Aseries of random interviews with practicing clinicians in several cities revealed a mixed picture with considerable awareness of the September 17 occasion among doctors associated with big corporate hospitals and very little knowledge among those working in small healthcare organizations.
Dr M I Sahadulla, Chairman & Managing Director of KIMS Healthcare Group, one of Asia’s leading hospital chains and a veteran healthcare professional with extensive global exposure, says that patient safety and delivery standards in Indian healthcare in general needs to improve significantly to match up with global settings.
When you compare standards based on the global parameters, set for patient safety, we can easily find that several of those key result areas (KRAs) are not really addressed in Indian hospitals in general, though there are many exceptions to this due to the emergence of several professional run and accredited hospitals in the country of late.
Even if one talks about patient safety aspects exclusively, leaving the patient experience factor which is another important area that is grossly ignored in India, there are enough examples of negligence, unhygienic practices and medical induced errors. For example, even in the simple case of x-rays, there are often repeated x-rays causing extra radiation in the patient and similarly radiation being given by not exactly locating the part causing damage to other organs or locations. This happens because enough care is not being taken while doing such procedures by technicians, para medics and even by doctors. The example that I gave is of just one procedure, but there are umpteen examples of similar issues in other procedures, including surgeries.
Accreditation or quality certification alone won’t help to keep patient safety intact. It should rather come from within and there should be a system that is formulated by taking care of the finer details of care, which lasts from the time a patient is admitted all the way to the measurement of the final outcome of the treatment.
Infection control is another area that is critically important in a hospital. But this is also one area that is largely neglected in India.
I must say India is fortunate to have brilliant doctors and a medical skillset and knowledge base par excellence as compared to any other part of the world. The infrastructure that is available in the modern healthcare settings in India is also second to none. But unfortunately, these advantages haven’t really translated into or culminated in better healthcare delivery. I would say this is a problem mainly with the mindset and culture, which needs to be changed.
Dr Alok Roy, himself a senior practicing surgeon and the CMD of Kolkata-based Medica Group of Hospitals, said his organization was not only aware of the WHO announcement of the Patient Safety Day but were also planning several events to mark the day.
In the opinion of Dr Roy, the frequency of medication errors, surgical site infections and other MAE could range between 8-10 percent of all hospital admissions. However, he said, organizations like Medica Group have taken multi-dimensional steps to prevent MAE. This includes a variety of checks and balances, including clinical audits conducted from time to time.
On the other hand, Dr Arshad Ghulam, a senior general surgeon, and Dr J K Lalmalani, a urologist, both practicing in Mumbai, were both of the view that in corporate hospitals the incidence of serious medical errors was very, very rare. Dr Arshad Ghulam said that NHSRC’s figure of significant medical errors at 10-12 percent of hospital admissions was highly exaggerated. But he added that they were much more frequent about three-four decades ago, when advanced imaging tools like CT scan were not available. He cited the case of a paediatric patient in a public hospital who was given intravenous chloroquine instead of IV chloromycetin. The child went into a coma as a result, but his life was saved by timely remedial action.
Similarly, Dr Lalmalani mentioned a recent incident in a municipal hospital in Mumbai in which an LSCS (lower segment Caesarean section) was performed on an HIV positive patient without the necessary anti-infective precautions because the gynecology resident forgot to tell her seniors about the test report. It was a near disaster because all the operating surgeons could have been infected with HIV because of one team member’s mistake.