Search

Organisational competitive procurement environment positively impacts prices while supply side factors also determine participation in bidding. With strong competition costs come down. Instances of low competition in equipment purchase in the apex tertiary care hospital led to this study aimed at determining procurement practices, competition in procurement and its determinants. Review of tender records for three financial years (2011-2014) was conducted to ascertain procurement practices and resulting competition. Sellers' perspective on factors determining participation was captured through a questionnaire. Although four bids per tender were received only two qualified technically emphasising need for broad based specifications. Both sellers and peer staff also feel that specifications are not broad based. Regression analysis showed that one unit increase in bid led to six per cent price reduction. Increase in number of equipment led to an increase in the number of bids received but no price decrease. Pre-bid meetings have no effect on the price offered. Quality of tender document and feasible demonstration are modifiable bidding factors. Procuring agencies need to be transparent to reflect an organisationally supported competitive environment. The future research directions are interventional studies on specifications, pre-bid meetings and increasing transparency.

Aim Healthcare infrastructure projects are a requirement for the progress of the country. The aim of this study was to identify major completed healthcare infrastructure projects in a tertiary teaching hospital in Northern India and to find out the various factors that influenced the success or failures and the cost and time overrun during the project implementation. Materials and methods Periodical review meetings were conducted, right from the planning to the execution and commissioning of these projects. All these had been documented as minutes of the meetings, and the records of the same had been maintained. The study comprised of studying all these documents in detail and finding an answer to the research questions. Results Four major completed projects of a tertiary medical institute of India, All India Institute of Medical Sciences (AIIMS), New Delhi, India, were studied. These were the new Outpatient Department (OPD) Block, Burns and Plastic Surgery Block (BPS), Maternal and Child Health Block (MCH), and National Cancer Institute (NCI). Our study revealed that there was no dearth of funds, and hence, there was no cost overrun in any of the projects. Whenever the funds had to be reworked, the funds that were asked for were released. However, there was a considerable time overrun in all the projects ranging from about one to four years. The various reasons that could be attributed to this are the delay in obtaining statutory clearances, political interference, communication hurdles, improper planning, introducing a project officer late into the project, safety concerns, and the COVID-19 pandemic. Conclusions This study focuses mainly on the very important hurdles that were faced during the implementation of the projects and tries to suggest an average time frame for various activities for project implementation in a healthcare project in the Indian scenario. This can be taken as blueprints while planning newer healthcare projects of this magnitude.

A study was done to create and run a discrete event simulation in the outpatient department (OPD) of a tertiary care cancer hospital in North India to project and optimize resource deployment.The OPD processworkflow as per the expected load at tertiary care cancer hospital were finalized with various stakeholders in a focused group discussion. The finalized OPD processworkflow along with the OPD Building plans were utilized to develop a discrete event simulation model for the OPD at a tertiary care cancer hospital using a discrete event simulator. The simulation model thus developed was tested with incremental patient loads in 5 different scenarios/"What if" situations (Scenario 1-5). The data regarding initial patient load and resources deployed was taken from on-ground observations at the tertiary care cancer hospital.It was found that rooms and doctors were over-utilized and support staff utilization remained low. This was implemented with a lesser waiting time for patients. No additional support staff was provided thus improving utilization of existing staff and saving on resources. The simulations enabled us to deploy resources just when it was required, which ensured optimal utilization and better efficiency. The peak census helped us to determine the capacity of the waiting area in different scenarios with incremental patient load and resource deployment.The simulation software was very helpful, as "what if scenarios" could be created and the system tested, without disturbing the normal functioning of OPD. This enabled decision-making before making on-ground changes which saved a lot of time and money. Also, the processes of the old system were reengineered to fit the needs of changing times.

Background Staffing ratios based on hospital beds and norms do not adequately address the requirement of infection preventionists (IP) in hospitals. We, therefore, aimed to determine staffing of IP (nursing category) based on actual workload involved. Methods The study design was quantitative and longitudinal conducted for 1 year. The study was structured around the steps of the World Health Organization's Workload Indicators of Staffing Need (WISN). Results We identified infection control activities, support activities and additional activities to be performed by 4 IP with a total available working time of 6,132 hours for an annual workload of 6,238.25 (±372) hours in an acute care hospital with 182 beds and 69,331 annual admissions. Core infection control activities consumed 78% time. Support and additional activities consumed the remaining 22% time. Active surveillance required 44% time and education consumed 32% time. WISN ratio of available staff and required staff was 0.75. Discussion A WISN ratio less than 1 suggests inadequate staffing. Therefore, the WISN method recommends 4 IP instead of 3 based on existing workload. We compared our results with the existing quantification-based staffing studies. Conclusions WISN is a valuable method to measure all infection control activities and translate workload into IP (nursing) full time equivalents.

Background: Maintenance is the core function of biomedical engineering and is essential for the optimum functioning of equipment. This study was undertaken to understand the current maintenance practices of ventilator and its cost implications from administrative point of view. Methodology: 179 Ventilators supplied and installed by one vendor in different wards of the hospital were studied. It was a retrospective, descriptive study. Equipment related data was taken from various service reports. This data was used to calculate spares failure and their costs implication. Results: A total of 692 maintenance visits were undertaken for 179 ventilators of 5 different modals over 27 months by 6 Bio- Medical Engineers (BME). The mean number of spare changed throughout the study was 2.73. The uptime was within satisfactory limits. The yearly repair to cost ratio was 3.50 %. The cost of spare changed was a factor of modal under consideration and the status of equipment concerning its coverage under maintenance contact. Conclusion: The findings of the study should enable researchers in the future to formulate an effective equipment maintenance policy for the hospital.

The study aimed to analyse the utilization of the operation theatres at a tertiary care teaching hospital. An observational study with time monitoring of various processes was carried out from January to December 2016 in the OT complex of a public sector tertiary care hospital. OT complex comprised of 12 operating rooms and all the elective OTs (11) were included in the study except the emergency OT. One OT for a full day per week was observed. Selection of operation theatre and weekday for data collection was done using simple random sampling without replacement using chit system. OTs were observed for 26 days spread over a period of 6 months with resource hours of 15,000 min (250 h). A total of 129 (69.34%) surgeries out of 186 scheduled surgeries were conducted with an average of 4.61 surgeries per day and an observed cancellation rate of 30.66%. Overall raw utilization of OT was observed to be 99.29%, while overall adjusted utilization was 128.53% with an idle time of 0.81% only. Total time spent on “anaesthesia preparation” was 1624 min (8.42%), “surgical preparation time” was 1930 min (10.01%), “actual surgery time” was 9554 min (49.56%), “room set-up and room clean-up time” was 4441 min (23.04%), “surgery finish and anaesthesia finish time” was 574 min (2.98%) and “turn over time” was 1000 min (5.19%). The operation theatres are being optimally utilized, however, an effort should be made to make the ancillary processes (room set up and clean up) more efficient.

Introduction: Radio diagnosis service plays a crucial role in diagnosis of the patient’s disease. The volumeof patients utilising this service is very high. This service also takes away the sizeable share of total capitalinvestment and therefore, the optimal utilization of this service becomes important.Methodology: Literature review was done through Google scholar, electronic database of PubMed andother relevant databases. The query terms like Utilization Review of Imaging Equipment, Utilisation of CTScanners, Capacity of Scanners in Radiology and Waiting Times for Imaging were used to fetch the relevantdata sources. Around 130 articles were reviewed and analysed.Results: The number of CT Scans per 1 million of population in High Income (HI), Upper Middle Income(UMI), Lower Middle Income (LMI) are 14.7, 7.3, 3.7. The CT scanners are one of the most expensivepieces of medical equipment in hospitals, with CT scanners costing between $1 million (?7 crore) and $2million (?14 crore).There is a substantial variation in the utilisation of these services, including number of scans per day andwait times. Increasing the scanner efficiency and utilisationcan significantly decrease the cost per scan andincrease access to imaging services.Expanding capacity, improving operating procedures by reducing change-over times, and improvingcapacity allocation in combination with scheduling procedures can contribute to the overall reduction of CTaccess time.Discussion and Conclusion: By acquiring Utilization data about CT Scanners, we get to know a completeand accurate overview of how Scanners are used. The CT scanner utilisation can be improved in both publicand private health sector by analysingthe key information about the utilisation of their own and other healthservices’ CT scanners.

BackgroundHealthcare is growing more complex with mandate expanding from the primary function of providing care to include economic, legislative and social conditions that has led to the rise of numerous ancillary services. These have necessitated multiple new processes and systems which are closely intertwined. A study was done to create and run a discrete event simulation in OPD of a tertiary care cancer hospital of North India to project and optimize resource deployment.MethodsThe OPD process & workflow as per the expected load at tertiary care cancer hospital were finalized with various stakeholders in a focused group discussion. The finalized OPD process & workflow along with the OPD Building plans were utilized to develop a discrete event simulation model for the OPD at tertiary care cancer hospital using a DES. The simulation model thus developed was tested with incremental patient loads in 5 different scenarios/ “What if” situations (Scenario 1-5). The data regarding initial patient load and resources deployed was taken from on ground observations at tertiary care cancer hospital. ResultsIt was found that rooms and doctors were over-utilized and support staff utilization remained low. This was implemented with lesser waiting time for patients. No additional support staff was provided thus improving utilization of existing staff and saving on resources. The simulations enabled us to deploy resources just when it was required, which ensured optimal utilization and better efficiency. The peak census helped us to determine the capacity of the waiting area in different scenarios with incremental patient load and resource deployment.Conclusion The Simulation software was very helpful, as “what if scenarios” could be created and the system tested, without disturbing the normal functioning of OPD. This enabled decision making before making on ground changes which saved lot of time and money.

Hospital Supportive Services complement the clinical services in any setting. They have a crucial role in mitigation of infection and delivery of safe care to the patients. The spectrum of hospital supportive services encompasses linen & laundry, dietary, Central Sterile Supply Department (CSSD), transport hospital stores, mortuary and engineering services. Each of these services has a significant role to help abort the ‘chain of transmission’ of COVID-19 infection across various patient care areas in the hospital, while providing them supportive services. The overall patient satisfaction greatly depends on the quality of hospital supportive services rendered to him during his stay. These Services usually work at the back end but their contribution in the overall care of a patient is no where less than that of the clinical services.

Background: Hospital fires are real dangers and have historically caused life and property damages. A review of major research databases like Scopus, IEEE Xplore Digital Library, IET site, PubMed, Cochrane library and ASCE Library was conducted to explore fire safety challenges faced by existing hospitals and possible recommendations made thereof to overcome such challenges. Methods: The review was conducted for key words- “Fire safety”, “Hospital Fire”, “Fire risk” and “Fire safety challenges”. The search found 684 articles in total which were screened for relevance to research area and 27 articles were reviewed in detail. Findings: There is poor enforcement of law by agencies. Retrofitting for conformance to fire safety regulations is difficult. Issue like faulty equipment, improperly kept inflammable material, evacuation difficulties due to higher acuity of patients, operational issues like maintenance of all fire safety equipment and installations, and training of staff, etc. are highlighted. Conclusion: Focussed interventions and an all-encompassing fire safety risk management plan is the need of the hour. Significant insights into critical issue of fire safety is of immense benefit to healthcare professionals as a basis to make hospitals safe places.

IntroductionEffective implementation of standard precautions specific to COVID-19 is a challenge for hospitals within the existing constraints of time and resources.AimTo rapidly design and operationalise personal protective equipment (PPE) donning and doffing areas required for a COVID-19 care facility.MethodsLiterature review was done to identify all issues pertaining to donning and doffing in terms of Donabedian’s structure, process and outcome. Training on donning and doffing was given to hospital staff. Donning and doffing mock drills were held. 5S was used as a tool to set up donning and doffing areas. Instances of donning and doffing were observed for protocol deviations and errors. Plan–do–study–act cycles were conducted every alternate day for 4 weeks. The initiative was reported using Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines.ResultsBest practices in donning and doffing were described. Our study recommends a minimum area of 16 m2 each for donning and doffing rooms. Verbally assisted doffing was found most useful than visual prompts.DiscussionChallenges included sustaining the structure and process of donning and doffing, varied supplies of PPE which altered sequencing of donning and/or doffing, and training non-healthcare workers such as plumbers, electricians and drivers who were required during emergencies in the facility.ConclusionOur study used evidence-based literature and quality improvement (QI) tools to design and operationalise donning and doffing areas with focus on people, task and environment. Our QI will enable healthcare facilities to rapidly prototype donning and doffing areas in a systematic way.

BackgroundIndian healthcare is rapidly growing and needs efficiency more than ever, which can be achieved by leveraging healthcare analytics. National Digital Health Mission has set the stage for digital health and getting the right direction from the very beginning is important. The current study was, therefore, undertaken to find what it takes for an apex tertiary care teaching hospital to leverage healthcare analytics.AimTo study the existing Hospital Information System (HIS) at AIIMS, New Delhi and assess the preparedness to leverage healthcare analytics.MethodologyA three-pronged approach was used. First, concurrent review and detailed mapping of all running applications was done based on nine parameters by a multidisciplinary team of experts. Second, capability of the current HIS to measure specific management related KPIs was evaluated. Third, user perspective was obtained from 750 participants from all cadres of healthcare workers, using a validated questionnaire based on Delone and McLean model.ResultsInteroperability issues between applications running within the same institute, impaired informational continuity with limited device interface and automation were found on concurrent review. HIS was capturing data to measure only 9 out of 33 management KPIs. User perspective on information quality was very poor which was found to be due to poor system quality of HIS, though some functions were reportedly well supported by the HIS.ConclusionIt is important for hospitals to first evaluate and strengthen their data generation systems/HIS. The three-pronged approach used in this study provides a template for other hospitals.

Introduction: This research aimed to study the outcome of patient care being rendered in Paediatric Intensive Care Unit (PICU) of an apex public sector teaching hospital of North India.Material and methods: A descriptive and observational study was carried out in PICU. Medical records of all admitted patients from January to June 2011 were analysed. Demographic, morbidity and mortality parameters were studied. PIM II score was calculated to assess the severity of illness.Results: In PICU, from January to June 2011, 110 patients were admitted. Almost equal number of patients got admitted in PICU through emergency ward/casualty and other inpatient areas. Of the total patients, 66% (62) were male. Mean age of the patients admitted to PICU was 4.56 years. Three fourth patients admitted in PICU required mechanical ventilation and 652 days of mechanical ventilation was given. Patient’s required mechanical ventilation on an average of 7.01 days. Almost one third, [36.61% (21)] patients were reintubated. Majority (78.7%) of the patients required oxygen support, while 72.3% (68) required vasopressor support. Prevalence of bed sore rate was 2.1%. Only 2.1% patients required readmission within 72 hours. Mean hospital and PICU length of stay was 16.82 and 8.7 days respectively. Mean PIM 2 score of patients was 14.13% (range 0.2% to 86.9%).Conclusion: 43.6% of patients died in PICU, while hospital mortality in PICU admitted patients was 47.2%. Sepsis with septic shock was the major cause of mortality followed by pulmonary haemorrhage, disseminated intravascular coagulation. Standardised mortality was calculated to be 3.09.

Background Cancellation of surgeries is a regular phenomenon in any hospital, and reasons may vary from clinical to managerial ones. The aim of the study is to suggest scheduling to address the problem of time over run related cancellations. This is an observational and descriptive study conducted in a tertiary care hospital with ophthalmology facilities. The sample size is calculated with 95% confidence interval using Epi Info 6 from the total surgeries performed in the last 5 years (n = 380). Simple random sampling technique was used. Methods Surgical time for all types of ophthalmic surgeries (n = 582) was observed. Allocation of listed cases to the available operating rooms (ORs) was carried out using the observed time using LEKIN software. Results The time over-run of 2 h and 6 h was noted for two units, whereas idle OR time was observed in other units. An average idle time of 19% was noted on each day. Reallocation of the cases to the ORs was carried out taking all the planned cases (of both the operating units of the day) as the number of jobs and all the available ORs as parallel machines using LEKIN software. All the planned cases could be accommodated; still, an average of 17% of the total available operation theater (OT) time was found idle on each day. Conclusions Planning of cases using procedure time and scheduling on a daily basis using allocation models with simple algorithms can provide optimal utilization of OTs and can address the time over-run and related cancellations.

Background: Cleanliness is one of the main reasons for poor satisfaction among the patients and their attendants visiting healthcare facilities. Objective: To elevate and transform the sanitation in public sector facilities, a committee was constituted by Ministry of Health and Family Welfare, Government of India to study the existing system of Housekeeping in Central Government Hospitals and draft the Guidelines for house-keeping services, since no such literature is available in context of the healthcare facilities in India. Methods: The committee ascertained the housekeeping services in three tertiary care hospitals of Central Government and simultaneously conducted the literature review of the best practices in hospital sanitation and housekeeping. Results: Formulated national guidelines focus on various aspects of sanitation services in health facilities, i.e., hospital infrastructure; organization of sanitation services; human resource requirements; qualification, experience and training needs of sanitation staff; roles and responsibilities of different personnel; risk categorization of hospital areas; mechanized cleaning; cleaning agents; cleaning standards and standard operating procedures; effective supervision and monitoring; procurement of these services, etc. Conclusion: Formulated guidelines can be adopted by developing countries aiming for standardizing cleaning practices in public health facilities.

Background & objectives: Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India.Methods: This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. Results: The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ' 2,04,787 (US$ 3,413) and ' 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ' 1,48,200 (95% CI 55,716 to 2,40,685, p

Aims: There is limited literature on the outcome of care in intensive care units (ICUs), especially when it comes to neonatal surgical units. Hence, this study was aimed to observe the outcome of care provided in the neonatal surgery ICU (NSICU) at an apex tertiary care teaching institute of North India. Methods: A descriptive, observational study was carried out through retrospective medical record analysis of all the patients admitted in NSICU from January to June 2011. Results: In NSICU, from January to June 2011, 85 patients were admitted. More than two-third (69.9%) patients were admitted through the emergency department. Of the total admitted patients, 69.9% were male. Mean and median age of the admitted patients were 6.31 and 2 days (range 0–153 days), respectively. The most common diagnosis was esophageal atresia with tracheoesophageal fistula (36.1%). Within a day of admission at NSICU, 88% patients underwent surgical intervention. Of the total admitted patients, 56.6% required mechanical ventilation with 3.57 days (range 0–31 days) of mean duration of mechanical ventilation. Reintubation rate (within 48 h of extubation) was observed to be 15.7%, and 27.7% (23) of the patients required vasopressor support during their NSICU stay. Patients who developed postoperative complications were 34.25%, with the most common being wound infection/discharge/dehiscence. Two patients were readmitted within 72 h of their discharge/transfer out from the NSICU. Conclusion: NSICU survival rate was 85.5% and net death rate was observed to be 14.5%. Sepsis was the major reason for mortality in NSICU.

All India Institute of Medical Sciences (AIIMS), New Delhi, is a unique institution and one its kind in India. It was established in the year 1956 by an Act of Parliament of India as an autonomous institute of national importance. The act mandates that ‘the Institute shall be a body corporate by the name aforesaid having perpetual succession and a common seal, with power to acquire, have and dispose-of property, both movable and immovable, and to contract, and shall by the said name sue and be sued’. The objectives1 of the institute are to develop patterns of teaching in undergraduate and postgraduate medical education in all the branches of medicine so as to demonstrate highest standards of medical education in India. Accordingly, the Institute focuses on the trinity of objectives of training, research and patient care, with training being the foremost of all. It is this trinity of mission that guides all the endeavors undertaken in the institute. The primary objectives of the institute are teaching and research. Since these cannot exist without patient care, the patient care exists as means to these objectives. The institute runs a number of training courses in medical, paramedical and nursing fields and trains a vast pool of experts who become part of the healthcare personnel resource of the country. Undergraduate training has, since the very beginning, received special attention in the Institute. The undergraduate program Bachelor of Medicine and Bachelor of Surgery (MBBS) has an intake of 50 students out of which five students come as sponsored candidates from foreign countries.

Background: Water quality impacts the performance of the hospitals and leads to drastic health service deterioration affecting infection control programs, along with safety of the patients and staff. Good quality water is an essential prerequisite to ensure optimal patient care, and the well-being of the staff and visitors in a hospital environment. Objectives was to study the current water supply and treatment system in the cancer hospital. Also, to carryout root cause analysis of the causes of episodes of diarrhoea amongst patients and staff and to identify the source of infection and suggest improvement in the existing system to prevent recurrence.Methods: There were 25 reported cases of diarrhoea and other gastrointestinal symptoms between May 12 and June 2 2017, allegedly due to water contamination occurring in admitted patients and staff of a tertiary care cancer hospital in north India. This was reported to Hospital Administration, which prompted an epidemiological investigation.Results: Formation of Biofilms on the plastic taps was found to be the main reason for contamination of water.Conclusions: It was very clear that deposition of biofilm within the plastic taps was the main reason of diarrhea among the patients.

Introduction: This study aimed to observe the various patient care processes pertaining to patient safety including infection control. Materials and Methods: A descriptive, prospective, observational, qualitative study was conducted in operation theatre (OT) complex of a tertiary care teaching hospital of North India from January to December 2016. Eleven operating rooms utilised for performing routine surgeries were included in the study. Non-participant observations were made by the single trained observer, and in-depth unstructured discussions were also held with the key stakeholders. One OT each for a full day per week was observed. Simple random sampling without replacement using chit system was used for selecting the OT and day of the week for data collection. Results: There are documented infection control guidelines which are being utilised for infection control. There is no patient safety committee, no guidelines on patient safety and no mechanism has been established for reporting of the patient safety incidents. Implementation of surgical safety checklist was inadequate and only nursing personnel filled it. There is a comprehensive training programme available for infection control among nursing staff only but not on patient safety. Only one adverse event was observed during the study period, in addition to four near misses. Conclusion: Culture of patient safety needs to be established, especially in critical areas such as OT. Mechanism needs to be developed for capturing data pertaining to patient safety and patient safety practices, especially implementation of surgical safety checklist need intense and sustained efforts.

Over 1.4 million people worldwide suffer from HAI at any given time. Hospital wide prevalence of HAI varies from 5.7% to 19.1%, witha pooled prevalence of 10.1%. Surgical site infections are most frequent in developing countries, with incidence rates from 1.2 to 23.6 per 100 surgeries. The adverse impact includes increased mortality and morbidity, and compromised quality of life of the patient and family [1]. This study focuses on the economic consequences and social burden of HAI cases in a tertiary level hospital.

The All India Institute of Medical Sciences (AIIMS) is the apex super-specialty, quaternary referral hospital of India. Its outpatient departments (OPDs) handle over 2.5 million patients every year, a large proportion of whom travel up to 2500 km for treatment because specialist facilities are not available in their regions. We conducted a descriptive study of 58 AIIMS faculty staff members, using a self-administered questionnaire followed by interviews with selected faculty members. During the year 2006, a total of 2,566,492 patients attended the various OPDs at the AIIMS, of whom 1,427,466 (56%) were old patients, i.e. they attended the OPD for follow-up. The questionnaire responses revealed that 55 (95%) of the respondents routinely provided follow-up medical advice to their patients using the telephone, email and/or letters. Only 3 (5%) respondents stated that they did not use any such means for follow-up of their patients. Most of the respondents identified benefits in the use of telemedicine and did not envisage any major difficulties in using it for the follow-up of patients. If appropriate tele follow-up facilities were available, probably more than one million OPD visits could be avoided annually at the AIIMS.

India is a signatory to the UN backed Consumer Protection Resolution, and has enacted the Consumer Protection Act in 1986 to promote and protect the rights of consumers. A land-mark judgment of the Supreme Court of India in 1996, has paved the way for a number of lawsuits involving the public sector, including an eminent tertiary care medical institution. The case described in this study was filed with the State Consumer Dispute Redressal Commission in June 2000. The complainant was a fifty year old female who noticed a lump in her right breast; which was diagnosed as malignant by fine needle aspiration cytology (FNAC); and was treated by surgery and adjuvantradio-therapy (brachytherapy). Subsequently, the tissue sent for histo-pathological study was reported to be 'benign phyllodes tumour'; which was confirmed by other centres in India and the UK. The complaint filed for total damages amounting to Rupees 19 lacs (approx. 27,300 UK pounds) along with interest from the date of operation. Review of the relevant literature suggests that phyllodes tumour of the breast has various sub-types;and even borderline cases can develop malignancy at a later date. It is also clear that false positive cases had been reported previously in cases diagnosed by FNAC. Finally, avenues to minimise litigation through in-house mechanisms and a new concept of mediation have been explored.