTING CONSULTANT

    MAKES CHANGES (IF ANY)

    INV. ON DISCHARGE

    SAMPLES SENT EARLY MORNING

    (DAY OF DISCHARGE)

    SAMPLES PROCESSED

    WITHIN TAT

    REPORTS GENERATED

    & AUTHENTICATED

    PRINT TAKEN AT WARD

    IF CHANGES BY RESIDENT,

    SEND TO ADMITTING CONSULTANT

    FOR FINAL APPROVAL

    IF CHANGES MAILED BY

    ADMITTING CONSULTANT,

    TREAT AS FINAL APPROVAL

    APPROVAL BY

    ADMITTING CONSULTANT

    GENERATE PDF

    WITH DIGITAL SIGNATURE

    UPLOAD FINAL DISCHARGE SUMMARY TO HINAI

  • Project 2: Key Proposals for Discharge Summary Preparation Patients should be advised for discharge tomorrow and have the

    necessary investigative reports ordered in advance whenever possible

    Doctors may dictate the discharge summary to a central phone line

    Discharge summary drafts should be emailed to junior and senior doctors (SMS alerts may be used for doctors without smart phones)

    Doctors authorize the final draft of the discharge summary with a digital signature which generates a pdf of the final draft

  • Project 3: Preparation of Masters Thesis

    Analyzed data from 1,000 hospital discharges in the month of January 2014

    Research Question: How does financing method (cash, corporate, ESI, or scheme) affect the discharge turnaround time?

    Methodology: Multiple linear regression analysis

    Confounding Variables: Gender, length of stay, admission category, time of day of advised for discharge, ward location, and clinical department

  • Project 3: Results

    Independent Variable

    Regression Coefficient

    Std. Error t P

    Reference 557 29 19

  • Project 3: Conclusion

    Discharge turnaround time is shorter for scheme patients relative to cash patients

    There is no statistically significant difference in the turnaround time for corporate and ESI patients relative to cash patients

    Statistically significant predictors of discharge turnaround time: Time of day of discharge

    Ward allocation

  • Project 3: Writing the Paper

    Theoretical basis: As the health insurance market develops rapidly in India, it is important to understand the administrative burden placed on hospitals by third-party payers

    Hypothesis of this study was that administrative burden would lead to an increase in time spent on hospital processes such as discharges proven incorrect

    Included process maps as a more qualitative analysis of the impact of financing method on discharge processes

    Directions for future research: Quantify administrative burden of use of third-party payers in other terms (e.g.

    monetary costs, man-hours spent) Implement streamlined and standardized billing processes and analyze impact on

    hospital billing and insurance-related costs

  • General Observations on the Internship

    Overall very positive experience

    Would have been nice to have more time prior to my arrival to develop the topic Conflicting expectations of academic supervisor and management

    Need to meet managements expectations while using the scientific method and demonstrating aptitude in data collection and analysis

    Short time period limits possibilities, especially for testing implementation of a new process/protocol

  • Thank you!

    For the hospitality you have shown and the opportunity you have given me to learn from your institution. It has been a privilege to work with such dedicated professionals. I can think of many instances of members of the NH staff at all levels going out of their way to be helpful and welcoming.