Journal of Hospital Administration

Among communicable diseases, tuberculosis (TB) is the major cluster causing mortality in young patients. WHO reported a global estimation of 10 million people fell ill with tuberculosis (1.5 million fatalities in 2020), and India alone contributed about26%.The incidence of Extra pulmonary Tuberculosis (ETB) is about 15% of all TB cases in India. Central nervous system (CNS) tuberculosis accounted for approximately 1% of total tuberculosis. TB is a rapidly progressive and fatal disease if left untreated. The progression of the disease and the occurrence of complications vary from patient to patient. Here the authors present a case of a young adult who presented with acute onset of fever and headache and she expired within a span of 31 days after the symptoms began. The novelty in the case is that an undiagnosed rare cardiac complication of extra pulmonary tuberculosis was diagnosed at autopsy. The investigations prior to her death didn’t indicate TB, but the treating physician had suspected ETB. The autopsy examination and histopathological examination supported the physician’s diagnosis. The authors had deliberated the pathogenesis of the cardiac complication of extra pulmonary tuberculosis contributing to the death of the deceased.

The COVID-19 pandemic has resulted in a growing population of individuals with a wide range of persistent symptoms after acute SARS-CoV-2 infection. This comprises patients with symptoms that develop during or after COVID-19, continue for ≥4 weeks, and are not explained by an alternative diagnosis. Several terms have been used to describe prolonged symptoms following COVID-19 illness, such as "post-COVID conditions," "long COVID," "post-acute sequelae of SARS-CoV-2 infection (PASC)," "post-acute COVID-19," "chronic COVID-19," and "post-COVID syndrome." Whether the constellation of symptoms represents a new syndrome unique to COVID-19 or if there is overlap with the recovery from similar illnesses has not been determined.While most patients with mild acute COVID-19 disease are expected to recover quickly (e.g., two weeks), a longer recovery should be expected in those with moderate to severe acute disease (e.g., two to three months, sometimes longer in those who survive critical illness). The wide variability in time to symptom resolution likely also depends upon premorbid risk factors as well as illness severity during acute COVID-19.During the initial follow-up evaluation, we obtain a comprehensive history of the patient's COVID-19 illness, including the illness timeline, duration and severity of symptoms, types and severity of complications, COVID-19 testing results, and any management strategies. The need for laboratory testing is determined by illness severity, prior abnormal testing during their illness, and current symptoms. We do not routinely re-test patients for active infection with SARS-CoV-2 at the time of follow-up outpatient evaluation. Instead, we follow a non-test-based approach to removing infectious precaution.

National Accreditation Board for Hospitals and Health Care Organizations (NABH) has set a standard of 180 minutes for the completion of the discharge process. Hence, maintaining an acceptable level of discharge time provides competitive edge to the organization. Hospital discharge process is one of the very lengthy procedures. Discharge time taken by hospitals is an important indicator of quality of care and patient satisfaction. The patient as well as his relatives is eager to resume their routine life immediately and any undue delay in the discharge process leads to patient dissatisfaction and takes a toll on image of the hospital, even after a successful and satisfactory treatment. The present study was undertaken to analyze the discharge procedure system in the institution. The main objectives of the study were to explore problems faced by patients and employees during the discharge procedure and to improve the quality of health care facility by reducing average discharge time. The design used for this was comparative design. The setting of the study was Sun Medical Research Centre, Thrissur. Convenient sampling was utilized to collect data from 69 subjects, who meet the inclusion criteria. The tool used for this study was discharge process time analyzing checklist. The study was conducted from 14/3/2022 to 18/3/2022. The collected data were analyzed on the tabular and graphical analysis. The findings of the study revealed that the total average time taken for unplanned discharge was 3:56 hr and the planned discharge was 4:10 hr. While comparing the insurance and non insurance patients, average discharge time was increased among non insurance patient’s 4:01 hr and 3:17 hr in insurance patients. In planned discharge, total average time delay was 4:10 hr. Average discharge time was increased among non insurance patient’s 4:38 hr and 3:41hr in insurance patients. The most average time delay was observed in discharge summary department (1.56 hr), insurance and bill settlement time (1.43 hr), (1.24 hr) pharmacy department. The study explored the problems faced by patients and employees during the discharge procedure. Findings of the study are useful for the HCO to improve the quality of the institution. The study results are helpful to the quality department to improve the quality, to identify the patient’s, employee’s problems andcreate an action plan to reduce the problems at the time of discharge. The action plan includes the all department included in discharge procedure.