December 22, 2012

MH0052 [Hospital Organisation Operations & Planning] Set1 Q5

Q5. Write short notes on:
i. OPD


Out-Patient Department

The outpatient services of the hospital are significant. It is the first point of contact with the hospital. The reputation of the hospital thus, depends on how good the out-patient service is. It is also considered as the window of the hospital. It helps in reducing inpatient admissions and facilitates day care services. This helps the hospital management in reducing managing costs and as for as the patient is concerned, it benefits in terms of convenience and also reduced healthcare expenditure.

Define outpatient facility
Explain the importance of outpatient services
Illustrate the work flow in the department
List the minimum facilities required in the outpatient department.

The outpatient department is a part of the hospital with allotted physical facilities; medical and paramedical staff in sufficient numbers, with regular scheduled hours of work to provide care for patients who are not registered as in-patients.

  • Provides wide range of treatment, diagnostic tests and minor procedures.
  • Eliminates the need for hospital stay/reduction in hospitalization rates.
  • Reduces the cost burden on both hospital and patients.
  • Imparting education to professional staff and patients.
  • Benefits medical students, physicians and other healthcare professionals in terms of diversified clinical experience. 

Importance of Outpatient department:
  • The outpatient department is the first point of contact with the hospital.
  • Forms an entry point into the healthcare delivery system.
  • Inseparable link in the hierarchical chain of healthcare facilities.
  • Stepping stone for health promotion and disease prevention.
  • Contributes to the reduction in mortality and morbidity rates.
  • Reduces the number of admissions (IP), conserving hospital bed
  • Filters the inpatient admissions, ensuring admission to patients who necessarily require it.

Outpatients are those persons who are given diagnostic, therapeutic or preventive services through the hospitals facilities, who have not registered themselves as inpatients the hospital.

Categories of outpatients:
1. Emergency outpatient:
Emergency care is given in case of sudden severe illness or accident
Emergency can be from the patient point of view or from the physicians point of view

2. Referred outpatient: 
Generally referred from outside hospitals or general physician
For specific investigations or minor procedures

3. General outpatient:
Usually form the bulk of the outpatient attendance
For follow-up care rendered by the consultants in the hospital.

Source of origin of OP cases:
The various sources of outpatient case can be listed as
Direct walk in patients to the hospital
Referred case from outside hospitals, local doctors etc.
Attendance in casualty on an emergency basis
Follow-up cases or repeat visits

Flow pattern of work:
Reception and enquiry i.e. first point of contact in the hospital
Moves to sub-waiting area
Visits the doctor at OPD
Subjected to number of clinical investigations
Patient sent home based on clinical findings
Patient is admitted (if required) for further evaluation and treatment.

Planning of outpatient services:
It is important to note that the outpatient department which is a part of the hospital has functional and administrative links with the hospital. There are health centers, satellite clinics and dispensaries dependent on the outpatient services. As a matter of policy, preventive and promotive care should be provided along with curative care. In short, better services attract more patients.

The demand for outpatient services depends on number of factors like, expenses to the patient; distance to reach the OPD; transportation facilities available; socioeconomic status of the target population; degree of urbanization in the population and quality of care provided at the hospital.

Planning considerations:
At the time of planning the outpatient department, the following points are worthy of consideration-
1. Range of outpatient services to be provided; defining the functions.
2. Number of staff required by rank and the tasks to be performed by them.
3. Possible service time per patient, depending on daily and hourly capacity.
4. Flow of patients
5. Requirement of furniture and equipment
6. Layout of the department.

Facilities available at OPD:
1. Public areas and administration
Trolley bay
Reception and Help desk
Registration counter
Lobby and waiting lounge
Toilet and drinking water facilities
Public telephone
Coffee shop, gift/flower shop
Bank extension counter
Security out post and fire alarms

2. Clinical facilities
General examination rooms
Special examination rooms i.e. for ENT, EYE, etc.
Treatment/procedure rooms
Nursing station
Injection room
Laboratory and sample collection area
Pharmacy outlet
Radiology services 

Common problems encountered by patients at the OPD:
Long waiting time to consult the doctor
Non availability of lab investigation reports on time
Interruptions during patient consultations because of telephone calls to doctors
Poor designing of facilities
Breaking the queue in the appointment system

ii. Accident and emergency services
Accident and Emergency Services

The emergency department has become a key point in patient care in the healthcare delivery system, serving the market that demands modern, efficient facilities, trained staff and state-of-art healthcare. The volume of patients seeking routine care in emergency departments has grown considerably, since there is a large pool of mobile citizens who have no family physicians. Furthermore, the emergency department remains one of the few places where provision of healthcare unequivocally takes precedence over financial and legal considerations. Round the clock availability of services is another aspect that is characteristic of emergency departments.

The emergency department is required to render a comprehensive range of services right from the elementary first-aid and general outpatient services to sophisticated management of surgical and medical emergencies and full-scale trauma care. This service, like OPD has a lot of public impact and as a result helps strengthen the image of the hospital.

Maintaining a 24-hour service with its high fixed costs and periods of low utilization can be costly. A well designed and efficiently managed emergency department is an important source of revenue to the hospital. It can be noted that patients in emergency use diagnostic and supportive services of the hospital to a considerable extent and this brings in a lot of revenue.

Factors contributing to increased demand:
Rapid urbanization and industrialization
Increased diagnostic facilities in the hospital
Team approach to medical care
Medico-legal cases not attended by general practioner
Increased recognition of the hospital as a place of healing

A patient who requires immediate treatment, which if not given would mean loss of life/limb or result in any other disability.
An emergency as understood by the patient and his relatives is any illness/injury for which patient requires/desires immediate attention of the physician.

Phases of emergency medical care:
There are 3 phases of emergency medical care, they are-

1. Pre-hospital care:
Prevention i.e. by public education 
Establishing communication network
Notification i.e. trained technical manpower
Rescue operation
Initial stabilization: The trauma team should reach out to the accident scene quickly as the treatment initiated during the first one hour also called Golden Hour is of importance in clinical outcome in such cases. 
Transportation to hospitals
Continuous advance life support measures enroute the hospital.

2. Emergency department care:
The hospital accident and emergency unit is activated from the time the mobile unit arrives at the site of accident till the patient is transferred either to the in-patient area or to another hospital where facilities are available.

3. Hospital care:
This refers to general or specialized care received at the hospital in ICU/CCU/Burns/Trauma centre etc. This phase extends up to the rehabilitation stage of the patient.

Importance of A & E services:
The accident and emergency unit is a very sensitive area in public relations. Its services form the mirror image of the hospital and for some patients, the first point of contact with hospital care. 
The promptness exhibited in attending to the patients by the healthcare personnel reflects the hospital services. It is often an area for criticism
Trauma and cardiovascular diseases are the two leading causes of sudden death.
India accounts for nearly 6-8% of total road traffic accidents in the world.

The ideal location for the accident and emergency unit would be the ground floor, with direct and easy access for patients and ambulance from the main road. There should be a separate entrance to this unit and there should be clearly visible sign boards directing towards the entrance, with proper lighting (during night).Parking area should be spacious with a drive in for vehicles and transferring of patients from the ambulance comfortably. Other services to be located near the accident and emergency unit is, the admission counter; medical records department; laboratory services; radiology services; blood bank; intensive care unit; operation theater etc.

Physical facilities
1. Administrative and public areas:
Entrance should be wide enough to move stretcher, trolley
Public waiting area with toilet; drinking water; public phone facilities
Room for security; police out post; ambulance driver; patient bystanders
Office for the night supervisor
Coffee shop and snack bar in the vicinity 

2. Clinical facilities:
Trauma room
Examination/treatment room
Scrub room
Space for triage/observation room
Storage space for equipments
Room for duty doctors/nurses
Patients toilet
Soiled linen room; janitors closet
Locker room

Categories of staff:
The various categories of staff working in the accident and emergency unit include, casualty medical officer; consultants on call; nursing staff; attenders and orderlies; receptionist; medico-social workers; security staff; radiographers; laboratory and ECG technicians on call.

The hospital management should ensure that adequate security is provided to the various categories of staff from manhandling, as casualty is a highly sensitive and emotional area. Adequate measures to be taken in providing the staff with personal protective equipment to protect staff against infection.

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