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OUTPATIENT DEPARTMENT

Outpatient Department as you know is a very important


department of the hospital which is visited by large
section of community. It is also the first point of
contact between patients, their relatives and hospital
and its staff. The care provided in the OPD and
behavior of the staff determines the image of hospital
and is aptly referred to as 'shops window of the
hospital'.
Waiting time

Defined as the total time from registration until


consultation with a doctor. There were two
waiting
times, the first is time taken to see a doctor
and the
second is time to obtain medicine.
What critical X’s were tested as being root causes of the problem?
Environment People Materials Analyze
ED patient volume Staffing levels
ED patient acuity Experience & skill level
Influx of squad patients Resident specialty
Referral volume Volunteer/greeter utilization Availability of supplies
Clinics schedules Family needs
OR volume Role clarification
Hospital patient volume Match of skill sets and assignments
ED tx room limits/facility constraints Variation of practice

Triage process
Availability of diagnostic equipment Quality of measurement
Registration/Chart prep process
Availability of trams, pumps, etc. Are we measuring the right things?
Charting procedures 
Non-optimization of Tracking system What do we do with what we measure?
Communication
Inadequate IS system for tracking/trending Need to do more than “track”
No Physician Prescription Writing system Utilization of minor emergency unit Feedback systems to quality auditing
No integrated, on-line charting system Ancillary services levels Need for Improved flow sheet format
Specialty testing delays  Lack of on-line charting system for
ED used as admission unit automated monitoring
Measure
ED discharge practice  

Machines Hospital discharge process/timing


23
Consult responsiveness/practices 23variables
variables &&18
18time
timestamps
stamps
Analyzed
Analyzed via 2 . wave of datacollection
via 2 nd
nd. wave of data collection
Use of ED for boarding
 Patient
Patient Volume-Related:10
Volume-Related: 10
Segmentation/delineation  Staffing
Staffing Volume-Related:55
Volume-Related:
Sequential care vs. parallel processes Methods  Staffing
StaffingMix-Related:
Mix-Related:55
Improvement implementation/maintenance ownership  Misc:
Misc:33
Suggestions for improvement
a. Registration process
The registration system should be improved. For
example, unifying assignments based on importance
and avoiding work that could lengthen registration
time will improve the registration process. Improving
the record searching process, displaying information
of facilities and improving working environment will
also smoothen the registration process. The
consultation time should also be stated in the
appointment card and the usage of computers will
optimize the number of patients per hour.

b. Insufficient doctors
A doctor’s ability to properly handle problems would
improve patient care and reduce treatment time. A
more reasonable salary and a well planned schedule
would improve the doctors’ performance and
effectiveness.
c. Number of staff at counter
A better working shift schedule should be made to
balance workload among staff. There should be at
least one staff assign to provide information to
patients while others handle new cases. In addition, a
smaller number of staff with high competence would
help to lessen the problem of having insufficient staff
at the counter. Staff remuneration is important
because heavy workload and low salary will
demotivate and decrease staff productivity and
satisfaction towards work. Work related to training
should be done regularly and supervision from
superiors will also improve staff capability and
increase morale among workers.

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