Thursday, 22 January 2015

Day Care and Home Care Need of the Hour in India

Why Promote Day Care and Home Care Health Care

Dr K K Aggarwal, Padma Shri Awardees, Honorary Secretary General IMA

There is a shortage of hospital beds in the country. The international requirement is one bed for every 800 patients and in India the number is one bed for every 2500 patients.

Few issues

1. Are we really short of doctors: As per international standards doctor work for no more than 48 hours and sees no more than 8-10 patients in day. In India where doctors see over 50 patients a day these shortage may not be real.

2. Are we really short of beds: The World Health Statistics say that India ranks among the lowest in this regard globally, with 0.9 beds per 1,000 population - far below the global average of 2.9 beds. India's National Health Profile 2010 says India has a current public sector availability of one bed per 2012 persons available in 12,760 government hospitals — around 0.5 beds per 1,000 population. 

This shortage of beds can be tackled by bringing the concept of minimum hospitalization days and promoting day care and home care.

3. Minimum Hospitalization days: Hospitals are not hotels and prolonged hospitalization should be discouraged.

Healthy people, especially children should not be allowed to stay in the hospital.
There should be a separate night shelter away from the sick patients unit.
The discharge process should be quick so that the patients stay is shortened.
Package days does not mean one has to stay for that long.
Pre op admissions should be avoided just for investigations.
Post op care should be day care, clinic care or home care based.
Rehab care should not be in the settings and vicinity of serious patients.
Mediclaim does not recognize day care treatment for all conditions and in  ot networked nursing homes or hospitals.  Minimum 24 hour hospitalization is needed for most conditions. For example if a person gets admitted at 7 pm in the evening and gets stabilized in few hours will  remain in the hospital till next evening to complete 24 hours and invariably will gets discharged the next morning, consuming two night stay in place of 4 hours stay. A bed unnecessarily gets blocked for two nights apart from more charges and more chances of infection.

4. Promoting day care and home care?

In Ganga Ram Hospital alone in the year 2014, out of total 29494 surgeries 12473 surgeries were done as day care (13223 out of 28666 in the year 2013; 11942 out of 27186 in 2012 and 9955 out of 25135 in 2011). They have been able to reduce the need of beds by promoting day care surgeries.

Day care will also reduce the hospital acquired and health case associated infections and subsequent need for more beds.  Longer the duration of treatment more will be the chances of infections.

Of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one Hospital Acquired Infection. The estimated rate in USA was 4.5% in 2002, corresponding to 9.3 infections per 1000 patient-days and 1.7 million affected patients, with 99.000 deaths annually. The European centre for Disease Prevention and Control reports an average prevalence of 7.1% in European countries. The cumulative incidence of infection an adult high-risk patients is 17.0 episodes per 1000 patient-days. HAI in low- and middle-income countries; at any given time, the prevalence of HAI varies between 5.7% and 19.1%.

Day and home care will have early IV to oral switch in antibiotics with less resultant cost and less antibiotic resistance.

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