FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

MINISTRY OF HEALTH 1
 Learning objective
 Introduction
 Operational Standard
 Implementation Guidance
 Assessment checklist
 indicators

2
 At the end of this presentation the participant will able to:
◦ Explain Concepts and principles of inpatient service management
and organization
◦ Describe resources and infrastructure needed for inpatient service
management
◦ Identify tools and methods used to measure inpatient service
against the standard
◦ Describe indicators to measure inpatient service quality

3
 Patients enter inpatient service care mainly from
◦ previous ambulatory care such as referral from outpatients or
emergency outpatient department (OPD),
◦ Home (with an appointment),
◦ Transferred from inter-department or
◦ Referred from another facility
 Main purpose:
◦ provide high quality inpatient service through integrated,
respectful and compassionate team approach.

4
 The Hospital has established Management structures & job
descriptions that detail the roles and responsibilities of each
discipline within services/departments/units, including
reporting relationships
 IPD specific admission and discharge procedures are
established to reduce the unnecessary inpatient length of stay.

5
 All admitted patients have medical and nursing/midwifery care
plans that describes medical and nursing/midwifery interventions
to address their needs.
◦ The plans are regularly reviewed and updated as required
 The hospital implements a minimum of daily multi-disciplinary
team patient rounds.
 The Hospital has IPD service specific facilities as per hospital
tier level

6
 The hospital has IPD staffed with adequate, appropriately
trained personnel & equipped with necessary equipment
/supplies for Inpatient as per tier level of care

 The Hospital has established guidelines for verbal and

written communication about patient care, including verbal
orders and patient handover between disciplines

7
 The Hospital has established procedure for and inter-
professional and departmental consultation and transfer of
patients’ care to ensure continuity of care.

 The Hospital has a policy for accompanying all patients by

appropriately trained health provider/s during out of IPD
diagnostic services and transfer between wards/departments.

8
 Discuss your experience in regard to patient transportation and
recommend best methods.
 Discuss the importance of involving different categories of
professionals in patient care
 Discuss the importance of pre and post patient discharge
planning

9
 Inpatient Services Management and Organization
◦ The Director of Inpatient Services should oversee all
inpatient activities
◦ The director of inpatient service is directly accountable to
the CCO/MD
◦ Clinical & support staff should be organized into Case
Teams by type of specialty
◦ Case teams should comprised of specialists, general
practitioners, health officers, nurses, pharmacists, lab.
technologists, runners, and cleaners.

10
 In-patient Services Layout
◦ Patient wards located at close proximity to ER & OPD
◦ Easily accessible from elevators, ramps or stairways
◦ Each ward should have
 Adequate number of well-ventilated rooms with
 adequate number of functioning toilets, sinks and showers.
 Privacy of patient maintained at all times (mixed wards,
P/E, during sample collection etc)
 procedure room
 case team station.
◦ Laboratory and pharmacy dispensary & counseling services
should be readily accessible to the inpatient wards.

11
 Inpatient Case Management
 24/ 7 admission/discharge service, including holidays and
weekends facilitated through liaison unit

12
◦ Nursing process/midwifery standard
 completed within 8 hours after admission &
implemented.
◦ physicians regularly re-evaluate patient
 At least once a day for stable patients and
 Two or more times for critically ill patients,
◦ Nurses
 Four hourly for stable patients
 more often for critically ill-patients

13
 A
Patient needs admission
Physician completes
record/ admission
form
Patient escorted by staff to
IP with medical records

Ward clerk/nurse receives patient ,

register and put MR on IP folder

Orient patient to the ward and

D Assessment by ward case team

Inpatient Care - Progressive care and

feedback to patient and family --
Discharge
Diagnostic services - Pharmacy services
14
 Specific Inpatient facilities and services
◦ Patient gowns, linen and mattresses
◦ Operating theatre
◦ Intensive Care Unit (ICU) mixed
◦ Mental Health Care Service
◦ Isolation Rooms

15
Patient gowns, linen and mattresses
◦Adequate supply of clean blankets, bed sheets,
patient gowns.
◦Mattresses plastic covered and without any holes.
◦Beds made at least every 48 hours, more frequently,
if need arises.
◦All admitted patients have to wear patient gowns
◦patient clothes stored in a corner, inside a cabinet, or
shelf with sealed partitions, to avoid cross infection.

16
Operating theatre
Management: Team leader (or equivalent) of surgical services
accountable to Inpatient Services Director.
Layout:
◦Unobstructed by movement staff.
◦Table strong to hold the patient and is easy to clean.
◦Basic services of water, light, medical gasses
◦Adequate Instrument storage.
◦One OR table for every 25 surgical beds.
◦located on floor surgical ward connected by simplest possible route.
◦Adjoin the sterilization units, delivery suites and ICU.
Equipment and Staff: per national standard for hospitals.

17
Intensive Care Unit (ICU) mixed
Neonatal, medical, surgical, cardiac etc.
for critically ill patients who need constant medical

attention & highly specialized equipment,

Management: Team leader of respective specialty

accountable to Inpatient Director or equivalent.

layout

◦ adjacent to operating theatre and recovery unit.

◦ number of beds approximately 1-2% of total
hospital bed.
◦ controlled environment with medical
gasses/power sources.
Equipment and Staff: per the national standard

18
 Separate or Isolation rooms
◦ should have negative ventilation,
◦ Scrub- up facilities
◦ self-contained, or has en-suite facilities
 MDR-TB
 Tetanus and others.

19
 Discharge process
◦ Decision should be made by the treating physician
◦ Physician should complete a discharge summary
 First copy should be given to the patient and
 Second copy retained in the patient’s Medical
Record

20
◦ Patients ready for discharge should be counseled by
attending physician, nurse in charge and clinical
pharmacist before discharge.
 On patient’s Dx, Ix results & treatments given
 On medications patient should continue to take upon
discharge
 On follow up arrangements
 On any ‘warning signs’
◦ The discharge process should be complete in no
more than 2 hours (including administrative
process)
21
 Patient death
◦ Policy/Protocol
 Procedure to follow for dead body care
 informing next of kin/family members of the deceased,
taking all religious and cultural considerations
◦ Death should be confirmed by the attending duty physician
◦ Death summary should be completed & documented
◦ Separate room to provide post mortem care
◦ Body should be transferred to morgue immediately after PMC
22
 Pathologic examination for confirmation of cause of
death,
◦ Complete post mortem examination form
◦ Transfere body to pathology case team.
 If the deceased does not have a next of kin, the local
authority is responsible for funeral service.

23
 Inpatient Care Communication
◦ Guideline for working relationship within the same
and different profession
 Handover of clinical care
 Multidisciplinary ward rounds
 Communicating with patients and care givers

24
 Inpatient Care Communication
◦ Guideline for working relationship within the same
and different profession
 Handover of clinical care
 Multidisciplinary ward rounds
 Communicating with patients and care givers

25
 Inpatient Care Communication
◦ Guideline for working relationship within the same
and different profession
 Handover of clinical care
 Multidisciplinary ward rounds
 Communicating with patients and care givers

26
 Inpatient Care Communication
◦ Guideline for working relationship within the same
and different profession
 Handover of clinical care
 Multidisciplinary ward rounds
 Communicating with patients and care givers

27
 Specialist (s)  Dietitian
 General practitioner(s)
 Nurses
 Porters/runners
 Pharmacy technicians
and pharmacists
 Cleaners
(clinical and non-
clinical)
 Cashiers
 Laboratory  Security guards
technologists

28
 Emergency trolley  oxygen, pulse oximeter
with resuscitation  suction machine

equipment and  Vital sign and

emergency drugs diagnostic Set;

 Beds, mattresses, sphygmomanometer(s),
pillows, linens, rubber stethoscope(s),
sheets and blankets thermometer(s)
 chairs, tables, bedside Fundoscope, Otoscope
 Reflex hammer
tables

29
 weight scale and measuring
tape
 IV stands, bed screens
 trolleys, wheelchairs and
stretchers
 Autoclave (at least one, not
in central sterilization unit)
 Shelves
 personal protective
equipment
 Minor procedure sets
according to the type of
ward/case team
 LP set and enema can
 Refrigerators
30
no Yes no
1 There is an established inpatient management structure in
place.
2 Inpatient department is managed by Inpatient director.
3 There are job descriptions that detail the roles and
responsibilities for each inpatient discipline, including
reporting relationships.
4 All admitted patients have medical, nursing/midwifery care
plans.
5 There established guidelines for verbal and written
communication about inpatient care, including verbal
orders and patient handover by discipline and between
disciplines.
6 There is a written protocol for admission and discharge of
patients.
31
N Indicator Formula Frequency
o

1. a) Number of a) Total number of ER inpatient admissions Quarterly

emergency inpatient b) Total number of ER inpatient
admissions admissions/total number of admissions
b) % of total *100
admissions
2. a) Number of elective a) Total number of elective inpatient Quarterly
inpatient admissions admissions
b) % of total b) Total number of elective inpatient
admissions admissions/total number of admissions
*100
3. Number of major Total number of major surgeries/ total number Quarterly HMIS
surgeries per surgeon of surgeons indicator
4. Total length of stay in days (sum total of each Quarterly HMIS
Inpatient days per doctor
daily patient census)/number of physicians indicator
5. Total length of stay in days (sum total of each Quarterly HMIS
Inpatient days per nurse
daily patient census)/number of nurses indicator
32
N Indicator Formula Frequency Commen
o t
6 Number of doctors/Average number of beds Quarterly HMIS
Doctors per bed
indicator
7 Number of nurses/Average number of beds Quarterly HMIS
Nurses per bed
indicator
8 Total length of stay in days (sum total of Quarterly HMIS
Bed Occupancy each daily inpatient census) during reporting indicator
rate period /[number of beds available * number
of days in reporting period]
9 Total length of stay in days (sum total of Quarterly HMIS
Average length of each daily patient census) during reporting indicator
stay (ALOS) period /[total discharges + transfer outs and
deaths]

33
THANK YOU!!!

34