OUT PATIENT

DEPARTMENT

Introduction To OPD

OPD is the area which receives patients to providethem with healthcare facility for diagnosis , treatmentand planning.

It is the first point of contact between patients, their relatives and hospital and its staff.

It is referred to as “shop’s window of the hospital”.

FUNCTIONS

To provide various services on ambulatory basis to the people of community :

Preventive

Curative

Diagnostic

Rehabilitative

Promotive services

Types Of OPD Services

Centralized OPD

ServicesDecentralized

OPD Services

Centralized OPD

All the outpatient care relating to all specialties areprovided in a compact area which includes all diagnosis& therapeutic facilities.

E.g.- EHIRC (Escorts Heart Institute & Research Centre)

Decentralized OPD

The outpatient care is provided in the respectivedepartments. Specialty clinics are based on thisconcept.

E.g. - Medanta – The Medicity

PROCESS FLOW

Patient come to OPD

(Appointment, Referred, Walk-in,

Follow-up)

Filling of Registration form by patient

Deposit cash on billing counter

Doctor’s Consultation

Prescription given Referred For

Investigation

Pharmacy

Out

Report Collection

Doctor’s Consultation

Case Study

Medical Superintendent of more than 800 beddedhospital is receiving complaints for some time thepatients have to wait for long time for consultation atspecialist OPD’s. In Cardiology OPD after waiting forlong hours hardly a minute is given for consultation.

Even at times the ECG machine is not available forexamination. In Surgical OPD sterile surgical dressingwere not available for treatment of last few patients.MS on enquiry found out of which 30-40% cases couldhave have been disposed of at lower level.

Contd…

Consultant Cardiology on enquiry stated that therewas a long time list for ECG and Ultrasoundexamination. Sometimes the technicians are absentwhich adds to the problem.

Consultant Surgery stated that supply of steriledressing may be inadequate. Officer in charge CSSDstated that there was no short supply of dressing andissues were made according to demands. After apreliminary enquiry the MS formed a committee toinvestigate all aspects of functioning of OPD andrelated. Supportive services to makerecommendations for remedial measures

OBJECTIVES

To study the priority problems in OPD Services.

To ascertain the causes and effects of these problems.

To work out solutions.

Problem Areas Identified

Cardiology OPD

Surgical OPD

Problems at Cardiac OPD

Cardiac OPD

1) Long waiting time for investigation

2) Less consultation time

3) ECG machine not available

4) Technician’s absenteeism

PROBLEM EFFECTS RECOMMENDATIONS

1) Long waiting time 1. Patient dissatisfaction

2. Reputation of thehospital is affected.

3. Monetary loss

• Provision of adequatecomfortable waitingspace.

• Ensuring punctuality ofOPD staff.

• Having a separate FilterClinic/ separate time forchronic patients(ESM/dependent parents),many of whom come tocollect their monthlyquota of medicines.

• Re-in forcing OPD staff tomanage peak-hourworkload.

• Flexi time in OPDmanagement, where asubset of patients, may beattended during eveninghours.

PROBLEM EFFECTS RECOMMENDATIONS

2) Less consultation time Quality of care is not appropriate

• More load

If required newconsultant can be appointed.

• 30-40% extra load

Screening required.

• Late arrival of Doctors

Doctor can be requested to come on time.

PROBLEM EFFECTS RECOMMENDATIONS

3) Non availability of ECG machine

1. Dissatisfaction of the patients.

2. Patients tend to go to other diagnostic centers .Less revenue generation.

3. Delay in treatment.

• Sufficient availabilityof ECG machine.

• Equipment purchasepolicy

• Need of policy ofequipmentmaintenance.

• Record maintenance.• Regular monitoring

of equipment .

PROBLEM EFFECTS RECOMMENDATIONS

4) Unavailability of technician

1. Delay in treatment 2. Patient dissatisfaction

• In charge responsibilityshould be assigned.

• Non monetary reward.

• Punch card system.

• CCTV monitoring.

• According to work load,technician can be allottedto the Department.

Problems at Surgical OPD

Surgical OPD

1) Unavailability of sufficient sterile dressingmaterial

PROBLEMS EFFECTS RECOMMENDATIONS

1) Unavailability of

sufficient sterile

dressing material

• Interdepartmental

conflicts

• Possibility of Pilferage

• Less accountability of

Department.

• Scarcity of surgical

material

• Delay in care

• Dissatisfaction

• SOP should be

prepared for CSSD &

Surgical OPD

• Responsibility fixation

Nursing Incharge

OPD

CSSD Technician

• Indent & record

maintenance

• Waste monitoring

(inform to Admin.)

• Supply of surgical

material based on

data analysis of

previous use

Other Problems Observed

Long time for Registration

Long process time for investigation

Equipment Down-time

Medication Errors

Real-time lab reporting (Turn Around Time of lab reporting)

Occurrence of ‘Sentinel Events’

Complaint frequency and management

Long Queuing

Improper scheduling of appointments

Ontime availability of drugs

Recommendations

Effective execution of appointment

Separate general and specialized OPD

Starting OPD in time and prolonging OPD timings

Sufficient waiting areas and resources

System of redressal of grievances immediately

Sufficient space for expansion

Automated flow of operations

The general functions of the OPD need to be automated for bringing in more efficiency in the service-chain. A sequence of the flow pattern may be as follows:-

1) Every node of the OPD services should be on LAN.

2) Registration of every patient will be automated on a standardized format and patient will only be given aregistration number.

3) Waiting numbers will be displayed by a “Digital DisplaySystem”.

5) Clinician can enter management plan in the patientrecord.

6) Subsequent interfaces namely procedure/diagnostics can have access to the same information on their own computers and act accordingly.

4) Past medical record will be available to the clinicians from the databank, displayed on the computer screen.

Drug Formulary

Every OPD will prepare a selected inventory of drugs that will be prescribed in the dept. This ‘Drug formulary’ can be prepared by preparing a VED analysis, the formulary being open to review on a quarterly basis. This procedure will result in NIL wastage and zero stock out, if Reorder level is worked out at the same time.

Dissemination Of Vision And Values

Every OPD staff must be fully aware of the vision of the hospital, about functioning of the department as well as a set of value system that will be followed while providing OPD service. The vision and value system will be prominently displayed in the OPD for consumption of all OPD staff.

Training of OPD Staff.

Quality standards need to be laid down for periodic testing of knowledge and skill of every OPD staff in BLS/ACLS/ATLS protocols and operation of every equipment `available in the OPD.

Empowerment of OPD staff in solving

problems

OPD staff shall be empowered to deal with and solve any and every problem arising during functioning of the department without looking for his superior.

1) Training of all OPD staff in behavioral science, particularly communication, conflict resolution and problem solving methods.

2) Analysis of complaints/problems and their resolution.

3) Feedback to client and staff.

Equipment Management

Every equipment in the OPD will have to be functional with “NIL down-time”. Moreover, every OPD staff shall be capable of operating any equipment in the department.

Standards for operating and maintaining equipments will be :-

1) All OPD staff fully trained to operate any and every equipment.

2) All equipments divided into categories depending ontheir criticality towards life-support, the criteria ofcriticality deciding the periodicity of Preventive Maintenance tasks for each equipment.

3) Each equipment to have individualized Preventive Maintenance task.

4) Each equipment to have a log-book, maintainingdetails of Preventive Maintenance task carried out.

5) Every equipment be checked every morning by thenominated staff for its functional status, beforecommencement of OPD.

Ethos

S - Speed in appreciating the value of time of the waiting

patients. P - Personal interaction of every OPD staff with the

consumers to understand their grievances andappreciations.

E - Expectations of the consumers to be assessed by“Consumer Need Analysis” and aligning service facilitieswith the expectations identified.

C - Courtesy while interacting with consumers in the OPD andcompetence of every OPD staff to add value to the servicesbeing provided.

I - Information to every consumer by effectivecommunication at every interface, particularly duringconsultation and at the dispensary.

A - Attitude of “Can do” and “Can help” L - Long term relationship to be developed with the captive client of the

OPD services.

Thank You!!!!