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Khurram Owais Shah



Joined: 07 Nov 2007
Last Visit: 09 Oct 2010
Posts: 45
Location: Karachi
PostPosted: Thu Nov 19, 2009 5:56 pm    Post subject: CCF Reply with quote

Project Team: Waqas Satti, Minza Zahid, Asher Safvi
EC: Akbar Bhaidani, Omar Biabani
Partner NGO: Children's Cancer Foundation
Project: Pediatric ICU
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Akbar



Joined: 15 May 2008
Last Visit: 15 May 2010
Posts: 1
Location: Boston
PostPosted: Fri Nov 20, 2009 3:12 pm    Post subject: Potential questions to help lay out broader workplan Reply with quote

Management
• How many personnel are available that are trained to operate and maintain the equipment? Is this sufficient to cover all shifts? What’s the tenure of these individuals?
• Is there a certification/re-certification process?
• Is the hospital accredited? What’s the track record/reputation?
• How do survival rates at this hospital compare to those at comparable hospitals?
• What other expansions are planned? (trying to understand management capacity)


Financial / Budget

• Are the costs associated with each item appropriate? (e.g. Air matters at ~$120)
• What are the ongoing operating costs for the equipment?
• How will ongoing operating costs be funded?
• Can used items be purchased more cheaply? Are there substitutes available for any of this equipment?

Other
• How does the current transfer process work?
o How far is the other hospital?
o Are there other hospitals with ICUs that have better Oncological care?
o What costs are incurred to make the transfer?
o Are patients returned once they no longer require ICU?

• Statistics around ICU patient transfers
o Average time for admittance from time of request
o Number of transfers per year (and % of total patients)
o What percent of patients that are transferred to ICU survive in the near term? How does this compare to ICU Cancer patients at comparable hospitals (trying to understand how much onsite availability of ICU impacts survival rates)
o Is there a detailed “Cause of death” report available for patients transferred to ICU? How much of this can be prevented with onsite ICU? (Looking for a likely % reduction in deaths)


Essentially, I'd advocate developing a detailed current state/baseline estimate (number of total patients, % requiring ICU, cost per ICU transfer, outcomes of ICU transfers relative to comprable hospitals with onsite ICUs). Once we have this, we can ask them their assumptions around how things should improve (and backup to substantiate assumptions).
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Waqas Satti



Joined: 17 May 2009
Last Visit: 11 Dec 2009
Posts: 4
Location: Karachi
PostPosted: Thu Nov 26, 2009 7:37 am    Post subject: Notes from Kick off call Reply with quote

a)Organisation seems to have a solid track record with a solid revenue stream.

b)Incremental Capacity required is 10%.

c) Will need to Focus on the expected age of these machines, expected repair and maintenance costs of these machines.

d) Will need to see if the they require any specific types of monitors etc.

e) Establish the logistical issues faced in shifting the patient else where for ICU, see the (monetary and non monetary) cost involved in it and weigh that against setting up a ICU at their premises.

f) For sustainibility, need to establish, how many staff they will require, their operating costs, any on going certifications etc.

g) What constitutes a function ICU, is this the only/final funding that they require or is it an on going process where they are/will improve step by step.
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Minza Zahid



Joined: 06 Jan 2010
Last Visit: 09 Jan 2010
Posts: 2
Location: USA
PostPosted: Sat Jan 09, 2010 6:40 pm    Post subject: ICU care - Reasons, impact and equipment Reply with quote

Some of the primary reasons cancer patients get admitted to ICU are (http://www.mdanderson.org/publications/cancerwise/archives/2009-january/cancerwise-q-a-critical-care-for-cancer-patients.html):

1) Respiratory failure (most common reason cancer patients need critical care-may be due to pneumonia, bleeding in the lungs)
2) Cancer surgery
3) Life-threatening effects of cancer treatment: These may be caused by chemotherapy or radiation.
4) Infections (Cancer patients can lose white blood cells very quickly especially post chemo therapy. Therefore their resistance level to infections is very low. Infections can lead to shock and major organ damage)
5) Underlying medical conditions
6) Progression of cancer

In such cases patients generally require special care and are required to be kept in isolation and need intensive care and monitoring.

The chances of survival for cancer patients increase significantly if admitted to ICU in a timely manner. As of now, most hospitals have defined policies on whom they admit to ICU based on patient's chances of survival etc (http://jco.ascopubs.org/cgi/content/abstract/23/19/4406).

Our discussion with St. Judes Childrens Hospital (a leading pediatric cancer treatment and research facility in the US) established that cancer patients/children do not have specific ICU equipment needs, and they only need the basic equipment that would be needed in any other ICU. The reason being that ICUs are needed for cancer patients for general care, example treatment after surgery or as part of some other distress (repiratory failure, infections etc). The only thing that would differ was the size of the mask that is needed for children in the ICU.

According to St. Judes having an ICU onsite (versus transferring patients to other hospitals) improves the quality of care for patients, provides ease of access and lowers cost of care for patients.
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Minza Zahid



Joined: 06 Jan 2010
Last Visit: 09 Jan 2010
Posts: 2
Location: USA
PostPosted: Sat Jan 09, 2010 6:56 pm    Post subject: CCF - Management Discussion Reply with quote

This documents helps us establish that this project will result in cost savings in terms of what CCF has to pay to other hospital for daily rental of their ICUs. With an onsite ICU CCF can free up cash from there and utilise elsewhere.

The company is a profitable venture and will be able to sustain operations incase of any replacement costs.

Document Details:

Management:

BoD consists of businessmen who are all running successful businesses which include Air Freight, Leather Business etc.

A couple of these directors had their own children as cancer patients which lead to their joining this initiative.

Organization’s financial strength:

June End------------------2007-------2008-------2009
Revenue (PRs mn)-------34.22------44.49------55.74
Exp-------------------------31.90------33.72------54.98


Revenue sources: 60% Zakat (Collected in Ramadan), 20% donations, and 20% funded by patients themselves.

Upon questioning that if the organization was profitable especially in 2008 (11 mn profit), why exactly do they require funding for relatively such a small project?

Ans. Since most funds are received in Ramadan, the face a liquidity shortage between June and Sept/Oct (When Ramadan usually takes place).

Future Plans:

CCF is planning to expand its operations from its current capacity of 25 beds to 50 beds.

For this they are looking to buy land (40,000 sq feet) and then build on it as opposed to current rental premises.

Project cost is PRs 200 mn. Funding is being arranged with some commitments from donors already obtained.

Current Operating Structure:


Types of Patients ----------2005------2006------2007------2008------2009
New Patients-----------------200------222--------219--------228-------335
OPD---------------------------6536----7967------8086------8993------11223
Day Care--------------------3373-----5052------5915------6065------6081
Inpatients (Bed Occpnts.)--4016-----4524------5658------6146------8148


Types of diseases

Blood Cancer 30%
Germs 15%
Hutching 15%
All others 40%

Plan for ICU

Hired 3 new nurses and 2 doctors. Coverage will be around the clock with shifts of 8HRS with 1 nurse and 1 doc present all the time. During the day, the existing doctors will take over for 8 HRS.

No special certification required for nurses/ doctors to work in ICU. However, CCF has hired individuals who have at least one year experience of working in an ICU before.

Roughly speaking they shift about 2 patients a day to near by hospitals. Most are shifted to Ziauddin and Patel hospital, both of which are with in 3-4 km distance and takes only about 10-15 mins.

However, these places themselves are expensive as CCF has to pay between 15000-25000 per day to these hospitals and even then sometimes these hospitals are completely filled. CCF also does rationing in patients whereby they shift only those which are in most critical need. They currently have a temp ICU at their place with a monitor as well. They utilize it if they are not able to shift the patient.

On average each patient spends 2-3 days in ICU before recovery. Success rate is 80%.

Essentially, bottom line is that 1) there will be cost savings once the patient is treated in house and 2) As CCF has patients entire medical history with them, they would be able to treat the patient even more effectively as compared to other hospitals. They expect the success rate to go up to 90%.


Purchase of ICU Machines:

Want to purchase from ‘Noor International’ who is their vendor.

1 year warranty with all products.

Key concern remains electricity shortage in Pakistan which could impact the lifeline of these machines. Estimated lifeline is 2-3 years.
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