Medicall 2008

'About 50 Per Cent of Revenue is Taken by Materials Department'

Attracting almost 4000 visitors from all over India, the third edition of Medicall Expo just got bigger and better

'Hospital needs expo' was the caption of third annual Medicall Expo held on August 1, 2 and 3, 2008 at Chennai. Keeping up the promise, the show had a gamut of 165 exhibitors displaying their products and service such as surgicals, consumables and medical disposables, cleaning equipment, Hospital Information System (HIS) solutions, surgical and examination furnitures, rescue and emergency equipment and so on. The show not only displayed the various hospital related products but also hosted a series of seminars on various topics for the benefit of hospital administrators and for all those who wished to construct or expand a hospital. Express Healthcare was the official media partner for the event.

Day One

Dr R Chandrashekhar, Senior Architect, DteGHS

Kasturi Rangan, Airconditioning Consultant, Airvan Systems

Gopinath, Consultant, J&J Consultants

The three day exhibition was inaugurated by MRK Paneerselvam, Minister of Health and Family Welfare, Government of Tamil Nadu. This was soon followed by a seminar on Infection Control for ICU and OT Nurses. Welcoming the gathering, Dr S Manivannan, CEO, Medexpert - the organiser of the event said, "Doctors usually have little knowledge on hospital infrastructure and administration. This event is convened for the benefit of small and medium hospitals' administrators and those doctors who wish to build a new hospital." Dr P Mohan, Former Surgeon, Dr MGR Medical University, spoke on 'Infection Prevention in Hospitals.' He urged that mere washing of hands is not adequate in preventing infection. "Hospitals must be well equipped with gloves, lab coats, gowns, shoe covers, goggles, glasses with side shields, masks and resuscitation bags in order to control infection," he informed. Since, most of the infection is spread through syringes, disposable needles and syringes should be used. It is important to dispose them properly. "The staff should be trained by giving proper policies and guidelines on infection control and prevention," he said. The seminar also broke some common myths regarding infection prevention. For example, a common myth in sterilisation is that if the indicator tape has changed colour in the steam autoclave, it is evident that instruments have been sterilised. But the reality is that the colour change indicates that instruments have been exposed to steam and sterilisation depends on temperature, pressure and saturation level of steam.

Day Two

The second day covered two interesting topics namely, 'Material Management, Designing Packages for Hospitals' and 'IT in Hospitals.' The first session was presented by Venu, General Manager - Materials, Global Hospitals, Chennai. "About 50 per cent of revenue is taken by materials department," said Venu. He suggested the formation of purchase committee comprising the Project Head, Medical Director, Materials Head and CFO in order to ensure transparency in purchase. Similarly, a drug committee comprising a physician, medical director and general surgeon can review the standard drug list. There can be separate committees to co-ordinate with other departments, to review the purchase of consumables, to take care of statutory obligations relating to licenses. "With proper representation from each department, these committees will help in knowing the need of each department," said Venu.

He also emphasised conducting internal audits and surprise audits in addition to annual audits to keep a check at the performance. It is mandatory to rate the vendors periodically in terms of quality, delivery, price and service. Identification and disposal of scrap is an important area in materials management. The chances of rectifying the fault should be assessed before considering equipment a scrap. Once decided as scrap and non-saleable, it should be properly disposed. "Out of all the face masks purchased, only one-fourth are utilised. Hence, controlling wastage is important in materials management," said Venu. The performance indicators for effective materials management are material consumption, inventory days and process days.

The succeeding session was conducted by S Manivannan, Director, Parama Healthcare, Chennai, who spoke on 'Designing Packages for Hospitals.' Referring to the hospitality industry Manivannan explained, "A medical package can be compared to a buffet lunch. It satisfies the customer, as the same food when ordered separately will cost more. It is cost-effective for the management too as it attracts more volume." A package should be decided keeping in mind the medical and commercial aspects. While the medical aspects include specialty, repeated surgery and time frame, commercial aspects considers costing, capacity utilisation and marketing. A regular health check-up can be designed comprising the diagnosis tests. The same package can be offered to a corporate client at a discounted rate. This will increase the number of people walking in, which in turn increases the revenue. Citing an example of increasing capacity utilisation during off-peak hours, he said, "A hospital in Pune announced 40 per cent discount on CT scan taken after eight in the night. It later added a dormitory in its premises for those who visited late at night. This way the equipment was used round-the-clock." Similarly, a package for a cataract surgery can be designed. These kind of packages can be relaxed in case, the surgery is complicated. The last session for the day was a brief presentation by Dr S Manivannan, who was also the Executive Director of Kavery Medical Center, Trichy.

He explained the various IT tools used in this 220 bed hospital. "Using IT in hospitals can improve the productivity of the staff. It also reduces the manpower in clerical side," he said. The hospital has been using computer aided navigation for minimal invasive surgery. SMS alerts are sent to patients on billing information, treatment details, and appointment details and so on. The system is used among the hospital staff to remind them on complaints, pending task, calls to be attended and so on. The presentation also featured major IT developments in healthcare like HIS, PACS, EMR and telemedicine.

Day Three

The third day had exhaustive seminars on hospital infrastructure. With six speakers covering various topics on hospital construction, the forenoon session was witnessed a fully packed hall. The forenoon session was coordinated by TS Ramanishankar, Managing Partner, Sankar & Associates, Coimbatore. He started the session with a brief insight on designing hospital buildings. For building a new hospital, one should plan its size followed by choosing an apt site. The selection of site should be decided keeping in mind the future expansion plans, accessibility, availability of utilities, waste disposal, sanitary measures and overall cost. Next comes, deciding the number of entrance like, main entrance, OP entrance, emergency entrance and service entrance. The number of departments and specialties, number of rooms, operation theatres, pharmacy, labs and service like kitchen, canteen, meditation room, service lobby etc. Out-patient department is needed to be designed by considering the patient inflow, waiting time and number of consultation room. "The recent trend is to follow a colour scheme," he said and added "Choosing the right colour scheme collectively for walls, floor, ceiling, furniture and curtains will give an aesthetic look to the hospital." The art of designing lies in working the details, to meet every need of user. The presentation featured interiors of various hospitals. Next was a presentation by Dr R Chandrashekhar, Senior Architect, DteGHS on 'Flooring and Lighting Design Criteria in Healthcare.' Indian hospitals usually have hard floor tiles and marble, despite being brittle and noisy. "Indian centric problems are dust and poor maintenance. That is why hard floors are preferred," he said. But vinyl floors are the best option for hospitals since the joints in ceramic or marble floor can spread infection. Vinyl floors are flexible, easy to lay and maintain, anti-bacterial and anti static. Since hygiene is an important factor in healthcare, the hospital can be divided in high, medium, low and severe risk zones based on traffic and hygiene. Suitable flooring can be selected. The corridors can be a medium risk zone with more traffic and moderate hygiene. Multi layered vinyl flooring can be opted. An operation theatre is a severe risk area that requires a single layer, anti-static, insulated flooring with no joints. In case of lighting, Chandrashekhar favours maximum utilisation of natural lighting. Each department demands special lighting. Lights should be energy effective, high luminance. CFL are best choice. For OT, LED lights can be used that covers a larger field area. Media bridge, a unit that can be fixed just above the surgical table, is an all in one solution that takes care of lights, gas supply, air control, electrical supply and equipment carrier system in a single unit. This new concept will eliminate unnecessary tubes, wires and pipeline systems in the operation theatres.

TN Sivakumar, Electrical Consultant, TNS Consultants, spoke on 'Hospital Electricity.' About 50 per cent of electrical consumption in a hospital is from A/C, he said. He suggested the entire load consumed by hospital to be divided into critical, essential, normal and auxillary loads based on the priority. Critical care unit, OT needs uninterrupted supply of electricity. They come under critical load. ICU and emergency lift can be treated as essential loads. Passage lights and wards are normal loads, stores, canteen etc come under auxillary loads. "Staff nurses can be given training to meet electrical emergency like voltage fluctuation," he said. He also emphasised the need of an electrical kit accessible to all comprising multi-meter, tong tester, test lamp, meggar and hand gloves.

This was followed by a presentation on Facility Planning by Sameer K Mehta, HOSMAC India. "Planning is as important as executing a project. Sometimes it is much more important," said Sameer Mehta. He explained the 'who, what, when, why and how of hospital planning.' 'What' comprises the finance, engineering, architecture, clinical facilities and economic aspects of hospital planning. 'Who' refers to the skilled manpower involved like architects, engineers, administrators etc. 'When' is assessing the time involved in the planning and execution. 'Why' to plan is to check the various parameters like cost efficiency, technology, integration with business plan and meeting standards and accreditation. 'How' is an important parameter defining the execution of plan. This covers all aspects of execution like floor plan, layout, detailed schematics, medical equipment schedules and monitoring of execution.

The last speaker of forenoon session was UK Ananthapadmanabhan, President, Kovai Medical Center, Coimbatore, who spoke on "Facilities Engineering in a Modern Hospital." "Technology has now become an integral part of the process," he said and added, "Technology has grown rapidly in both biomedical field as well as hospital buildings." Highlighting some new technological advances like multi level parking, green building concept, pneumatic pipeline systems, modular operation theatres and a host of medical techniques like 128 slice CT scan, capsule endoscopy, Linac etc, Ananthapadmanabhan said, "These technologies give high returns and increases the productivity." He claimed his hospital saves Rs 10 lakhs every year after installing liquid oxygen supply in its premises last year.

The afternoon session had three speakers speaking on CSSD, energy conservation and project report. The first speaker was by Gopinath, Consultant, J&J Consultants, on Central Sterile Supply Department. Referring CSSD, "a manufacturing plant for sterile goods, Gopinath said, "The aim of CSSD is to provide sterilised goods and reducing the hospital infection." The CSSD unit should have close proximity to OT, casualty and wards. For a large hospital (more than 500 beds) an additional theatre sterile supply unit to meet the demands of operation theatre. "For a 100 bed hospital, 1000 sq ft should be dedicated for CSSD unit," he said. He suggested the use of chemical and biological indicators to undertake process monitoring. This was followed by Abraham Varughese, Head, National Sales, Conzerv. "Energy management is a three step process - measure, detect, control," he said. The company conducts energy audits and prescribes energy management techniques. For the benefit of small hospitals who cannot afford a full fledge energy monitoring, the company undertakes energy outsourcing.

The three day exhibition attracted more than 4000 visitors largely comprising hospital administrators, architects and consultants. "Sizeable visitors came from Bangalore. We are planning to host a show in Bangalore," said Dr S Manivannan. The next Medicall is scheduled on July 31, August 1-2, 2009.

EH News Bureau