Comparative Analysis of two Multi-Superspeciality Hospitals for assessing the performance of Dialysis Unit
Agency : Dialysis Unit, Dialysis Unit Records, Quality Care Control
Objective : To find out the gaps between
the standard guidelines and the processes followed. The objective of the study
was to do a gap analysis
of the parameters that reflect the efficacy
of the dialysis unit with standard guidelines and to compare
it with its older peers
and then give recommendations so as to improve the
quality of life of dialysis patients. In this endeavour studied.
Background : Chronic kidney disease
is increasing worldwide, but due to lack of
awareness the incidence is increasing in the developing countries. In India, there is no existing data available and the patients undergoing renal replacement therapy form
only tip of the iceberg. In
India the setups providing dialysis are not doing a great job either.
Methodology : Secondary data available in hospital records
in the form of patient files, dialysis unit documentation registers
and records on hospital information system the patients who had been examined
on outpatient basis when they were in chronic
kidney disease stage-IV
was studied. The data was analyzed
using Microsoft excel.
Findings : It was found that the hospital
is a new setup, its dialysis unit was being underutilized, no. of
dialysis being thrice weekly in 68% patients;
AVFistulas created prior to first hemodialysis in 52% patients; improper documentation of time
of vaccination for hepatitis and pneumococcus; target hemoglobin of 11-12
achieved in 32%; serum albumin of 52% patients meeting the standards. No
seroconversions and line infection
rates of 14% more than the standards.
When compared to second hospital it was
found that there was better utilization of the dialysis unit but the staff patient ratio was not meeting
the standards; almost all patients had hemodialysis done twice/week and AVFistulas were created prior to first dialysis in none of the
patients. Hemoglobin level was in the standard range in 20% patients while urea
reduction ratio was not evaluated, though serum albumin was meeting standard in
48% but the lowest value was 2.2mg/dl. Seroconversion rates for hepatitis B, C and HIV were 16%, 16%,
4% respectively. There were no records available
for the time of immunization of patients and no records
were there for line infections. On comparing the two, the
dialysis unit is doing better than its old competitor, yet lot needs to be done in order to achieve the standards and reach
to a state where it can give real quality
of life to its patients.
Recommendations : VIP rooms may be utilized
by other patients
when there is no booking of VIP rooms.
Night shifts to be started
to incr5ease the utilization
of dialysis unit. Results should be monitored as part of comprehensive quality care control programme. Proper documentation
needs to be done in order to ensure quality.
the study was to do a gap analysis of the parameters that reflect the efficacy of the dialysis unit with standard guidelines