PLANNING AND MANAGEMENT OF CLINICAL SERVICE DEPARTMENT

PRESENTED BY DR.PRIYANKA

(1) Outermost zone, which is the most community oriented with out-patient department emergency department administration admitting office, reception (2) Second zone, which receives workload from diagnostic X-ray laboratories pharmacy (3) Middle zone between outer and inner zones operating department intensive care unit delivery (4) Inner zone, in the interior but with direct access for the public wards and nursing units (5) Service zone, disposed around a service yard ~ dietary services laundry and housekeeping& storage maintenance and engineering mortuary

DEPARTMENTAL PLANNING AND DESIGN

CASUALTY
ORGANIZATIONAL CHART

CEO

COO

Chief Nursing Officer

CMO

Nurse Manager

Clinical Assistants

Staff Nurse

Unit Clerk

Housekeeping Staff

Staffing

Responsibility Matrix

Personnel CMO

Morning 1 on duty 1 on call General

Night 1 on duty 1 on call M Evening or ni n g 2 2 2 2 1 1 2 1 Night

Nurse Manager Staff Nurse Ambulance driver Ambulance attendant Male Attendant

1 -

2 2 1 1

RECORDS AND REGISTERS MAINTAINED IN THE DEPARTMENT Casualty Register Laboratory Specimen Dispatch Register Daily Inventory Register Assignment Register Communication Register Medical Record Dispatch Register Morgue Register MLC Forms/Register Death Certificate

PERSON INITIATING /ATTENDING THE ACTIVITY Receiving the patient Nurse/ security/House keeping boy Medico legal case Staff nurses / CMO / Staff Nurse Death CMO Medical orders Staff nurse/CMO Carrying out Staff nurse /CMO procedures Urgent Staff nurse /CMO diagnostics/blood transfusion Patient brought in Staff nurse/CMO dead Indenting medicines Staff nurses Requesting for CMO diagnostics Transfer out of Staff Nurse / CMO patient Daily inventory Staff nurses Nurses records Staff nurses Equipment Staff nurses management Infection control in Staff nurses ward / Procedure Room Waste disposal Staff nurses/Housekeeping staff Medical Records CMO/consultant Complaints Staff nurses ACTIVITY CMO duty schedule -in-Charge Ambulance driver Manager Admn duty schedule House keeping staff Supervisor house keeping

PERSON SUPERVISING Nurse Manager /CMO CMO / Nurse Manager CMO/Consultant Consultant Nurse Manager /Consultant CMO / Blood Bank officer CMO / CNO Nurse Manager Consultant/CMO CMO / Consultant / Nurse Manager Nurse Manager Nurse Manager / Nurse Manager Nurse Manager / HICC

Nurse Manager /Supervisor CMO / CNO / MRD Nurse Manager / CNO / PRO Manager Admn Supervisor keeping house

OPD
ORGANOGRAM CEO

DIRECTOR NURSING

MANAGER MEDICAL SERVICES

DIRECTOR PROFESSIONAL SERVICES

HOD PATHOLOGY

EXECUTIVE NURSE

CONSULTANTS

TECHNICIAN (Blood Sample Collection)

STAFF NURSES

ATTENDANTS

TECHNICIANS

FRONT OFFICE STAFF IN OPD

 Staffing
Customer Relations Staff: PRO, Reception and Enquiry, Registration and Appointments Billing Counter, waiting lobby. Nursing Staff : Procedure Room Staff Nurse Housekeeping Staff: Attendants to maintain cleanliness and to assist in transporting patients to emergency, screening or diagnostics.

Working Hours The OPD should be open 12 hours every day from 8 a.m The basic requirements of an outpatient

reception and waiting areas, consultation rooms, examination rooms, treatment rooms, and staff and supply areas. to 8 p.m.

PATIENT FLOW CHART

ENTRANCE (arrival of patient)

Patient taking prior appointment

ENQUIRY (received / registered)

Time confirmed to patient

Referred to billing

If investigation required by Consultant

Referred to concerned Consultant

Patient to be referred to billing

If investigation is not required by Consultant

Patient goes for collection of sample

Follow up is explained to the patient

Patient comes for collection of report the next day

Patient leaves the hospital

OUT PATIENT OPERATIONS:- 1)OPD Registration 2)Consultation 3)Admissions or Diagnostic 4)Pharmacy OPD DEPARTMENTS :- 1) Pediatric OPD 2)Antenatal Clinic/ Gynaecology 3) Dental Clinic 4) Ear Nose & Throat 5)Ortho 6)Medicine INVENTORY MANAGEMENT:- The OPD will maintain the following Inventory Records. 1)Equipment and Instruments2)Linen3)Emergency trolley4)Stationery5)Hand wash 6)Dustbins7)Gloves 8)stethoscope9)Hand Towel10)BP apparatus. RECORDS AND REGISTERS MAINTAINED:1) Communication Register 2)Laundry Register 3)Inventory Register 4)Immunization Register 5)Consultant Performance Record 6)CSSD Book 7)Ante Natal Record 8)Equipment Register 9)Vaccine Stock Register

IN PATIENT DEPARTMENT
CEO
ORGANIZATIONAL CHART

COO Chief Nursing Officer

Consultants

RMO

Nurse Manager

Team Leader

Staff Nurse

Health Care Asst.

Unit Clerk

Hospital Attendants

Staffing (Per Shift) R.M.O. Nurse Manager

2 2 (Morning & Evening One Each) Team Leader - 2 (Morning & Evening One Each) Staff nurses -1 : 6 patients Health Care Assistants - 2 Female attendant -3 Male attendant -3

Shifts R.M.O.s will be on 8 hour shifts. They will hand over at 7 am, 2 pm and at 9 p.m. Team Leaders will be on 8 hours shift .They will hand Over & Take Over at 7 am & 2 pm. They will be on duty from 7 am to 3 pm, 2 pm to 10 pm. Staff Nurses will be on 8 hour shifts. They will hand over and take over at 7 am, 2 p.m. and 9 p.m. The Nurse Manager will be on duty from 7 am to 3 p.m.,2 pm to 10pm. The Nurse Manager will be on duty from 9 pm to 7 am & 2 pm to 10 pm when deputed by Chief Nursing officer as Shift Coordinator

ACTIVITY Admission procedures

PERSON INITIATING Doctor/Nurse/Front Office Unit Clerk RMO / Consultant

PERSON SUPERVISING Nurse Manager, Executive Front Office Consultant Consultant/Nurse Manager Nurse Manager/ Consultant Nurse Manager/ Consultant Nurse Manager/ Consultant Nurse Manager/ Executive Front Office Consultant, Consultant,

Diagnosis Treatment/ Tests Records Transfers Discharge Medication

RMO/Consultant RMO/Consultant Staff nurse/RMO Staff nurse/RMO Staff nurse/RMO

Follow-up Ward Protocol Nursing Procedures Waste Management

Nurse Manager Nurse Manager Staff Nurse /RMO/Health Care Assistant

Consultant, Chief Nursing Officer Chief Nursing Coordinator Officer/Shift

Nurse Manager/Educator/Shift Coordinator Nurse Manager/Facility Manager

Infection Control

Staff Nurse/RMO/Consultants

Nurse Manager/Chief Nursing Officer Infection Control Nurse Facility Manager/Chairman Infection Control Committee

IPD OPERATIONS
Admission of the Patient in the Ward:-1)Planned 2)Emergency registration Allotment of room and bed Deposits Allotment of visitors pass Schedule Of Planned Procedure/Surgery/Investigations Transfer In of Patient Within Hospital Transfer Out Within the Hospital Patient Transfer to Operation Theatre/Procedure Room Consultant / R.M.O. s Rounds NURSING MANAGEMENT OF PATIENTS IN THE WARD Handing Over Process Requisition for Emergency Investigations Collection of Reports INDENTING FROM CSSD MAINTENANCE OF EQUIPMENT BILLING VISITORS POLICY DISCHARGE OF THE PATIENT DEATH MEDICO-LEGAL ASPECT OF PATIENT MANAGEMENT

DIAGNOSTIC SERVICES
INVESTIGATIONS

RADIOLOGICAL

SEROLOGICAL

Radiology
IMAGING SERVICES
SL EQUIPMENT . N O. 1 COMPUTERIZED RADIOLOGY 2 200 MA HF X-RAY UNIT 3 100 MA PORTABLE X-RAY UNIT 4 SONOGRAPHY MAKE/MODEL

CEO

COO

CR 35 / DRYSTAR 5503 MULTIPHOS X-RAY MULTIMOBILE 2.5 VOLUSON PRO 730 GE LOGIQ E (PORTABLE) GE MAMMOMAT 3000 NOVA (SIEMENS)

CONSULTANT

HOD

SR TECHNICIAN

FRONT OFFICE ASSISTANT

MAMMOGRAPHY

TECHNICIAN STAFF NURSE ORGANIZATIONAL CHART ASSISTANTS

RADIOLOGY
Functioning
Enquiry Appointment Scheduling Registration Payments IMAGING REPORTS Dispatch of Reports QUALITY ASSURANCE PROGRAMME FOR IMAGING SERVICES (VERIFICATION / VALIDATION / MONITORING / CALIBRATION)
RECORDS AND REGISTERS MAINTAINED IN THE DEPARTMENT

Appointment Booking Register X Ray Register CT scan Register Sonagraphy Register Mammography Register Inventory Register for X- Ray Film Inventory register for contrast Inventory Register for Materials Inventory Register For Linen Inventory Register For medicine Inventory Register For CSSD Dispatch Register Request for Follicular Study Form F - Form for Maintenance of Record with respect to Pregnant Woman by Genetic Clinic / Ultrasound / Imaging Centre (Radiology)

LABORATORY
CEO

DIRECTOR PATHOLOGY

Histopathologist/ consultant

QUALITY CONTROL MANAGER TECHNICAL SUPERVISIOR SENIOR TECHNICIANS JUNIOR TECHNICIANS PATHOLOGY STAFF/FRONT OFFICE STAFF

HOUSEKEEPING

Responsibilities and Authorities

Selection, approval and commencement of test methods. Designing and implementation of internal and external Q.C.program. Ensure the smooth running of the department . Ensure that all equipments are operational Supervise the staff Provide Continuous Medical Education Evaluate competency of Staff at regular intervals. To ensure confidentiality Address any complaints, requests or suggestions from patients / Staff / Doctors. Ensure good staff morale. Review MIS. Manage the overall efficient and effective administration of the laboratory including approval of the indents/purchase requisitions for the material raised by the Lab Technical Supervisor. Define, implement and monitor standards of performance and quality improvement of the medical laboratory services. Review the laboratory policies regularly Work towards lab improvement in terms of processes, systems & workload. Review any new examination procedures which are developed in-house.

Quality Manager
Overall control of quality and advising and monitoring all aspects of quality in the laboratory. Check all the quality control, record keeping of daily and planned maintenance, and calibration of equipment. Ensure the staff follows all SOPs Planning and organizing audits and reviews. Ensuring that the details of the reviews are recorded. Give a feedback to the Director Pathology about the staff performance. Prepare and maintain a schedule for continuous training programme for the lab staff. Maintain & correlate record of quality indicators of the lab. Review operational procedures with the Laboratory Director, once in 6 months.

MANAGEMENT SYSTEM IN PATHOLOGY

The management system of Path-lab is based on the policies and the procedures that are documented and are for complying to the requirements of ISO-15189. The entire documentation of the laboratory is in the form of Quality Manual,Procedures,Work instructions, forms and formats,charts,check list ,safety &Regulatory Norms etc. DOCUMENT STRUCTURE QUALITY MANUAL PROCEDURE MANUAL WORK INSTRUCTIONS CHARTS ,REPORTS,FORMS ,RECORDS

OPERATION THEATRE
ORGANIZATIONAL CHART CEO COO

CHIEF ANAESTHESIOLOGIST

CHIEF NURSING OFFICER

ASSISTANT ANAESTHESIOLOGIST

NURSE MANAGER

ANAESTHESIA TECHNICIAN

TEAM LEADER

STAFF NURSE

O T ASSISTANT

OT ATTENDANT

HOUSE KEEPING STAFF

 Staffing ACTIVITY The Operation Theatre will have the following Staff : Anaesthesiologist OT booking Asst Anaesthesiologist Nurse Manager Handing and taking over Equipment management Team Leader Staff Nurses Anaesthesia Technician OT Attendant OT Assistant House keeping staff : Male Female

PROCESSES: OT Booking OT Timings Preparation of OT List Cancellation of Surgery Implants

Responsibility Matrix

PERSON PERSON INITIATING SUPERVISING Staff Nurses / Nurse Manager Assistant Staff Nurses Nurse Manager Staff Nurses / Nurse Manager Anaesthesiologist / Attendant Information to Consultant Nurse Manager Consultant Requesting for diagnostics / Staff Nurses Nurse Manager sending samples for histopathology Key handling. Staff Nurses Nurse Manager Medical orders RMO Consultant Nurses records Staff Nurses Nurse Manager stores Staff Nurses Nurse Manager OT Anaesthesia stores Anaesthesia Technician Daily inventory Staff Nurses Nurse Manager Nursing procedures Staff Nurses Nurse Manager Infection control in OT Staff Nurses Nurse Manager Waste disposal Staff Nurses / Nurse Manager Housekeeping Staff Death RMO/Consultant Manager Admin/CNO Complaints Staff Nurses Nurse Manager / CNO Indenting CSSD Linen, Staff Nurses Nurse Manager Consumables.

DAILY TASKS Getting the Trolleys Ready Entry of Patient into OT On the O.T. Table Recovery and Transfer to Ward Disposal of waste Daily Cleaning - Prior to Commencement of Surgery Cleaning in Between Cases Cleaning at the Close of Day Weekly Cleaning: to be Done on Sundays Fumigation of O.T. HISTOPATHOLOGY SAMPLES AND SPECIMENS Billings Requirements:O.T. Tables Boyles Apparatus Trolleys C-ARM Microscope and other accessories used in O.T. Cauterizing machines X-ray viewing Box Suction Apparatus Linen

RECORDS AND REGISTERS MAINTAINED IN THE DEPARTMENT Narcotic Register Pathology Register Daily Inventory Register OT Consumables Charge Sheet Communication Register Booking Register(Hard copy and soft copy) Operation Register Fumigation Register OT Daily Maintenance Register OT Complaint Register OT Implant Register - Ortho OT Implant - Ophthalmic Register Charge Sheet OT Operation Record Pre-Operative Anaesthesia Chart OT Consumables Charge Sheet Ortho Labour Anaelgesia Chart OT Handing Over & Taking Over Patients Register

INTENCIVE CARE UNIT

CEO COO

CHIEF INTENSIVIST

CHIEF NURSING OFFICER

CLINICAL ASSISTANT

NURSE MANAGER

TEAM LEADER

STAFF NURSE

HEALTHCARE ASSISTANT

UNIT CLERK

HOSPITAL ATTENDANTS, HOUSEKEEPING STAFF

Responsibility Matrix

Sr. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2520

Activity Admission procedures Admission of patient Handing and taking over Information to Consultant Medical orders Carrying out procedures Indenting medicines Requesting for diagnostics Transfer in/out of patient Daily inventory Nurses records Equipment management Stock Nursing procedures Infection control Waste disposal Medical Records Accidents & MLC Death Complaints

Person Initiating Doctor/Nurse/Front Office Staff nurses Staff nurses/Registrar Registrar Registrar/ Chief Intensivist Registrar/staff Nurse Consultant Intensivist Staff nurses Staff nurses Registrar/staff Consultant Intensivist

Person Supervising Executive Front Office Nurse Manager / Chief Intensivist Chief Intensivist / Nurse Manager Chief Intensivist / Nurse Manager Chief Intensivist / Consultant Chief Intensivist/Consultant/Executive

Nurse Manager Chief Intensivist /Consultant/ nurse Chief Intensivist/Consultant/Executive Nurse Manager Nurse Manager Nurse Manager / Biomedical Engineer Nurse Manager Nurse Manager Nurse Manager Nurse Manager Nurse Manager /Chief Intensivist Nurse Manager /Chief Intensivist Nurse Manager /Chief Intensivist Nurse Manager /Chief Intensivist/CNO

Staff nurses Staff nurses Staff nurses Staff nurses Staff nurses Staff nurses Staff Nurses/Housekeeping staff RMO/consultant/unit RMO/consultant/clerk unit RMO/consultant/clerk unit Staff nurses

TRANSFER FROM O. T.

TRANSFER FROM CATH LAB

TRANSFER FROM WARD / CASUALTY/OPD

Admission of patient in ICU

CRITICAL CARE MANAGEMENT

RECOVERED

EXPIRED

TRANSFER TO WARD

FORMALITIES FOR POST LIFE CARE

DIALYSIS UNIT
CEO

COO

CHIEF OF NEPHROLOGY

AKD MANAGER

TECHNICI AN STAFF NURSE HOUSE KEEPING

ADMISSION OF A PATIENT STANDING ORDERS IN THE UNIT INSTRUCTIONS TO THE PATIENT TRAINING RECORDS AND REGISTERS MAINTAINED IN THE DEPARTMENT Admission Register Procedure Register Communication Register Daily Inventory Register (only for Dialysis department) Hemodialysis Record Dialysis Flow Chart Consent Form (Consent for Vein Catheterization & Hemodialysis) Investigation Chart for Renal Dialysis

PHYSIOTHERAPY
CEO COO

Sr.No Key Personnel . 1 Physiotherapist

Responsibility Consultation, assessment & treatment of patient.

Authority Supervise & maintain facilities available in Physiothera py / rehabilitativ e services Department Handling equipments NIL

SPECIALITY CONSULTANTS

PHYSIOTHERAPIST

TRAINEE PHYSIOTHERAPISTS

Trainee Physiotherapist House Staff

HOUSEKEEPING

3
PSYCHIATRIST CONCERNED CONSULTANTS

Keeping

PHYSIOTHERAPIS T

Responsibility Matrix

Assisting consultant physiotherapi st Maintaining cleanliness of the department. Taking care of equipments. Wheeling patients to the department.

Functional and space requirements in outpatient department

Registration OPD

Reception Enquiry Waiting

Admin

OPD

Waiting OUT CLINICS

X-ray

LAB

INVESTIGATION

Wards

Inj & Dressing

Pharmacy

People Involved
In general, the people involved in this process are: Health planners, functional planners, financial planners and physical planners. Architects Engineers (such as civil, mechanical and sanitary) Quantity surveyors Finance managers Staff responsible for procurement of supplies Staff members such as doctors/nurses, clients/end users

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