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OPD: Origins

Originated

in mid 17th century by Sir George Clark


In hotel Dieu in Paris: 6 Physicians were detailed for
regular session on Wednesday or Saturday advising poor
individually, in turn which introduced the idea of OP
clinic.
Modern OPD services emerged in 1850 in USA from
frame work of dispensaries.
General Practitioner ~ Physician ~ Specialist opinion ~
Institutional Care V/s Domiciliary Care.

Importance of OPD Services

First point of contact


It is the shop window of hospital
Makes or mars the hospital image
A good OPD service can reduce the load on inpatient services
It is a place for implementing preventive &
promotive health activities.
Facilitates teaching
About twice the in-patients attend OPD every day

Functions of OPD
Early

diagnosis, curative, preventive & rehabilitative


care on ambulatory basis
Effective treatment on ambulatory basis
Screening for admission to hospital
Follow up care & care after discharge
Promotion of health by health education
Rendering of preventive health care
Promotion of health through health education

Functions
Training

of medical / nursing students


Keeping upto date records for future treatment,
medical education, epidemiological & social
research

Preventive Health activities


Well

baby clinics
ANC, marriage counseling, planned parenthood etc
School health clinic.
Control of communicable diseases
Early diagnosis & detection of chronic diseases like
Cancer, TB, RHD etc.
Health education & nutritional advice
Rehabilitation & prevention of disabilities &
handicaps

Types
OUT PATIENT

Any person given general or emergency diagnostic,


therapeutic or preventive health care and who at that time
is not registered as an in-patient in the hospital
Two types of OP Services
Centralized Outpatient Services : All services are
provided in a compact area which includes all diagnostic
and therapeutics facilities being provided in the same
place.
Decentralized Outpatient Services : Services are
provided in the respective departments.

CONTD..
GENERAL OUT PATIENT

All the patients other than emergencies who report directly to


the OPD
EMERGENCY OUT PATIENT
A person given emergency medical care for condition which
is real or perceived emergency.
REFERRED OUT PATIENT
A person referred to an OPD by his attending medical/dental
practitioner for specific diagnostic/treatment procedure.

Staffing
Staffing

depends upon objectives of department and volume of work

load.
Ancillary staff in OPD e.g X-Ray, EEG & ECG technicians.
Clerical staff to carry out registration patient billing, cashiering etc.
In teaching hospital interns and residents assisting physicians.
Receptionist & other volunteer staff .
Availability of Administrator for planning, organizing, supervising,
evaluating, coordinating and improving out patient services.

Planning Considerations
Location
Separate

entrance
Easily accessible
Should have approach from main road
Adjacent to supportive facilities, x-ray & laboratory
Amenable for Expansion

ENTRANCE

EXIT

EASY TO LOCATE

Principles of Planning
Layout
Principles:
Patient

flow should move in one direction to avoid undue back

traffic.
Sharing with the IPD, All Diagnostic facilities, such as X-Ray &
pathology laboratory.
Should be amenable for expansion without serious dislocation of
work.
Layout:
Double

loaded single corridor with rooms on each side of the


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 Of OPD
Type

& 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 A/c to BIS(Bureau of Indian Standzards):
For Entrance Zone - 2 sq.meter/bed.
Ambulatory Zone - 10 sq.meter/bed.
Diagnostic Zone
- 6 sq.meter/bed.
Total hospital area - 60 sq.meter/bed.

Physical Facilities
Physical facilities categorized into 4 groups:
Public Areas(Entrance

zone)
Clinical Areas(Ambulatory zone and Diagnostic
zone)
Administrative Areas
Circulation Areas

Public Areas (Entrance Zone)


Entrance

: Should be Easily accessible, with wide door and have


ramps and steps
Reception and Information : A desk or a counter located within the
public area.
Registration and Records Area : Should be located near the
entrance. 100 cm high and with work surface 60 cm wide and with
file drawers. One desk for 20 patients/hours. 2 square meters per
bed for OP records.
Waiting Area : Main waiting area should be adjacent to registration
area, sub-waiting area in each clinical department. Area- 4 sq.meter
with min. of 0.1 sq.meter/patient. (Holding Capacity & Lifting Capacity)

Contd..
Public

toilets & washrooms: One for each 200


patients & visitors separate for males & females.
Snack bar: Should be located near the main waiting
area.

Clinical areas
OPD

include:
Surgical , Dental , Opthalmic , ENT.
Obstetric & gynecological
Pediatric , Medical, Psychiatric
Dermatology & Venerology
Ortho & emergency department
SUPER SPECIALITY LIKENeuro , Cardio , Urology.

PATIENTS WAITING AREA

MINOR O.T AREA

PATIENTS WAITING LOUNGE

PLAY AREA

PROCEDURE ROOM

DOCTORS CHAMBER &


EXAMINATION ROOM

RECEPTION AREA

PATIENTS WAITING AREA

General requirement
Sub-waiting

area: Should be 1/3rd of total patients


visiting clinic /day
Consultation room: Space for doctors chair, patients
stool, follower seat ,wash basin, examination couch ,
equipment for examination. Area 15-17 Sq.meter.&
each clinic should handle 100 cases /day.
Special examination room : Required for certain
departments.

Ancillary facility
Injection

room : It should be with waiting area for


10-20 patients with 0.6-0.8 sq.meter/patient. Area may
vary from 12 to 40 sq.meter depend on work load.
Treatment & dressing room: About 12-16 sq.meter.
Pharmacy : It should accommodate 5% of total
clinical visits to OPD in one session

Auxiliary facilities
Laboratory

Should be able to serve IP&OP Patients


with 2 (male & female) washrooms & toilets 15
sq.meter.
Bleeding room 15-20 sq.meter with two or more
examining tables.
Radiology Should serve both IP & OP PATIENTS.
Blood Bank

Contd
Health

Education Facilities Min. area required is 15


sq.meter.
Medical Social Service Facilities should be located in
OPD with suitable cubicle for each social
worker/Counselor.
Screening Clinic required in teaching or tertiary
hospital & should be located near reception area having
one or more cubicle with 12 sq.meter area for each
cubicle

Administrative Areas
Administrative

Office : For 100 bed hospital -15 sq.meter


Business Office : Office for personnel section requisition,
making reports etc.
House keeping : Janitors closet, for house keeping and
cleansing material with size of 4 sq.meter
Storage Facility :
General stores
Drug stores
Linen Stores : On each floor a closet with shelves, for
storage of daily supply linens with area of 2 sq.meter

Circulation areas
This

includes corridors, stairs, lifts etc.


Occupies about 30% of total building area, easy
accessibility of elevator specially for obstetrics and
cardiac pt.
Corridor should be 1.8 meter wide.
Security check post at strategic location.
Availability of STD/ISD facility.

Equipment
Equipment

related to specialty examination


should be available in concerned room.
Each consultation cum examination room should
have- Work table, physicians desk, wall
mounted cabinets, X-ray view box, revolving
stool, wash basins, instrument trolley, chairs
beside examination couch.
All OPD should have equipment for
resuscitation of patients collapsing suddenly.

Work load.
The no. of patients visiting OPD depend on
many factors
1. Location of hospital
2. Community needs
3. Programme & resources
4. Season of the year
5. Transport & Communication

Out Patient visits


New

out patient visit


Repeat out patient visit
Ratio between New : Repeat
= Varies between 1:1 TO 1:2

CONTD.
DAILY OPD ATTENDANCE:

Usually 4 per In-patient bed or 10

per daily admission.


THUMB RULE: 4 patients for every bed each day about 40%
new & 60% old.
PROBLEMS IN OPD:
Patients overcrowding
Long waiting time
PROBABLE REASONS:
oWrong planning of departments
oRestricted registration time
oAbsence of appointment system
oShortage of staff

WORK FLOW
{Out Patient Flow Chart}
ENTRANCE
RECEPTION & ENQUIRY
REGISTRATION
RECORDS
SUB-REGISTRATION & WAITING
EXAMINATION & TREATMENT
INVESTIGATION
ADMISSION

PHARMACY
HOME

Organization and Managerial Considerations


Policy

The policy should be able to achieve continuity of high


quality patient care with modern techniques & methods.
Procedures
Managerial Considerations
Public Relations
OPD timing
Management structure
Waiting time (Queuing theory, Patient Scheduling)
Flow of patient should be smooth , easy & quick
Provision of sufficient no. of staffs

Monitoring and Evaluation


Volume

Clinic/department

and yearly basis.

wise statistics of new and repeat visits on monthly

Percentage

change in new and repeat visit.

Fluctuation

in visit by day of week(month)-average, high and low.

Utilization

and vital statistics : Average number of visit per


person/year, vital statistics of population(age & sex).

Visit

Levels : (New & old visits)

Costs

and revenues : Cost of each service should match with


revenue

Gender

wise calculation of patient

Calculation

of PEDIATRIC & GERIATRIC visits.

Hospital utilization statistics


The

statistics pertaining to OPD services as follows:


Number of new cases.
Number of repeat cases.
Specialty wise break-up cases.
Unit wise break-up of cases.
Age & Sex distribution of cases.
Diagnostic statistics.

CONTD
Daily

average out patient attendance:

Total no. of OPD attendance during the period


No. of OPD working days during the period
Average

outpatient attendance per patient:

(average duration of the spell of sickness treated in OPD)


Total no. of OPD attendance
Total no. of New cases

Requirements of Consulting
Rooms
Direct

Population 200000

Indirect

Population 100000

Consulting

Per Person per year (Direct Pop) 2

Consulting

per person per year (Indirect Pop) 0.5

Avg

First Consultation 30%

Avg

Second Consultation 70 %

Time

Taken for First Consultation 20 Min

Time Taken for Subsequent Consultation 10 Min

Scheduled

Hours of OPD

Calculate No of Consulting Rooms Required