OUT PATIENT DEPARTMENT

Introduction To OPD

OPD is the area which receives patients to provide them with healthcare facility for diagnosis , treatment and planning.

It is the first point of contact between patients, their relatives and hospital and its staff.
It is referred to as shops 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 Services

Decentralized OPD Services

Centralized OPD
All the outpatient care relating to all specialties are provided 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 respective departments. Specialty clinics are based on this concept.

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 Doctors Consultation

Prescription given Pharmacy

Referred For Investigation Report Collection Doctors Consultation

Out

Case Study
Medical Superintendent of more than 800 bedded hospital is receiving complaints for some time the patients have to wait for long time for consultation at specialist OPDs. In Cardiology OPD after waiting for long hours hardly a minute is given for consultation. Even at times the ECG machine is not available for examination. In Surgical OPD sterile surgical dressing were not available for treatment of last few patients. MS on enquiry found out of which 30-40% cases could have have been disposed of at lower level.

Contd
Consultant Cardiology on enquiry stated that there was a long time list for ECG and Ultrasound examination. Sometimes the technicians are absent which adds to the problem.

Consultant Surgery stated that supply of sterile dressing may be inadequate. Officer in charge CSSD stated that there was no short supply of dressing and issues were made according to demands. After a preliminary enquiry the MS formed a committee to investigate all aspects of functioning of OPD and related. Supportive services to make recommendations 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) Technicians absenteeism

PROBLEM

EFFECTS

RECOMMENDATIONS

1)

Long waiting time

1. 2.

3.

Patient dissatisfaction Provision of adequate comfortable waiting Reputation of the space. hospital is affected. Ensuring punctuality of OPD staff. Monetary loss Having a separate Filter Clinic/ separate time for chronic patients (ESM/dependent parents), many of whom come to collect their monthly quota of medicines. Re-in forcing OPD staff to manage peak-hour workload. Flexi time in OPD management, where a subset of patients, may be attended during evening

PROBLEM

EFFECTS

RECOMMENDATIONS

2) Less consultation time

Quality of care is not appropriate

More load If required new consultant 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

1.

machine

Dissatisfaction of the patients.

2.

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

Delay in treatment.

3.

Sufficient availability of ECG machine. Equipment purchase policy Need of policy of equipment maintenance. Record maintenance. Regular monitoring of equipment .

PROBLEM

EFFECTS

RECOMMENDATIONS

4) Unavailability of technician

1. 2.

Delay in treatment In charge responsibility Patient dissatisfaction should be assigned. Non monetary reward. Punch card system. CCTV monitoring. According to work load, technician can be allotted to the Department.

Problems at Surgical OPD

Surgical OPD
1) Unavailability of material sufficient sterile dressing

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 a registration number. 3) Waiting numbers will be displayed by a Digital Display System.

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

5) Clinician can enter management plan in the patient record.

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

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 on their criticality towards life-support, the criteria of criticality 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, maintaining details of Preventive Maintenance task carried out.

5) Every equipment be checked every morning by the nominated staff for its functional status, before commencement 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 and appreciations. E - Expectations of the consumers to be assessed by Consumer Need Analysis and aligning service facilities with the expectations identified. C - Courtesy while interacting with consumers in the OPD and competence of every OPD staff to add value to the services being provided. I - Information to every consumer by effective communication at every interface, particularly during consultation 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!!!!