Professional Documents
Culture Documents
OF CARDIAC SCIENCES
PROJECT ON MANAGEMENT OF INPATIENT DEPARTMENT
NAME: DEBLINA DUTTA, BBM ( H )
SESSION: 2017-18
DINABANDHU ANDREWS INSTITUTE OF TECHNOLOGY & MANAGEMENT
LOCATION:124, EASTERN METROPOLITAN BYPASS, PREMISES
NO.1489, MUKUNDAPUR, KOLKATA, WEST BENGAL, 700099.
HOURS: 24 HOURS
2. ROLL NO.- 07
Thank you,
DEBLINA DUTTA
EXECUTIVE SUMMARY
1. INTRODUCTION
2. REVIEW OF LITERATURE
3. OBJECTIVE
4. HISTORY OF THE HOSPITAL
5. HOSPITAL PROFILE
6. VISION, MISSION, VALUES & SCOPE OF SERVICES
7. FACILITY LAYOUT OF ACTC BUILDING
8. MANAGEMENT OF INPATIENT DEPARTMENT
9. JOB DESCRIPTION OF A EARD COORDINATOR
10.SAFETY AND SECURITY
11.INPATIENT IDENTIFICATION
12.PATIENT VALUABLE POLICY
13.DISASTER PREPARDNESS
14.METHODOLOGY
15.DATA COLLECTION
16.SUMMARY OF FINDINGS
17.CONCLUSION
18.BIBLIOGRAPHY
19.ANNEXURE
INTRODUCTION
Nursing Station
The beds
Necessary services, storage work
Public areas, needed to carry out the nursing care
Sitzia, J. and Wood, N. (1997). Patient Satisfaction: A Review of Issues and Concepts.
Social Science and Medicine, 45: 1829-1843. Sitzia and Wood review the literature
and suggest that patient satisfaction could be assessed by measuring 1) the degree to
which patients believe that care possesses certain attributes and 2) the patient’s
evaluation of those attributes. They suggest that satisfaction is no single concept made
up of multiple determinants, but that there exist three independent models of
satisfaction, each associated with one determinant.
Inui, T. and Carter, W. (1985). Problems and Prospects for Health Services Research
on Provider-Patient Communication. Medical Care; 23(5): 521-538. In this review of
studies of provider-patient communication, the authors assert that even with the vast
knowledge available on biological processes and disease mechanisms, communication
between health care provider and patient is an extremely important aspect of health
care. Attempting to measure this, however, requires interdisciplinary activities, since
merely measuring satisfaction at the conclusion of an interaction cannot measure all
the nuances of communication (both verbal and non-verbal).
Andaleeb, Siddiqui & Khandakar (2007) said that the ability to satisfy customers is
vital for a number of reasons. For one, today’s buyers of health care services in
developed countries are better informed, a condition that is being driven by greater
levels of information available to them. These buyers are therefore more discerning,
knowing exactly what they need.
Feldman, Novack & Gracely (1998) looked at specific aspects of managed care, such
as gate keeping and capitation, to assess physicians’ views. To gain more information
about the impact of managed care, they developed a survey to assess the attitudes of
primary care physicians on how managed care affects (1) physician patient
relationships, (2) their abilities to carry out their ethical obligations to patients and
quality of care. There is widespread agreement that trust between patient and
physician is important for high-quality health care.
Sultana, Riaz, Rehman & Sabir, (2009) suggested that quality of health care showed
that efficient delivery of Primary Health Care through the existing health system will
lead to improved health conditions by reducing morbidity, maternal and infant
mortality and population growth rate. Nurses need to know the factors influencing the
patient satisfaction in order to improve the quality of health care.
OBJECTIVE
MISSION
We dream to make sophisticated health care facilities available to the masses
irrespective of status, class, creed or community with the sole aim of care and
service to the sick and unhealthy.
VALUES
Values are represented by the acronym “I care” where
SCOPE OF SERVICES
Services available are-
AIM- The aim of inpatient services is to provide best possible patient care
through medical skill combined with compassionate care and continuous
improvement and services.
Floor coordinator will receive the patient on arrival on admission to the ward
after admission formalities.
She will wish the patient and introduce herself as the Ward-Coordinator.
She will inform the patient that for any assistance he/she should call for her.
Brief the patient about her availability.
Educate the patient and relatives about their rights and responsibilities.
Enter the details of the patient in the Master Register & Allocation board.
Instruct the sister to take the patient to the allocated bed after checking the
bed is ready.
Inform the consultant about the patient arrival.
Inform the ward RMO about the new admission.
Provide the patient with a new pair of slippers & take a receiving signature
in slipper register.
Inform the patient relative to bring required toilet articles.
If the patient comes from Emergency, then provide the patient with tooth
paste & brush.
From ward stock.
UPDATING SYSTEMS:
BED RESERVATION:
Send the X-Ray requisitions (I-1)to the radiology department for reporting
on daily basis.
After 48hrs contact the department for the reports.
Keep the reports in the patient file.
Send the reports of the discharged patients to the MRD department.
Taking a list from Ward in charge containing all the due reports, contacting
with the concerned department & collecting the reports.
In case of any delay of report following up regarding the same.
ADMINISTRATIVE WORK FOR THE WARD:
Prepare planned discharge list of the ward by 5pm everyday & keep the
same in server hence any person can go through the discharge list of a
particular ward.
Inform the relatives about the discharge procedure for planned discharge
during the visiting time.
Furnish following information to the relatives:
Time of discharge.
To report first at Discharge desk in Admission room & take the
Provisional discharge pass if both discharge summary& bill is
ready.
Take final bill from cash counter & clear all the billing formalities.
Relatives should get the dress.
Prepare the Patient list in the ward.
Handover one Patient list to the security once in the morning & during the
visiting time.
Take rounds during the visiting hours and attend to the queries of patient’s
relatives.
Refer to the Senior IPD Manager for any problems.
Check the patient tasting food before the food is served & give a round
during lunch & dinner.
Checking the food being served for the patients attendants.
Call up the required hospital and take the booking for the patient.
Note the details about the time, the cost of the test, required preparation
of the patient and the documents that the patient need to carry.
Inform the consultant and the sister in charge of the ward.
Check with the consultant whether the patient requires any escort or not.
In case the patient requires a paramedic for escort, and then inform the
doctor of the Emergency ward for the needful.
Organize vehicle conveyance of patient with the support services.
Handover details of the patient to the escort accompanying the patient.
Ensure the form for sending a patient outside the hospital for test is
completed in all respect before sending the patient.
The form should be duly signed by the Medical Super, Nursing Super,
Security Supervisor and the Sister in charge of the ward.
Inform the MOD and the Floor Manager.
The Floor Manager will write an interdepartmental note to the GM
Finance for the cash required for the test.
The patient name, ward number, the required cash, the destination and the
time of arrival should be given to the hospital escort who will accompany
the patient.
All the details should be provided to the patient relatives.
Patient relatives may or may not accompany the patient, however in case
the patient is below 14 years of age then relatives will accompany.
Patient to wear the hospital uniform only.
Patient file may be given for reference if the patient is going to R N
Tagore Surgical Centre.
If the patient is going to any other hospital, then photocopy of the reports
and prescription should be given.
Keep in touch with the hospital driver as or when required.
PROTOCOL-DISCHARGE OF PATIENTS:
Handover the patient medical file to the ward RMO to write the draft
discharge.
Send the file along with the draft discharge to the Discharge Typing
Section.
Instruct nursing staff to return back the unconsumed medicines to the
store and obtain the return voucher
Received the Return Voucher and keep it in the patient file.
On receipt the return voucher sends the Charge Sheet to the billing
department & does MARK FOR DISCHARGE in system to generate the
final bill.
Enter the patient’s name, the ID number and the name of the HK in the
“Charge Sheet Sending Copy” and send to the billing department.
After receiving the Charge Sheet Sending Copy please check the
receiver’s signature.
Inform the patient party about the discharge time and the formalities.
In case the patient is of Corporate/TPA category then only the
photocopy is to be given and original sent to the corporate billing desk
In case the patient is an MLC (Medico Legal Case) only photocopy is
given and originals are sending to the medical record department.
In case DORB (Discharge on Risk Bond) the relatives have to sign the
DORB form declaring reason for taking their patient& intimate the same
to the Consultant, IPD manager, Medical Superintendent & the same is
kept in the MRD file before the discharge procedure commences.
The RMO has to take the signature of the patient NOK (Next of Kin as
recorded in the Admission Form) on the DORB form.
In case of DORB all original documents are given to patient.
Rest of the Discharge Procedure remains the same as enunciated before.
At the time of discharge coordinator must check the discharge I.P. card
to confirm the bill clearance, put signature & time in Discharge time
tracking card, provide the patient with Feedback form.
After the patient is dressed up & the explanation of discharge sum &
medication is done by nursing staff co-coordinator must counter check
the patient file & take patient relative signature confirming that they get
all the correct reports of their patient.
If the patient relative faces any language problem in understanding the
discharge sum she will help them to clarify queries.
Provide the patient a wheel chair & HK girl to escort the patient till the
hospital premises.
CORPORATE DISCHARGE:
If a file is returned back from MRD department due to some reasons she
has to make the file ready at the earliest & send the file back to MRD.
MANAGEMENT OF STORE:
Monitoring the overall operation of canteen and kitchen from where food
is served to the in-patients.
Planning of menu and kitchen operation.
Looking after the standard of services, cooking method, overall cleaning.
Checking all the billing, accounting and food costing of catering services.
Handling and sorting out in-patient’s complaints regarding quality of
food and food services to minimize their inconvenience.
Checking the quality of food and services.
Handling and organizing all outdoor and indoor catering of our hospital.
1.PURPOSE- To ensure good quality of patient food and achieve a high level
of satisfaction of patients and guest regarding the food and beverage services of
the hospital.
2.RESPONSIBILITY- The F & B In charge are responsible for ensuring the
quality of food provided and ensuring its monitoring through established
methods.
3.PROCEDURE- The F & B In charge / Floor coordinators/Sister in charge
taste the food prepared for the patients for lunch and dinner to ensure quality in
the food being served to the patients. The supply of food to the patient does not
commence without approval of them.
4.FEED BACK ABOUT F&B SERVICES- A feedback form is provided to
each and every patient before their discharge to get a feedback about the food
services and any suggestions. Any complaints / grievances / inputs regarding F
& B services are registered through the complaint management system of
PEARLS.
PEARLS:
Patients and Employee Ailment and Resolution and Learning System, shortly
called as PEARLS.
All Kinds of complaints can be raised to a single forum.
Complaints are tracked and resolved which triggers corrective & preventive
actions.
Continual improvement- It provides a basis for continual review and
analysis of complaints-handling process, the resolution of complaints and
where improvements can be made.
Operational efficiency- It ensures a consistent approach to handling
complaints, enabling to identify trends and eliminate the causes of
complaints, as well as improve organization’s operations.
Management Information-An effective complaints and feedback
management system should provide management information that is
essential in identifying problem areas. It can tell which areas need
improvement and how you can efficiently plan your resources.
Customer Care- By adopting the complaint management system, ability to
retain the loyalty of patients will be enhanced. The organization is
committed in managing customer care issues and has processes in place to
handle, analyse and review complaints.
Continual Process Improvement- Co-coordinators prepares different
trackers in the process of day to day Improvement. They are-
1. PAEDIATRIC LIST:
3. ITU TRACKER:
This tracker contains the post-surgical stay of a patient in ITU.
With the help of this list we track the average Length of Stay of
a patient in ITU.
5. MASTER TRACKER:
7. INVESTIGATION TRACKER:
RESPONSIBILITY AS A COORDINATOR-
h) Pearls register
Interact with patients during their tenure of duty and ensure availability
for any problem they face.
After admission interact with patients and relatives and give some basic
information about the hospital protocol.
To speak with every patient while giving ward round and document the
problems and keep a softcopy of the same in respective wards and try to
solve the problems with the help of HOD s.
Act as a bridge between patients, doctors, nursing staffs and
administrations.
Indent all requirements of the ward through HOD from general store
Change the stickers (package/non-package) on the patient file.
Take rounds of the ward during lunch and dinner and solve problems
arising there.
To maintain a count of lunch & dinner plates served for the patient and
make an entry in tally of the same daily.
To check the smooth serving of food till the end whether extra food is
properly given or not. To check if the crockery s is removed on time.
To make it ensure that the in pediatric wards the attendants have food on
proper time.
Co-ordinate for ASSAM and ORISSA GOVT pts to make them easy in
wards. Have the proper food arrangements, look after their lodging
arrangements when patient is in ITUs and make proper arrangements of
their discharge.
Solve any issues regarding the medicine indent & return or clinical items
placed by nursing staffs.
Give rounds for corporate patients and send their x-ray plates for
reporting as per requirements.
After the discharge of patients collect all the pending reports and send to
respective departments.
In case of discharge or expiry of MLC patients, send a Xerox of MLC
paper, admission paper and discharge or death certificate to the MOD and
also collect a received copy from them and keep in the MRD file.
Taste patient’s food before serving to patients.
Maintain inventory of their ward and account for every item.
Send all relevant medical documents after rechecking to MRD within 48
hours of the discharge of the patients. All the files should have the Final
Bill for that particular admission.
MRD files are checked in different criteria as follows-
C-15
C-14
Consultant signature within 24 hours
Proper discharge order
Signature of doctor present in all blood reports
PFE paper present in file
All consent paper is properly signed
Photocopy of charge sheet present
For expiry patient to check D.C. & death summary
If the MRD files are not having the Xerox copies of charge sheet, then try
to arrange it from the billing department.
If files are returned from MRD for any kind of incompletion to co-
ordinate with nursing staff to make the file ready and send back to MRD
within 48 hours.
Take classes of the nursing staffs to help them in administrative works
To manage all kinds of problems arising in emergency situations in the
ward through the help of their HOD.
Report all lapses and ward incidents in their ward to the Floor Manager.
Response to all emergency codes and acts accordingly.
While giving discharges check all the reports present in patient’s file and
final bill of the patient and discharge card.
As doctor confirms the discharges co-ordinate with medicine return store
to return the residue medicines and co-ordinate with billing department
for Final Bill and inform patient parties also the same. Arranging the
discharge summary to be written by concerned doctor & send the pink
sheet with file to printing department for preparing discharge summary.
Co-ordinate with discharge printing department time to time for making
ready the discharge sum in 3 hours of time to make the discharge happen
in between 4 hours and try to make the vacant as early as possible.
Maintain a proper discharge list where the timings are maintained for
sending medicine for return in store, after return the time of sending
charge sheet, the declared time for patient to come for discharge, time of
sending the file for making sum. The discharge list is kept in server for
every respective ward & this list is updated till the co-coordinator leaves
ward at the end of day.
Co-ordinate with all the investigation rooms to get all the tests done and
get the respective reports on time.
Prepare all the corporate files with all the reports as per the final bill and
send it to corporate department within 48 hrs.
Co- ordinate with nursing staffs and give support to them to run the ward
smoothly.
Co-ordinate with House Keeping department for patient’s linen and send
a written document for required linen.
Maintain all the lists of the ward and send it to HOD.
Co-ordinate with doctors for patient’s proper treatment, patient’s transfer,
inform referrals.
Inform patient parties about their OT/ CATH timings while taking the
patient to OT or CATH lab or any unplanned tests need to be done.
Get the print out of all the blood reports of ITU1/2 and ITU7/8/9 and get
it signed by the doctors and keep it in patients file.
Give updated information to MAY I HELP YOU DESK and
DISCHARGE desk
Check the green files of patients having printed pre op Echo report,
Family Education paper, proper admission paper containing surgeon’s
name.
Send day to day X- ray reporting for corporate patients.
In GWs for surgical pts maintain a daily tracker for Expected Date of
Discharge and work accordingly.
In ITU s for surgical pts maintain a daily tracker for shifting the pts from
ITU to ward in proper time.
In Pediatric GW maintain a daily list of all pediatric pts in hospital for
regular updating of pediatric pts.
In CCU & ITU maintain a Transfer in & Transfer out tracker of pts
arrival & departure time and send the same to Quality department in
every fortnight.
Co-ordinate for minimum usage of resources to maintain the cost.
POLICY:
To safeguard the valuables of its patients.
To inform the patient that the hospital cannot assume responsibility
for valuables or personal property retained by them.
DEFINITION:
PROCEDURE:
The Hospital is not responsible for lost, theft, or breakage of
personal items that the patient maintains in their possession while
hospitalized.
During admission, the admission room staff and the floor
coordinators/ nurse in-charges explains the patient /relatives - the
necessary items to be brought by the patient on admission.
On admission the nurse shall handover the jewelry, old medical
records, clothes, and any other belongings to the relatives and shall
get their signature confirming the handing over.
All old records shall be photocopied before handing over and
photocopy shall be kept in the case file.
All the old medication brought by the patient/ relatives shall be
returned to them.
Patient shall be informed to take care of the other belongings that
they bring along such as mobile phones, spectacles, dentures, etc on
admission.
On transferring the patient for Surgery/ any other procedure/ to
critical care areas, the nurse shall make sure that the relatives have
taken all the patient valuables.
METHODOLOGY
>30 MIN
30MIN-1HR
1HR-2HR
2HR-3HR
Work Efficiency
50%
45%
40%
35%
30%
25% PERCENTAGE
20%
15%
10%
5%
0%
EXCELLENT VERY GOOD GOOD FAIR
NO. OF ADMISSIONS
900
800
700
600
500
NO. OF ADMISSIONS
400
300
200
100
0
JAN'18 FEB'18 MAR'18
NO. OF DISCHARGES
790
780
770
760
750
NO. OF DISCHARGES
740
730
720
710
700
JAN'18 FEB'18 MAR'18
70%
60%
50%
40%
QUALITY OF FOOD MAINTAINED
30%
20%
10%
0%
GOOD FAIR Poor
450
440
430
420
JAN'18
410 FEB'18
MAR'18
400
390
380
370
360
No. of surgeries performed
0.3
0.25
0.2
JAN'18
FEB'18
0.15 MAR'18
0.1
0.05
0
% of SSI
MONTH % OF SSI
JAN’18 0
FEB’18 0.27
MAR’18 0.3
ALOS
JAN'18
FEB'18
MAR'18
MONTH ALOS
JAN’18 4.64
FEB’18 4.62
MAR’18 4.85
BED OCCUPANCY
MAR'18
FEB'18
BED OCCUPANCY
JAN'18
TOTAL DEATHS
2.5
TOTAL DEATHS
1.5
0.5
0
JAN'18 FEB'18 MAR'18
FEB’18 3
MAR’18 1
NUMBERS
2
1.5
1
0.5
NUMBERS
0
HEART NUMBERS
FAILURE PNEUMONIA
ARRHYTHMIA
UTI
MORTALITY %
2.80%
2.75%
2.70%
2.65%
2.60%
MORTALITY %
2.55%
2.50%
2.45%
2.40%
JAN'18 FEB'18 MAR'18
MONTH MORTALITY %
JAN’18 2.75%
FEB’18 2.54%
MAR’18 2.62%
Clinical Problems: -
1. Patient relatives have many clinical queries (RMOs are not available to
speak to them).
2. Intimation of Discharge- Consultants does not inform the discharge at
proper time in wards.
3. We come know from relatives that one particular patient is being asked to
discharge.
Nursing: -
1. When a bulk of discharge comes at the same time the nursing staffs are
unable to make the entire patients ready at the same time due to less
nursing staffs.
2. Collection of reports by nursing staff is a big problem. At the last moment
they ask for X-ray plates or other diagnostic reports which they don’t
collect at the proper time. In last hour we have to arrange a HK girl and
collect the reports.
3. Discharge files are not kept ready all the times.
4. Sometimes discharge summary is not signed by the nursing staff and the
patient relatives as nursing students release the discharges and they didn’t
know about the procedures.
5. If a coordinator is not available for any reason they don’t send the file for
printing or charge sheet for billing quickly.
6. Medicine returns by nursing staffs are not done properly. Many times
medicines are left unreturned in the cupboard.
7. Explaining discharge summary by junior staffs takes a long time as they
are unable to explain properly.
Arranging wheels: -Wheel chairs along with HK girls are a time taking
factor for every patient.
Billing problems: -
1. Patient relatives come to the ward with many billing related problems.
Final bill settlement takes a long time.
Housekeeping problems: -
1. Behavior of some of the housekeeping staffs is very bad.
2. There are always less number of housekeeping staffs which make it
difficult for the patients to go for certain tests and discharges.
RECOMMENDATIONS:
1. At least two RMOs should be present during the morning & afternoon
shift to cope up with the huge discharges.
2. RMOs should be requested to write the summary properly in the pink
sheet so that discharge printing is not delayed.
3. Nursing staffs should be appointed more.
4. Discharge files should be made ready prior to the discharge time.
5. Nursing students must be well trained before giving them duties in the
ward.
6. Before returning medicines all cupboards should be checked so that no
medicines are left.
7. Senior staffs must explain the discharge summary as junior staffs cannot
do it properly.
8. Final bill settlement time must be reduced.
9. Housekeeping staffs should be educated to behave properly with
coordinators and the nursing staffs.
10. More HK staffs should be appointed in the GW as it remains busy for the
whole day.
11.Need to focus on time management.
14.Public holidays should be clearly displayed on the notice board for the