The Cost Of Anaesthesia At Kenyatta National Hospital

Abstract

A prospective study was carried out during the period of six months from 14th March,1985 to 13th September 1985 on three hundred and nine patients who were given general ~naesthetics at the Kenyatta National Hospital,with the aim of determining the cost of anaesthesia per hour, per patient. Kenyatta National Hospital, the largest hospital in the country,is a referral, as well as a teaching hospital ~ith a bed capacity of 1866 beds. The oldest part of 'the hospital, originally called the NalLve Civil Hospital, was built in 1901 with an initial bed capacity of 45(1). In 1951 the old theatre block and Ismail Rahimtula Wing were completed and opened. At this time the hospital had six operating theatres. Four clinical officers and one qualified consultant anaesthestist were responsible for general anaesthesia, as well as running the polio unit at the Infectious Diseases Hospital (IDH). With the building of the new tower block the number of operating theatres has increased to 20. Considering the history of anaesthesia over the last thirty years, general anaesthesia has moved from a predominant diethyl-ether with or without muscle relaxants followed by introduction of trichlorethylene in the sixties. At present halothane and enflurane have been introduced in the general practice of anaesthesia. With the increasing number of operations requiring general anaesthetics, about 10,000-15,000 each year, the cost of anaesthesia has tremedously increased. The author embarked on this study with the aim of determrning the cost of general anaesthesia in this hospital and to make suggestions on how to reduce the cost and at the same time make improvements on the present standards. Considering the drugs,intravenous fluids, blood, equipment, salaries of staff, cost of maintaining anaesthetic machines involved in the period of study and other essential services like telephone, electricity and water, the cost of ana8sthesia per hour was calculated. This was three hundred and five shillings and ninety-five cents (Ksh.305.95) or fourteen point one two pounds sterling (£14.12). Finally suggestions have been made with the aim of improving the safety of patients in operating theatres and at the same time reducing the cost of anaesthesia while maintaining the efficiency. These include:- 1) Training of our own personnel for service and repair of anaesthetic machines and vaporisers. 2) To train anaesthetic nurses for proper handling of anaesthetic machines and maintenance. 3) Encourage the wide usage of local analgesics 4) Reappraise the use of ether and trichlorethylene with or without muscle relaxants. 5) Increase the salaries of the health workers in order to boost the morale and at the same time stop the brain drain from government to private hospitals. 6) Charge a minimal fee to all patients coming for surgery. 7) Set up foundations to which well-wishers cat send their money for the improvement of health services in this hospital. 8) Encourage the use of closed system with carbon dioxide absorber. 9) Stop grouping and cross-matching of blood for routine surgery where not more than 20% of blood loss is anticipated in adults. 10) Avoid unnecessary investigations before surgery particularly routine chest x-ray, and electrocardiographs (ECG). 11) Make sure that oxygen, nitrous oxide and volatile anaesthetic agents are switched off after every operation. 12) Improve the monitoring and resuscitation facilities in the recovery ward and~eproy more qualified nursing staff there so that the ratio of nurse to patient is 1:1.