From getting the appointment with a doctor to discuss the surgical plan, finding the closest good quality hospital in one’s budget to delivering prompt postoperative rehabilitation, there’s a lot that goes into preparing for surgery. But fret not because experts have got you covered!
“It is only when your eyes tend to blur that you realise the importance of vision and how it impacts your life,” says 40-year-old Ashwini Mandlik, who began to suffer symptoms of cataracts at the beginning of the year.
A homemaker based out of Mumbai, Ashwini loves to cook and take care of her family, but her fleeting vision slowly began to cause hindrance in her life. “It started with putting too much salt in food and slowly progressed to minor mishaps in my daily chores. When my vision would blur I would squint my eyes to get by. But slowly this got worse when the headaches began and I couldn’t function,” she recalls.
It was at this point that her husband, Vinayak Mandlik took her to a doctor for consultation. A few tests later, she was diagnosed and advised to undergo cataract surgery in both the right and left eye.
But even the thought of surgery seemed scary and daunting for the couple. From searching for the right hospital, and ensuring good care to managing insurance coverage, it was meant to be a tedious process, one that had Vinayak truly overwhelmed. However, he is not alone in this.
In a country where every year 20 million surgeries are performed, around 80 per cent of them fall under secondary care , which can range from acute care, injury, treatment for short periods of serious illness or other health conditions including cataracts. These surgeries are crucial and can truly impact one’s quality of life.
However navigating through the complex mechanisms of surgeries, which can include – finding the right hospital that fits one’s budget, ensuring quality pre and post-surgery care and understanding insurance coverage, among other processes– can be a challenge for patients and their families.
For most, the challenge starts with looking for a hospital but it doesn’t end there. Mumbai-based Navin Sawant is one such individual whose previous experience in hospitals made him anxious about the entire process.
“A few years back I was admitted to the hospital for typhoid and the process of figuring it all out, getting the right documents and completing all the administrative processes while undergoing treatment was extremely hectic and too much to handle. I didn’t want that to happen again, especially when I was about to undergo surgery for kidney stones,” he says. The 41-year-old was detected with several kidney stones last year. While medication helped dissolve five of them, the remaining two grew considerably. By January 2022, one was around 12 mm while the other 10 mm and was causing acute pain. It was then that his doctor advised surgery and his search for the best suited surgical plan began.
In situations like this, Dr Abhijit Paul, medical director and senior anaesthesiologist at Practo suggests keeping in mind a few cardinal points when seeking secondary care surgery. According to him a patient’s surgical outcome and recovery journey are deeply impacted by these processes, hence making them crucial for the delivery of quality healthcare.
“The specifics of what to expect before, during and after surgery can vary from case to case, depending on the speciality, doctors and the patient. But there are a few salient points like hospital infrastructure, infection control and safety processes, certification and training of the surgeon, the pre-surgical optimisation of the patient’s physiological status, the correct anaesthesia technique,and pre and post-surgery assistance, etc., that one can keep in mind when planning a patient’s journey to surgery and back,” says Dr Paul, while answering questions to aid a patient’s surgical journey.
How to Find the Best-Suited Hospital?
A primary step when planning surgery is to find a hospital that is credible with good quality healthcare delivery, accessible and affordable. In India, the National Accreditation Board for Hospitals & Healthcare Providers (NABH) has been established to certify hospitals and hold them accountable for quality healthcare. In addition to this, it is also crucial to find a facility with quality infrastructure and credible processes.
According to Dr Paul, a hospital with good infrastructure should be equipped with:
- Wheelchair and trolleys with belts and brakes
- Functional elevators to accommodate beds and stretchers
- 24X7 emergency department with trained personnels
- Labs and radiology imaging facilities
- A post-surgery recovery unit
- A preoperative holding area in the Operation Theatre (OT) complex for quick pre-surgical assessment
- Good infection control processes along with good in-house sterilisation units like CSSD
- A team of BLS/ACLS trained anesthesiologists from reputed and accepted international training bodies.
- Post-operative ICU in case of complications
- Proper documentation and record keeping
- Safe medication practices
- A facility offering 24X7 coverage of doctors, nurses and technicians in all critical areas
Although fundamental, a patient preparing for surgery should have access to all these facilities in order to ensure a safe treatment and recovery environment for them.
“From a fast and smooth admission process with a monitored turnaround time (TAT) to other facilities and processes, every detail matters and contributes to ensuring due diligence. For instance, a small infrastructure detail like having bathrooms that contain anti-skid tiles, grab bars and call bells and are designed with no internal automatic lock system to enable quick access to the patient in case of any emergency, can truly be a lifesaver, ” adds Dr Paul.
How To Determine That A Hospital Delivers Quality Healthcare?
Any good surgical treatment should commence with a thorough physical examination in a well lit and spacious OPD clinic which also has all measures to ensure patient’s privacy. The OPD assessment form or prescription should have pre-marked templates to ensure that all the items of the patient’s chief complaint, past, family, allergy, medication history including allergies and all previous OPD and hospitalisations is captured.
Relevant investigations that are focused on the patient’s pre-existing disease and current condition should be ordered so as to optimise the patient’s clinical status and make him/her fit for surgery and anaesthesia.
All healthcare facilities are required to implement certain processes such as these, to ensure patient safety and quality of treatment. These include:
- Adoption of a surgical safety checklist formulated by the World Health Organisation(WHO)
- Conducting a pre-anaesthesia assessment by a senior anaesthesiologist as a must for all surgery cases
- Clearly communicating fasting instructions and omission or continuation of certain medication before surgery.
- Following the Aldrete scoring system to determine shifting of a post-surgical patient from post-operative ward to patient’s room
- Conducting an on-table quick safety check for sign-in, time-out and sign-out before starting surgery ,and at the end of the procedure respectively.
WHO Surgical Safety Checklist
The WHO Surgical Safety Checklist was developed by WHO with an aim to reduce errors and adverse events during surgery.
“Using this list by medical team members reduce operations on the wrong patient, wrong side and site, wrong surgery, allergies, avoid difficult airways, administer the correct antibiotic choice, avoid leaving gauge and instruments items inside the body through proper counts and so on and so forth. Also patients should be absolutely pain-free, both during and after the operation through a good postoperative pain management program which is constantly monitored by nurses and intervened by anaesthesiologist 24×7. Adopting a good ‘pain assessment’ scale for both adults and children also goes a long way in ensuring success in the post-operative pain management program,” explains Dr Paul.
Aldrete’s Scoring System
Devised by a Mexican anesthesiologist, Jorge Antonio Aldrete in 1970, and modified in 1995 as the Modified Aldrete Scoring System. The Modified Aldrete’s Score is used to determine when a post-surgical patient can be safely shifted from the immediate post operative ward (Post operative care unit-PACU) to the patient’s room.
“A score of 9 and above indicates fitness to shift from the PACU to the ward and a score close to 12 suggests that most effects of all anaesthetics are worn off. A different scoring system like Post Anaesthetic Discharge Scoring System (PADSS) is used to assess the patient’s ability to ambulate and take home discharge on the same day as the surgery as in ‘day-care procedure. A score of 9-10 in PADSS means that the patient is deemed fit to go home with an attendant who should be able to provide assistance if so needed,” says Dr Paul.
This is to prevent any disaster or complication on postsurgical patients when they are being shifted out of the recovery area. Also, the patient is discharged only when their physiology is back to normal, and the process is often followed with a post-surgical recovery plan.
“However, sharing of information as this is often limited to a few facilities only and can be hard to access for patients. That is why many independent bodies like Practo verify all of the above processes and ensure quality delivery of healthcare to patients, by following a robust process of verification through credentialing and auditing,” shares Dr Paul.
The Practo Way
Imagine having to run from pillar to post identifying all these points and efficiently addressing them before undergoing surgery! It is no doubt an overwhelming undertaking, especially for the patient or their nearest kin.
To aid in these complex processes and ensure that a patient’s journey is hassle-free and rewarding, Practo Care Surgeries (PCS) has introduced a system of transparent assistance driven by a fleet of healthcare coordinators or care buddies.
From getting the appointment with a doctor to discuss the surgical plan, finding the closest good quality hospital in one’s budget to delivering prompt postoperative rehabilitation, a Practo Care Buddy provides end-to-end assistance, hand-holding patients throughout the journey and delivering personalised healthcare.
Recalling his experience, Vinayak Mandlik shares, “Just after the doctor told us to get a Cataract Surgery done for my wife, I began searching for a good hospital and soon realised that there’s more to the process than meets the eye. With my limited knowledge about all this, and health insurance that was yet to be reviewed I realised it would become a challenging experience. But I was wrong thanks to PCS which turned out to be a one-stop platform for the entire end-to-end surgical support. The care buddy assigned to us did all the legwork, got the best hospital at the best price, got our finances sorted and even arranged for transportation from home to the hospital and back.”
Getting surgery is an extremely sensitive and vulnerable endeavour for a patient and their families and it’s important to ensure they are taken care of at all times. This is where delivery of quality healthcare becomes paramount for Practo.
And Practo makes sure of it by following certain strict procedures:
- Rapid call back – Anyone searching solutions to surgical ailments on the practo.com is called back within 10 min by a dedicated central team for facilitation and handholding
- Upon decision on a consultation with a nearest surgeon, Practo provides a Care Counsellors (CC) who assists in assigning the OPD appointment to the nearest location, at the earliest
- The CC also provides financial assistance by picking the best pricing, insurance and if needed, also helps with an EMI supported program.
- In case a surgery is recommended, the Practo team organises for the investigations, admission and booking an earliest slot with the best available hospital of convenience.
- Practo also organises cabs from both, pre and post hospital transport. From assistance in pre-anaesthetic assessment, admission process, continuity of medication management, monitoring of the infection control processes, to obtaining consent for surgery and anaesthesia, Practo’s CC accompany the patients in their journey through various departments and areas in the hospital until discharge.
- In addition to care counsellors, each patient is assigned a Care Buddy who accompanies the patient through their in-hospital experience.
- Practo keeps a thorough audit on all the processes and documentation of the medical records in real time.
- From free postoperative OPD consultation, close follow-up from immediate postoperative period until complete recovery to taking constant feedback with escalation to the central medical team, Practo provides quality healthcare with a 360° approach.
- Equipped with an unique scoring system , the team assesses each patient experience in both OPD and IPD and has an objective ranking for all its surgeons and hospitals.
How Practo ensures Quality delivery of healthcare at all times:
“When looking for a hospital, my biggest concern was quality and availability of cashless payment that would allow me to complete the processes via my Mediclaim. Practo Care Surgeries provided me both, and I was pleasantly surprised by the 360° patient-centric approach they had. I was assigned a Care Buddy and from then on my journey was extremely stress-free. They even scheduled all the doctor consultations according to my convenience and time. I didn’t even have to lift a finger and the Care Buddy took care of everything, from cab service with pick-up and drop, insurance claims and even postoperative follow-ups. I could finally concentrate on the most important thing, that is, my health and recovery,” shares Navin, who underwent three surgeries over three months.
The goal at the end of the day should be to ensure that the patient and their kin are able to concentrate on the doctors guidance and instructions around their treatment and recovery, instead of engaging in the complex nuances of these processes. And PCS with its patient-centric system helps make that a reality and enables a truly stress-free healing experience, one that every patient deserves.
After all, as the father of modern medicine Hippocrates says, “Cure sometimes, treat often and comfort always.”