Shreeji Hospital, Bhilad, Gujarat, India - Program Director: Dr Rajesh Kumar Shrivastava
Jeevanshree Hospital, Dombivili, Maharashtra, India - Program Director: Dr Rahul Mahadar
Institutes of Hernia & Abdominal Wall Reconstruction, Apollo Hospitals, Chennai, India - Program Director: Dr B Premkumar
MGM Healthcare, Aminjikarai, Chennai, India - Program Director: Dr Deepak Subramanian
Max Superspecialty Hospital, Vaishali, Delhi NCR, India - Program Director: Dr Vivek Bindal
Regency Hospital Ltd., Cancer and Gastro Care Center, Kanpur, India - Program Director: Dr Abhimanyu Kapoor
Ramkrishna Care Hospitals, Raipur, Chattisgarh, India - Program Director: Dr Sandeep Dave
Shantiraj Hospital Pvt. Ltd., Bhupalpura, Udaipur, India - Program Director: Dr Sapan Ashok Jain
Sparsh Superspeciality Hospital, Yeshwanthpur, Bangalore, India - Program Director: Dr Muralidhar S Kathalagiri
Higher standards of assessed centers should logically improve patient safety and outcomes
Improve the quality of the services offered by both Institutions and surgeons
Incentivize efficient and safe patient treatment
Advise existing institutions to upgrade their status to level of excellence
Be a pillar of the Indian Hernia Registry that will guide our decisions and respond to challenges from our colleagues, insurance carriers, health care providers, governments and the public
A Center of Excellence (COE) would be considered an invaluable resource for training and research
COEs would be eligible to have the Fellowship programs of AWRSC
They would naturally be part of multicentric trials and publications
It would be a major branding for hospital practice and conferences/meetings
The AWRSC will endeavor to help patients find their choice of COEs
The Center of Excellence in Abdominal Wall Reconstruction Surgery program is an AWRSC initiative aimed at Indian national patient safety and quality improvement available to all Hernia surgeons and facilities across the nation. The COEAWR program reflects the specific needs of hernia or AWR patients and the unique roles and responsibilities of hernia and surgery providers.
Safe patient care is the result of both the individual surgeon and the facility where the surgery is performed. The COEAWR certification is therefore awarded to a facility and its associated surgeons who have successfully completed the designation process, which enables patients to distinguish providers who have met the state-of-the-art requirements with regards to volume, manpower, and facility for delivering high-quality perioperative and long-term follow-up care.
Ensure patient safety
Improve the quality of the services offered by both Institutions and Surgeons
Ensure highly efficient and safe patient treatment
Advise existing Hernia institutions to upgrade their status to a level of excellence
A Registry that will guide our decisions and respond to challenges by our colleagues, insurance carriers, health care providers, governments, and the public
An invaluable resource for research
The primary requirement for applying to COE is that the applicant surgeon should be a Life member of AWRSC at the time of application. The application facility should have a dedicated Hernia surgery department functioning for at least 12 months at the time of application. The department should also have entered their surgical data of at least 3 months of entry: 2 months retrospective and one month of current data.in to the registry by the time of inspection.
The applicant surgeon/facility has performed at least 100 qualifying Hernia surgery procedures in the preceding 12 months for a single surgeon center. If the center has two or more surgeons, then a minimum of 150 surgeries will be required. All the surgeons will be assessed individually. Also, each applicant surgeon has performed at least 200 qualifying Hernia surgery procedures in their lifetime. Application failing to comply with the above clause will not be considered for COE.
Each applicant facility and surgeon should meet surgical outcomes benchmarks for mortalities, complications, readmissions, and re-operations. More surgeons from the same facility can apply for Program Director if he/she satisfies the surgical experience requirement.
All hernia or AWR, MIS, and open surgeries will qualify.
Applicant facilities and surgeons are required to meet the following outcomes benchmarks:
Mortality: Overall mortality for all Hernia surgery procedures performed at the applicant facility: less than 0.1% at 90 days
Complications: ≤10% at 90 days (including major and minor) Bleeding requiring blood transfusion, DVT, Pulmonary embolism, Respiratory failure, SSI, SSO, Sepsis, Intestinal Obstruction, and others
Readmissions: ≤5 % at 90 days, Bleeding, Intestinal obstruction, SSI, SSO, Mesh sepsis, Chronic Pain, Other
Reoperations: ≤1% at 90 days
The applicant/ Hernia surgeon would be the Program Director.
A minimum of three-member Hernia co-ordination committee would need to be constituted following given members, where the surgeon and anesthetist will be the mandatory committee members. More than one Hernia surgeon can be a part of the committee.
The applicant holds interdisciplinary team meetings at least half yearly to ensure that decisions related to Hernia surgery are addressed comprehensively. The minutes of the meetings need to be recorded and uploaded which will be checked by the assessor. The Director would be primarily responsible for coordinating the interdisciplinary services and guidelines for hernia surgery.
This would comprise of:
Full-time with 24-hour coverage:
A dedicated anesthesiologist team who supervises anesthesia on all hernia surgery patients.
A fully equipped Intensive Care Unit with a full-time critical care team (CCM) that manages the patient in the immediate postoperative period and during any sudden emergency, respiratory or cardiac arrest through its acute response team. anesthetist/surgeon/physician, or, at least one of which is available on-site at all times when patients are present, with an established protocol.
On-site within 30 minutes of request:
Interventional radiologist or other physician capable of performing percutaneous drainage of intra-abdominal abscess.
An integrated physician with critical care credentials to manage complications.
The facility is also able to identify the following consultative staff:
Infectious disease specialist, Emergency department, Physiotherapy/Occupational therapy, Ambulance services, and 24-hour laboratory services.
The facility has a full line of equipment and surgical instruments to provide appropriate perioperative care for Hernia surgery patients, including:
Furniture in the OPD
Availability of crash cart in the recovery room and wards where the patients would be shifted in the postoperative period
Specific operating room tables to accommodate hernia patients
Hernia specific surgical instruments
Presence of laryngoscope/bronchoscope if required in OR for difficult airways
Radiologic capabilities like CT scan, MRI, Fluoroscopy/dye study, etc. Centers without advanced radiological facilities will need to provide document of MOU with an eligible outsourced facility along with dedicated ambulance services available
The applicant facility should have policies and guidelines in place that require applicant/all eligible Hernia surgeons to have qualified call coverage, and the applicant surgeon certifies that each covering surgeon is capable of identifying and treating Hernia surgery complications.
The applicant surgeon spends a significant portion of his efforts in the field of Hernia surgery and completes continuing medical education. The applicant surgeon is a general/ gastrointestinal surgeon by the highest certifying authority and is a life member of AWRSC. The applicant surgeon has privileges as both a Hernia and general surgeon at the applicant facility. The application facility should have a dedicated department of Hernia and surgery under which all the protocols, guidelines, and SOPs are functioning. The applicant facility also should have Clinical Pathways for each service provided.
The applicant formally adopts and implements clinical pathways that facilitate the standardization of perioperative care for the relevant procedure:
Preoperative multidisciplinary evaluation, education, preparation, admission workup/evaluation, and informed consent of the Hernia surgery candidate
Anesthesia, including monitoring and airway management
Perioperative care, including monitoring and airway management
Deep vein thrombosis (DVT) prevention
Identification and evaluation of early warning signs of complications
Pain management
Postoperative Follow up including entering data in the AWRSC Registry
The applicant provides organized and supervised education for all patients who may undergo or have undergone Hernia surgery regularly. 24-hour helpline number to be provided for emergency calls and tele-consult / counseling services.
The applicant/facility would be committed to spreading the science of safe Hernia surgery. At least one course/ CME would be attended every year by the surgeon.
This accreditation will be a “Level One” Centre of Excellence.
The application for the accreditation will be filled online through the official AWRSC website www.awrsurgeons.com
The application will be accompanied by an online application fee of Rs 10,000/- payment to the AWRSC account
After receiving the fees AWRSC COE committee will credential the application and if approved, will appoint two assessors for an onsite inspection
The cost of traveling and local hospitality for the assessors will be taken care of by the applicant
After the inspection, if the facility is approved, and communicated by email, the COE will pay an additional Rs 1,00,000/-within two weeks. Then the certificate for COE will be given to the applicant/center. The accreditation will be valid for 2 years
If some deficiencies are found in the inspection, the center/applicant will begiven a period of up to three months, for correction of the deficiencies. If after re-evaluation, still the application fails to achieve a successful grant of COE, then the COE committee will make a final decision about the award or non-award of the COE
After two years, renewal of the accreditation will be done by an online process and the renewal fees will be after 2 years, the amount of which will be notified in due course of time
If the Program Director leaves the facility, it will cease to exist as a “Centre of Excellence”. A fresh application with a new Program Director with all the required documentation would be needed to reapply and meet the desired criteria. The rules and fees for the new center will be applicable as new.
Dr Arun Prasad & Dr Rahul Mahadar
Disclaimer: Application to COE is Subject to Membership of AWR Surgeons’ Community and fulfillment of T&C.
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