“An achievement, not just for AHI but also for the country and the Indian healthcare sector as a whole”

Proving once again that India’s hospitals can set global benchmarks, Mumbai’s Asian Heart Institute (AHI) came out with flying colours in a three year International Cardiac Surgery Benchmarking (ICSB) survey carried out by the Joint Commission International (JCI). Dr Ramakant Panda, Vice Chairman, MD and Chief of Cardiology, AHI gives more details of the results of this survey to Viveka Roychowdhury

Dr Panda, congratulations on this most recent achievement.

Dr Ramakant Panda

It’s not just me, the whole team at AHI is responsible for and proud of this achievement. We have shown the world what an Indian hospital is capable of, and so I feel that it’s an achievement not just for my hospital but also for the country and the Indian healthcare sector as a whole. This reminder of our capabilities is especially needed after Aamir Khan’s critical comments on doctors and hospitals in his talk show Satyamev Jayate. Yes, there may be some grey areas, but I believe that the majority of us behave in a very responsible manner. Unfortunately its’ the ‘bad apples’ among the community, not more than 10 per cent, who make the news.

Could you give us details on the scope of the survey?

15 JCI-accredited hospitals from eight countries, spanning Asia, Europe and the US, volunteered to participate in a JCI survey, called the International Cardiac Surgery Benchmarking (ICSB) Project, which is a pilot programme addressing international clinical cardiac indicator. It enables hospitals to evaluate the current status of their coronary artery bypass graft (CABG) and valve-related surgery risk-adjusted mortality rates and encourages hospitals to implement and measure rates of improvement using the New York State Department of Health (NYSDOH) Cardiac Surgery Reporting System (CSRS) as a model.

The objectives of the ICSB project were that firstly, participating hospitals would get information to help them improve quality of care and assess a patient’s risk factors before cardiac surgery. The second objective was that multi-site and multi-country use of the ICSB assessment and reporting tool would guide organised quality improvement and benchmarking efforts. The long-term goal is to improve the outcomes of cardiac surgical procedures in participating organisations.

What exactly did the survey involve, on a daily basis?

The participating hospitals had to cooperate in terms of daily data capture on the surgeries conducted and reported, based on certain parameters set to measure the quality of care provided and also allow inspections of JCI officials during the duration of the survey.

Data analysis was performed on six quarters of data, across more than 6000 cardiac surgeries from October 2009 – March 2011. Here at AHI the project was driven by senior doctors, particularly Dr Vijay DSilva, Medical Director and Dr Darshana Rathod, Consultant-Critical Care Management Representative (Quality) who is in charge of quality and JCI matters. She was in charge of overseeing that each patient undergoing cardiac surgery during the survey would fill out a nearly 80 page survey form, requiring details as per the parameters laid out. Using various scoring systems and risk stratification techniques to allow for varying levels of risks across individual patient parameters, data across hospitals were compared to arrive at a very objective assessment and results.

What were the highlights of the survey results?

After a detailed three year study, AHI ranked No.1 in terms of “lowest complication rates” and “highest survival rates.”

1. AHI performed the maximum number of CABGs (bypass surgeries) of all the surgeries performed in the 15 hospitals.
2. At AHI, the percentage of redo bypass surgeries performed is higher than the benchmark set by ICSB indicating that AHI does more redo bypass surgeries as compared to the benchmark.
3. AHI performs more valve surgeries on females as compared to the benchmark.
4. The number of aortic valve replacements at AHI performed were much higher than the benchmark.
5. AHI performed more number of valve surgeries on patients who have had a previous cardiac surgery as compared to benchmark.
6. AHI performed more number of CABG+ valve surgeries on patients greater than 65 years as compared to benchmark.
7. AHI’s complications rates were much lesser than the benchmark.
8. The number of patients requiring blood transfusion was much lesser than the benchmark.
9. AHI’s mortality rates were much lower than the benchmarks.

You say that your team had a big role to play in achieving these benchmarks. How have you succeeded in building a team which works to global standards when the industry is faced with a shortage of skilled talent?

One, you have to drive from the front to build up such a team. And that requires you to practice what you preach. For instance, I am absolutely focussed on infection control and carry an alcohol hand wash in the pocket of my surgical scrubs in addition to having them placed in my office as well because this is where I also meet patients. So when my team sees me constantly disinfecting my hands, they follow my example as well. And I constantly audit the level to which these infection control systems are being followed by nominating an intern to keep track of these systems. No one knows who this person is, but they know they are being monitored so now its become a habit to follow these systems.

The second important message I want to give to the industry is that quality is not synonymous with cost. For example, putting in place infection control systems may seem costly in the beginning but we save so much on antibiotics. Here at AHI, thanks to the high level of infection control, we do not need to use third generation antibiotics.

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