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Summer Project on Kidney/Dialysis Disease Centre

DIALYSIS CENTRE PATIENT CENTRIC ISSUES

(As Contributed voluantrily by a follower of my blog, )Thanks Buddy

MAJOR RESEARCH PROJECT

Kidneys Can
ON Recover
Boost your kidneys
Study on Problems faced by Dialysis Patients and Caretakers
performance with
alternative treatment

STUDY CONDUCTED AT:

ABC HOSPITAL

U.P.
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ACKNOWLEDGEMENT Join this site

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Undertaking a project is never a one-person job. It always involves help from other Members(67) More
people, who are either reviewing your work or teaching you things. It would have
never been completed without the co-operation and sincere efforts of all the staff
members of hospital who guided me throughout this project.

My sincere Thanks goes to:

ABC. Rajiv Ranjan , MBA (HA)

DECLARATION

I student of M.B.A. (Hospital Administration), hereby declare that this project has been
completed by me is a part of our major research project. This report has not been
submitted anywhere else to the best of my knowledge.

Date-

Student
MBA (HA) 4th Sem Follow by Email

Email address... Submit

CONTENTS

1. HOSPITAL PROFILE
Google Drive For
Work
2. PREFACE Unlimited Storage For
Your Docs, Slides And
3. INTRODUCTION TO THE TOPIC Spreadsheets - $10/Month

4. LITERATURE REVIEW

5. AIM

6. OBJECTIVES Rajiv Ranjan, MBA (HA)

7. METHODOLOGY
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8. DATA ANALYSIS AND INTERPRETATION complete
profile
9. FINIDINGS
Total Pageviews
10. RECOMMENDATIONS
61,955
11. CONCLUSION

Blog Archive
12. REFERANCES
2014 (2)
2012 (7)
November (1)
HOSPITAL PROFILE
September (1)
Introduction July (2)
March (1)
Hospital is the only multicrore, Super speciality Tertiary Care corporate hospital in
February (1)
Utter Pradesh, which has been established in 1993 with a view to fill the wide gap
between demands of high class medical services and actually available services thereof. January (1)
The hospital was established with technical consultancy with Indian Hospital
2011 (6)
Corporation Ltd it is a listed Public Ltd. Company at BSE and UP Stock Exchange Ltd.
2010 (1)
2009 (3)
The hospital has OPD, 24 hours emergency service and in-patient admission facilities 2008 (11)
for 175 patients. The hospital has General Wards, Paediatric Ward, Semi- Private and
Deluxe Rooms, bedsides ICU, ICCU and Neonatal Intensive Care Unit, PICU. The hospital
Labels
is centrally Air-Conditioned including all rooms and General Wards. Round the clock
diet and meals are provided to all patients free of cost under the supervision of Colleges for Hospital
Dietician. Administration
Common Medical Term
Explanation
Hospital is having fully equipped 4 OTs with laminar flow, zero bacteria air Healh Cares Sytem
Challenges
conditioning facilities with C-Arm, Laproscope Microscope and OT Tables of BLANCO
How to Organise a
GMBH made etc.
Medical Camp / CME
Infection Control
A new state of Art OPD wing has been started in , wherein Covering of all specialties are Committe
available under one roof. Inject Safely (Safe
Injection Practice)
Locational Advantage MBA(HA)
MS
ABC Hospital Ltd. is strategically located in the city of UP, which is one of the 10 largest
Medical Record
metropolitan cities in India, and being the industrial and commercial capital of the state Department
of Uttar Pradesh is a major service centre for surrounding districts. Medical Records
Medical Videos
There existed a wide gap between the demand of high quality medical services and
Model_Health
supply available thereof, with a result that most of the patients are forced to go to other Care_Business
cities like Delhi and Bombay to get Medicare in corporate hospitals. Pharmacy Protocol
Project Topics
The company thereof has an assured clientele from the inhabitations of UP and Quality
surroundings districts. SOP Contractual Jobs
SOP Hospital Laundry
Summer Project on
Vision Dialysis/Kidney Diseases.
Which degree MHA
Reaching beyond excellence in high-end tertiary healthcare, while doing business with
Why SOPs Required?
a soul.
changes required in
healthcare

Mission
Eat Right
To become a leading professional healthcare company in super - specialty and tertiary
care in the Region, leading in cardiac care with a range of products, services and quality
To Lose
consistent with the highest customer expectations. To maintain the pioneering Weight
leadership in health care in this region. Lose Upto 2
Kgs in just 1
week! Try
Anjali
HOSPITAL QUALITY POLICY Mukerjee's
Program
ABC Hospital Ltd. aims Today.

Commitment to provide high standard of healthcare with the best of technology

Working environment and a team of highly qualified doctors, nurses and other skilled
paramedics of the country.

To meet the need and expectation, by providing healthy environment, safety, security,
for the patients, staff and visitors.

RENAL SCIENCES CENTRE

INTRODUCTION

ABC Hospital Ltd. is all set to bring yet another health care facility at UP, meeting all
international standards. We are coming up with an exclusive dedicated 70 bedded renal
hospital for dedicated Nephrology and Urology patients. It is an ultra modern hospital
with facilities for all kinds of Dialysis and Kidney Transplant.

The new centre will be backed by a dedicated team of highly qualified and experienced
doctors, nursing staff and technicians. Along with Renal disease management, the
centre will focus on preventive health management through its various community
interaction programmes and scientifically designed preventive renal health care
checkup."

The Aim of the Hospital is to give the best quality of treatment for all types of Kidney
diseases. The hospital is fully computerized and well equipped seventeen dialysis
machines were patients can get the most comfortable dialysis. Even many outsider
patients are regularly coming to our hospital for dialysis. They feel no difference rather,
some claim, they felt better.

We have advanced operation theatre including high definition image intensifier (C-
Arm) for various operation of kidney. The Operation theatre is ultra modern OT of its
kind.

We have computerized uroflowmetry for diagnosis of various lower urinary treat

diseases including prostate & urethral diseases. The Laboratory is also computerized
where result is obtained within an hour. The intensives care unit care unit (ICU) of the
hospital is well managed by experience doctors and nursing staff round the clock.

NEPHROLOGY

The Department of Nephrology at ABC Hospital is the oldest and first of its kind in
Northern India. The Department is headed by a senior nephrologists consisting of a
dedicated team of nephrologists and Para-medical staff. The Nephrology wing of renal
sciences deals with all sorts of diagnostic and therapeutical modalities of Kidney
diseases.

For the diagnosis of complex renal diseases the department provides a combination of
conventional and most sophisticated investigations like - 3 D US with Doppler study for
Renal vessels, CT scan, IVP, Renal Angiography and Kidney Biopsy - to name a few.
Kidney Biopsy is done by modern US guided automated gun. Biopsy needle & tissue thus
obtained is studied by light & IF Microscope.

All possible modes of therapeutic interventions like maintenance hemodialysis on

ultramodern Japanese hemodialysis machines with superb volumetric control ( Acetate
as well as Bicarbonate), Emergency hemodialysis round the clock, continuous
Ambulatory Peritoneal dialysis, Acute Peritoneal dialysis, Automated Peritoneal dialysis
(APD), Hemofiltration, continuous Renal replacement therapy (CRRT) and Kidney
transplantation.

A strictly related Renal Transplant programme is being conducted in the hospital for the
last 5 years. The Department has a separate kidney transplant ICU with ventilator, C-
PAP, CVP monitoring & Cardiac monitoring equipments. Isolated nursing care is
provided to the patients by well trained & experienced Nursing Staff with special
attention to asepsis, nutritional support & minimal handling to these immuno-
compromised patients these immuno-compromised patients.

A post transplant OPD is run for all follow up patients on every Thursday of the week,
where all these patients are seen by a team of nephrologists and Transplant surgeons.
Apart from the above mentioned facilities, the department has taken special interest to
promote preventive nephrology i.e. the prevention of Kidney diseases in susceptible
individuals. For this a preventive nephrology OPD is run once a week and the
department runs Kidney disease detection camps, public education programmes and
CME programmes for Family Physicians throughout the year.

UROLOGY

Urology is that discipline of medical science, which deals with both medical and
surgical diseases of urinary and genital systems of men, women and children.

The common ailments/subdivisions are:

Stone Disease

Stone formed in urinary system is a common ailment of human race from time
immemorial. They are made of calcium, oxalate, uric acid, phosphate etc. in various
combinations. There has been a remarkable advancement in treatment of stone disease.
The common concept that every stone needs operation is not true. Majority of stone
patients (up to 80%) do not need any intervention or operation. With modern
techniques of ESWL (Lithotripsy) PCNL &URS, the need of open operation has gone
down to about 5%. For details of these, please contact our Urologist.

Prostate Enlargement

Prostate is a gland present around the upper part of the urinary passage of men. It
enlarges in size in all men after the age of 45 years. It is the commonest cause of urinary
problems in aged men. If a man is troubled by urinary symptoms, the prostate needs to
be removed. The technique of TURP is the best in today's date. In this technique, the
enlarged prostate is removed by a telescopic instrument passed through the urinary
passage. But before the decision of treatment is taken, it is important to prove that the
urinary symptoms are due to prostate enlargement and not some other problem. This is
a vital question and it requires the tests or UROFLOMETRY & CYSTOMETROGRAM.

Urinary Infections (UTI)

These are very common particularly in women. Frequent discharge of urine, burning,
pain and difficult urination are present symptoms. For proper treatment, an Urologist
should be consulted who carry out the urine would culture, uroflowmetry and
ultrasound examination to find out the cause and nature of infection. The proper and
effective treatment is based on these test reports.

Blood in Urine

Passage of blood with urine is known as hematuria. The commonest cause is urinary
infection. The presence of blood in urine should not be neglected. It should always be
investigated by tests such as urine culture, ultrasound, IVP and CT scan. The cause may
be a stone, tumour of bladder or Kidney, vascular malformation, prostate enlargement
etc. The treatment is according to the cause.

Stricture

Stricture is a term applied to narrowing of a tubular structure. When it occurs in

urinary passage, it causes decrease in the flow of urine. This later causes effects on
urinary bladder and kidneys. In majority of patients, its treatment is by a telescopic
instrument (nonoperative) but in some it requires reconstruction of the urinary passage
(urethroplasty).

Kidney Disease

Surgical diseases of kidney such as STONE, TUMOURS, CYST, and VASCULAR

MALFORMATIONS require appropriate and timely treatment. The treatment is
operative or minimally invasive or conservative depending upon the type and nature of
the disease.

Kidney Failure

When both kidneys have failed working due to any disease, they need replacement. The
best mode of kidney replacement is KIDNEY TRANSPLANTATION and a very
economical package for this is available at ABC hospital.

PREFACE

Dialysis patients represent the overwhelming majority of patients cared for by all
nephrologists. This patient group represents complex medical problems, is increasing in
number at an annual rate of 8%, and suffers from very high morbidity and mortality.
This would seem to represent the ideal situation for an academic research faculty. i.e. a
major and increasingly problematic health issue and a patient population of sufficient
number and motivation about which to pose investigative issues. Curiously, a
significant fraction of the nephrology world views dialysis purely as a technology
necessary to insure survival but requiring little in the way of intellectual contribution.

The record shows a failure of much of the academic community to become interested in
the problems of the end-stage renal failure patient. In many academic circles, the tasks
attendant to this procedure are often delegated to the most junior faculty members and
research questions rarely present themselves at any higher level. That this attitude
permeates the entire nephrology research establishment is shown by the very low level
of research support for dialysis-related research by either the National Institutes of
Health or Veterans Administration. Bear in mind that more than $5.4 billion is spent
annually in the direct care of end stage renal disease patients. There had been support
for research relevant to morbidity and mortality of the dialysis population in the early
1970s.
Many of the technological treatment advances of today in hemodialysis and peritoneal
dialysis, followed this period of activity. Unfortunately this program was discontinued
and no replacement was developed to fill the void.

INTRODUCTION TO TOPIC

In recent years the principal areas of research have been in the development of
products which improve the safety and efficiency of dialysis including synthetic dialysis
membranes and new delivery systems. Computerization of such machines with
accompanying ability to produce and manipulate data is in its early stages. Similarly,
work to develop machines which will provide on-line Information useful in altering
pressures flows, and dialysate concentration in response to patient needs is in its
infancy. Essentially all of these advances have been supported by Industry.

Research relevant to the health of the dialysis patient has been largely neglected. The
reasons for this are complex, but a small group of Investigators, believed that part of
the problem was the complexity of the problems and the lack of data.

ABC Hospital Ltd. is all set to bring yet another health care facility at UP, meeting all
international standards. ABC hospital coming up with an exclusive dedicated 70 bedded
Renal hospital for dedicated Nephrology and Urology patients. It is an ultra modern
hospital with facilities for all kinds of Dialysis and Kidney Transplant.

Dialysis is a treatment for people in the later stage of chronic kidney disease (kidney
failure). This treatment cleans the blood and removes wastes and excess water from the
body. Normally, this work is done by healthy kidneys.

THE EMOTIONAL EFFECT OF RENAL FAILURE

Stress

One of the main causes of stress is change. All human beings find change stressful -
even change that we are looking forward to, like moving house, raises our stress levels.

As a person with renal failure you will have to deal with more change than most people
do. Not just the initial change of lifestyle that comes with the diagnosis, but ongoing
changes as you deal with alterations to your diet, medication and forms of treatment.

All these changes will mean you have to take in a great deal of new information, make
decisions, and learn new practical skills. You also have to adjust to new ways of doing
things, to doing less than you would like to, and to asking for help... This is all extremely
stressful - and it comes in addition to coping with the physical effects of kidney failure.

Different people react differently to stress - some get anxious or feel overwhelmed,
others may get irritable or hostile, others may deny there is a problem and keep
pushing themselves to "cope."

The best way of coping with stress is to recognize that it can be a problem in its own
right and that if you are suffering from it, it is with good reason. Accept that you need to
actively take time to "de-stress". There are many ways of doing so and they can all
contribute to helping you cope with kidney failure.

Anxiety

This can be a specific "worry" related to something in particular, or a more general

sense of "being on edge" or "not feeling safe."

Specific anxieties that renal patients may have include:

Worries about how the illness will affect your relationships,

 Your ability to work,

Your finances

Your quality of life

You may also be anxious about understanding your condition or managing your
treatment.

Ways of reducing anxiety are:

To see if there is something practical you could do to help you feel better. Make that
appointment to see the doctor/dietitian/social worker/counselor about what is worrying
you. Ask a nurse about that part of the procedure you don't understand.

There will of course be things that worry you that you can do nothing practical about.
Most patients will say, however, that they find it helpful simply to talk about their
worries to people who understand. Whether it's another patient, a nurse, a family
member or a counselor, don't keep yourself alone with your anxiety.

Generalized anxiety is just as difficult to live with as anxiety that has an obvious cause.

Feeling generally "unsafe" may have something to do with a sense of "having no

control" over your own body and life.

Many patients find that they can regain a sense of control by learning as much as they
can about kidney failure and its treatment. Becoming an "expert" enables them to
participate more actively in making decisions and to feel that they are working with the
medical staff to control the condition rather than being passive.

Other people find that setting reasonable goals for themselves, such as going out,
exercising, or keeping up certain activities - and achieving them - gives them a feeling of
control.

Depression

Like anyone else, you will have times when you feel a bit down and less able to cope
with life in general. You may also feel sad and "need a good cry" sometimes. If,
however, the sadness turns into a real sense of despair that goes on for some time, this
is depression.

You may feel depressed because you are having difficulty coming to terms with some of
the changes their condition is imposing on you.

These might include:

The loss of your previous lifestyle

The loss of independence and self-confidence

The changes to your body and appearance

Difficulties with sex or with having children

Awareness of your own mortality

If you are feeling depressed it may help you feel less isolated if you talk to others who
understand. This may be one of the renal unit nurses, the renal social worker, a
counselor or even a good friend. Sometimes a short course of anti-depressant
medication may be useful to get over these acute problems.

Anger

It seems quite appropriate for people who are going through these experiences to feel
angry at times. It can even be energizing, sometimes, to feel angry.

Where problems arise, however, is if you get "locked into" your anger in a way which
makes you unhappy and you can't seem to move through it into some degree of
acceptance.

Anger is also a problem when it is expressed in destructive or self-destructive ways -

when the feelings of anger and frustration lead to rebellion against diet and fluid
restrictions, for example, or to aggressive behaviour towards friends, relatives and
staff. When people are angry, they may tend to "push away" the people who want to
support them.

Anger expressed in these ways is self-destructive because it puts your health at risk, and
- on an emotional level - leaves you feeling even more isolated.

It can feel like the hardest thing in the world to reach out for support when you are
feeling angry. Paradoxically, it may be the one thing you can do to regain a real sense of
power and control in your life.

Sexual problems

Some kidney patients never have sexual problems, but many do.

The reasons for these problems may include:

Hormonal problems: The hormones that control sexual urges may be either higher or
lower in people who have kidney failure.

Medication: Some of the medication prescribed to renal patients may have the effect of
inhibiting sexual desire.

Tiredness: This can be caused by anaemia or by not having dialyzed sufficiently.

Emotional factors: When people feel stressed, depressed or anxious, they often do not
feel like having sex.

Relationship difficulties: The stress that kidney failure can bring to a relationship may
affect the couple's sex life.

Sexual problems in men

Impotence (the inability to get or maintain an erection) may be a problem in male

kidney patients.

There are various approaches to treating impotence. Initially, doctors will look at
possible causes such as anaemia, under-dialysis and medication, and consider the
treatments for them. There are physical treatments for impotence that can be
considered including physical techniques and drugs. Two recent studies have shown
that Viagra is effective in haemodialysis patients like it is in patients with normal
kidney function. Remember though, it is not a guaranteed success and some patients do
not show any response. UK patients can receive Viagra on the NHS scheme as kidney
disease is on the list of conditions allowing prescription

Sexual problems in women

When women patients experience a lack of sexual desire or inability to have orgasms,
causes related to anaemia, under-dialysis and medication can be investigated.

There may be changes in the menstrual cycle and there is no doubt that the chances of
getting pregnant if the kidneys have failed are much reduced. If kidney function is only
mildly impaired and the blood pressure is under control before and during pregnancy,
it is likely that pregnancy will progress as normal, but there will be a close liaison
between the kidney doctor and the obstetrician. Some drugs particularly ACE inhibitors
will need to stop before pregnancy and the blood pressure will be checked very
carefully.

REVIEW OF LITERATURE

The department of Nephrology and urology are important part of any hospital. It
functions with a full complement of infrastructure needed both for diagnosis and
treatment of renal disorders such as Acute & chronic nephritis Connective tissue
disorders and other renal problems like Acute & chronic renal failure Nephritic
syndrome Secondary hypertension Diabetic nephropathy etc.

WHAT IS KIDNEY?

In humans, the kidneys are two small organs located near the vertebral column at the
small of the back. The left kidney lies a little higher than the right kidney. They are bean
shaped, about 4 in. (10 cm) long and about 21/2 in. (6.4 cm) wide.

WHAT DOES KIDNEY DO ?

Your kidneys are bean-shaped organs, each about the size of your fist. They are located
near the middle of your back, just below the rib cage. The kidneys are sophisticated
reprocessing machines. Every day, your kidneys process about 200 quarts of blood to
sift out about 2 quarts of waste products and extra water. The waste and extra water
become urine, which flows to your bladder through tubes called ureters. Your bladder
stores urine until you go to the bathroom.

The wastes in your blood come from the normal breakdown of active tissues and from
the food you eat. Your body uses the food for energy and self-repair. After your body
has taken what it needs from the food, waste is sent to the blood. If your kidneys did not
remove these wastes, the wastes would build up in the blood and damage your body.

The actual filtering occurs in tiny units inside your kidneys called nephrons. Every
kidney has about a million nephrons. In the nephron, a glomerulus-which is a tiny
blood vessel, or capillary-intertwines with a tiny urine-collecting tube called a tubule. A
complicated chemical exchange takes place, as waste materials and water leave your
blood and enter your urinary system.

At first, the tubules receive a combination of waste materials and chemicals that your
body can still use. Your kidneys measure out chemicals like sodium, phosphorus, and
potassium and release them back to the blood to return to the body. In this way, your
kidneys regulate the body's level of these substances. The right balance is necessary for
life, but excess levels can be harmful.

In addition to removing wastes, your kidneys release three important hormones:

erythropoietin, or EPO, which stimulates the bone marrow to make red blood cells

renin, which regulates blood pressure

calcitriol, the active form of vitamin D, which helps maintain calcium for bones and
for normal chemical balance in the body

The Kidneys filter the blood and remove waste products and fluid which is called urine.
The kidneys balance the potassium and sodium levels and also produce several
hormones. When patients are diagnosed to have renal failure, it means these kidneys
are not filtering properly and harmful waste products are accumulating in the blood.
Some of the most common causes are diabetes, high blood pressure (hypertension),
infections, drugs and polycystic kidney disease.

The treatment option available is dialysis and transplantation.

What is dialysis?
It is a technique of removing fluid and waste products from body with a In medicine,
dialysis is primarily used to provide an artificial replacement for lost kidney function in
people with renal failure. Dialysis may be used for those with an acute disturbance in
kidney function (acute kidney injury, previously acute renal failure) or for those with
progressive but chronically worsening kidney functiona state known as chronic
kidney disease stage 5 (previously chronic renal failure or end-stage kidney disease).

Dialysis works on the principles of the diffusion of solutes and ultra filtration of fluid
across a semi-permeable membrane. Diffusion describes a property of substances in
water. Substances in water tend to move from an area where they are in a high
concentration to an area of low concentration. Blood flows by one side of a semi-
permeable membrane, and a dialysate, or special dialysis fluid, flows by the opposite
side. A semi permeable membrane is a thin layer of material that contains various sized
holes, or pores. Smaller solutes and fluid pass through the membrane, but the
membrane blocks the passage of larger substances.

Sometimes dialysis is a temporary treatment. However, when the loss of kidney

function is permanent (as in end-stage kidney failure), you must continue to have
dialysis on a regular basis. The only other treatment for kidney failure is a kidney
transplant.

TYPES OF DIALYSIS

Hemodialysis

In hemodialysis, the patient's blood is then pumped through the blood compartment of
a dialyzer, exposing it to a partially permeable membrane. The dialyzer is composed of
thousands of tiny synthetic hollow fibers. The fiber wall acts as the semipermeable
membrane. Blood flows through the fibers, dialysis solution flows around the outside
the fibers, and water and wastes move between these two solutions. The cleansed blood
is then returned via the circuit back to the body. Ultrafiltration occurs by increasing the
hydrostatic pressure across the dialyzer membrane. This usually is done by applying a
negative pressure to the dialysate compartment of the dialyzer. This pressure gradient
causes water and dissolved solutes to move from blood to dialysate, and allows the
removal of several liters of excess fluid during a typical 3 to 5 hour treatment.

Peritoneal dialysis

In peritoneal dialysis, a sterile solution containing glucose is run through a tube into the
peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal
membrane acts as a semipermeable membrane. The peritoneal membrane or
peritoneum is a layer of tissue containing blood vessels that lines and surrounds the
peritoneal, or abdominal, cavity and the internal abdominal organs. The dialysate is left
there for a period of time to absorb waste products, and then it is drained out through
the tube and discarded. This cycle or "exchange" is normally repeated 4-5 times during
the day, sometimes more often overnight with an automated system. Ultrafiltration
occurs via osmosis; the dialysis solution used contains a high concentration of glucose,
and the resulting osmotic pressure causes fluid to move from the blood into the
dialysate. As a result, more fluid is drained than was instilled. Peritoneal dialysis is less
efficient than hemodialysis, but because it is carried out for a longer period of time the
net effect in terms of removal of waste products and of salt and water are similar to
hemodialysis.

Hemofiltration

Hemofiltration is a similar treatment to hemodialysis, but it makes use of a different

principle. The blood is pumped through a dialyzer or "hemofilter" as in dialysis, but no
dialysate is used. A pressure gradient is applied; as a result, water moves across the
very permeable membrane rapidly, "dragging" along with it many dissolved substances,
importantly ones with large molecular weights, which are cleared less well by
hemodialysis. Salts and water lost from the blood during this process are replaced with
a "substitution fluid" that is infused into the extracorporeal circuit during the
treatment.

Intestinal dialysis

In intestinal dialysis, the diet is supplemented with soluble fibres such as acacia fibre,
which is digested by bacteria in the colon. This bacterial growth increases the amount
of nitrogen that is eliminated in fecal waste.

Does hemodialysis hurt?

Insertion of the needles causes pain, but only for a brief time. This can be difficult for
some people. Occasionally nausea, muscle cramps or dizziness can occur due to the fast
removal of extra water from your body, which may cause your blood pressure to drop.

How long does hemodialysis take?

Each hemodialysis treatment normally takes four to five hours, and usually three
treatments a week are needed. More frequent, shorter treatments or longer treatments
may be indicated for certain patients. Only a small amount of your blood is out of the
body at one time. Therefore your blood must circulate through the machine many times
before it is cleaned.

What is home hemodialysis?

Many dialysis centres in India offer the option of training patients or their partners to
carry out hemodialysis at home. The dialysis machine and necessary modifications to
your home are provided by the hospital. While some home hemodialysis patients follow
a standard schedule of four to five hours three days a week, some Canadian centres are
also offering nocturnal home hemodialysis in which patients go on dialysis four to six
nights a week for six to eight hours while they sleep. Nocturnal home hemodialysis
greatly improves the removal of waste products from the body and has been found to
improve well-being, allow for a more liberal diet and reduce the need for medications.

What other changes are needed with hemodialysis?

You will need to plan your week around your hemodialysis schedule. You may have to
take time off work or school before you start hemodialysis and when the treatments
begin. However, once your health is more stable, you should be able to return to your
normal activities. Depending on your energy level, you may have to make some
adjustments in your work situation or limit your activities.

Is travel possible on hemodialysis?

There are dialysis units across India and in many parts of the world. They have suitable
facilities for visitors who need hemodialysis treatment. However, it is necessary to plan
several months in advance due to limited space and staff. Your dialysis unit and local
Kidney Foundation office can provide more information and advise you about travel
costs and arrangements.

AIM

To study the Problems faced by Dialysis Patients and Caretakers

OBJECTIVES

1. To get in-depth knowledge about the Dialysis unit of hospital.

2. To find out importance of artificial kidney unit for hospital.

3. To find out problems of the dialysis patient & their caretakers and provide
recommendations.

4. To reduce the problems in the new set up of hospital with the help of research results.

METHODOLOGY

STUDY DESIGN: -

Survey questionnaire.

STUDY SETTING :

ABC hospital, Madhuraj hospital, Rajaram hospital, KMC UP.

SAMPLE SIZE: -

100 Patients of Dialysis and care takers.

SAMPLING METHOD: -

Simple random sampling

INCLUSION CRITERIA: -

Acute and chronic dialysis patients.

METHODS OF DATA COLLECTION: -

Primary data is collected through questionnaire filled by dialysis patient and care
takers.

STUDY PERIOD: -

15 May- 05 Jun: - Data collection

06 Jun- 11 Jun: - Data analysis and report preparation.

STATISTICAL ANALYSIS: -

Mean and percentage was calculated.

Pie and bar diagram is used for representation.

PATIENT SURVEY

To understand the patient expectations and their preference of hospitals and to know
the factors which affect their choice of the hospital for dialysis a questionnaire is
prepared. This questionnaire is filled by the 100 dialysis patients of various hospitals
which are chosen for the study. The questionnaire contains following questions:-

SURVEY QUESTIONNAIRE

SAMPLE QUESTIONNAIRE

1. On an average, how often do you undergo dialysis treatment?

a. Once a week

b. Twice a week

c. Three times a week

d. Four times a week

2. On an average, after how many treatments do you replace your dialyzer?

a. After 8 treatments or less

b. Between 9 and 10 treatments

c. Between 11 and 12 treatments

d. Between 13 and 14 treatments

e. After 15 or more treatments

3. Approximately how much does it cost per week to buy Erythroprotein and other
medicines?

a. 200 or less

b. Above 200 and up to, and including 250

c. Above 250 and up to, and including 300

d. Above 300 and up to, and including 350

e. Above 350 and up to, and including 400

f. Above 400

4. What brand of Erythroprotein do you currently purchase?

________________________________________________

5. Approximately how often do you have your tests done?

a. Once a month

b. Twice a month

c. Three times a month

d. Four times a month

e. Five times a month

f. More than five times a month

g. Every 12 months or less often

6. Approximately how much do you spend on diagnostics and tests a month?

a. 1200 or less

b. 1201-1300

c. 1301-1400

d. Above 1400and up to, and including 1500

e. Above 1500and up to, and including 1600

f. Above 1600

7. Approximately how often do you visit your Nephrologists?

a. Twice a month or more often

b. Once a month

c. Once every two months

d. Once every three to five months

e. Every six months or less often

8. When you for dialysis, how do you usually get to the hospital?

a. Walking

b. Shared Tempo

c. Rickshaw

d. Auto

e. Own Scooter

f. Own Car

g. Other, If so, how? ___________________________________

9. Approximately, how much do you spend on transportation per visit?

a. 5 or less

b. Above 5 and up to, and including 10

c. Above 10 and up to, and including 20

d. Above 20 and up to, and including 30

e. Above 30 and up to, and including 40

f. Above 40 and up to, and including 50

g. Above 50

10. Please rank the following services that you would like a dialysis center to offer from
1 to 7 according to your personal preferences; 1 being the most important and 7 the
least important.

Pick-Up and Drop-Off Services

Personalized TV Screen

Wi-Fi

Package Pricing (One combined price for medicines, dialyzer and dialysis)

Counseling (How to better take care of yourself; dialysis friendly recipes, etc.

Flexible scheduling

Nice facilities for attendants

11. Which of the following best describes your dialysis treatment routine?

a. I go to my attendants by myself

b. I go to my treatments by myself and someone visits me while I receive dialysis

c. Someone takes me to and/or picks me up from the hospital, but he/she doesnt stay

d. Someone takes me to the hospital and stays with me while I receive dialysis

12. Please mark the three schedules that are most convenient for you:

M Tu W Th F S

Morning(7:00-11:30)

Afternoon(11:30-17:00)

Evening (17:00-21:30)

Night (00:00-6:00)

13. If your current hospital began offering a Pick-Up & Drop-Off service for an
additional charge, how much would you be willing to pay?
_______Rs per visit

14. If your current hospital began offering comfortable chairs with a personal TV screen
for an additional charge, how much would you be willing to pay?

_______Rs per visit

To better understand how opinions vary among people with different characteristics,
we need some additional information. Again, this information is confidential, and will
be analyzed anonymously.

15. Age..

16. Sex

a. Male

b. Female

17. What is your home address?

18. What is your work address?

19. How many people currently reside within your household?

20. What is the total income in your household?

a. Under and up to, 10,000

b. Above 10,000and up to, and including 25,000

c. Above 25,000and up to, and including 50,000

d. Above 50,000and up to, and including 75,000

e. Above 75,000and up to, and including 100,000

f. Above 100,000and up to, and including 125,000

g. Above 125,000
End of Questionnaire

Thank you for taking the time to complete this survey. If you have any questions related
to this research, please contact:

***********

DATA ANALYSIS

AND

INTERPRETATION

Survey Results

The survey was conduct in various hospitals of UP, with a total number of 100 Patients
as the sampling population. The Sample includes Acute and chronic dialysis patients.

Q. 01. On an average, how often do you undergo dialysis treatment?

Q.02. On an average, after how many treatments do you replace your dialyzer?

Q. 03. Approximately how much does it cost per week to buy Erythroprotein and other
medicines?
Q.04. What brand of Erythroprotein do you currently purchase?

Q.05. Approximately how often do you have your tests done?

Q. 06. Approximately how much do you spend on diagnostics and tests a month?

Q.07. Approximately how often do you visit your Nephrologists?

Q.08 When you for dialysis, how do you usually get to the hospital?

Q.09. Approximately, how much do you spend on transportation per visit?

Q.10. Please rank the following services that you would like a dialysis center to offer
from 1 to 7 according to your personal preferences; 1 being the most important and 7
the least important.

Pick-Up and Drop-Off Services

Personalized TV Screen

Wi-Fi

Package Pricing (One combined price for medicines, dialyzer and dialysis)

Counseling (How to better take care of yourself; dialysis friendly recipes, etc.

Flexible scheduling

Nice facilities for attendants

Q.11. which of the following best describes your dialysis treatment routine?
Q.12. Please mark the three schedules that are most convenient for you:

M Tu W Th F S

Morning(7:00-11:30) 74 2 60 24

Afternoon(11:30-17:00) 10 2 2 2

Evening (17:00-21:30) 2 2 4

Night (00:00-6:00) 4 6

Q.13. If your current hospital began offering a Pick-Up & Drop-Off service for an
additional charge, how much would you be willing to pay?

_______Rs per visit

Q. 14. If your current hospital began offering comfortable chairs with a personal TV
screen for an additional charge, how much would you be willing to pay?

_______Rs per visit

FINDINGS

1. The principal areas of research have been in the development of products which
improve the safety and efficiency of dialysis, Including synthetic dialysis membranes
and new delivery systems.

2. Research relevant to the health of the dialysis patient has been largely neglected. The
reasons for this are complex, but, it is believed that part of the problem was the
complexity of the problems and the lack of data.

3. Dialysis patient group represents complex medical problems, is increasing in number

at an annual rate of 8%, and suffers from very high morbidity and mortality.

FINDING IN RESPECT OF ABC HOSPITAL

1. Charges for the dialysis are varies from hospital to hospital according to policy of
hospital. In some hospitals charges for dialysis varies according to the fee of the doctor
or nephrologists.

2. 90% of the patient undergo dialysis treatment twice a week.

3. In 94% cases the dialyzer is replaced after 8 treatments or less.

4. About 95% patient spent more than Rs. 400 to buy erythropoietin and other
medicines.

5. About 96% of the patient have their test done once a month and 4% twice a month.

6. 86% of the patient spend approximately Rs. 1200 or less for the diagnostics and tests
in a month.

7. The visit to the nephrologists are in 72% cases once a month, 14% twice a month, 6%
cases once every two months and in 8% cases once every three to five months.

8. Patient get to the hospital for dialysis in 26% cases by own scooter, 22% cases by auto,
in 20% cases by rickshaw, 14% cases by shared tempo, 10% cases by own car, 4% cases
walking and other transport.

9. 78% of the patient spent more than Rs. 50 on transportation per visit.

10. Pickup & drop-off services and nice facilities for attendants is the top priorities of
patient and Wi-Fi is the least priority.

11. In 92% cases patient come with the attendant who stay in the hospital during
dialysis.

12. The most convenient time for the patent to receive dialysis are Monday and Friday
morning.

RECOMENDATIONS

1. Pickup and Drop-off services can be started by the hospital for the dialysis patient
according to survey results.

2. There should be nice facilities for attendants in waiting area.

3. The scheduling for the dialysis should be flexible and comfortable to the patient and
relatives.
4. Counseling should be done by an expert or nursing staff about various issues of
dialysis like how to better take care of yourself; dialysis friendly recipes, etc.

5. The hospital can increase number of patient coming for dialysis by reducing the
charges for the dialysis to that level which patient find easy to pay.

6. As dialysis is a costly treatment so it is not possible for dialysis patients to afford the
treatment for a longer time especially those who belong to the middle class or lower
class families. such type of patient need some help in monetary terms so that hospital
should increase their contacts with the trusts such as Sai baba dialysis help centre,
Bharat vikas parishad etc. Such type of organizations not only provides help to the
patient but helps hospital in attracting new patients and retaining them for a longer
time.

7. The hospital should conduct aggressive promotional campaigns in remote areas or in

villages so that a large number of populations come to know about the hospital and the
facilities it providing for the dialysis.

CONCLUSION

Over the coming years, more and more people will have a renal condition in India.
However, both the amount and choice of dialysis services in India is limited. For
instance, at present, no Service providers appear to offer home haemodialysis, despite
national guidance that says it should be offered.

We are pleased that many of these problems are being addressed and that renal
services are now a priority in India. It is clear that the effect of dialysis on a persons
whole life and that of their family is not widely understood. We hope this review will
bring about changes in provision and support which will help them.

This document makes recommendations to the ABC Hospital about renal services for
people. It is based on local research conducted and led by me in cooperation with the
ABC hospital and Institute of Management Studies.

REFERANCES
Research methodology C.R. Kothari

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