Administrative Aspects of Critical Care Abhinav Gupta, Nagarajan Ramakrishnan, Atul Prabhakar Kulkarni
INDEX
ABCDEFGHIJKLMNOPQRSTUVW
Page numbers followed by f refer to figure, and t refer to table
A
Acetyl salicylic acid 113
Acute renal failure, incidence of 102
Adjusting surrogate and physician roles 71
Adverse drug events 41
Advisory jurisdiction 84
Agreement 69
Alcohol abuse 76
Allocation 123
versus evidence-based medicine 123
American Association of Critical Care Nurses 2, 77
Analyzing current manpower inventory 16, 17
Anger 67
Appellate jurisdiction 84
Aspirin 113
Attitudes 67
in patient safety, role of 104
Authentic leadership 77
Autoanalyzer purchase business case 49
Automatic external defibrillation 42
B
Bargaining mix 68
Bloodstream infection
central line-associated 110
rate 22
Budgeting 136
Burnout syndrome 74
effects of 76
pathogenesis of 75f
prevention 76
treatment of 76
Business case 37
development 37
document 47t
need for 37
presentation 46
C
Calcium channel blocker 113
Cardiopulmonary resuscitation 8
Care
cost of 110
level of 17
Center for disease control and prevention 103
Central venous
access device infection 39
catheter 22
Civil cases 83
procedure in 84
Civil laws 82
Clinical support services 108
Competitive strategy 66
Computerized physician order entry business case, expected benefits of 41
Concurrent jurisdiction 84
Conflict
and end-of-life care 60
contextual 59
de-escalation 60
emergence 59
escalation 59
hidden/latent 59
in ICU 58
management 60
organizational 59
personal 59
procedural 59
stagnation 59
Continuous quality improvement 135
Contracts, law of 81
Cooperative strategy 66
Cost
analysis perspective 119
and charge 28
benefit 45
block
analysis 121
method 30
effectiveness 45
minimization, short cycle improvement method for 122
Creativity, environment of 15
Criminal case 83
procedures in 86
Criminal laws 82
Criminal procedure code 86
Critical care
case, expansion of 40
medical ethics in 135
medicine 107
team 1, 2
unit 21
Critical incidence reporting system 97
Critically ill patients, treatment of 134
D
Data, collection and processing of 24
Decision maker and controller 134
Decubitus ulcer 102
Design training programs 16, 19
Developing quality improvement program 23
Developing recruitment plans 16, 18
Dietitian 4
E
Early goal directed therapy 126
Effective communication 99
Effective decision making 77
Emotional intelligence 14
Employee, satisfaction survey for 102
Environmental safety 102
Errors
anatomy of 93
classification of 93t
knowledge-based 93
medication 94, 102
prevention 93
rule-based 93
skill-based 93
F
First information report 86, 88
Frequency scale 17
Frustration 67
G
Generic substitution, evidence for 127
Growth 110
H
Healthcare associated infections 4
High performance teams, framework for 6t
Hospital acquired infections 110
Human capital
importance of 15
measurement of 14
Human resource 39t, 102
I
Iatrogenic pneumothorax 102
Iceberg phenomenon of failures 98f
ICU
budgeting 28
care, measuring cost of 29
communications and conflict management in 54
cost minimization in 119
day-to-day operations in 134
design and technology acquisition 137
director 133f
administrator 136
functions of 133, 134
qualities of 132, 133f
role of 132, 133
electrical and fire safety issues in 102
fixed versus variable costs in 108
human capital needs of 16
interpersonal relations in 134
multidisciplinary rounds in 9
organization of 136
predicting future manpower needs in 18
readmission rates 102
skills checklist 17t
team members, preventing burnout in 74
type of 17
understand human capital needs of 16
Indian Society of Critical Care Medicine 18, 121
Infection control 102
nurse 4
program 40t
Intelligence 14
Intensive care
cost of 107, 120
economics of 107
unit 13, 28, 107, 119, 132
Intensivist and multidisciplinary team building 1
International Classification of Disease 33
Interpersonal skills 67
Interpretive strategy 67
J
Judgment, 14
Judicial system 83
Jurisdiction of
high court 84
supreme court 84
K
Knowledge 67
empowerment 134
L
Labor, specialization and division of 15
Law serves several purposes 80
Leadership 8
and teamwork 23
style 8
Legal remedy 82
Liaisons with hospital administration 137
M
Making foolproof system 97
Manpower planning 15
steps in 16, 16f
Maslach-Burnout inventory 75
Medical Council of India 107
Medical errors, increased risk of 76
Medical teaching 135
Mitigation plan 43
Monetary profit 45
Morbidity parameters 102
Multidisciplinary
critical care team, members of 3
team, communication in 101
N
National Accreditation Board for Hospitals and Healthcare Providers 22, 38
National Coordinating Council for Medication Error Reporting and Prevention 94
Needle stick injury 102, 103
Negotiate towards positive outcome 69
Nonclinical support services 107
Nosocomial infections, cost of 110
O
Organizational factors 76
Original jurisdiction 84
P
Post-traumatic stress disorder 76
Pressure ulcer 102
Procedural laws 80
Proficiency scale 17
Profit and loss sheet 30
Protocols, guidelines and checklists, role of 99
Psychological safety 6
Q
Quality
cost of 26
improvement initiative 39t, 40t
in critical care, assessment of 22
R
Randomized controlled trial 114
Reintubation rate 102
Respiratory therapist 4
Right against
double jeopardy 88
ex post facto laws 87
self-incrimination 88
Root cause analyst 137
S
Safety, zone of 2
Scoring system based cost assumption 33
Sequential organ failure assessment score 33
Social
skills 14
worker 4
Society of Critical Care Medicine 2
Staff, polarization of 67
Standardized mortality rate 101
Stick injury rate 22
Suicidal ideation 76
Summary trial 87
Summons trial 87
Supporting documents/appendices 49, 50t
Swiss cheese model of accident causation 98f
T
Target point 68
Technology in patient safety, role of 103
Tele-ICU business case, executive summary of 48
Tension 67
Therapeutic intervention scoring system 33, 110
Third party administrators 109
Transactive memory 8
U
United States Food and Drug Administration 113
Urinary
catheter related infection 22, 102
tract infection, catheter-associated 110
V
Ventilator-associated pneumonia 22, 39, 102, 110, 114
W
Warrant trial 87
Waste segregation 103
Writing business
case 38
plan 24
×
Chapter Notes

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fm1Administrative Aspects of CRITICAL CARE
fm2
An Endeavor of Indian Society of Critical Care Medicine
fm3Administrative Aspects of CRITICAL CARE
Editors Abhinav Gupta MD DNB FNB EDIC Formerly, Principal Consultant Critical Care Medanta—The Medicity Gurugram, Haryana Formerly, Additional Medical Superintendent and Head of Intensive Care School of Medical Sciences and Research Sharda University Greater Noida, Uttar Pradesh, India Nagarajan Ramakrishnan AB (Int Med) AB (Crit Care) AB (Sleep Med) MMM FACP FCCP FCCM FICCM FISDA Director Critical Care Services Apollo Hospitals Chennai, Tamil Nadu, India Atul Prabhakar Kulkarni MD (Anesthesiology) FICCM PGDHHM Professor and Head Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Tata Memorial Hospital Mumbai, Maharashtra, India Foreword Kapil Zirpe
fm4
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Administrative Aspects of Critical Care
First Edition: 2019
9789352704743
Printed at
fm5Dedication
“To all dedicated intensivists who tirelessly work for
ever-improving outcomes of their patients”fm6
fm7Contributors fm9Foreword
It gives me a great pleasure to write the foreword for the much awaited book Administrative Aspects of Critical Care. Critical care medicine has been practiced for decades in India and India being a developing country, a major concern is cost in intensive care unit (ICU). I must mention that there is a dearth of information available on this subject. So, it is nice to welcome this book. It has an impressive list of topics which are highlighting day-to-day administrative issues with special relevance and application in resource-limited settings.
I am sure this book will be useful tool to know different aspects of ICU administration.
Kapil Zirpe MD FCCM FICCM
Director and Head
Neuro-Trauma Unit
Grant Medical Foundation, Ruby Hall Clinic
Pune, Maharashtra, India
President
Indian Society of Critical Care Medicine (ISCCM)fm10
fm11Preface
The current day Intensivist is not just a clinician. Our role extends to be a Team Leader and Manager, which requires skills in communication, negotiation, human capital and conflict management, budgeting and much more. While multi-tasking to achieve these goals, it is equally important to ensure work-life balance and prevent burnout of team members. While most of us acquire some or all of these skills on-the-job, it is essential to have structured learning on par with evidence-based scientific knowledge that we acquire. This book makes an effort to address some of these aspects of ICU management although by no means exhaustive. We aim to create structure modules and hopefully plan a short-term course to practically apply these concepts.
When I (APK) took over as the President of Indian Society of Critical Care Medicine (ISCCM), it was well established as a robust education hub for critical care training in India. We produced excellent doctors well founded in theory and pragmatic in their approach to the patient care. Unfortunately, the medical education in India, at both undergraduate and postgraduate levels, does not prepare the clinician to face problems in other non-medical areas of patient care, such as communication with patients and families, dealing with non-paramedics on the team in the hospital staff and many other tasks. The vision for this small monograph comes from this basic problem. I therefore requested Dr Gupta and Dr Ramakrishnan, both active and resourceful members of the ISCCM and experts in their own right, of administrative aspects of critical care. They have taken to this task with admirable keen-ness and produced a small but important work in the area with the help of all authors. Hope you enjoy reading this book as much as we enjoyed putting it together. Last but not the least, despite my tenure being over, Dr Zirpe, the President, ISCCM, allowed me complete this assignment, my heart's desire, to whom many thanks are due!
Abhinav Gupta
Nagarajan Ramakrishnan
Atul Prabhakar Kulkarnifm12
fm13Acknowledgments
We wish to acknowledge the help of Dr Jacob George, MD (Respiratory Medicine), IDCCM, in preparing the proofs of this book and Dr Natesh R Prabu, MD, DNB (Anesthesiology), DM (Critical Care Medicine), EDIC, Assistant Professor, Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India.
We also wish to acknowledge Sri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Ms Chetna Malhotra Vohra (Associate Director—Content Strategy) and their entire team, for their tireless effort to publish this book on time.fm14