Fall 2011

MBAHCS Semester 3 MH0052 Hospital Organization, Operations and Planning (4 Credits)

(Book ID: B1213)

Assignment Set- 1 (Marks 60) Note: Each question carries 10 Marks. Answer all the questions.
Q.1 a. Explain zoning in the Operation Theatre complex. [5 Marks] Definition Specialized facility in hospital where invasive treatment is given under strict aseptic controlled environment by trained personnel.

Objectives of planning Promote high standards of asepsis Ensure safety Optimal physical working conditions Ensure optimum utilization Facilitate coordinated services Rigidity and flexibility Following the Design considerations: Location Workflow Basic work areas and Division of space Zoning concept Air filters Machinery and equipment Organization Policies and procedures problems
Zoning ZONE 1 PROTECTIVE - reception, waiting,trolley bay, change rooms ZONE 2 CLEAN AREA preoperative,recovery,plaster room,staff lounges,stores ZONE 3 STERILE AREA operating room, scrub room, anesthesia room,setup room ZONE 4 DISPOSAL AREA dirty utility, disposal corridor

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Special considerations Air supply, direction of flow, pressure changes in areas,air changes, monitoring of quality Temperature and humidity 21-24 centi, 45-60% humidity Lighting at incision area 50 to 125K lux with intensity cntrl, non-shadow ,blue-white color of daylight, heat control. Planning for an Operation Theatre 1. O.T. Needs Specialized Planning. 2. Different zones of OT Complex 3. Basic Principles of Planning an O.T & Recovery room 4. Administrative policies & Work schedules in OT functioning 5. Measures to check the infection rate O.T. Needs Specialized Planning. O.T. Work is complex and concentrated and requires intense coordinated team work within the unit & with other agencies providing them the essential supporting services like Transport of Men and Machine Cleaning & Sterilization

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Disposal Record Keeping and Monitoring - Caters to 50% of the total Healthcare seekers. - Wide range & level of skilled persons working as team. - Equipments vary from pin to most sophisticated machines - Both the Team members & health care seekers are at the peak of their sympathetic activity at some or the other time of the operative procedure.

These special features regarding the O.T. work makes the place very special & hence needs special structural & functionability planning to render better services safely, comfortably and with economy. Different zones of OT Complex (1) Protective Zone includes Change rooms for all staff with conveniences Transfer bay for patient, material & equipments Rooms for administrative staff Stores & records Pre & Post operative rooms I.C.U., Sterile Stores (2) Clean Zone Connects protective zone to aseptic zone (O.R.) Has areas Equipment Store room Maintenance Workshop Kitchenette (Pantry)

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Firefighting device room Service room for staff Close circuit TV Control area - Emergency Exit 3) Aseptic zone Operation Rooms (Sterile) 4) Disposal zone Disposal areas from each OR & Corridor leading to disposal zone Basic Principles of Planning an O.T & Recovery room 1. Location: 1st floor & above very near to Surgical wards & SICU 2. Corridors : 3 - 3.5 m width for easy movements of men & machines 3. Zone wise distribution of the area so as to avoid criss cross movements of men & machine 4. Provision for emergency exit (Many people & Machine) 5. Operation rooms: No. & size as per the requirement (50% of the surgical beds) Size 20X20X10 Glass windows one side only Sliding door, (2 Flap door,1.5 mts) 6. Ventilation & temperature control 20-30 air exchanges / Hr Up to max 80% recirculation of air Ultraclean Laminar airflow (90% removal of particles >0.5 ) Temperature 20-240 C (for Pt needs) 0.005 H2O Positive air pressure in OR Humidity 50-60% 7. Strong & impermeable flooring with minimum no. of joints Conductive flooring to dissipate static electricity (Min 1 Ohm - Max 10 Ohm Recommended) 8. Washable WallLaminated Polyester or smooth Paint Collusion corners to be covered with steel Colour should allow reflection of light yet give soothing to eyes.

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b. List out the various functions in hospitals?

[5 Marks]

Q2. Classify hospitals. [10 Marks] For the purposes of administration, all hospitals are classified by the Bureau of Health in accordance with the following descriptive titles: A. General hospital. To operate as a general hospital, an institution must provide complete medical and surgical care to the sick and injured, and maternity care, and have: 1. An organized staff of qualified professional, technical and administrative personnel, with a chief or chairman of the attending staff, and appropriate hospital department heads; 2. An approved laboratory with standardized equipment necessary for the performance of biochemical, bacteriological, serological and parasilogical tests, and the services of a consulting clinical pathologist. Necessary equipment should be available for the preparation of pathological specimens. Housing and lighting facilities for the laboratory must be adequate for the accurate performance of all the required tests; 3. X-ray facilities with the services of a consulting radiologist. These facilities shall include, as a minimum, a complete radiographic unit, consisting of a transformer, tube stand, table with a stereoscopic attachment, fluoroscopic equipment adjustable to horizontal and vertical positions, a viewing box, a stereoscope, and a dark room equipped for the development of films; 4. A separate surgical unit, with the following as minimum facilities: An operating room, a sterilizing room, a work room, a scrub room and a dressing room; 5. A separate isolation unit, consisting of sufficient number of rooms, according to the size and needs of the hospital, located either in a separate building or in a location that may be isolated as a separate Section, with separate lavatory and toilet facilities; 6. Separate maternity facilities, preferably a separate maternity unit with a separate entrance, including as minimum requirements wards or rooms for patients, labor rooms and delivery room, all exclusively designated and used for maternity patients, and a nursery; 7. Mental unit. In the case of all general hospitals, hereafter constructed, provision shall be made for a mental unit, consisting of an adequate number of soundproofed rooms with adequate safeguards for the patients, and in case of all other general hospitals such facilities should be provided at their earliest convenience; 8. Dental unit. In the case of general hospitals, with 100 or more beds, hereafter constructed, it is recommended that consideration be given to the inclusion of a separate dental unit, in charge of a duly licensed dental surgeon, with standardized equipment for the diagnosis and treatment of diseases of the teeth, performance of orthodontia, and

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rehabilitation of the defective teeth and oral surgery, including all necessary anaesthetic and sterilization equipment. B. Intermediate general hospital. To operate as an intermediate general hospital, an institution must have not less than 16 nor more than 75 beds for patients, provide medical and surgical care to the sick and injured, and maternity care, and have: 1. A staff of qualified personnel; 2. The services of an approved laboratory, such as required for a general hospital, readily available, in addition to which hospitals in this classification with 30 or more beds shall have suitable space, laboratory equipment and supplies for the performance of urinalyses, blood counts, blood cross-matching and serological tests for syphilis, as minimum facilities within the institution; and those having less than 30 beds shall have, as an absolute minimum, laboratory facilities for blood counts and urinalyses within the institution. 3. X-ray facilities, such as required for a general hospital, conveniently available with portable x-ray facilities as minimum equipment within the institution. 4. An operating room with standard equipment, in addition to which there shall be adequate provision for sterilization of equipment and supplies. 5. Isolation facilities, with adequate and proper procedures for the care and control of infectious, contagious and communicable disease, and for the prevention of cross infections. 6. Maternity facilities, consisting of wards or rooms a delivery room, all exclusively designated and used for maternity patients, and a nursery. C. Contagious disease hospital. To operate as a contagious disease hospital, an institution must be maintained in a separate building, be devoted exclusively to the care of persons who have, or are suspected of having, infectious, contagious, or communicable disease, and meet the requirements for an intermediate general hospital, except for the isolation facilities required of such hospitals. D. Convalescent hospital. To operate as a convalescent hospital, an institution must have at least 20 beds for patients, provide medical and nursing care for persons afflicted with a chronic illness, or a chronic disability resulting from injury, or are convalescing from illness or injury, and exclude the acutely ill, the acutely injured, and persons who are surgical or maternity patients. Persons with tuberculosis shall not be admitted unless they are in a noninfectious stage, and are admitted primarily for the care of another chronic disease, or will be cared for in an isolation unit under strict isolation procedures, conforming to Section B of Regulations VII in the booklet Rules and Regulations of the State Board of Health for the Control of Communicable Diseases. The institution shall have:

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1. A staff of qualified personnel, including a dietician on a consultative basis; 2. The services of an approved laboratory readily available; 3. The X-ray facilities conveniently available, with portable X-ray facilities within the institution; 4. Isolation facilities, with adequate and proper procedures, for the care and control of infectious, contagious and communicable diseases, and for the prevention of cross infections, sufficient to care for such illnesses as may occur in persons being cared for within the institution until such persons can be transferred to an institution equipped to care for acute illness. If persons suffering from infectious, contagious or communicable disease are to be admitted, a separate isolation unit as required for a general hospital must be provided; 5. Mental unit. If mentally disturbed patients are to be admitted to the institution, provision must be made for a mental unit as required for a general hospital. A convalescent hospital shall have at least one room equipped as a psychiatric unit in which patients who may become mentally disturbed may be cared for until such time as they may be transferred to a mental disease hospital; 6. Physical therapy facilities. Reasonable physical therapy facilities and equipment adequate to meet the needs of those patients requiring physical therapy are to be provided, including as a minimum wheel chairs, walkers, crutches, walking bars, suspended bar over beds and heat therapy equipment and are to be under the supervision of a physician and qualified physical therapist on a consultative basis; 7. The building shall have adequate space to use the physical therapy equipment and room or rooms in which the physical therapist may carry out procedures and direct the recreational activities of patients; 8. Adequate provision shall be made for immediate removal of acutely ill patients to a general hospital or intermediate general hospital. E. Maternity hospital. To operate as a maternity hospital, an institution must be in a separate building, provide service for maternity patients exclusively, have on the staff professional personnel especially qualified in obstetrics, meet the requirements for a general hospital except that when the hospital is operated in connection with a general hospital the requirements for a laboratory, X-ray, surgical and isolation facilities may be met through appropriate technique by the use of those in the general hospital, and in addition all special regulations governing maternity hospitals and maternity units in general hospitals must be carefully observed. F. Medical hospital. To operate as a medical hospital, an institution must provide special facilities for diagnosis and drug therapy; meet all minimum requirements for an intermediate

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general hospital except those pertaining to the operating room, delivery room and nursery; have on its staff professional personnel especially qualified in internal medicine, including one or more physicians qualified by training and experience for certification by the American Board of Internal Medicine; have an approved laboratory under the direct supervision of a physician qualified by training and experience for certification by the American Board of Pathology; have an X-ray department directly under the supervision of a physician qualified by training and experience for certification by the American Board of Radiology; exclude surgical and maternity patients; and have an enforceable agreement in writing with a licensed general hospital or intermediate general hospital permitting the prompt transfer to and admission by the latter of any patients requiring surgical or maternity service. G. Mental hospital. To operate as a mental hospital, an institution must be devoted exclusively to the care of mental patients, have on the staff professional personnel especially qualified in the diagnosis and treatment of mental illness, have adequate facilities for the protection of the patients and staff against physical injury by patients becoming violent, and meet the requirements for an intermediate general hospital, except that maternity facilities need not be provided as part of the mental hospital service if provision is made for adequate prenatal care at the institution and for the delivery and postpartum care of the mother and infant at some readily available licensed hospital that does provide the service. H. Orthopaedic hospital. To operate as an orthopaedic hospital an institution must be devoted exclusively to the care of orthopaedic patients, have on the staff professional personnel especially qualified in the diagnosis and treatment of orthopaedic conditions, and meet the requirements for a general hospital, except that maternity facilities are not required and isolation facilities may be substituted for separate isolation unit. I. Paediatric hospital. To operate as a paediatric hospital, an institution must be devoted exclusively to the diagnosis and treatment of paediatric patients, have on the staff professional personnel especially qualified in the diagnosis and treatment of diseases of children, and meet the requirements for a general hospital, except that maternity facilities are not required. J. Tuberculosis hospital. To operate as a tuberculosis hospital, an institution must be devoted exclusively to the care of tuberculosis patients, have on the staff professional personnel especially qualified in the diagnosis and treatment of tuberculosis, and meet the requirements for a general hospital, except that maternity facilities need not be provided as a part of the tuberculosis hospital service if provision is made for adequate prenatal care at the

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institution, and for the delivery and postpartum care of the mother and infant at some readily available licensed hospital that does provide the service. K. Chiropractic facility. To operate as a chiropractic facility, an institution must be devoted exclusively to treatment by adjustment with the hand or hands of the bony framework of the human body and the employment and practice of physiotherapy, electrotherapy, and hydrotherapy; exclude all persons requiring surgical, maternity, or drug therapy; comply with the requirements for an intermediate general hospital except those for a laboratory, an operating room, X-ray and maternity facilities; except that a registered nurse is not required if the nursing personnel is under the direct supervision of one or more licensed chiropractic physicians constantly on call and available in an emergency. L. Community health facility. To operate as a community health facility, an institution must have not more than 15 beds for patients, provide medical and surgical care to the sick and injured, and maternity care, and meet the requirements for an intermediate general hospital, including minimum laboratory equipment for urinalyses and blood counts. M. Facility for the treatment of alcoholism. To operate as a facility for the treatment of alcoholism, an institution must be maintained in a separate building, provide facilities and services for the treatment of patients suffering from acute alcoholism exclusively, and meet the requirements for a mental hospital, except that surgery and maternity facilities are not required. N. College infirmary. To operate as a college infirmary a facility must be part of a college or university, provide care primarily for college students, have registered nurses and other qualified personnel, and the facility shall be directed by a physician licensed by the State Board of Medical Examiners, provide nursing care, diagnosis and treatment of illness and injury, post-operative care, perform minor surgery; and meet the regulation governing communicable diseases, and those pertaining to the general sanitary regulations of the State Board of Health.

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Q3. Kunnath enterprises is a construction company would like to open a new hospital at Yelahanka, Bangalore. They have got a team who constitute the hospital planning
A. Who are the team of experts who constitute the hospital planning? [5 Marks] o o o

Choose a consulting and architectural team. These people will be the primary individuals working with the client during the project. Create the hospital plans. Construction planning involves creating blueprints, which are the technical instructions and diagrams for the hospital project. Review the plans with the client. This stage involves meeting with the client and getting approval for the hospital plans. Any changes will result in alterations to the plan prior to obtaining the client's final approval. Initiate the construction process. This involves obtaining permits, selecting a site, placing bids to subcontractors and setting deadlines for certain activities in the project. Control the construction process. Building a hospital can take several months or years, depending on size, resource availability, complications and weather conditions. This process can be difficult if the project includes numerous subcontractors or fine detail work requiring specialized services.

B. What are the steps followed in hospital planning? [5 Marks]

Step 1 : Project Conceptualization: This is the preliminary stage where one is trying to visualize his / her hospital in terms of its ownership, philosophy, bed-mix, facility-mix, etc. This requires undertaking at the very least a basic but comprehensive research of the physical, geographic surroundings of the proposed area. Most important, this information can be obtained through the web, current and archived newspaper mentions, municipality reports, and then undertaking a short survey or holding focus group discussions. The basic idea is to understand the gaps in the medical market in that area and intending to fulfill them, unless of course, the owner is a Doctor entrepreneur, who knows exactly what he wants. Step 2 : Feasibility Analysis: When the project concept in understood, agreed on and locked-in, the next stage is to understand the viability of the proposed hospital. This would mean undertaking a detailed working of at least the following : Project Cost: Comprising of civil work, medical equipments, furniture and fixtures, professional fees, interest during construction, pre-operative expenses and contingency expense appropriations. Department wise assumptions of income, expenses, depreciation schedule, loan repayment schedule, etc. Profit & Loss, Balance Sheet, Cash Flow Statements. Sensitivity Analysis: This is the most important document generated for the project and helps the Promoter to undertake a go or no go decision. It also identifies the financial limitations of the proposed project and frequently helps the Promoter to structure the

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means of financing the project. Its important to note here that all assumptions should be made with a realistic view. Step 3 : Hospital Designs: Hospitals are highly engineered buildings, so this step requires a meticulous attention to micro details. For this reason alone, its vital that one hires a competent team of designers, which would include a architect, a structural consultant, a electrical consultant, a plumbing consultant, a interior and designer consultant, a landscape consultant, etc. The emphasis should be a building which does its job brilliantly, more functional than glamorous. The focal point of this exercise should be to ensure that energy efficiency, natural light and ventilation and ease of maintenance get all the special attention they need. Always remember that the highly engineered buildings cost more and the per sq.ft. cost would vary between Rs. 1,500 and Rs. 3,000 per sq. ft. Step 4 : Project Management: The notion that an architect is automatically a good Project Manager is a myth. Even from a laymans angle, it should not be very difficult to understand that the architecture should effortlessly accommodate the complexities of engineering services and the installation of very sophisticated, very costly medical equipment apart from the various financial and speed of work related issues involved in project execution. You can see why it is extremely important to have a separate project management entity to ensure that the final designs are executed as per what was envisaged. All tendering activities, quality of construction, managing change of design midway, site safety and bill certification periodically are some of the vital aspects of project management. Step 5 : Commissioning the Hospital: The last step of hospital project is to ready it for accepting patients and starting all operations. This process should begin at least 6 to 9 months prior to inauguration as there are a plethora of activities to be completed before the patient walks in, issues like developing personal policy, salary structure, standard operating procedure for all department selecting and customizing hospital information system, recruitment, trial runs of equipments, stationary, designs, etc. It is generally easier to put up the hardware, but the success of the project will depend on how the software bit of commissioning the hospital is handled.

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Q.4. Explain the various ward designs. Explain them with diagrams. [10 Marks] Plan In modern hospitals the water-closets, bathrooms, and sinkrooms are generally planned with short passages or lobbies between them and the wards, these passages having windows and openings for air on both sides. Among the many positions in which these rooms can be placed, the most generally approved is at the extreme angles of the wards, as shown in figs, 1 and 2. These should be planned so as not to obstruct the ward windows, and so that the currents of air through the lobbies are not in the direction of the windows either in the sides or ends of the wards. The conveniences and lobbies ought to be warmed and ventilated. If there is an upper story of wards, the same arrangement of conveniences is repeated, thus simplifying both the plumbing and drainage.

Fig. 1. Plan of Conveniences for Hospital Ward.

Fig. 2. Plan of Conveniences for Hospital Ward. In some cases the conveniences are now placed at the corridor ends of the ward blocks, so as to be within easier reach of the nurses and doctors. This position is undoubtedly more convenient, but is not as freely exposed as the extreme angles of the block. A good arrangement is shown in fig. 3. The conveniences ought, if possible, to be placed on the more sunny side of the ward corridor.

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Fig. 3. Plan of Conveniences at Corridor End of Hospital Ward. In small fever hospitals, the water closets and sinkrooms are often placed at the side of a verandah, as shown in figs. 4 and 5. There is therefore a free current of air between them and the pavilions to which they are attached. In exposed situations, however, this arrangement is somewhat trying, as the verandah cannot, of course, be warmed; in the case of one hospital, built in this manner from the writer's design, the openings in the fronts and ends of the verandahs were a few years afterwards filled with wood and glass. Baths on wheels are provided, and are kept in the. verandah and hall when not in use.

Fig. 4. Plan of Conveniences for Small Isolation Wards.

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Fig. 5. Plan of Conveniences for Small Wards.

Day Room Fig. 6. Plan of Conveniences for Workhouse. Similar or slightly modified arrangements may with advantage be adopted in other public buildings, such as workhouses (fig. 6), and also in hotels, etc. A cloakroom with lavatory and water-closet on the ground floor of a house may have over it a bathroom, lavatory, and water-closet, as shown in fig. 7. In small houses, where much money cannot be afforded, probably the utmost that can be done is to arrange that the approach to the bathroom and water-closet shall be properly lighted by means of a sash or casement window, and not, as is so often the case, a dark, unventilated passage. In tenement dwellings of the cheapest class, only one sink and one water-closet are sometimes provided for two tenements, as shown in fig. 8. The arrangement is repeated on the different floors.

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Fig. 7. Plan of Conveniences for House.

Fig. 8. Labourers' Dwellings, Oldham Road, Manchester. The illustrations already given also serve as examples of the grouping of sanitary fittings. This is an important point for consideration, as the grouping of fittings reduces the length of water-pipes, waste-pipes, soil-pipes, and drains, and therefore reduces the cost and also the dangers arising from defective materials and workmanship. An isolated fitting often requires a long branch-drain, and the nature of the fitting may be such that its discharge is not sufficient to cleanse the drain; hence, unless some method of periodical flushing is devised, deposit occurs, and the drain becomes foul and is ultimately choked. With a little care in planning, the sanitary rooms of a house can be much better grouped than is usually. the case. The bathroom and water-closet can be placed over the ground-floor lavatory and water-closet, or over the butler's or maid's pantry, or over the scullery. It is a great mistake to place such rooms over living-rooms or larders, particularly if the floors are constructed with ordinary joists and boards. Water-closets are often placed in most unsatisfactory positions. In a great many houses they are entered from the half-space landings of the stairs, or from other equally-exposed thoroughfares. Such arrangements are most objectionable. Privacy ought to be one of the

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guiding thoughts in the planning of these rooms, and this is best secured by arranging the lavatory and water-closet in close proximity to each other, and by approaching the two rooms by means of a short passage or lobby, as shown in fig. 7. It is a mistake to place the water-closet in the same room as the bath and lavatory, though this is too often done. It is also a mistake to place a water-closet in such a position that it is separated from an important room by nothing more than a lath-and-plaster partition. The noise made by the flushing of the apparatus will be heard on the other side of such a partition, and even of a 4 1/2-in. brick wall, and it is best, therefore, to build a 9-in. wall wherever possible. The arrangement shown in fig. 7 will effectually prevent all sounds passing to the rest of the house. It is even more essential that the housemaid's closet should be out of the way, and this can best be effected by placing it near the servants' stairs. In this country lavatory basins are not now fixed in bedrooms as frequently as was formerly done, but if the lavatories themselves, and the plumbing and drains, are thoroughly satisfactory, there cannot be any serious objection to the practice. A better position would, of course, be the dressing-room or small room adjoining the bedroom.

Fig. 9. Typical Plan of Underground Conveniences for Men and Women. Public conveniences are now erected in every town, although in many cases provision is made for one sex only. At one time cast-iron urinals above the street level were in favour, but their unsightliness and publicity and the obstruction they sometimes cause to traffic have led during recent years to the more frequent use of underground conveniences, in which not only urinals but also water-closets and lavatories are provided. These are a great improvement on the wooden structures which form such prominent objects in some of the streets of Paris and other continental cities. A typical plan of two underground conveniences for men and women, designed by Mr. D. J. Ross, the London city engineer, is given in fig. 9. They are covered with a flat roof, part of which forms a refuge for foot passengers as shown by the dotted lines A A. Fig. 10 is a plan of underground conveniences for men only. The design will be governed to a great extent by the position which the conveniences will occupy and by the amount of accommodation required. In many cases a single flight of steps will

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suffice, but in busy streets separate flights ought to be provided for ingress and egress. The walls ought to be faced with glazed bricks. The divisions between the closets may be formed with slate or marble slabs, or with glazed bricks; wood is sometimes used but is not as satisfactory. Enamelled sheet-iron divisions have also been tried but are not sufficiently durable. The conveniences are generally lighted by means of pavement lights, and ventilation is effected by means of a ventilating curb or a ventilating shaft, the latter being preferable as it discharges the air at a higher level.

Fig. io. Underground Conveniences for Men only, at Glasgow Cross, Glasgow. Q5. Write short notes on:
i.

ICU [5 Marks]
An intensive-care unit (ICU), critical-care unit (CCU), intensive-therapy unit/intensivetreatment unit (ITU) or High-Dependency Unit (HDU) is a specialized department in a hospital that provides intensive-care medicine. Many hospitals also have designated intensive-care areas for certain specialties of medicine, depending on the needs and resources of the hospital.

Specialized types of ICUs include:

Neonatal intensive-care unit (NICU) Special-Care Nursery (SCN) Pediatric intensive-care unit (PICU) Psychiatric intensive-care unit (PICU) Coronary care unit (CCU) Cardiac Surgery intensive-care unit (CSICU) Cardiovascular intensive-care unit (CVICU) Medical intensive-care unit (MICU) Medical Surgical intensive-care unit (MSICU) Surgical intensive-care unit (SICU) Overnight intensive recovery (OIR) Neurotrauma intensive-care unit (NICU) Neurointensive-care unit (NICU) Burn wound intensive-care unit (BWICU) Trauma Intensive-care Unit (TICU) Surgical Trauma intensive-care unit (STICU) Trauma-Neuro Critical Care (TNCC) Respiratory intensive-care unit (RICU) Geriatric intensive-care unit (GICU) Mobile Intensive-Care Unit (MICU) Post Anaesthesia Care Unit (PACU)

Equipment and systems

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Common equipment in an ICU includes mechanical ventilators to assist breathing through an endotracheal tube or a tracheotomy; cardiac monitors including those with telemetry; external pacemakers; defibrillators; dialysis equipment for renal problems; equipment for the constant monitoring of bodily functions; a web of intravenous lines, feeding tubes, nasogastric tubes, suction pumps, drains, and catheters; and a wide array of drugs to treat the primary condition(s) of hospitalization. Medically induced comas, analgesics, and induced sedation are common ICU tools designed to reduce pain and prevent secondary infections.

Quality of Care
The available data suggests a relation between ICU volume and quality of care for mechanically ventilated patients. After adjustment for severity of illnesses, demographic variables, and characteristics of different ICUs (including staffing by intensivists), higher ICU staffing was significantly associated with lower ICU and hospital mortality rates. A ratio of 2 patients to 1 nurse is recommended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1 typically seen on medical floors. This varies from country to country, though; e.g., in Australia and the United Kingdom most ICUs are staffed on a 2:1 basis (for High-Dependency patients who require closer monitoring or more intensive treatment than a hospital ward can offer) or on a 1:1 basis for patients requiring very intensive support and monitoring, for example a patient on a mechanical ventilator with associated sedation such as a midazolam and use of strong analgesics such as morphine, propofol, fentanyl and/or remefentanyl. Staff Medical staff typically includes intensivists with training in internal medicine, surgery, anesthesia, or emergency medicine. Many nurse practitioners and physician assistants with specialized training are also part of the staff that provide continuity of care for patients. Staff typically includes specially trained critical care registered nurses, registered respiratory therapists, clinical pharmacists, nutritionists, physical therapists, occupational therapists, certified nursing assistants, social workers, etc.

ii.

Nuclear medicine [5 Marks]

Nuclear medicine specialists use safe, painless, and cost-effective techniques to image the body and treat disease. Nuclear medicine imaging is unique, because it provides doctors with information about both structure and function. It is a way to gather medical information that would otherwise be unavailable, require surgery, or necessitate more expensive diagnostic tests. Nuclear medicine imaging procedures often identify abnormalities very early in the progress of a disease long before many medical problems are apparent with other diagnostic tests. Nuclear medicine uses very small amounts of radioactive materials radiopharmaceuticals) to diagnose and treat disease. In imaging, the radiopharmaceuticals are detected by special types of cameras that work with computers to provide very precise pictures about the area of the body being imaged. In treatment,

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the radiopharmaceuticals go directly to the organ being treated. The amount of radiation in a typical nuclear imaging procedure is comparable with that received during a diagnostic x-ray, and the amount received in a typical treatment procedure is kept within safe limits. Today, nuclear medicine offers procedures that are essential in many medical specialties, from pediatrics to cardiology to psychiatry. New and innovative nuclear medicine treatments that target and pinpoint molecular levels within the body are revolutionizing our understanding of and approach to a range of diseases and conditions. Diagnostic In nuclear medicine imaging, radiopharmaceuticals are taken internally, for example intravenously or orally. Then, external detectors (gamma cameras) capture and form images from the radiation emitted by the radiopharmaceuticals. This process is unlike a diagnostic X-ray where external radiation is passed through the body to form an image. Radiopharmaceuticals A typical nuclear medicine study involves administration of a radionuclide into the body by intravenous injection in liquid or aggregate form, ingestion while combined with food, inhalation as a gas or aerosol, or rarely, injection of a radionuclide that has undergone micro-encapsulation. Some studies require the labeling of a patient's own blood cells with a radionuclide (leukocyte scintigraphy and red blood cell scintigraphy). Most diagnostic radionuclides emit gamma rays, while the cell-damaging properties of beta particles are used in therapeutic applications. Refined radionuclides for use in nuclear medicine are derived from fission or fusion processes in nuclear reactors, which produce radionuclides with longer half-lives, or cyclotrons, which produce radionuclides with shorter half-lives, or take advantage of natural decay processes in dedicated generators, i.e. molybdenum/technetium or strontium/rubidium. The most commonly used intravenous radionuclides are:

Technetium-99m (technetium-99m) Iodine-123 and 131 Thallium-201 Gallium-67 Fluorine-18 Fluorodeoxyglucose Indium-111 Labeled Leukocytes

Q6.Write short notes on [10 Marks] a. ABC analysis The ABC analysis is a business term used to define an inventory categorization technique

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often used in materials management. It is also known as Selective Inventory Control. it stands for Always Better Control. Policies based on ABC analysis: A ITEMS: very tight control and accurate records B ITEMS: LESS TIGHTLY CONTROLLED and good records C ITEMS: simplest controls possible and minimal records The ABC analysis provides a mechanism for identifying items that will have a significant impact on overall inventory cost, while also providing a mechanism for identifying different categories of stock that will require different management and controls. The ABC analysis suggests that inventories of an organization are not of equal value. Thus, the inventory is grouped into three categories (A, B, and C) in order of their estimated importance. 'A' items are very important for an organization. Because of the high value of these A items, frequent value analysis is required. In addition to that, an organization needs to choose an appropriate order pattern (e.g. Just- in- time) to avoid excess capacity. 'B' items are important, but of course less important, than A items and more important than C items. Therefore B items are intergroup items. 'C' items are marginally important.

ABC analysis categories There are no fixed threshold for each class, different proportion can be applied based on objective and criteria. ABC Analysis is similar to the Pareto principle in that the 'A' items will typically account for a large proportion of the overall value but a small percentage of number of items. Example of ABC class are
A items 20% of the items accounts for 70% of the annual consumption value of the items. B items - 30% of the items accounts for 25% of the annual consumption value of the items. C items - 50% of the items accounts for 5% of the annual consumption value of the items.

Another recommended breakdown of ABC classes:

1. "A" approximately 10% of items or 66.6% of value 2. "B" approximately 20% of items or 23.3% of value 3. "C" approximately 70% of items or 10.1% of value

b. Economic Order Quantity

Economic order quantity is the level of inventory that minimizes total inventory holding costs and ordering costs. It is one of the oldest classical production scheduling models. The framework used to determine this order quantity is also known as Wilson EOQ Model or Wilson Formula. The model was developed by Ford W. Harris in 1913, but R. H. Wilson, a consultant who applied it extensively, is given credit for his in-depth analysis.

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EOQ applies only when demand for a product is constant over the year and each new order is delivered in full when inventory reaches zero. There is a fixed cost for each order placed, regardless of the number of units ordered. There is also a cost for each unit held in storage, sometimes expressed as a percentage of the purchase cost of the item. We want to determine the optimal number of units to order so that we minimize the total cost associated with the purchase, delivery and storage of the product. The required parameters to the solution are the total demand for the year, the purchase cost for each item, the fixed cost to place the order and the storage cost for each item per year. Note that the number of times an order is placed will also affect the total cost, though this number can be determined from the other parameters.
Underlying assumptions

1. The ordering cost is constant. 2. The rate of demand is known, and spread evenly throughout the year.
3. The lead time is fixed.

4. The purchase price of the item is constant i.e. no discount is available 5. The replenishment is made instantaneously, the whole batch is delivered at once. 6. Only one product is involved. EOQ is the quantity to order, so that ordering cost + carrying cost finds its minimum. (A common misunderstanding is that the formula tries to find when these are equal.) The total cost function The single-item EOQ formula finds the minimum point of the following cost function: Total Cost = purchase cost + ordering cost + holding cost