END OF YEAR REPORT FOR MEDICAL DEPARTMENT-2022(OPD/ER/WARD) PENTECOST HOSPITAL

MADINA (PHM)

Introduction:

The medical department which serves as the gateway of PHM, mainly comprises the Out-Patient
Department, the Emergency Unit and the Medical Surgical Ward. It’s tentacles spread out to include
work at the Isolation ward and Specialist Clinics set at the Corporate unit. The following Targets for
2022 were set up and Team players from various categories worked together to ensure Optimal
achievement of our set targets with Prescribers of various grades in all the teams.This report spans 1st
January 2022 to 31st December 2022. However, it is noteworthy that most of the issues tackled are
similar to that of 2021 as well as forms the foundation for the targets set for 2023 . This report should
therefore be viewed as a continuium or a spectrum of our Quest to be the Best.

<1>TARGETS FOR 2022

KEY RESULT AREAS/TARGETS

i) CLIENT CARE/service Provider Targets

-To reduce Client waiting time at OPD from above 5 hours to less than 2 hours

-To increase the number of prescribers from 2 to 3 prescribers to ensure effi cient running
of Night OPD/ER to facilitate quality 24 hour services

-To improve Client satisfaction by improving communication with clients and relatives by holding mini
family conferences during management of both in and out patients.

-To Reduce Net Mortality and Morbidity by 5% of current rate of clients who visit our facility

ii) ACADEMIC/TEACHING /TRAINING TARGETS

-To ensure Weekly Ward rounds are done on a set day of the week led by Senior Prescribers

-To conduct regular weekly clinical meetings as a department

-To ensure Monthly Mortality Meetings are held for the Medical Mortalities that occur Supervised by
Consultants , Specialist and Senior Officers.

-To ensure Medical Officers have a schedule to present Mortality Meetings held Monthly to serve as
Audits, learning points and to ensure quality of care.

-To create an academic /Teaching /Training based environment for Medical graduate interns preparing
for MDC exams, for PA intern training and clinical rotations.
-To ensure House Officers and Physician Assisstant Interns under training are put on schedule for
Clinical Morning meeting presentations

-To organize and participate fully in CPDs and In-ServiceTraining being organized by the Medical team
to ensure quality work.

-To Organize internal and external OSCE/Exams for PUC students as part of Training for interns and to
fulfill our Academic and teaching target.

iii) LOGISTICS/RESOURCES TARGETS

- To write requesting for 2 perfusers and 2Monitors for ER and Medical Ward each.
- To ensure availability of Radiological viewing box for consulting rooms and er/wards
- To ensure Resuscitation Tray is adequately prepared for the Isolation ward.
- To put in request for more space / consulting rooms for prescribers use
- To put in request for extra Tablets/PC for doctors/prescribers use in Wards/ER

1a)TARGETS ACHIEVED / 1b) TARGETS NOT ACHIEVED/ REASONS FOR NON-ACHIEVEMENT –

BY THE MEDICAL UNIT FOR 2022

i)Client Care /Service Provider targets

-Client waiting time has generally improved based on random interviews of clients at the opd, also
general evidence gathered from some of our long term (10years or more of assessing our
services)clients reveal that waiting time has improved, however, the target of 2hours is yet to be
achieved. The Quality Management Team has revealed that waiting time is not a single unit problem,
therefore , appropriate measures have been put in place by the LAB, PHARMACY, OPD Triaging etc.

On our part, Prescriber issues have been tackled by calling individual prescribers to attention and
ensuring that certain unrequired Laboratory investigations are withheld .Prescriber meetings held to re-
inforce optimal Primary Care of patients without prolonging their stay in the hospital.

-Target of scheduling 3 Prescribers (MO/PA/SHO)/(MO/SHO/SHO)/(MO/PA/PA)was achieved. This

Policy was initially piloted in the second half of JUNE 2022 successfully.

-however, challenges along the line caused wrong permutations such as(sho/sho/sho) which led to poor
decision making in the management of patients and also inability of our junior colleagues to call for help,
as well as non-availability of outlines/protocols at the said time in order to streamline decisions onfor
e.g. BID/unconscious patients etc.
-another challenge which mars the success of this initiative was the complaint that one prescriber was
assigned to solely see to only OPD cases whilst the 2 other prescribers attended to Emergencies and
were not forthcoming when they had to move to OPD to help at times when the ER was less busy. This
challenged was tackled by holding all 3 prescribers responsible for both units and ensuring the lead
Medical Officer amongst the 3 designated times for everyone to have a fair share of rest when it is
possible to do so.

- The Target of ensuring Communication from Prescribers whenever clients are being managed
whether in-patient or out-patient is also partially achieved and is a work in progress. There are still
incidences during ward rounds where Clients complain of not receiving feedback on their management.
Calls for re-emphasizing the need and also ensuring good supervision for this to be done.

-To Reduce Net Mortality and Morbidity by 5% of current rate of clients who visit our facility –The net
mortality the medical unit in January 2022 was 9.7% and as of September 2022 was 9.6%, this target
has not been achieved one topmost reason being the health-seeking behavior of our clientele.

ii) Academic/ Teaching/Training Targets Achieved, Not Achieved and Reasons for non-Achievement

-To Create an enabling academic environment /teaching /training environment to ensure Medical
graduate interns preparing for MDC exams, PA interns and ultimately Senior House Officers will benefit
from Clinical rotations and hands-on training at the unit especially ER/OPD/Wards.This target has been
achieved so far, but could progress higher and better.

- To ensure Weekly Ward rounds are done on a set day of the week led by Senior Prescribers. The set
day for weekly Grand ward rounds is Wednesdays at 9:30a.m This has been consistent from 1st January
2022 to 31st December 2022. The Grand ward rounds is led by a Specialist or a Consultant and could also
be led by a Senior Medical Officer and consists of a Team of various health workers and staff ;from
nurses, to pharmacist, to dieticians and student interns. The rounds serves as a check for decisions
pertaining to Clients care according to Standard current treatment guidelines, it also serves as a
teaching session for all present, drug combinations are guided by pharmacists present etc. Emergencies
are attended to even when our ward rounds are in session and it is continued as soon as possible.

-To conduct regular weekly clinical meetings as a department. This target has also been achieved .
Conducting of our weekly clinical meetings has been on Wednesday Mornings at 8;00am. The challenge
with this is the time we begin each meeting , 7:30am has gradually become 8:00am.

-To ensure Monthly Mortality Meetings are held for the Medical Mortalities that occur Supervised by
Consultants , Specialists and data presented to the hospital by a Senior Medical Officer. This target has
so far been achieved to the best of our circumstances.

-To ensure Medical Officers have a schedule to present Mortality Meetings held Monthly to serve as
Audits, learning points and to ensure quality of care. The schedule has since been drawn and followed
from January 2022 to December 2022. The schedules are seen attached to this document.
-To ensure House Officers and Physician Assistant Interns under training are put on schedule for
Clinical Morning meeting presentations This target has also been achieved as per our schedule.

-To organize and participate fully in CPDs and In-Service Training being organized by the Medical team
to ensure quality work. This Target has also been achieved and details are outlined in this document.

-To Organize internal and external OSCE/Exams for PUC students as part of Training for interns and to
fulfill our Academic and teaching responsibility for the PA students from the Pentecost University
College.The first Internal OSCE (Objective Structured Clinical Exam) was organized on Wednesday, 2nd
March 2022.The second External OSCE was done on Tuesday 25 th October 2022 for the end of year
Exams for the PA Students/Interns from Pentecost University College. Their scores were collated and
duely submitted to the University for grading.

iii) LOGISTICS/RESOURCES TARGETS achieved /not achieved /reasons.

- To write requesting for 2 perfusers and 2Monitors for ER and Medical Ward each.
This target was not achieved in 2022, however, in January2023, this specific logistic target has
been achieved .

- To ensure availability of Radiological viewing box for consulting rooms and ER/Wards.This
Target has not yet been achieved. May be due to presence of same at the radiology units or
could be due to plans of relocation of medical wards.

- To ensure Resuscitation Tray is adequately prepared for the Isolation ward. This target has not
been achieved, more so, the isolation ward itself needs a complete overhaul to help make
nurses and doctors work less risky in terms of IPC.

- To put in request for more space / consulting rooms for prescribers use.This target is yet to be
achieved for reasons obvious to us all due to the perennial Space Challenge of PHM.
Occasionally, the nurses station at OPD had been used for consultation in the year 2022 which
breaches patients confidentiality and privacy of care.

- To put in request for extra Tablets/PC for doctors/prescribers use in Wards/ER. This target
has partially been achieved. We still face challenges with our PC and tablets availability and
private phones are sometimes used by prescribers to speed up putting in patients reviews and
prescriptions.
<2> MAJOR ACTIVITIES CARRIED OUT IN 2022

These would include all activities that were significant in making an impact as a unit and in whole
attaining the mission and vision of PHM. Another noteworthy point is that, Majority of the prescribers
assigned to carry out these activities are Key prescribers from the Medical department, and so their
participation in these activities directly and indirectly affects the normal flow of work in the medical unit,
though these major activities may have been organized directly by PHM as a whole.

-i)OSCE for PUC PA students- 2nd March 2022 and 25th October 2022 Organised by Specialist in the
Medical Team and supported by Medical Officers.

-ii)Annual Ministerial Medical Screening (AMMS) –A Major Activity that has direct bearing on the
organization of Time Schedule, in order to make way for prescribers to participate fully and at the same
time make sure normal goes on at the OPD/ER and sometimes even the corporate clinic.For the year
2022, participation and re-organization of our various timetables covered the months of March 2022 to
September 2022.

-iii)In-Service Training on Casting of Plaster of Paris (POP) by an Orthopeadic Sugery Team from Korle
Bu Teaching Hospital 11th and 18th June 2022. All ER staff nurses/prescribers successfully under went
this training organized by our Medical Administrator, to the benefit of PHM and our for initial
management of our Clients with simple fractures.

iv)Continuous Professional Development(CPD) MDC accredited also organized by Medical Admin were
a major activity for our unit in 2022 as follows.

-Updates on the Management of Diabetes Mellitus and Diabetic Ketoacidosis – 15 th June 2022-CPD-
2Credits

-Updates in Fluid and Electrolyte Management and Hemotransfusion-3 rd August 2022-CPD- 2Credits

-Current Trends in Management of Hepatitis B and C-14th September 2022-CPD-2Credits

v)Participation in Medical Outreach at Avenor which was organized by our Director, More than
6prescribers Volunteered and Actively offered Medical Screening services and Primary Care to the
Locality- Saturday, 25th June 2022.
vi) Participation in Staff Medical Screening Organised by Our Clinical Care Co-ordinator- from
September 2022 to November 2022.Doctors in the Medical unit took an active part in examining and
reporting on our fellow staff as well also being seen by other doctors

<3>MEETINGS /IN-SERVICE TRAINING HELD BY MEDICAL DEPARTMENT IN 2022

MONTH AUDITED PRESENTER MODERATOR DATE/REMARKS

January 2022 Dr Eric Gyan Dr Sarkodie Done

February 2022 Dr Paul Annan Dr B Swanzy Done

March 2022 Dr Samuel Anim Dr C Ampong Done

April 2022 Dr Kumi-Larbi Dr Sarkodie Done

May 2022 Dr Kumi-Larbi Dr Sarkodie Done

June 2022 Dr Samuel Anim Dr B Swanzy Done

July 2022 Dr Agyeman-dua Dr C Ampong Done

August 2022 Dr Agyeman-dua Dr C Ampong Done

September 2022 Dr Agyeman-dua Dr C Ampong Done

October 2022 Dr Hubert Adjei Dr Sarkodie Done

November 2022 Dr Hubert Adjei Dr Sarkodie Done

December 2022 Dr Hubert Adjei Dr Sarkodie -

COPY OF SCHEDULE FOR MORBIDITY/MORTALITY MEETINGS/PRESENTATIONS HELD AT PUBLIC HEALTH

FOR 2022
<3>MEETINGS /IN-SERVICE TRAINING HELD BY MEDICAL DEPARTMENT IN 2022

PRESENTATIONS DONE BY DOCTORS DURING OUR 2022 CLINICAL MORNING MEETINGS AS PART OF IN-
SERVICE TRAINING

DATE CLINICAL TOPIC OF PRESENTER FACILITATOR/MODERATOR REMARK

INTEREST
19/01/2 Chronic Kidney Dr Prosper Duut Dr Agyemang-dua/Dr Done
2 Disease/Overview/Mngt Sarkodie
23/02/2 CVA/Strokes/overview etc Dr Valencia Adjei Dr Sarkodie Done
2
02/03/2 COVID-19 overview/mngt.. Dr Sandra Brown Dr Sarkodie Done
2
09/03/2 PUDX/GERD/Gastritis… Dr Sina Boatey Dr Agyeman-dua Done
2
16/03/2 HTN overview/dx/mngt Dr Evelyn Owusu- Dr S Anim Done
2 ansah
23/03/2 Diabetes M/DKA mngt Dr Maame Dr D Sakyi Done
2 Asaanewa
8/04/22 Sickle Cell dx/overview Dr Sharon Awuni Dr M Oduro-baah Done
22/06/2 DVT/PE/overview etc Dr F Nketiah Dr D Sakyi Done
2
29/06/2 Chronic Liver Dx Dr Precious Duah Dr P Annan Done
2 overview/mngt/ etc
27/7/22 Asthma/ Overview/Mngt/ Dr Zeena Muktar Dr E Gyan Done
etc
17/08/2 Acute Adominal Pain(all Dr Jerry Lokko Dr Kumi-Larbi Done
2 common causes etc
7/09/22 Acute Coronary Syndrome Dr Yaw Bader Dr Hubert Adjei Done
28/09/2 Malaria overview/mngt Dr Edith Kissi DrAgyeman dua Done
2
19/10/2 Enteric fever dx/mngt /etc Dr R Fynn Dr S Anim Done
2
16/11/2 Seizure disorders Dr Daniella Edisi Dr D Sakyi Done
2
30/11/2 Alcohol use disorders Dr Olamide S Dr Gyan/Dr Ampong Done
2
12/10/2 Pneumonia mngt/ etc Dr Akua Ennin Dr Kumi-Larbi
2
26/10/2 Lower Back Pain mngt etc Dr Precious Andoh Dr Oduro-baa
2
21/12/2 Haematological disorders- Dr Sandra Ansong Dr Anim/Dr Sarkodie Done
2 scd
7/12/22 General Medical Unit Dr Sarkodie Dr Ampong Done
Meeting, open discussions
 14/12/2 Update on LHIMS Mr Mohammed -IT Dr Sarkodie/Dr Ampong Done
2
28/12/2 DM/DKA mngt etc Dr Ekua Mensah Dr H Adjei/Dr Ampong Done
2
30/12/2 Polypharmacy/Drug Dr Sherifa Karim Pharm Matthew/ Dr Done
2 interactions Sarkodie

<4> HUMAN RESOURCE DATA FOR 2022 FOR MEDICAL UNIT (PRESCRIBERS)

4a)Total Number of Prescribers for 2022.

Month Specialists SMOs MOs PAs SHOs total

Jan 2022 1FP,1PS=2 3 5 4 9 23
Feb 2022 1FP,1PS=2 3 5 4 9 23
Mar 2022 1FP,1PS=2 3 5 4 9 23
Apr 2022 1FP,1PS=2 3 5 4 7 21
May 2022 1FP,1PS=2 3 5 4 7 21
Jun 2022 1FP,1PS=2 3 5 4 6 20
Jul 2022 1FP,1PS=2 2 5 4 9 22
Aug 2022 1FP,1PS=2 2 5 4 12 25
Sept 2022 1FP,1PS=2 2 5 4 12 25
Oct 2022 1FP,1PS=2 2 5 4 12 25
Nov 2022 1FP, 1PS 2 5 4 8 21
endocrine
=2
Dec 2022 1FP,1PS 2 7 4 8 23
endocrine
=2
Total 2 2 7 4 8 23

4b)Resignation/Retirement= None in 2022 , However 2 SMO Transferred from PHM to other CHAG
facility.

4c) New Staff= 2 New Medical Officers in December 2022 Joined the Pool of Prescribers.

ADDENDUM: OPD attendance 2021= 110,219

OPD attendance 2022= 102,215 averages 280 clients at opd per 24hour period

ER admission 2021=396 /ER admission 2022=470.

Total admissions 2021=6249/ Total admission for 2022=6047 on average 17 clients admitted in a 24hr.

FP clinic 2021=235 /FP clinic 2022=475

PS clinic 2021=541/ PS clinic 2022=412.

<5>VISITORS /DONATIONS RECEIVED

Not applicable, to contact The Medical Administrator for any possible details.

<6>TARGETS FOR JANUARY TO DECEMBER 2023 (MEDICAL DEPARTMENT-PHM)

6a) GENERAL TARGETS FOR ALL PRESCRIBERS WORKING AT OPD/ ER/ MEDICAL WARDS/SPECIALIST
CLINICS

-To Reduce Current Mortality rate by 10% by liaising with public health to educate clients more on
seeking care early.

-To Schedule Internal Mortality Audits within 72hours of Deaths occurring in ER/Ward before the usual
Monthly Mortality Meeting is done.

-To organize forum/training for Prescribers on Proper documentation on LHIMS system in the 1 st half of
the year to minimize losses in the System

-To ensure “Final diagnoses” is provided on LHIMS for all patients on admission to minimize losses.

-To Maintain academic, teaching and training environment by adhering to Schedules for Clinical
Meetings, Weekly Grand Ward rounds , Participation and Organization of CPDs and in-service training.

-To establish a Research Unit within the Medical Department.-To assign a medical Officer to the Public
Health unit to ensure (No doctor at public health unit)

-To ensure Mortality Meetings are done Monthly for the death occurring in the Medical unit.

-To improve Client Satisfaction by reducing the OPD waiting time by 50% of current rate by the
following means; To bring to book any prescriber who is in the habit sends all clients to the lab without
any proper examination documentation etc( to address prescriber issues in general more sternly)

-To Collaborate /communicate better with Pharmacy, Lab , to improve waiting time.

-To provide regular Scheduled updates to Clients on admission( and their relatives).

-To provide written list of Medications and review dates for discharged Clients.

-To assign a given number of Clients per prescriber for morning OPD sessions.

-To Maximize bed Capacity by reducing length of stay for clients in ER/Ward.(lab ,pharmacy, nursing
collaboration needed to achieve this target)

-To book Clients at Specialist Clinic based on time and date to avoid overcrowding and to reduce the
waiting time at these Clinics.
-To Start a new Endocrine Clinic (Specialist Clinic), others still remain.

- To ensure adequate logistics such as PC and tablets, working areas for prescribers to improve quality of
care.

-To ensure Protocols or Standard procedures are duly followed by prescribers by Supervising work and
making the material available on media platforms for easy access.-To ensure quality care by Minimizing
enthusiasm to hemotransfuse Clients without taking prior blood samples for detailed investigations to
determine cause of chronic anaemia.-To supervise writing of Death Certificates by Medical Officers.

<7> KEY CHALLENGES TO OUR WORK AT OPD/ER /MEDICAL WARD/GENERAL CHALLENGES

-Inadequate number of Consulting Rooms at OPD for prescribers . The suggested solution is to build
more consulting rooms or to establish make shift consulting areas to facilitate prompt Client care.

-Inadequate number of PC/tablets for use by prescribers at ER and Ward. To be requested for.

-Introduction of LHIMS in February 2022 posed a huge challenge for prescribers e.g issues with final
diagnoses, prescription issues on LHIMS (same medication could be served twice whilst new ones do not
appear on the system, interface for clerking patients, strange icd-10/11 diagnoses etc. Training has been
done but there’s more room for improvement.

-Prolonged OPD waiting time. Still working to reduce the waiting time.

-Financial Constraints on part of our Clients/relatives , which tends to affect their care in terms of
paying for external investigations and doing certain labs . Also the “good Samaritan syndrome” is a huge
challenge where clients are abandoned to the hospital, but are always brought in by someone.

-Overcrowding at the ER. We need to reschedule our student interns on other shifts to avoid
overcrowding at the already small ER to protect us from spread of infections.

-Bureaucracies with labs (payment before sampling etc) and pharmacy delays treatment of Clients.

-Long turnover time for Biochemistry labs and other hormonal labs e,g Thyroid function test.

-Lack of Mobile X-ray and other Mobile diagnostic devices.

-To improve IPC within the ER and wards by prompting prescribers to use sanitizer, wash hands or glove-
up to examine Clients. This has been a challenge because prescriber in prior years were always getting
infections which affected the workforce at a point in time.

- Fluctuating Human Resource , especially of Senior House Officers. The need to streamline and provide
specific dates for a group to begin work together and to plan ahead for the time a particular group
completes housemanship. For Medical Officers and PAs replacements should be made promptly if they
leave for school or are transferred out.

-AMMS affecting schedule of those left behind, however, since it is usually planned ahead adjustments
are made to accommodate the absence.
-PCC volunteering takes a toll on our regular schedule for OPD/ER/ Corporate so going forward an
Annual schedule for PCC could be brought forward in advance to smoothen our monthly schedules. Also
a group of prescribers could be assigned and excluded from regular schedule during those times.

-Proper Orientation of New Medical Officers to prepare them for possible full time work at obs/gynae
unit. When medical officers are comfortable working in the Medical unit it becomes difficult to move
them to OBS/GYN and also creates a loss of workfoce at the Medical unit. Therefore, suggested Solution
is to Move a New M.O straight to OBS/GYN right after interview and start of work.

-Security of prescribers especially during night duties. Security officers should be checking up on ER staff
during night shifts and to be strict on relatives or others using the ER as thorough fare.

- Challenges with timing of leave for prescribers, need to streamline leave for the whole year to ensure
all months have adequate number of prescribers.

-Referral from peripheral centres , to compile the letters and follow up to those facilities to organize
forums to train them.

<8> SUGGESTED RECOMMENDATIONS FOR REBRANDING OF PHM

-Create Social Media Handles to indirectly advertise by showing short videos of public health interest.

-Improve OPD waiting areas with Comfortable chairs.

- To improve general perception about PHM by engaging more with our locality/community through
durbars held for them and free screenings etc.

-To have time to review inputs from our general public ‘Suggestions box”.

-To make the environment more beautiful by placing flower pots with plants which also give oxygen.

-To create more space within the yard.

- To provide LABELS of prescribers name on door post during consultations

-To re-enforce name tags wearing.

-To improve lab space and to do certain labs like Urine c/s ,blood c/s, Arterial Blood gases etc.

<9> CONCLUSION

The TARGETS set for 2023 do not stand in isolation from those set for 2022 nor prior , and so this report
serves as a template for 2023 and beyond. The Ambitions of the Medical Unit could only be achieved
with dedication and team work from all parties involved and the same goes for the overall Progress of
Pentecost Hospital Madina Estates. We PRAY for God’s guidance and Blessings in our quest for
Excellence.

THANK YOU

COMPILED BY DR SW SARKODIE-YEBOAH( MEDICAL UNIT HEAD-from OCT 2021 till date)

REVIEWED BY DR CHARLOTTE AMPONG( CONSULTANT Endocrinologist PHM)

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