STEP 1: Hospital Registration Form for STEP UP Fellowship program

Hospital Registration Form for STEP UP Fellowship program

DakshamA Health will follow a systematic approach by first processing the hospital requirement form, ensuring that the hospital is eligible to have fellowship in place, before opening the application for fellows to apply through the hospital.
Please enter the name of your hospital*
Please enter your name*

First NameLast Name
Please enter your designation*
Please enter your official email address*
example@example.com
Please enter the address of your hospital*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Please enter the official URL of the hospital*
Does the hospital have dedicated unit for orthopedic/joint replacement surgery?*

YesNo
Does the hospital have orthopedic surgeon/guide at Professor level or an orthopedic surgeon with more than 15 years of experience?*

YesNo
Can you please provide a short bio of the experienced ortho surgeon.

Cancelof
Is your hospital (NABH/JCI) Accredited*

YesNo
Please mention your NABH/JCI certificate reference number
(eg H-2006-0029)
Does the hospital have comprehensive inpatient facility (ED, ICU and Orthopedic services)*

YesNo
Has the hospital been offering orthopedic surgery and treatment service for a duration of more than 12 months?*

YesNo
Does the hospital conduct a minimum of 250 knee and hip replacement surgeries per year, including at least 200 total knee replacements and 50 total hip replacements, with an average and median surgeon volume of at least 10 primary or revision surgeries for both types of replacements.*

YesNo
Does your hospital has National Quality Improvement Initiatives*

Universal ProtocolWHO Safety ChecklistQCI
Does the hospital have Multidisciplinary Clinical Pathways and teams?*

YesNo
Does the hospital have Data Management and Patient Tracking procedures in place (Internal registry for treatment and outcomes, process to track complications and revisions, evaluates patient satisfaction)*

YesNo
Does the hospital have Patient Selection Criteria (written criteria, depression and anxiety screening)*

YesNo
Does the hospital have Preoperative Patient Education setting ? (Multiple choice)*

ClassesMaterialsProtocol informing of risks
Does the hospital have Thromboprophylaxis protocol (specific for knee/hip)*

YesNo
Please select all the option your hospital has in the Transitions of Care management (Multiple choice)*

Case managementDischarge planningMonitoring of transitions
Does the hospital have Functional Assessments (standardized indexes for pre- and post-op assessments)*

YesNo
Does the hospital have Physical Therapy and Rehabilitation Services (protocols for assessment and treatment)*

YesNo
How much is the hospital capable of performing a combined total of TKR and THR surgeries within a reported 12-month period (Please select the range)*

< 250 surgeries250 - 300 surgeriesmore than 300 surgeries
Does the hospital have Revisions (Performs ≥10 net revisions for TKR and THR)*

YesNo
What Is the average length of stay for TKR in your hospital (please select the range)*

less than or equal to 3.5 daysbetween 4 - 5 daysmore than 5 days
What Is the average length of stay for THR in your hospital (please select the range)*

less than or equal to 4 daysbetween 5- 6 daysmore than 6 days
Is the 30-Day Readmission Rate for TKR and THR patients ≤ 10% in your hospital*

YesNo
Does your hospital provide any educational/fellowship programs?*

YesNo
For how long have you been running the fellowship program in your hospital?
mention the duration in years
If yes, please list all the fellowships offered in your hospital.
On an average how many fellows enroll in your present fellowship program?
What is the tenure of your present fellowship program?
Please select the components of the teaching programme provided at your hospital (multiple choice)

Case presentations & discussionSeminarJournal clubGrand round presentation (by rotation departments and subspecialties)Faculty lecture teaching- once a monthClinical Audit-Once a Monthposter or oral presentation
req criteria calculation
Other criteria calculation
Process criteria calculation
V&O criteria calculation
Privacy Policy

At DakshamA Health, safeguarding your personal information is of utmost importance to us. We adhere to strict privacy and security protocols to ensure the confidentiality of your personal data.

When you visit our website, we generally do not collect any personal information from you. Instead, we obtain most of the information we require from the application you submit to us. We process your data to evaluate and process your application for study, as well as for other related purposes such as determining your eligibility for the STEP-UP program and establishing a partnership with DakshamA Health.

We will retain the hospital's data only after they have completed and submitted the application form and met all the necessary requirements (including those related to legal, accounting, or reporting) to establish the fellowship program at their facility.

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