Chapter 6
Inpatient Service Management
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Chapter Objective
By the end of this chapter, you will be able to implement the standard
practice of care in inpatient service management at hospital level
Enabling Objectives:
•Describe operational standards of inpatient service management
practice
Design a system to implement inpatient service management.
Explore quality management activities across inpatient service
management
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Outline
Introduction
Operational standards
System design
Quality management activities
Summary
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Overview
Inpatient hospital Services
Aims to provide guidance on establishing effective, efficient and integrated
inpatient care services from admission through discharge
are medical care and treatment of inpatients provided under the direction of a
physician
Inpatient hospital services vary across hospitals depending on the tier level
and may include units
staffed by multi-disciplinary team including physicians, nurses, dietician,
clinical pharmacists, laboratory professionals, and other cadres
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Operational standards
The Hospital provides standard inpatient services meeting
relevant regulatory standards
Inpatient staff regularly follow and implement the hospital's
admission and discharge protocols
All inpatient records contain completed medical record formats
The Hospital conducts multidisciplinary team rounds twice per
day and conduct chart audit by senior for newly admitted patient
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The inpatient department is staffed with adequate personnel
appropriately trained and equipped for inpatient care per regulatory
standards
The department has guidelines for verbal and written communication
on patient care including handovers within and between disciplines
Established procedures exist for inter-professional and inter-
departmental consultations and patient transfers to ensure
continuity of care
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System design for standard inpatient services layout &
flow
Inpatient services management structure
The director should oversee all inpatient activities
Clinical and support staff should be organized into specialty-based case Teams
Efficient inpatient services require coordination with:-
Nursing care service
Clinical Support Services
Health Information Services
Facility Management
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Service layout
Safe, comfortable inpatient rooms facilitate healing.
Room sizes should meet minimum standards per the hospital's tier level and
separate room for male and female..
Each ward should have at least 1 nurse station for every 35 beds located close
to patient rooms.
Should estimate the oxygen requirements for each ward to determine the total
supplemental oxygen needs.
allocate 15% of total beds for private services operating 24 hours a day, 365
days a year
Mobile diagnostic services like ultrasound, mobile x-ray, and ECG should be
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available in the wards.
Quality management activities across inpatient
services
Inpatient case management
key activities
Efficient bed management to avoid inappropriate hospitalization
and improve bed access
- Patient-centered services
- Patient involvement in decision-making
- Available beds for elective admissions to reduce waiting times
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Clinical care Service Activity
Plays a major role to the improvement of quality of inpatient care
and reduce average length of stay.
implement multidisciplinary team round twice per day
conduct chart audit by senior physician for newly admitted patient
Medications are administered and documented per standardized
formats
supplemental oxygen is fully prescribed, delivered and adherence
monitored by clinical pharmacists.
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Complete oxygen orders specifically:-
1. Flow rate
2. Delivery system/mode
3. Monitoring frequency
4. When to report
5. When to change delivery device
6. When and how to stop administration
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Food/Nutrition service
Menu planning is the cornerstone of food services
Isolation rooms
Well-designed isolation rooms are very essential:
To separate patients who are likely to be infectious to other persons
To provide an environment that allows reduction of the concentration of airborne
Particles through various engineering methods
To prevent the escape of airborne particles from such rooms into the corridor and
other areas of the facility using directional airflow
To protect patients who are immune-compromised from potentially harmful
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Discharge process
The Hospital should have a written discharge protocol defining all steps
discharge is planned counsels the patient decides discharge and
completes a summary
For referred patients
, the discharging physician also completes the feedback section of the
referral form given to the patient to return to the referring facility.
The patient should advised / counseled prior to discharge (Pre-
discharge counseling).
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Patient Death
There shall be a protocol that states the procedure to be followed
for dead body care
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Activity 6.1 Individual Reflection
Instruction:- assume that you are delegated to lead
the IPD.
Activity:-Forward your view on the minimum
requirements of inpatient Service equipment and
Supply?
Time Allowed : 03 Minutes
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Inpatient Service Human Resource Requirements
inpatient services should be provided by Case Teams comprised of
All required health care professional mix
Inpatient Care Communication
Clear communication ensures care continuity, avoids duplication
and is essential legally
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Handover of Clinical Care
Activity 6.2: Paired Discussion
Instruction:-Consider your hospital setup and share your idea
o Write your ideas on a piece of paper
o Reflect
o Debate on the recorded ideas
Activities
What are the benefits of proper handover and
Consequence of poor handover?
Time: - 5 min.
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Handover involves transferring professional
responsibility/accountability for some or all aspects of patient care.
Effective handovers are vital for care continuity and should align with
documentation like referrals, transfers and discharge summaries.
Timing of handover
Daily in all hospital settings during shift changes
During transfer within/between facilities
Admission/referral/discharge
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Methods of handovering
Include face-to-face,
Telephone,
Electronic tools.
Bedside,
Staff areas,
Reception desks
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Communicating with patients
Healthcare providers should inform the patient/s and their
careers/relatives about
information on diagnostic tests and clinical findings and with whom they
can raise questions after the ward rounds
Documentation and Record-Keeping
Comprehensive clinical documentation is integral to quality care
Thus records should be updated by all involved multidisciplinary staff
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Patient attendants or Visitors management
Effective visitor management is imperative for smooth
functioning.
Reception Management System for Hospital
The system facilitates visitor management, enhancing reception
operations.
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Summary
Standardized inpatient service management plays a crucial role
in maintaining and improving the continuum of quality of care.
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THANK YOU!
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