Statutory Disclaimer : The Following Write Up covers many seemingly unrelated (but in fact related) topics and it may be incoherent / flight of ideas. Read at your own Risk !
These Images were taken in a Medical College in 2018. Those who have not seen this may be wondering about this. Let me explain. These are vials of Injections (probably Ampicillin) undergoing an elaborate process. 
- Rinse the Penicillin bottle in Saline for 24 hours
- Use a scissor to prise open the metal cork (and get injured in fingers – cut or stab)
- Remove cork
- Keep in sun for drying
After these elaborate preparation, which is complicated and time consuming, these bottles are used to Collect Blood when the hospital needs to send the Blood to Lab for Investigations.
Now
This is in a hospital where we have severe shortage of paramedical and nursing personnel
How much of time is spend in doing this
A staff nurse on average gets RS 30000 (Except for first two years)
Sees 22 to 23 duties per month (Reduce her five off per month plus CL etc)
We pay her RS 1500 per duty
That is RS 250 per hour
And make her do this
If we buy containers to collect blood, it costs much less
Many private hospitals use disposable paper bed sheet and OT dress and theatre linen
Because
They found that
- Having a staff nurse spend time daily tallying number of bed sheets and number if towels send to laundry
- Maintaining two register
- Receiving from laundry
- Entering again
- Salary of laundry staff
- Salary of transport from ward to laundry
All costed more than disposable OT dress and scrub sheets
This Reinforces my pet theory
Of the 100 problems in a hospital
30 percent are due to ignorance
30 percent are due to stupidity
30 percent are due to laziness
Only
10 percent is due to corruption or willful disregard of rules
Very few workers are bad, corrupt
Most workers are just ignorant or lazy
-oOo-
Let us analyze why it has happened and how to rectify it
Why vaccutainers are not used ?
The indent is not placed
Why it is not placed ?
The chief pharmacist does not know it exists
Or
That it is available in TNMSC
So
Who should tell him ?
Professor of Micro Biology / Biochemistry
Or
Professor of Medicine / Surgery
Why professor of Micro Biology / Biochemistry does not initiate ?
Because
If he / she suggests this
The cost of this will be recovered from the budget of micro / biochem (our people are notoriously good at this ) and at the end of the year biochemistry department will run short of reagents needed to do tests
It usually happens
Test kits for some investigation. Like say amylase, lipase etc are not available in March
And
As far as biochem is concerned
They are not losing anything now (when staff nurses waste their time in making these bottles)
So
Why raise an issue and make buying reagents difficult
Who else can change ?
Staff nurse association can
They can protest
The administration will immediately buckle
But the question is
Why we need this to come at level of association
Once upon a time
Manual labour was cheaper and vaccutainers costly
So
This decision was taken
But
During the course of evolution
Labour has become costly and vaccutainers cheaper
But switch has not happened
We are waiting for the staff nurse association to raise the voice
We are waiting for the difference to increase and explode through some way
Rather than effect the switchover on the day “the descending limb of vaccutainer price met the ascending limb of labour cost”
We should have a mechanism through which We effect changeovers as and when needed For many of the protocols and procedures in a hospital
Disposable syringes and disposable gloves were used because of HIV
Else even in 2021
- we would have happily washed the gloves
- Hung them
- Powdered them
And - Reused them
Shall I suggest something
We need to fix a cost for all activities in the hospital
Say blood test for sugar
What is the cost of it
For example
Cost of blood sugar test is
Cost of
- 1. One cotton swab
- 2. One two ml syringe
- 3. 1/1000 of tourniquet cost
- 4. Cost of bottle (ten minutes of staff nurse time to prepare the bottle)
- 5. Blood drawing and labelling (5 minutes of staff nurse time)
- 6. Transport (human or pipes)
- 7. Lab reagent
We need to ask hospital to report their cost
We need to see whether one hospital does at high cost and one at low cost
Learn from there
Ideally we should have switched long back and saver more money had we had due financial prudence into the system
Need to build these into HMIS
State health data resource center should track these
But
Those guys are putting charts for Total OP, Total IP, Total deliveries
Had we done this
We would have found that
PHCs using vaccutainers doing blood sugar at cheaper rate than Rajaji hospital
They use the technology available when the start
Remember
PHC gives Anti Rabies Vaccines 24x7x365
While MMC gives it
2 hours a day
Monday to Saturday
- If you are bitten by a dog in valaparai, you can get vaccine in five minutes
- If you are getting bitten in park town at 11 am Saturday, sorry gentleman, you need to wait till 8 am Monday
So
Coming to the main issue
We need
- 1. A cost for each procedure at each institution
- 2. Cost to be compared across institutions and outliers identified and reasons found out
The cost revised every year
Say
Lab costs : at jan
Pharmacy : at feb
Vehicle : at March
Etc