Chawla committee suggests overhaul of major hospitals, medical colleges

The expert panel constituted to assess improvement in medical facilities in a report has suggested an overhaul of major tertiary care hospitals and medical colleges which it said will significantly improve health care services in Jammu and Kashmir.

The committee which has suggested a number of measures for better patient care services across hospitals was headed by Prof Y.K. Chawla, former Director PGI, Chandigarh.

Prof Showkat Ali Zargar, Former Director, SKIMS, Srinagar, Prof Kaisar Ahmad, Former Principal, Government Medical College (GMC), Srinagar, Prof Ravi Gupta- Medical Superintendent, GMCH, Chandigarh (now retired) were the members of the committee.

Creation of paid wards
The committee in its report has said that none of the hospitals associated with Medical Colleges in Jammu and Kashmir has private wards for patients.

“The majority of medical colleges and institutes in the country have private wards. Paid beds in Government colleges have advantages such as revenue generation, provide a separate room for those who desire such facility and can afford it,” the report said.

It said that paid beds will significantly reduce the movement of patients from UT to Delhi, Chandigarh, Amritsar, and other places.

As per the recommendations, paid beds generate goodwill and enhance the reputation of public hospitals because patients of opinion makers get admitted there.

It has been observed that at least 10 percent of beds in all hospitals should be as private wards.

“Different departments of hospitals in Srinagar are spread out in different areas, far apart, which cause difficulty in taking consultations for patients from different specialists,” it said.

The committee notes that a new area of 150-200 acres should be identified, where separate hospital blocks with all specialties in the same location are made available.

“The present structures could be used. As far as possible those areas should be identified where both hospital and college can be located in same campus,” it said.

Rapid surface transport
The committee said that a system of Rapid Surface Transport or a shuttle system with rapid access corridors for patients and medical personnel can be created between these far apart departments.

“At places, the colleges are 5-6 km away from associated hospital making it difficult for students to reach them, especially in hilly areas. Good arrangements should be made for transportation of students for their clinical training in the hospital after their classes in college,” the committee recommended.

At peripheral Medical College Hospitals, it observed that the approach roads are congested, slow and hazardous for transportation of patients in emergency situations.

Residential facilities
The committee said that residential facilities for faculty are planned for newly created colleges but are almost non-existent in GMC SKIMS Bemina and GMC Srinagar. Also, residential facilities are inadequate for nursing staff and paramedics.

“For those who can’t be provided residential facilities immediately, a proper arrangement should be made for their transportation during an emergency. Excellent accommodation could be a big attraction for good faculty to join,” the report said.

e-hospital and IT initiatives
The committee observed that except in SKIMS Soura, e-hospital services and IT cells are almost non-existent in all colleges. IT-cell with qualified staff should be created in all colleges.

“These departments will ensure digitization of medical records, hospital management systems, pharmacy, laboratories, finance, purchases, academic records,” it said.

The committee suggested that IT initiatives such as telemedicine, teleradiology, tele-ICU, tele evidence, and some others need to be created.

“These facilities will overcome the shortage of staff, bring quality improvement in reporting and patient care and provide expert opinions instantaneously,” the report said.

Picture archiving and communication system (PACS) should be made available in the hospital for image transmission from the site of image acquisition to multiple physically disparate locations.

“Tele-consultations will provide a great platform for improving patient care especially for patients in far-flung areas,” it notes.

Creation of dedicated engineering wing
During the inspection, the committee observed that the present expansion and creation of new Medical Colleges have made it necessary to create a dedicated Engineering Wing with engineers from civil, mechanical, electrical, bio-medical, and hospital architects branches.

“The planning, creation, up-graduation of the major hospitals and major renovations should be carried out with the approval of this wing,” it said.

It said that there is a need to start courses in Hospital Engineering in collaboration with reputed engineering institutes and there should also be increased focus on patient safety.

Creation of Trauma and Emergency Medicine Department
As per the committee’s recommendations, the creation of Trauma and Emergency Medicine has become a necessity and recent years have witnessed the creation of such departments in medical colleges.

“Except SKIMS Soura, none of the other colleges in J&K has such a department. The creation of such a department will promote organ donation and will pave the way for solid organ transplantation in the UT,” it said.

Notably, the National Medical Council (NMC) has recommended courses in Emergency Medicine in every medical college.

As per the committee, it will create job avenues for internists, intensivists, surgeons, plastic surgeons, orthopedics, neurosurgeons and other supporting support

ICUs
The committee said although a few beds have been created for ICU activities. At least, 10 percent of total beds should be dedicated as ICU beds. “Ideally, there should be separate Medical ICU, Surgical ICU, Neonatal ICU, and Pediatric ICU,” it said.

Operation Theatres
The report said that Operation Theatres including modular ones should be made which will speed up surgeries with better results and will reduce the waiting period. “Currently, patients are in long queues for waiting to get operated,” it added.

Hospital pharmacy at low cost
The report notes that like SKIMS, every hospital should have an in-hospital pharmacy wherein drugs, disposables and medical devices should be available at a cost of less than 50 percent of market prices. It adds that alternately, models of Tata Memorial Mumbai or CMC Vellore can be adopted.

Crèche
There is a need to have a well-equipped and adequately staffed crèche in each of the hospitals which will take care of the children of the staff while they are performing their duties without worries, the committee suggested.

High-end ambulances
The expert committee feels that there is an urgent need for high-end ambulances fitted with all resuscitative equipment and staff certified with Basal Life Support and Advanced Life Support courses. It said that audit of referrals and back referrals should be encouraged.

Multilevel parking
The committee said that parking and Dharamshala for patient attendants should be made urgently. Parking is a big issue in all hospitals and will get worse over the next few years.

Equipment
It notes that almost all colleges are deficient in medical equipment due to lack of adequate funds and faulty procurement system except in SKIMS Soura.

“Request for equipment should come from user departments and faculty members should be involved in technical specifications or follow AIIMS/PGIMER website/J&K,” it said adding that the requirement of equipment should be done as per MCI guidelines.

More PET CT machines needed
During the visit, the committee was informed that there is only one PET CT machine in whole of J&K in a government facility and suggests that many more need to be sanctioned.

“This will have great ramifications in the survival, economics and comfort level of patients who need to travel large distances for such an essential investigation in cancer cases,” it said.

Moreover, the committee said keeping load of cancer patients in the region, there should be at least one PET scan and MRI/CT machine in every college.

SKIMS Soura in need of Cath Lab
The committee noted with disappointment that Cardiology Department has a single Cath Lab which is almost 10 years old and can stop functioning at any time.

“Keeping a load of cardiac patients, there is an urgent need for procurement of a new Cath Lab. The Department of gastroenterology which used to be one of the few best-equipped departments doesn’t have now adequate number of simple endoscopes, lacks endo-ultrasound, and many other essential types of equipment,” it notes.

Likewise, the MRI machine in Radiology is about 15-years-old and old version. Such is a state of affairs in many other departments in SKIMS Soura.

Issues related to individual Colleges
GMC Srinagar
The report said that GMC Srinagar has seven associated hospitals which are spread out in different parts of Srinagar about 5 to 10 km apart.

“It is quite cumbersome to administer and coordinate for the principal, extremely difficult to have on-time consultation for patient care and difficult to mobilize sick patients for specialized investigations and intervention,” the report said.

“A thought process is required to locate all facilities near each other. Trauma, Orthopaedics, Medicine and its allied specialties, Surgery and its allied specialties, and some others should be in one place,” it notes.

New Medical Colleges
It noted that Government Medical College and Hospital Anantnag are at distance of 5 km from each other which poses hardships for students for clinical training and results in exhaustion and wastage of time. Equipment should be procured on an urgent basis for new medical colleges.

“Many faculty positions are vacant in all-new colleges, which has created hardships for working faculty and more importantly has been compromising patient care,” it said.

“Most departments in new medical colleges do not have junior and senior residents. New colleges should start DNB or MD/MS Courses which will bring perceptible improvement in inpatient care as well as academics and provide more working hand,” it said.

The committee said that there is a huge shortage of sanitary staff, nursing ward attendants, technicians, and other support staff.

“Most of the departments lack essential equipment. For instance, the Department of Pathology in Baramulla did not have microtome and other smaller equipment,” it said.

Blood banks
The expert committee said that blood banks need to be upgraded and facilities for the separation of components need to be created urgently.

DM programs
The committee also notes that DM/MCh programs should be started in as many specialties as possible as per MCI guidelines so that individual departments grow and get working hands by way of residents for better patient care made available.

It also said that the valley’s largest maternity hospital Lal Ded faculty was keen to start courses in Fetal Medicine and IVF facility and these initiatives should be supported.

Recommendations to improve health care
Overall, the committee felt these recommendations would significantly improve health care services in Jammu and Kashmir. It was felt that the committee should be informed periodically of the changes implemented. Rising Kashmir