BASIC HOSPITAL PROCEDURES

Learning Outcome

Demonstrate the knowledge of a health facility set up

Content
Meaning of terms
Types of departments in a health facility
Management structure and ministerial organogram
Levels of health facilities
Theatre layout
Units in a theatre
Meaning of terms
General hospital. A hospital that provides a range of different services for patients of various
age groups and with varying disease conditions.
Specialized hospital. A hospital admitting primarily patients suffering from a specific disease
or affection of one system, or reserved for the diagnosis and treatment of conditions affecting
a specific age group or of a long-term nature.
District/first-level referral hospital. A hospital at the first referral level that is responsible
for a district or a defined geographical area containing a defined population and governed by a
politico-administrative organization such as a district health management team.
The role of district hospitals in primary health care has been expanded beyond being
dominantly curative and rehabilitative to include promotional, preventive, and educational
roles as part of a primary health-care approach.
The district hospital has the following functions:
- It is an important support for other health services and for health care in general in the
district;
- It provides wide-ranging technical and administrative support and education and training
for primary health care;
-it provides an effective, affordable health-care service for a defined population, with their full
participation, in cooperation with agencies in the district that have similar concerns.
Primary health-care centre. A centre that provides services which are usually the first point
of contact with a health professional. They include services provided by general practitioners,
dentists, community nurses, pharmacists and midwives, among others
Physicians/doctors. All graduates of any faculty or school of medicine, actually working in
the country in any medical field (practice, teaching, administration, research, laboratory, etc.).
Midwives. All persons who have completed a programme of midwifery education and have
acquired the requisite qualifications to be registered and/or legally licensed to practise
midwifery, and are actually working in the country. The person may or may not have prior
nursing education.
Nurses. All persons who have completed a programme of basic nursing education and are
qualified and registered or authorized to provide responsible and competent service for the
promotion of health, prevention of illness, the care of the sick, and rehabilitation, and are
actually working in the country
Pharmacists. All graduates of any faculty or school of pharmacy, actually working in the
country in pharmacies, hospitals, laboratories, industry, etc.
Dentists. All graduates of any faculty or school of dentistry, odontology or stomatology,
actually working in the country in any dental field.
Other health-care providers (including community health workers). All workers who
respond to the national definition of health-care providers and are neither physicians/doctors,
midwives, nurses, pharmacists, or dentists.
Inpatient. A person who is formally admitted to a health-care facility and who is discharged
after one or more days.
Outpatient. A person who goes to a health-care facility for a consultation, and who leaves the
facility within three hours of the start of consultation. An outpatient is not formally admitted
to the facility.
Ambulatory care. All types of health services provided to patients who are not confined to an
institutional bed as inpatients during the time services are rendered
Ambulatory care delivered in institutions that also deliver inpatient care is usually called
“outpatient care
Day care. Medical and paramedical services delivered to patients who are formally admitted
for diagnosis, treatment or other types of health care with the intention of discharging the
patient the same day
Long-term care. Long-term care encompasses a broad range of help with daily activities that
chronically disabled individuals need for a prolonged period of time.
Long-term care is primarily concerned with maintaining or improving the ability of elderly
people with disabilities to function as independently as possible for as long as possible; it also
encompasses social and environmental needs and is therefore broader than the medical model
that dominates acute care
Social care. Services related to long-term inpatient care plus community care services, such
as day care centres and social services for the chronically ill, the elderly and other groups with
special needs such as the mentally ill, mentally handicapped, and the physically handicapped.

Types of departments in a health facility

OPD
In-patient
Medical

Surgical
Paediatric
Dental
Medical Laboratory Radiology Pharmacy What is an OPD?
OPD is the short form of the Outpatient Department. It is the section of any hospital where
the patients that require medical attention are treated. People need to pay consultation
charges, and the doctor will visit the patient to conduct the necessary check-up. The doctor
examines the patient, conducts necessary tests, and prescribes medication and treatment on
the basis of the health condition of the patient

Services Provided by the OPD

These services are classified as -Prevention and wellness -
OPDs provide guidance to the patients for overall wellness and prevention of health issues.
Doctors guide patients to maintain a healthy weight, improve sleep, balance sugar levels,
etc.
Diagnosis -
OPD is the first place where the patient and doctor meet and discuss the patient's health
condition. After discussing the issue, the doctor suggests the necessary tests for the patient.
The lab tests and MRI scans are conducted in the OPD.
Treatment -
Treatment and minor surgeries can be done in the outpatient department. Modern OPD has
all the necessary equipment to treat a patient. Surgeries such as cuts, wounds, etc., can be
easily handled in the modern OPD.
Types of Outpatient Department
Primary Care Clinic -
Primary care clinics are facilities where patients consult the physicians. These physicians
conduct tests and direct the patient to specialists when the need arises. Examples of primary
care physicians include nutritionists, family doctors, gynaecologists, etc. These are regular
doctors that conduct the check-up.
Community Clinic
The community health clinic is for the people who cannot access healthcare. These allow
people with low incomes, no health insurance, workers, or migrants.
Urgent Care Centre
The urgent care centre is a clinic that serves the purpose of an emergency ward.
It is for those treatments which require urgent attention but are not life-threatening.
The patients are treated for illness and injuries without the emergency rooms.
Hence the urgent care centre reduces the workload of the emergency rooms by providing it
Specialized Outpatient Clinic
Specialized Outpatient Clinic is for the patients suffering from a specific illness under the
specialization like cardiology, nephrology, wound care, pain management, chemotherapy
treatment, and radiation treatment at specific centres
Pharmacy
Nowadays, a pharmacy functions much beyond what it used to do years ago. Today, the
pharmacy provides preventive measures for health conditions, possible side effects and other
information associated with the drug, and the readings such as heart rate and blood pressure.
These facilities are provided rather than simply providing medicines to the patients and
convenient treatment to the patients
Emergency Department
The emergency department is popularly known as emergency rooms, abbreviated as ER.
The emergency department is in every hospital and provides service to the patients who
require immediate treatment and attention.
The staff of the ER department is highly skilled and includes doctors, nurses, and radiologists
who treat emergency illnesses or injuries.
All these professionals identify the problem and immediately work on recovering the patient
Importance of OPD in Healthcare Systems
An Outpatient Department is at the entrance of any hospital. It acts as the first place where the
patients and doctors communicate.
It is a crucial link between the patients and the healthcare system and is hence inseparable.
It is vital in preventing diseases and ensures fast recovery of the patient.
It controls the number of patients in the inpatient ward by providing small surgeries and
treatments.
It evaluates the patients, and only those who require a bed or special care are shifted to the
inpatient ward. Thus, saving the number of occupied beds.
Generally, people that visit for the first time and have minor health are treated in OPD.
Doctors conduct tests, provide consultancy, and give prescriptions to the patient in the OPD.
Process of Admission in the Outpatient Department
There is a certain process that is to be followed while treating the patients in the OPD. It
includes the following:
The patient is screened, and tests are conducted as an initial process.
The patients are allotted appointments for consulting a doctor.
A new patient must maintain a file that can be issued at reception.
A patient is generally charged for consultation on the basis of whether they are a new patient
or it is their follow-up.

In-patient department
IPD is a department in a hospital that takes care of patients admitted in the hospital for at least
a night.
An Inpatient Ward or Department is fully equipped with medical equipment and beds.
The patient admitted to an Inpatient Ward is taken care of by the nurses and doctors for
appropriate treatment
What are IPD Benefits?
Following are the list of IPD benefits that one may reap as an inpatient in a hospital:
1. Constant care of doctors and nurses
2. Proper diagnosis of your medical condition through lab tests
3. Treatments related to cardiology, neurology, oncology, orthopaedics, and general surgery
4. After-care due to surgery, childbirth, or traumatic injury
5. Pre-planned inpatient care for a knee transplant or bypass heart surgery
6. Emergency healthcare for serious conditions like heart attack, accidental injuries

What are the Types of Inpatient Care offered in an IPD?

Following are some types of inpatient care offered in a hospital’s Inpatient Department:
1. Severe burn injuries
2. Serious illnesses like stroke, cardiac attack
3. Traumatic head injuries
4. Treatment for serious mental illness or disorder
5. Treatment for chronic diseases like COPD and cancer
6. Few cosmetic surgeries
What is the Difference between OPD and IPD?
The basic difference between an OPD and IPD is in the level of care and treatment given to a
patient.
Duration of Stay: The former does not require a patient to get admitted to a hospital for even
a night. While a patient is required to stay in an IPD for at least 24 hours.
Cost Factor: Secondly, there is a lot of difference in terms of cost of both OPD and IPD.
OPD is cheaper than IPD because here the patient is not admitted to the hospital.
Revisiting Parameter: Thirdly, a patient might need to revisit an OPD again and again for
consultation, but this is not the case with an Inpatient Department.
Type of Care: More dedicated care is provided to the patient in an IPD as compared to an
OPD, where the patient has to often wait in long queues to consult a doctor or specialist

Medical department
The department of Medicine deals with the prevention, diagnosis and non-surgical treatment
of various diseases.
It serves as the first point of contact whenever a patient visits the hospital. A general physician
conducts a physical examination of the patient and then recommends necessary tests and
diagnostic procedures.
The results of these tests, the general physical examination and symptoms are then correlated
to arrive at a final diagnosis.
Depending on the final diagnosis, the general physician gives the necessary treatment (usually
medication) to the patient or refers to a specialty department for further treatment.

Surgical department
It is composed of multiple subspecialties covering the entire scope of practice such as General
Surgery, Neurosurgery, Urology, Cardiac, Orthopaedic, Ophthalmology, Paediatric, Plastic
Surgery as well as Ear, Nose, Throat, Head & Neck surgery.

Paediatric department
Paediatrics is the branch of medicine dealing with the health and medical care of infants,
children, and adolescents from birth up to the age of 18
A paediatrician is a child's physician who provides not only medical care for children who are
acutely or chronically ill but also preventive health services for healthy children.
A paediatrician manages physical, mental, and emotional well-being of the children under
their care at every stage of development, in both sickness and health
Paediatrics is concerned not only about immediate management of the ill child but also long
term effects on quality of life, disability and survival.
Paediatricians are involved with the prevention, early detection, and management of problems
including:

Developmental delays and disorders

Behavioural problems
Functional disabilities
Social stresses
Mental disorders including depression and anxiety disorders
Dental department
The Department of Dental Medicine provides comprehensive diagnostic and therapeutic
dental health procedures to all its patients.

Services Offered
Aesthetic Dentistry
Endodontics (pulp and roots of a tooth)
Oral Surgery
Orthodontics (correction of malpositioned tooth)
Paediatric Dentistry
Prosthodontics (prosthesis/restoring missing teeth)
Restorative Dentistry (repair or replacing teeth)
TMJ (Temporo Mandibular Joint) Management (temporal bone and law jaw)

Medical Laboratory department

A medical laboratory or clinical laboratory is a laboratory where tests are carried out on
clinical specimens to obtain information about the health of a patient to aid in diagnosis,
treatment, and prevention of disease
Medical laboratories vary in size and complexity and so offer a variety of testing services.
More comprehensive services can be found in acute-care hospitals and medical centres,
where 70% of clinical decisions are based on laboratory testing

Radiology department
Radiology is a branch of medicine that uses imaging technology to diagnose and treat
disease.
Radiology may be divided into two different areas, diagnostic radiology and interventional
radiology

DIAGNOSTIC RADIOLOGY
Diagnostic radiology helps health care providers see structures inside your body.
Using the diagnostic images, the radiologist or other physicians can often:
Diagnose the cause of your symptoms
Monitor how well your body is responding to a treatment you are receiving for your disease
or condition

Screen for different illnesses, such as breast cancer, colon cancer, or heart disease The most
common types of diagnostic radiology exams include:
Computed tomography (CT), also known as a computerized axial tomography (CAT) scan,
including CT angiography

Fluoroscopy, including upper GI and barium enema

Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA)
Mammography
Nuclear medicine, which includes such tests as a bone scan, thyroid scan, and thallium
cardiac stress test
Plain x-rays, which includes chest x-ray
Positron emission tomography, also called PET imaging, PET scan, or PET-CT when it is
combined with CT
Ultrasound
INTERVENTIONAL RADIOLOGY
Interventional radiologists are doctors that use imaging such as CT, ultrasound, MRI, and
fluoroscopy to help guide procedures.
The imaging is helpful to the doctor when inserting catheters, wires, and other small
instruments and tools into your body. This typically allows for smaller incisions (cuts).
Doctors can use this technology to detect or treat conditions in almost any part of the body
instead of directly looking inside of your body through a scope (camera) or with open
surgery.
Interventional radiologists often are involved in treating cancers or tumors, blockages in the
arteries and veins, fibroids in the uterus, back pain, liver problems, and kidney problems

Examples of interventional radiology procedures include:

Angiography or angioplasty and stent placement
Embolization to control bleeding
Cancer treatments including tumour embolization using chemoembolization or Y-90 radio
embolization

Tumour ablation with radiofrequency ablation, cry ablation, or microwave ablation

Vertebroplasty and kyphoplasty
Needle biopsies of different organs, such as the lungs and thyroid gland Breast biopsy,
guided either by stereotactic or ultrasound techniques Uterine artery embolization Feeding
tube placement
Venous access catheter placement, such as ports and PICCs
Pharmacy department
Hospital pharmacy is the health care service, which comprises the art, practice, and
profession of choosing, preparing, storing, compounding, and dispensing medicines and
medical devices, advising patients, doctors, nurses and other healthcare professionals on their
safe, effective and efficient use.
Hospital pharmacy is a specialized field of pharmacy which forms an integrated part of
patient health care in a health facility.
Hospital pharmacy is the profession that strives to continuously maintain and improve the
medication management and pharmaceutical care of patients to the highest standards in a
hospital setting.

Management structure and ministerial organogram

Hospital Organization and Management Board
All hospitals include some form of governing body responsible for making high-level
decisions about the organization.
The board of directors is the highest in the hospital chain of command and is made up of
experts in their respective fields. Religiously affiliated hospitals often include clergy on their
boards of directors.
Teaching hospitals often include university faculty from the medical school with which
they’re affiliated
Executives
In the hospital leadership structure, executives are responsible for managing the organization,
making financial decisions, and overseeing business strategy.
Medical and health services managers may oversee entire practices or clinical areas.
A hospital typically has a chief financial officer who tends to the financial aspects of the
business and a chief operating officer or chief executive officer responsible for high-level
business strategy and decision-making.
Department Administrators
Department administrators report to the hospital executives and manage the day-to-day
operations of the hospital department structure.
The chief of surgery, for example, is responsible for overseeing daily activities within the
surgical department as well as performing surgery.
A chief of surgery might engage in public relations activities, fundraising and recruitment.
Other segments within a hospital, such as transcription or switchboard personnel, also have
department administrators.
Patient Care Managers
Nurse Managers and supervising physicians are both patient care managers.
These individuals manage small groups of professionals who provide direct patient care.
They ensure that orders are carried out, that hospital employees are fulfilling their duties
appropriately, and that employees are complying with legal requirements
Service Providers
The vast majority of hospital workers are service providers: doctors, nurses, orderlies,
physical therapists, laundry workers, and the many other people required in order for a
hospital to function.
They provide patient care, maintain records and ensure that the hospital is able to deliver care
to patients in an effective manner. Service providers have their own hierarchical structure in
healthcare. For example, doctors often give orders to nurses, who might delegate to orderlies.
A customer service charter is a document that outlines how an organization promises to
work with its customers along with providing insights into how an organization operates.

Service charter may include

• Mission
• Vision
• Core values
• Services offered

Levels of health facilities

There are six different levels of health care facilities.
The first five are managed on the county level, the sixth level by the national government. In
this system the patients may move from one level to the next by using a referral letter.
LEVEL 1 - Community Facilities

they are run by certified medical clinical officers.

Some of the services:
Treatment of minor ailments like diarrhoea
Tuberculosis (TB) screening, home visits, contact tracing of TB patients and tracing of TB
defaulters

Screening of malnutrition Malaria rapid test

Blood pressure and blood sugar testing HIV testing
Health talks with pregnant women and observations of signs of danger
Issuance of referral letters to other facilities
LEVEL 2 - Health Dispensaries
These facilities are run by clinical officers:
The dispensaries in the cities act like a health centre (see level 3), with the difference that the
dispensary does not have in-patient facilities.

These are some of the services you will expect in a dispensary:

Outpatient services
VCT services
Tuberculosis services
Laboratory Services
Well baby Clinics
Antenatal and Postnatal services
Pharmacy
Counselling services Curative treatment
They issue referral letters to other facilities LEVEL 3 - Health Centres
These are small hospitals with minimal facilities, yet they offer services like the big hospitals.
They are run by at least one doctor, clinical officers and nurses.

These are some of the services they offer:

Maternity in-patient services with a ward
Curative services
Laboratory services
Dental
Counselling
Pharmacy
TB Clinics
Diabetes & hypertension clinics
Comprehensive care clinics for patients living with HIV Baby well clinics
Antenatal and postnatal services
They issue referral letters to other facilities
LEVEL 4 - County Hospitals
These are hospitals that offer holistic services and are ran by a director who is a medic and at
best a doctor by profession
In many counties there’s just one hospital but in larger cities like Nairobi there are two
They have in principle the same services as the Level 3 hospitals, plus X-Ray services they
issue referral letters to other facilities
LEVEL 5 - County Referral Hospitals
These are the county referral hospitals formerly the provincial hospitals. They are run by
Chief Executive Officers who are medic by profession and have over 100 beds capacity for
their in-patient. They are also do research about health.
In Nairobi Mama Lucy Hospital and Mbagathi Hospital both double up as county referral
hospitals and Level 4 hospitals.

Services include what other hospitals offer, plus

Ultrasound
CT-Scan
Surgery
Pharmacy
Physiotherapy
Orthopaedics
Occupational Therapy
They issue referral letters to other facilities
LEVEL 6 - National Referral Hospitals
In Kenya there are three Teaching and Research referral hospitals: Mathari Hospital,
Kenyatta National Hospital, Moi Teaching and Referral Hospital and the National Spinal
Injury Referral Hospital.
Their range of services is the same as of on Level 5, but they offer specialised treatments to
patients and are not only accessed by Kenyans but do serve East Africa and Central Africa.
Mathari Teaching and Referral Hospital offers specialised mental services.
Kenyatta National Hospital and Moi Teaching and Referral hospital offer specialised
consultations in curative care.
National Spinal Injury Referral offers specialised services in orthopaedic and spinal injuries.
The national government manages these three hospitals
Theatre layout
OT are designed and built to carry out investigative, diagnostic, therapeutic and palliative
procedures of varying degrees of invasiveness.
Many such setups are customized to the requirements based on size of hospital, patient
turnover and may be speciality specific.
The aim is to provide the maximum benefit for maximum number of patients arriving to the
operation theatre.

Both the present as well as future needs should be kept in mind while planning OT OT
design
Most surgical suites are constructed according to a variation of one or more basic designs.
The basic designs are:

Central corridor plan - these plans are two types

Racetrack plan - In this design, the front entrance to each OR is from the outer corridor, and
supplies are retrieved through a rear entrance to the room leading to the central-core storage
and work areas.

Hotel plan - In this design, the ORs are situated along a central corridor, with separate clean
core and soiled work areas.
The primary difference in this plan is that all traffic enters and exits the surgery department
through a single entrance or a primary entrance and holding area entrance situated along the
Peripheral corridor - In this design, the front entrance to each OR is from the peripheral
corridor, and supplies are retrieved through a rear entrance from the OR leading to the central-
core storage and work areas.
Specialty grouping plan - The "specialty grouping" plan is simply a variation on the hotel or
race track plan, in which ORs are grouped by specialty (e.g., neurosurgery, general surgery),
each with its own closely associated clean storage areas and, in some cases, each with its own
soiled instrument work area corridor
Different Zones/ Areas
The OR department is divided into four zones based on varying degrees of cleanliness, in
which the bacteriological count progressively diminishes from the outer to the inner zones
(operating area) and is maintained by a differential decreasing positive pressure ventilation
gradient from the inner zone to the outer zone.

1. Unrestricted zone or clean area.

2. Semi restricted zone or sub sterile area
3. Restricted zone or sterile area
4. Disposal zone or area Unrestricted/ Clean zone or clean area
This is the area where hospital personnel, OT personnel, patient's & their attendants can
move about in street clothes.

Connects protective zone to aseptic zone and has other areas also like
Stores & cleaner room
Equipment store room
Maintenance workshop
Kitchenette (pantry)
Firefighting device room Emergency exits Service room for staff Close circuit TV
control area
Semi restricted/ Protective zone or sub-sterile area
After changing from street clothes, with clean gown, cap & OT slipper, the OT team or
personnel are, enter in this area. (Operating room attire is required)

It includes -
Change rooms for all medical and paramedical staff with conveniences
Transfer bay for patient, material & equipment's
Rooms for administrative staff
Stores & records
Pre & post-operative rooms
I.C.U. and P.A.C.U.
Sterile stores
Restricted/Aseptic zone or sterile area:
This zone has operation theatres & operation room where operations are done.
This is a place where staff & patients in street clothes & shoes are not allowed to enter.
Scrubbed personnel wear sterile gowns & gloves & get ready for operation procedure.
(Operating room attire is required)
Disposal zone or area
Dirty utility area
Disposal corridor
OT attire mandatory in this area
Advantages of zoning
Minimizes risk of hospital infection.
Minimizes unproductive movement of staff, supplies & patient.
Increases efficacy of operative team members.
Ensures smooth workflow.
Deceases hazards in operating room.
Ensures proper positioning of equipment's