4. In which ways is the initiative creative and innovative?
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We have dedicated sessions to perform endoscopic procedure – currently on Mondays, Tuesdays, Wednesdays and Thursdays for ERCP. We ensure that nurses and doctors have dedicated times so that there are no delays during sessions. Nurses are allocated to the endoscopy unit through their off-duty and we no longer are in a position where nurses have to be scrambled on the day of the endoscopy sessions (which has been the case in the past). We ensure that patients are contacted by phone to confirm their attendance to keep the ‘DNA’ (Did Not Attend) rates low. We stagger the appointment times to ensure the flow of patients with minimum waiting times for patients. We ensure that the patients receive all the necessary information on fasting and bowel preparation so that no procedure is cancelled on the day. We ensure that our equipment is in functioning order by regular inspection (for example, leak testing). We also ensure we have all the disposables in stock – this includes endotherapy equipment and disinfection fluids. We perform the procedures in a timely and internationally recognized standard way by highly trained staff such that failure rates are kept low and patients do not have to attend again. We have dedicated waiting, changing and recovery rooms to ensure a laminar flow of patients but more importantly to ensure patient dignity and confidentiality. We endeavour to provide an inpatient service (patients who are already in hospital as opposed to patients who come on an outpatient basis) within 2 days of any request to keep the length of stay in hospital to a minimum.
Our endoscopists have been highly trained to perform procedures which up to 2010 would have required an open operation leading to a long length of stay in hospital. For example, ERCP’s allow the removal of gallstones from the bile duct, which would otherwise require an operation with a high morbidity and mortality and would require a hospital stay of at least 7-10 days. In contrast, following an ERCP the patient can be discharged either the same or the next day. Furthermore, whereas in the past some of these patients would have to be sent abroad with the associated monetary and social costs, now we can provide these services locally with the associated savings and patient wellbeing.
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5. Who implemented the initiative and what is the size of the population affected by this initiative?
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The Ministry of Health and Quality Of Life has been fully committed for the approval of the Unit to be opened in the Medical Ward. After the set in the Medical Ward the unit has been opened with more space and fully equipped new technology to perform ERCP endoscopy procedure
Dr. Moreea is the key stakeholders that help Dr. F. Bholah for the implementation of the unit by given in house training and training in England (Leeds, Bradford and York Hospitals)
The Ward Manager of Female has given her approval for the Unit to be in the medical Ward
The Ministry and the Regional Health Director has given a bigger place for running of the unit
The Store has involved for the purchase of equipment and consumables respecting the green policy of the environment
The Infrastructure has involved several stakeholders for supplier the set of the Medical equipment such as C-arm has involved the X-ray dept and Physicists for control and ensuring the amount of X-rays emitted in the unit is within the control limits in accordance to the Radiological Act and regularly measured by providing the dosimeter
The Ministry of Public Infrastructure has given a helpful hand in the design and installation of the electrical supplies in accordance to electricity at work regulations for providing good source of light using during endoscopy procedures
The Head of Nursing Unit, Regional Health Director and the Regional Hospital Administrator has totally involved in this process by providing skilled and the required staff including Medical Specialist, Nursing Officers, Health Care Assistant and Health Care Attendant
However, infection control set up was performed by the Infection Control Committee
The Biomedical Unit has set up the equipment as per the user manual and has been calibrated to provide good results.
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6. How was the strategy implemented and what resources were mobilized?
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Equipment were purchased through the procurement section of the ministry of health . Total cost 30 million Mauritian rupees.
Infrastructure development funding was made through the Ministry of Public Infrastructure (MPI) approximate cost 10 million Mauritian Rupees.
Running cost including medical disposables, repairs and maintenance, funding through central supply department ministry of health and at hospital level.Rs 500000 monthly
Staffing salary as per contract with the ministry of health.
All financing was funded by the ministry of health and the ministry if public infrastructure.
Applications for the above funding were made by the head of the unit through the hospital director following established procedures to ensure full transparency.
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7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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1 The creation of the first dedicated and up to date endoscopy unit for Mauritius.
2 In addition to diagnostic endoscopy this unit is able to provide a full range of therapeutic endoscopic treatment.
3 The unit provides a full ERCP service and Mauritian patients for the first time are benefitting such treatment.
4 There is now no need for Mauritian patients to go abroad for endoscopic treatment in gastroenterology.
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8. What were the most successful outputs and why was the initiative effective?
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We evaluate services by auditing every aspect of ‘endoscopy’ – from pre-procedure waiting times and patient experience to endoscopic outcomes.
We keep a central record of all procedures and outcomes performed in the unit.
We also keep a hard copy of every single procedure carried out on the unit for audit purposes and for ease of access of reports for the future.
We hope to develop an electronic reporting system which can be shared with future endoscopy units in other hospitals.
All endoscopists keep a log of their procedures and these are audited in terms of fixed international criteria on a yearly basis. For example, endoscopists need to reach the end of the colon in at least 90% of cases and if this is not achieved, remedial training is provided.
We record all cases of adverse effects and we analyse these at regular intervals for educational and remedial purposes. Patients Satisfaction Surveys are utilized to evaluate the level of services provided by the unit before discharge.
A suggestion box is fixed in the unit where the patients can suggest measures that can be implemented so as to bring improvement in the service.
Track records of the improvement of health of our patients are kept by giving them regular reviews. They are also given the liberty to call up at the unit in person or by phone and inform our team of any change in their health status so that corrective measures could be taken in time.
A visitor’s book is available for any person as a member of the hospital community to write his feedback on anything at the unit during his treatment. The book is reviewed at least every two weeks.
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9. What were the main obstacles encountered and how were they overcome?
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1 Shortage of funds to develop and upgrade the infrastructure. – several problems were encountered in modernizing the infrastructure namely
2 Buying the best equipment for the unit encountered problems because of the open bidding exercise where the cheapest quotation is awarded the tender.
3 Overcoming objections from the adjacent gynaecology unit who wanted to make use of the existing premises.
4 Staffing the unit
5 Seeking expertise for advanced endoscopy.
The above obstacles were overcome by us making a strong case to develop this prototype unit and made representations to higher officials at the ministry, several correspondences were also sent to the minister of health and even the prime minister of the island.
The project convinced the authorities of the major contributions the unit will bring to the population of the country. Following this we obtain the green light to develop this unit.
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