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PubMed1998

Hospital at home or acute hospital care? A cost minimisation analysis.

OBJECTIVE: To compare, from the viewpoints of the NHS and social services and of patients, the costs associated with early discharge to a hospital at home scheme and those associated with continued care in an acute hospital. DESIGN: Cost minimisation analysis. SETTING: Acute hospital wards and the community in the north of Bristol (population about 224 000). SUBJECTS: 241 hospitalised but medically stable elderly patients who fulfilled the criteria for early discharge to a hospital at home scheme and who consented to participate. MAIN OUTCOME MEASURES: Costs to the NHS, social services, and patients over the 3 months after randomisation. RESULTS: The mean cost for hospital at home patients over the 3 months was 2516 pounds, whereas that for hospital patients was 3292 pounds. Under all the assumptions used in the sensitivity analysis, the cost of hospital at home care was less than that of hospital care. Only when hospital costs were assumed to be less than 50% of those used in the initial analysis was the difference equivocal. CONCLUSIONS: The hospital at home scheme is less costly than care in the acute hospital. These results may be generalisable to schemes of similar size and scope, operating in a similar context of rising acute admissions.

Aged↗

PubMed1992

Hospital-physician integration: case studies of community hospitals.

Hospitals are attempting more meaningfully to involve physicians in management as one approach to increasing the efficiency and effectiveness of their operations. The purpose of this research was to explore the relationship between the structure of the medical staff organization, the extent to which physicians are integrated into hospital decision making and the hospital's financial performance. A measure of hospital-physician integration was developed based on Alexander et al's (1986) dimensions of hospital-physician integration which were based on Scott's (1982) organizational models, ie, autonomous, heteronomous and conjoint. A multiple case study design, which comprised eight community non-teaching hospitals over 200 beds located in the Province of Ontario, Canada, was used to examine the relationship between variables. Study results suggest that there is variation among community hospitals on both contextual and organization factors. Hospitals with high levels of hospital-physician integration were located in highly populated areas, had formulated and implemented a strategic plan, had highly structured medical staff organizations, and had no budgetary deficit. In contrast, hospitals with moderate or low levels of integration were more likely to be located in lowly populated areas, had little planning activity, had a moderately structured medical staff organization, and had deficit budgeting. Suggested areas for future research include examining the role of the Board of Trustees in determining physicians' organizational roles and identifying differences in commitments, characteristics, and motivations of physicians working in rural versus urban hospitals and their impact on integrative strategies.

Attitude of Health Personnel↗

PubMed1991

[Utilization of the National Hospital 1985-89. How many beds should there be in a new National Hospital?].

The Norwegian Parliament (Stortinget), has approved a proposal for construction of a new national hospital in Oslo. White Paper no. 38 (1987/88) proposes a hospital with 610 beds. The number of inpatient days at the present Rikshospitalet (The National Hospital) has declined by 19.4% during the period 1985 to 1989. In 1989 the use of inpatient services was equivalent to 530 beds with an occupancy rate of 80%. Based on an assumed further reduction in hospital use in the years to come, we estimate the need for beds to be 340 at the new national hospital. This lower number is assumed to cover local hospital functions (54 beds), regional hospital functions (220 beds) and national services (65 beds). The authors assert that the White Paper is based on outdated assumptions. The construction of a 610-bed national hospital involves a health care structure which could obstruct the reorganization of hospital care (more use of outpatient services) elsewhere in Norway. The County Councils responsible for financing hospitals will be forced to fund a hospital use that is motivated essentially by teaching and research rather than by caring for patients.

Bed Occupancy↗

PubMed2000

Services for reducing duration of hospital care for acute stroke patients.

BACKGROUND: Stroke patients conventionally receive a substantial part of their rehabilitation in hospital. Services have now been developed which offer patients in hospital an early discharge with community-based rehabilitation (early supported discharge, ESD). OBJECTIVES: The objective of this review is to establish the costs and effects of ESD services compared with conventional services. SEARCH STRATEGY: The Cochrane Stroke Group Specialised Register was searched and supplemented with information from individual trialists. Searching was completed in March 1999. SELECTION CRITERIA: Randomised controlled trials recruiting stroke patients in hospital to receive either conventional care or any intervention which has provided rehabilitation and support in a community setting with an aim of reducing the duration of hospital care. DATA COLLECTION AND ANALYSIS: Two reviewers scrutinised trials and categorised them on their eligibility. Standardised information was then obtained from the primary trialists. Results were analysed for all trials and for two subgroups depending on whether the intervention was provided by a coordinated multidisciplinary team (coordinated ESD team) or not. MAIN RESULTS: Outcome data are currently available for four trials. Patients tended to be a selected elderly group with disability. Overall, the odds ratio (95% confidence interval) for death, death or institutionalisation, death or dependency at the end of scheduled follow up were 0.87 (0.39-1.93), 0.69 (0.36-1.31) and 0.88 (0.49-1. 57) respectively. Apparent benefits more evident in the three trials evaluating a coordinated ESD team. The ESD group showed significant reductions (P<0.001) in the length of hospital stay equivalent to approximately nine days. REVIEWER'S CONCLUSIONS: ESD services provided for a selected group of stroke patients can reduce the length of hospital stay. However, the relative risks and benefits and overall costs of such services remain unclear.

Home Care Services↗

PubMed2000

Bacteraemia caused by hospital-type micro-organisms during hospital stay.

A sharp transition between community-type and hospital-type pathogens at the second or third day of hospital stay is often assumed. This study aimed to test whether such a threshold phenomenon exists for bloodstream infections and to examine the relationship between the proportion of infections caused by hospital-type pathogens and length of stay in the hospital. Blood stream infections were studied in a referral and a university hospital in west Denmark, and a university hospital in central Israel during three study periods (1994-1996, 1992-1995, 1989-1995 in the three hospitals respectively). No threshold effect at 2-3 days stay in the hospital could be demonstrated. However the percentage of Pseudomonas aeruginosa bloodstream infections increased constantly in the three hospitals from 1%, 1% and 7% during the first 2 days to 7%, 4%, and 14% during the third week of hospital stay (P<0.01 for all three comparisons-chi(2)for linear trends). For Candida sp. the increase was from 0%, 2%, 1% during the first 2 days to 3%, 4%, and 9% during the third week, P<0.05. Methicillin-resistant Staphylococcus aureus in Israel increased from 26% of the total number of S. aureus during the first 2 days to 69% during the third week, P<0.0001. For penicillin-resistant S. aureus in Denmark, the percentages were 84% and 100%, P<0.05.The percentage of infections caused by hospital-type pathogens increased almost linearly during the first 3 weeks of hospital stay, with no threshold effect. This trend should be taken into account when prescribing empirical therapy for nosocomial infections.

Bacteremia↗

PubMed2006

Care of hospitalized older patients: opportunities for hospital-based physicians.

BACKGROUND: Half of patients admitted to hospital for reasons unrelated to childbirth are age 65 years or older. Nonetheless, few hospital-based physicians have received training in geriatric medicine, and few geriatricians practice in the hospital. This paper describes the state of the science of hospital care for older patients, and identifies opportunities and barriers to improving their care. METHODS: General medical journals from 1980 to the present were selectively reviewed to identify original articles on the treatment of specific diseases and syndromes on hospitalized persons age 65 years or older. Information was synthesized to describe the course of these patients during and after hospitalization, and to identify effective management strategies and gaps in knowledge. RESULTS: Older persons in hospitals pose substantial clinical challenges: they have high rates of cognitive impairment, delirium, disability, and difficulty walking, and they often require increased attention, longer lengths of stay, and higher hospital costs than younger patients with the same diagnoses. Disease-specific interventions have not been studied extensively in those older than 75 years. Multicomponent interventions can reduce short-term rates of disability and delirium without increasing costs, but they have not been widely disseminated. Interventions to treat or prevent other common conditions in hospitalized older patients have not been proven effective. CONCLUSIONS: Fundamental discoveries in the science of hospital medicine are needed to prevent or treat geriatric syndromes, to treat common diseases in the very old, and to put into practice what is known. Hospital-based physicians can address these gaps in knowledge and practice with geriatricians, building from their shared perspectives on the care of the aged in complex health systems.

Aged↗

PubMed1989

Patterns and correlates of psychiatric hospitalization in a nationwide sample. I. Patterns of hospitalization with special reference to the "new chronic" patients.

A nationwide random sample of psychiatric patients (n = 832) admitted for hospitalization in Israel in 1980 was followed up until the end of 1984 regarding their hospitalization patterns. Information about hospitalizations as well as demographic and diagnostic data were obtained from the Israel Central Psychiatric Case Register. Two main contrasting patterns of hospitalization emerged. One pattern consisted of a single short hospitalization during the entire follow-up period. This pattern was found among more than 50% of those patients for whom this hospitalization was the first in their life. The second pattern characterized the patients who accumulated long periods of inpatient stay, that is, at least one year during the follow-up period. These are the "new chronic" patients (about 30% of the total sample). About one third of these "new chronic" patients (8.2% of the total sample) accumulated their long stay through one continuous hospitalization, thus resembling the "old chronic" patients; two-thirds accumulated their long stay over several hospitalizations. Each patient has a fairly constant pattern of hospitalization, regarding the length of stay in hospital and out of hospital.

Chronic Disease↗

PubMed2004

Recent and temporal trends (1975 to 1999) in the treatment, hospital, and long-term outcomes of Hispanic and non-Hispanic white patients hospitalized with acute myocardial infarction: a population-based perspective.

BACKGROUND: Extremely limited population-based data are available describing recent and temporal trends in the characteristics, treatment, and outcomes of Hispanic and non-Hispanic white patients hospitalized with acute myocardial infarction (AMI). METHODS: This was a community-based, observational study of 9649 greater Worcester residents hospitalized in all hospitals serving the Worcester, Massachusetts, metropolitan area in 12 one-year periods between 1975 and 1999. In the total study sample, 171 (2%) patients were Hispanic. Hispanic patients were matched with 395 non-Hispanic white patients on the basis of age, sex, and year of hospitalization. RESULTS: Hispanics were more likely to present to greater Worcester hospitals with a history of diabetes as compared with non-Hispanic whites. Hispanics were less likely to have an initial, Q-wave AMI during the index hospitalization. After controlling for a limited number of known potentially confounding factors, Hispanics were at lower risk for development of heart failure (OR, 0.63; 95% CI, 0.41, 0.96). Both Hispanics (13% vs 11%) and non-Hispanic whites (28% vs 9%), however, had declines in hospital case-fatality rates between 1975 and 1999. An overall similar treatment pattern and increasing trends in the use of effective cardiac medications over time were observed in both patient groups. However, Hispanics were significantly less likely to be treated with coronary angioplasty during the acute hospitalization. Trends of a worse long-term survival for discharged Hispanic patients were observed over a 10-year follow-up period. CONCLUSIONS: The results of this community-wide study suggest encouraging hospital outcomes in Hispanic and non-Hispanic white patients hospitalized with AMI. Enhanced secondary prevention efforts remain needed to improve the hospital and long-term outcomes of patients with AMI, irrespective of race or ethnicity.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Increased hospital expenditures in diabetic patients hospitalized for cardiovascular diseases.

OBJECTIVES: To measure the impact of diabetes on hospital resource use and expenditures in patients hospitalized for cardiovascular diseases (CVD). RESEARCH DESIGN AND METHODS: We conducted an observational study of 4865 hospitalizations for CVD over 2 years (January 1998 to December 1999). Information with respect of the presence of diabetes mellitus, length of stay, readmissions, mortality, and costs were obtained through retrospective chart review. RESULTS: Diabetic patients accounted for 35.1% of hospital admissions (1706 admissions), 40.8% of hospital stays (23,309 days), and 39% of direct medical cost (5,735,884 euros). On average, diabetic patients had longer hospital stay (13.6+/-13.2 vs. 10.7+/-11.2 days; P<.001) and direct in-patient cost (3438+/-4308 vs. 2513+/-3384 euros; P<.001) and experienced more readmissions (relative risk: 1.67; 95% CI: 1.45-1.91) compared with nondiabetic patients. However, despite the hospital mortality rate being higher in nondiabetic patients (6.3% vs. 5.8%), these results were not statistically significant (relative risk: 1.09; 95% CI: 0.86-1.40). CONCLUSIONS: Diabetic patients hospitalized for CVD have longer hospital stay, greater risk of short-term readmission, and are more costly than nondiabetic patients. However, in-hospital mortality risk in patients hospitalized by CVD is no greater in diabetic than in nondiabetics.

Aged↗

PubMed1998

Factors associated with pre-hospital and in-hospital delay time in acute myocardial infarction: a 6-year experience.

OBJECTIVES: To explore factors associated with delay time prior to hospital admission and in hospital amongst acute myocardial infarction (AMI) patients with particular emphasis on the delay time to the administration of thrombolytic therapy. METHODS: During a 6-year period we prospectively computerized pre-hospital and in-hospital time intervals for AMI patients admitted to the coronary care unit (CCU) direct from the emergency department (ED) or via paramedics, at Sahlgrenska Hospital, Göteborg, Sweden. RESULTS: Pre-hospital delay: independent predictors of a prolonged delay were increased age (P = 0.0007), female sex (P = 0.02) and a history of hypertension (P = 0.03). For AMI patients who received thrombolytic treatment and the only independent predictor of a prolonged delay was increased age (P = 0.005). In-hospital delay: for all AMI patients independent predictors of a prolonged delay were prolonged pre-hospital delay (P < 0.0001), increased age (P = 0.03) and a history of angina (P = 0.002), hypertension (P = 0.01) and diabetes (P = 0.01). For thrombolytic treated AMI patients independent predictors of a prolonged delay were prolonged pre-hospital delay (P < 0.0001), female sex (P = 0.02) and a history of diabetes (P = 0.02). CONCLUSION: Risk factors for both pre-hospital and hospital delay time could in AMI be defined although slightly different. Two factors appeared for both, i.e. increasing age and a history of hypertension.

Aged↗

PubMed2000

In-hospital mortality after transurethral resection of the prostate in Victorian public hospitals.

BACKGROUND: The purpose of the present paper was (i) to identify trends in in-hospital mortality after transurethral resection of the prostate (TURP) in Victorian public hospitals; and (ii) to explore associations between in-hospital mortality after TURP and age, adverse events, type of admission (emergency/planned), location of the hospital (metropolitan/rural), teaching status of the hospital and length of stay. METHODS: Trends in in-hospital mortality after TURP and the associations between in-hospital mortality and the aforementioned variables were studied using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) coded Victorian hospital morbidity data from public hospitals between 1987-88 and 1994-95. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) were based on univariate and multivariate logistic regression, respectively. RESULTS: After adjustment for age, comorbidity, and other confounding variables, the trend in mortality reduction over time was highly significant (P for trend < 0.0001, 95% CI for trend: 0.84-0.95). Highly significant associations with mortality were observed for emergency admissions (OR = 1.99, P < 0.0001), presence of adverse events (OR = 2.69, P < 0.0001), length of hospital stay (P for trend < 0.0001, 95% for trend: 1.88-2.15) and age (P for trend < 0.0001; 95% CI for trend: 1.26-1.48). CONCLUSIONS: Routinely collected data from hospitals can provide tentative evidence of improved effectiveness of a surgical treatment, provided analysis takes careful account of potential sources of bias, especially those related to possible changes in case selection over time. These kinds of data should stimulate a joint effort between clinicians, quality assurance experts and epidemiologists to confirm this attribution, and to locate the causative factors.

Adult↗

PubMed1998

Is the general practitioner hospital a potential "patient trap"? A panel study of emergency cases transferred to higher level hospitals.

OBJECTIVES: 1. To find out whether a stay in local general practitioner hospitals (GP hospitals) prior to an emergency admission to higher level hospitals aggravated or prolonged the course of the disease, or contributed to permanent health loss for some patients. 2. To detect cases where a transitory stay in a GP hospital might have been favourable. DESIGN: A retrospective expert panel study based on records from GP hospitals and general hospitals. The included patients had participated in a previous prospective study of consecutive admissions to GP hospitals during 8 weeks. SETTING: Fifteen out of 16 GP hospitals in Finnmark county, Norway. SUBJECTS: Seventy-three patients transferred to higher level hospitals from a total of 395 admitted to GP hospitals. MAIN OUTCOME MEASURES: Three outcome categories were considered for each patient: "possible permanent health loss", "possible significantly prolonged or aggravated disease course", and "possible favourable effect on the disease course". RESULTS: There was agreement about the possibility of negative effects in two patients (2.7%), while a possible favourable influence was ascribed to six cases (8.2%). CONCLUSION: Negative health effects due to transitory stays in GP hospitals are uncommon and moderate, and balanced by benefits, particularly with regard to early access to life saving treatment for critically ill patients.

Adolescent↗

PubMedDate not supplied

Hospital assessments of children with learning problems: perspectives from special education administrators and hospital evaluators.

BACKGROUND: The schooling of 1 of every 8 children is influenced by the Individuals with Disabilities Education Act (IDEA). The IDEA also governs, to a degree, the relationship between interdisciplinary hospital clinics that evaluate many of these children and the schools that provide educational services. Little is known about how this relationship functions or how educational personnel perceive reports from hospital settings. OBJECTIVES: To describe special education administrator and hospital evaluator perspectives on hospital assessments of children with learning problems. METHODS: A survey of attendees at a 1998 meeting of the Massachusetts Association of Special Education Administrators was conducted by use of a questionnaire using closed and open-ended questions. Subsequently, focus groups were held with hospital evaluators. RESULTS: Special education administrators describe a high level of frustration with hospital-school relations. They state that hospital reports do not meet the needs of children in the educational setting. They seek closer collaboration with medical evaluators. Evaluators working in hospital settings acknowledge frustration perceived by school personnel. They state that communication with educational personnel improves the quality of their reports and outcomes for the child. CONCLUSIONS: Hospital assessments of children with learning problems are associated with high levels of frustration among special education administrators. These assessments might be made more useful if careful attention were paid to the needs of educators. Greater communication between hospital evaluators and school personnel may increase the usefulness of hospital clinic assessments of children with learning problems.

Attitude to Health↗

PubMed2000

Pleural effusion and pneumothorax in hospitalized patients with HIV infection: the Pulmonary Complications, ICU support, and Prognostic Factors of Hospitalized Patients with HIV (PIP) Study.

OBJECTIVES: To describe the incidence, causes, and impact of pleural effusion and pneumothorax in hospitalized patients with HIV infection. DESIGN: Prospective, observational. SETTING: A university-affiliated medical center. METHODS: During a 3-year period, 599 HIV-infected patients with a total of 1,225 consecutive hospital admissions were followed. A total of 1,097 hospital admissions were included. Patients' medical records, chest radiographs, and computerized laboratory values were reviewed. RESULTS: Pleural effusions developed in 160 hospital admissions (14. 6%). The effusions were right sided (56%), left sided (29%), and bilateral (15%). Their sizes were small (65%), moderate (23%), large (9%), and massive (4%). The associated conditions were infectious: bacterial pneumonia (n = 50), pulmonary tuberculosis (n = 10), Pneumocystis carinii pneumonia (PCP; n = 5), and empyema (n = 2); and noninfectious: renal failure (n = 15), hypoalbuminemia (n = 12), malignancy (n = 9), pancreatitis (n = 7), hepatic cirrhosis (n = 5), congestive heart failure (n = 4), atelectasis (n = 3), pulmonary embolism (n = 3), trauma (n = 1), and surgery (n = 1). Pneumothorax developed in 13 hospital admissions (1.2%). The conditions associated with pneumothorax were iatrogenic (n = 4), bacterial pneumonia (n = 3), PCP (n = 2), positive pressure ventilation for PCP (n = 2), pulmonary Mycobacterium avium complex (n = 1), and trauma (n = 1). The in-hospital mortality of hospital admissions with pleural effusion was 10.0% compared to 5.4% of those without pleural effusion (p = 0.0407). The in-hospital mortality of hospital admissions with pneumothorax was 30.8% compared to 5.8% of those without pneumothorax (p = 0.0060). CONCLUSIONS: Pleural effusions occur in 14.6% of hospital admissions in our patient population with HIV infection. Bacterial pneumonia is the condition most commonly associated with pleural effusion. Pneumothorax, seen in 1.2% of hospital admissions with HIV infection, is associated with poor outcome.

Academic Medical Centers↗

PubMed1999

Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy.

BACKGROUND: Reports of better results at national referral centers than at low-volume community hospitals have prompted calls for regionalizing pancreaticoduodenectomy (the Whipple procedure). We examined the relationship between hospital volume and mortality with this procedure across all US hospitals. METHODS: Using information from the Medicare claims database, we performed a national cohort study of 7229 Medicare patients more than 65 years old undergoing pancreaticoduodenectomy between 1992 and 1995. We divided the study population into approximate quartiles according to the hospital's average annual volume of pancreaticoduodenectomies in Medicare patients: very low (< 1/y), low (1-2/y), medium (2-5/y), and high (5+/y). Using multivariate logistic regression to account for potentially confounding patient characteristics, we examined the association between institutional volume and in-hospital mortality, our primary outcome measure. RESULTS: More than 50% of Medicare patients a undergoing pancreaticoduodenectomy received care at hospitals performing fewer than 2 such procedures per year. In-hospital mortality rates at these low- and very-low-volume hospitals were 3- to 4-fold higher than at high-volume hospitals (12% and 16%, respectively, vs 4%, P < .001). Within the high-volume quartile, the 10 hospitals with the nation's highest volumes had lower mortality rates than the remaining high-volume centers (2.1% vs 6.2%, P < .01). The strong association between institutional volume and mortality could not be attributed to patient case-mix differences or referral bias. CONCLUSIONS: Although volume-outcome relationships have been reported for many complex surgical procedures, hospital experience is particularly important with pancreaticoduodenectomy. Patients considering this procedure should be given the option of care at a high-volume referral center.

Aged↗

PubMed1989

NAPPH (National Association of Private Psychiatric Hospitals) statement of principles of psychiatric hospital practice ethics.

A competitive and dynamic healthcare environment requires that psychiatric hospital administrators and physicians continually monitor their hospital's ability to deliver quality services to their patients. To ensure that hospitals stand for and abide by psychiatric hospital practice ethics, the National Association of Private Psychiatric Hospitals (NAPPH) Board of Trustees has formally approved and distributed to the industry a "Statement of Principles of Psychiatric Hospital Practice Ethics." Adopted at the June 22, 1989, Board meeting, the guidelines not only summarize views long held in the industry, but are a condition of NAPPH membership. Nine critical areas are identified in the NAPPH statement: admissions, advertising, marketing and referral development, resource allocation and appropriateness of care, treatment rendered, patients' rights, family rights and involvement, competition, and financial resources. Central to ethical hospital practice is a moral responsibility--shared among administrators, trustees, physicians and staff--to ensure access to care, quality of care, and fair treatment of patients. NAPPH represents more than 300 private psychiatric hospitals throughout the United States, and the NAPPH mission includes the promotion of high-quality care and treatment, efficient hospital operation, and advocacy for the patients served by its member hospitals. Each NAPPH hospital actively supports the appropriate, safe, and compassionate treatment of the mentally ill.

Ethics↗

PubMed1985

The relationship of hospital ownership and service composition to hospital charges.

The relationship of hospital ownership and service composition to hospital charges was examined for 456 general acute hospitals in California. Ancillary services had higher profit margins, both gross and net profits, than daily hospital services. Ancillary services accounted for 55.3 percent of total patient revenue. Charges per day were 23 percent higher for ancillary services than for daily hospital services. Net profits for daily and ancillary services were lowest at county hospitals. Proprietary hospitals had the highest net profits for total ancillary services and the highest mean charges. Not-for-profit hospitals had the highest profit margins for daily hospital services. Neither direct nor total costs for ancillary services were significantly different among ownership groups, although direct costs for daily hospital services were significantly higher at proprietary hospitals.

Analysis of Variance↗

PubMed2005

Hospital waste management in the teaching hospitals of Karachi.

OBJECTIVE: To evaluate the current practices of segregation approaches, storage arrangements, collection and disposal systems in the teaching hospitals of Karachi. METHODS: A cross-sectional survey was conducted in eight teaching hospitals of Karachi, using convenient sampling technique. The instrument of research was a self administered questionnaire, with four sections, relating to the general information of the institution, administrative information, information regarding Health Waste Management personnel and a check-list of Hospital Waste Management activities. RESULTS: Out of eight hospitals visited 2 (25%) were segregating sharps, pathological waste, chemical, infectious, pharmaceutical and pressurized containers at source. For handling potentially dangerous waste, two (25%) hospitals provided essential protective gears to its waste handlers. Only one (12.5%) hospital arranged training sessions for its waste handling staff regularly. Five (62.5%) hospitals had storage areas but mostly it was not protected from access of scavengers. Five (62.5%) hospitals disposed off their hazardous waste by burning in incinerators, two (25%) disposed off by municipal landfills and one (12.5%) was burning waste in open air without any specific treatment. No record of waste was generally maintained. Only two (25%) hospitals had well documented guidelines for waste management and a proper waste management team. CONCLUSION: There should be proper training and management regarding awareness and practices of waste disposal. Research must be undertaken to seal existing gaps in the knowledge about hospital waste management. The hospital waste management guidelines enacted on 7th June 2004 should be followed and regulated by law enforcement agencies rigorously.

Awareness↗