OUTPATIENT

DEPARTMENT
Alisha Biju
MHA 1st year
Introduction
Outpatient services are medical procedures, tests or consultations that can
be performed without an overnight hospital stay. They are also known as
Ambulatory Services. Many procedures and tests can be done in a few
hours.

Definition
• OPD is defined as a part of the hospital with allotted physical facilities and
medical and other staffs, with regularly scheduled hours, to provide care
for patients who are not registered inpatient.
• A hospital department where patients receive diagnosis and / or
treatment but do not stay at overnight.
Importance
• It is the shop window of the hospital
• A good OPD services can reduce the load on IPD services.
• It is the place for implementing preventive and promotive health
activities.
• OPD can make and mark the image of hospital.
• The cost of treatment in OPD is less than that of IPD.
• About twice in patients attend OPD every day
Functions of OPD
• Caring of the sick is the primary function of outpatient department.
• Early diagnosis, preventive and rehabilitation care on ambulatory
service.
• Effective treatment.
• Follow up care and care after discharge.
• It provides medical students, house physicians and other professional
staff such as nurses and technicians with valuable and diversified
clinical experience.
• Control disease by early diagnosis and timely treatment.
• Keep up to date records for future treatment, epidemiological study
and social research.
Objectives
• Provide quality of care.
• Facilities for total patient satisfaction.
• Modern facilities for investigation and treatment.
• Good public relation.
OPD Process
Types of Outpatient Services
• Centralized outpatient services
• Decentralized outpatient services

Centralized OP services: All services are grouped together in the form

of an OPD complex. It will include all the diagnostic, therapeutic and
utility areas.

Decentralized OP Services: Services are provided in the respective

departments.
Types of Outpatients
• General outpatient
• Emergency outpatient
• Referred outpatient

General Outpatient: all the patients other than emergencies who

report directly to the OPD.

Emergency Outpatient: a person given emergency medical care for

condition which is real or perceived emergency.

Referred Outpatient: a person referred to an OPD by his attending

medical / dental practitioner for specific diagnostic treatment
procedure.
Sources of origin of outpatients
Unreferred cases

Discharged cases
OPD Emergency and
from hospital
Accidents
(follow up)

Referred cases from

private practitioners and
peripheral hospitals.
Physical Facilities
• Public area – Entrance, wide ramps and steps, drinking water, toilet
and wash, waiting area, reception and info, ticket counter, registration
counter, snack bar.
• Clinical areas – Different OPD’s, sub waiting area, specialist room,
special exam room, consultation room.
• Administrative areas – Admin office, business office, housekeeping,
storage facility.
• Circulation areas – Corridor, stairs, lifts, security point, ATM card
booth.
• Ancillary areas – Injection room, PAC (Post Acute Care), pharmacy,
immunization and dressing.
• Auxiliary areas – ,Central collection, physiotherapy, medical social
worker, diet counselling and nutrition, x-ray/ultrasound, ECG room,
radiology, health education and counselling.
Location, Layout and Size
LOCATION – should have access from the entrance. There should be
sufficient parking for vehicles. Area should be noise free.

• Movement of patient should be in 1 direction.

• It should share IPD’s diagnostic services and therapeutic facilities.
• There should be scope for expansion.
LAYOUT

• Double loaded single corridor with rooms on each side of corridor.

• Double corridor for entry from the opposite sides of the room.
• Triple corridor which provides two rooms of examination treatment
rooms on each side of a staff corridor.
SIZE
Depends upon,
 Type and number of specialist clinics.
 Timings of OPD.
 Number of daily OPD patients.
 Number of attendants accompanying the patient.
 Availability of space.
 Plans for future expansion.

Some recommendations according to BIS (Bureau of Indian standards):

*Entrance zone – 2sq.meter/bed

*Ambulatory service – 10sq, meter/bed
*Diagnostic zone – 6sq.meter/bed
*Total hospital area – 60sq.meter/bed
Facilities to be made available
• Wheelchairs, stretchers, physician’s desk, wall mounted cabinets,
work table, x-ray view box, revolving stool, chair, examination couch,
instruments trolley, wash basin.
• Equipment for resuscitation, ECG machines, portable x-ray machine,
ultra- sonography machine.
• Every department will need equipment and instrument as per their
departments clinical needs, the type of cases seen in OPD, procedures
performed in OPD etc.
Staffing
1. Medical staff – staff from respective departments come to the OPD by
rotation on their OP days from the level of chief consultants to intern.

2. Nursing staff – nursing staffs are posted to the OPD’s on rotational basis
depending upon the size of OPD and the work load.

3. Paramedical staff , technician, security staff, clinical staff, housekeeping

personnel, depending upon the work load

4. OPD - in charge with his/her secretarial.

Policies
Every hospital should have a policy for its OP services regarding timing of
OPD hours, appointment system, VIP patient protocol, activation of disaster
program on the event of disasters, drug availability system, billing system
etc.
 Organisational components of
OPD
1. Medical staff – central to the organization .

2. Nursing staff – registered nurses, ANMs and nursing

FOUR MAJOR or hospital aids.
ORGANIZATIONAL
3. Ancillary staff – radiology, laboratory and ECG
COMPONENTS technicians.

4. Clerical staff - carries out registration, billing,

receiving cash, secretarial and medical records
function.
Cleanliness and Sanitation
• Appropriate, durable finishes for each functional space. Antimicrobial
surfaces might be considered for appropriate locations.
• Proper detailing of such features as doorframes, casework, and finish
transitions to avoid dirt-catching and hard- to clean crevices and
joints.
• Adequate and appropriately located housekeeping spaces.
• Incorporating operations and maintenance practices that stress indoor
environmental quality.
Security and Safety
Security measures
 Accesscontrol – restrict access to unauthorised personnel and
patients to maintain confidentiality and prevent unauthorised entry.
 CCTV surveillance – install CCTV cameras to monitor the premises and
detect potential security threats.
 Patientvaluables – provide secure storage for patients valuables such
as lockers or safe boxes.
 Stafftraining – each and every staff’s in the OPD should be well
trained (violent or unstable patients need to be controlled).
Safety measures
 Infection
control – implement proper sterilization, disinfection and
hygiene activities to prevent hospital acquired infections.
 Emergencypreparedness – have a plan in place for medical
emergencies, such as cardiac arrest or allergic reactions.
 Firesafety – ensure that fire extinguishers are accessible and proper
training for its uses.
 Patient
fall prevention – implement measures to prevent patient falls,
such as non-slip flooring and handrails.
 Managerial Issues
a) Public relation – external public relation is important and internal public
relation is even more important. Because a demotivated staff member
may mark the reputation of whole hospital. PR employees should be
sympathetic , compassionate, lovable, caring, and communicate.

b) OPD timing – the OPD time once fixed, must be followed strictly. Staffs
reaching the OPD late, leave very adverse opinion in the minds of people.

c) Appointment system – if there is no appointment system, or it is not

followed strictly, results in overcrowding, wastage of resources and
increased dissatisfaction among visitors.

d) Queue jumping – it is a very bad practice. Consultation turn must be

displayed.

e) Absenteeism – the visitors should not take it by surprise that the OPD
consultant is absent and not welcome. If so arrangements must be done
in time to avoid inconvenience of the visitors.
EMERGENCY
SERVICES
DEPARTMENT
Introduction
It is an integral part of an Hospital. It is a very critical and sensitive unit
of any hospital and is involved in the management of emergency cases.

Definition
• Medical emergency is defined as a situation where the patient
requires urgent and high quality medical care to prevent loss of life,
limb or organ and initiate action for the restoration of normal healthy
life.
Importance
• Public perception and opinion of a hospital is often based on their visit
to the accident and emergency department.
• This facility usually accounts for a significant number of all hospital
admissions.
• Effective functional operations in the department are important
variables for staff, patient and visitors satisfaction.
Functions
• To treat un announced patients life threatening and routine.
• 24 x7/365
• To provide immediate appropriate life saving care.
• Service both efficient and effective
• Provide ambulance services.
Objectives
• Quick assessment of the client’s need
• Prompt diagnosis.
• Right intervention
• Prompt evaluation of condition
• Necessary action for referral.
• Admission, discharge and follow up.
• Maintain individuality of the client.
• Maintain safety and comfort of the client.

Right treatment, Right time, Right place, Right resources

Types of Emergency Services
Major emergency and Disaster
management

Basic emergency or Routine with

sp, on call

Referral emergency

Stand by emergency
 Physical facilities
• Public areas – Entrance, reception and waiting area.
• Clinical areas - Triage area, resuscitation area and treatment areas.
• Administrative areas – Offices, secretarial space and a release of
information department.
Location, Layout and Size
Location
 Should be on the ground floor.
 Should have a separate entrance and exit.
 Visible and accessible from the street.

Layout
 Triage area : located next to the waiting area, this area assess
patients conditions and prioritizes care.
 Treatment areas : includes resuscitation, acute treatment bays
and procedure rooms.
 Other areas : includes a seclusion room, decontamination facility
and paediatric patient areas.
Size
 The minimum floor area for a triage or assessment cubicle is
16 square meters
 The minimum combined reception and triage area should be
1.8 square meters per 1000 patient attendances per year.
Facilities to be made available
 Triage : a designated area where patients are sorted based on the severity
of their condition.
 Red zone : a specialized area for treating severe injuries, such as head
injuries and fractures.
 Mini lab ; a mini lab is inside the red zone.(blood test, urine etc..)
 Yellow zone : 4-6 hr stay
 Green zone : minor cases
 Procedure room I : suturing procedures
 Procedure room II : for normal delivery
 Black zone : area to shift dead bodies.
 Nursing station
 Counselling room : for counselling patient by standers.
Conti…
 Monitoring equipment : monitors to track a patient’s condition.
 Essential drugs : drugs to treat a variety of conditions.
 Imagingequipment : x-ray machines, CT scanners, and other
equipment for imaging.
 Isolation area : a space for patients with infectious disease.
 Decontamination room : a space for patients who need
decontamination.
 Fastrack OPD : both paediatric and adults.
 Pharmacy : a pharmacy that is available 24x7.
 Public toilet
 Segregation of biomedical waste
Staffing
• Nurses
• Doctors
• Respiratory therapists
• Attenders
• ED technicians

 ED are staffed 24x7.

 Patients are assessed upon arrival and categorized into urgency level.
 Critically ill patients may need advanced medical equipment,
intravenous medications and continuous monitoring.
Policies and Procedures
• Medico-legal case such as road accidents, assaults, attempted suicide,
poisoning, industrial accidents, death resulting from criminal acts etc.
• Police procedures and reporting
• Notifiable deaths
• Patients brought dead or in a dying condition
• Disposal of bodies, autopsy, morgue procedures
• Accidents and emergency room register
• Medical record and release form procedures
Thank
You!