PROJECT ON

ILS HOSPITALS

STANDARD PROCEEDURE MAINTAIN IN OPD

IMPROVING EFFICIENCY OF WORKFLOW IN AN OUT PATIENT DEPARTMENT

PROJECT SUBMITED BY:

NAME: ANIRBAN DAS

ROLL: 122422

COURSE: BHM

YEAR: 2012-13

SELF DECLARATION

I, Anirban Das hereby declare that this declaration is based on the original project study conducted by me.

Submitted in partial fulfillment of the requirements for the degree of Bachelor in Hospital Management.

CERTIFICATION

This project report of Anirban Das '' OPD is approved and is acceptable in quality and form.

I

PROJECT GUIDE

Mr Parantap Dasgupta

Deputy manager Human Resource , ILS dumdum

ACKNOWLEDGEMENTS

THE MEDICAL HEAD – DR DEBASHIS SHARMA

MEDICAL ADMINISTRATOR – DR SAMEER SITAL RAJ

PROJECT GUIDE –DR SHUVRO ROY CHOUDHURY

RADIOLOGIST – PROF DR S. K .BASU ROYCHOUDHURY

RADIOLOGIST – DR SALIM PARVEZ

RADIOLOGIST- DR RAJESH GHOSH

RADIOLOGIST –DR GUNJAN GUPTA

ABSTRACT

It is hereby inform that the out patient department in ILS Hospital Dumdum is in the 1 st floor, the radiology section is also under the OPD bt this particular department has separate location in the hospital & that is in the ground floor.

Radiology & imaging Department

1.X-Ray (C.R system)-This is computer radiography system

2. CT Scan (64 slides)-This is multi detector computer tomography scan machine

3. MRI (1.5 tesla)-This is high resolution magnetic resonance imaging

4. INTRAVENTIONAL RADIOLOGY-This is x-ray machine with I. I. TV to guide the radiologist to do the interventional procedure.

5.USG- This is ultra sonography machine

6.MAMOGRAPHY –This the imaging of soft tissue of breast

The aim of the project is to reduce the time of imaging and in emergency to show all the images only on a single click. Patient will get only one CD.No film,no envelop, no plastic carry bag.No pollution.

CONTENTS:

Diagnostic imaging

Formerly known as X-ray, this department provides a full range of diagnostic imaging services including: general radiography (X-ray scans) scans for A&E mammography (breast scans) ultrasound scans angiography  (imaging of blood vessels) interventional radiology (minimally invasive procedures, eg to treat narrowed arteries) CT scanning  (scans that show cross sections of the body)

MRI scanning  (3D scans using magnetic field).

RADIOLOGY PREPARATION

X-RAY L.S.SPINE / K.U.B / ABDOMEN

BOWEL PREPARATION. (2 TAB. DULCOLAX & FESTAL- N AFTER DINNER.

TO COME TO RADIOLOGY DEPARTMENT IN THE MORNING WITH EMPTY STOMACH.

H.S.G

HSG DONE BETWEEN DAYS 8 TO 12 OF MENSTRUAL PERIOD

BARIUM STUDY

BA. SWALLOW OESOPHAGUS - NO FEED FOR 4 HRS.

BEFORE STUDY

BA.MEAL F.T - BOWEL CLEARANCE & EMPTY STOMACH

BA. MEAL I.C.R - BOWEL CLEARANCE

BA. ENEMA- BOWEL CLEARANCE

MAMOGRAPHY

NO PREPARATION REQUIRED.

I.V.U

2 TABS. CREMALAX OR DULCOLAX & 2 TABS. FESTAL N AFTER LUNCH & DINNER 1 TO 2 DAYS PRIOR STUDY

DAY OF STUDY- NO FOOD / WATER AFTER 6 AM

INVESTIGATION- UREA, CREATININE, PREVIOUS X-RAY, USG, IVU, OPERATIVE NOTES IF AVAILABLE.

QUESTION TO ASK PATIENT

WHETHER DIABETIC?

INFROM DOCTOR BEFORE EXAM

AVOID ANY RENO TOXIC DRUG.

ANY KNOWN ALLERGY?

ANY HISTORY OF REACTION TO CONTRAST?

WHETHER ASTHAMATIC?

USG WHOLE ABDOMEN

BOWEL CLEARANCE & EMPTY SOMACH WITH ONLY WATER INTAKE TO MAKE FULL BLADDER (HOLD URINE / NOT PASS URINE.)

USG LOWER ABDOMEN / KUB

NO NEED OF EMPTY STOMACH WITH ONLY WATER INTAKE TO MAKE FULL BLADDER (HOLD URINE / NOT PASS URINE.)

USG UPPER ABDOMEN

EMPTY STOMACH, WATER CAN BE TAKEN

USG DOPPLER OF RENAL ARTERIES / SPLENO PORTAL AXIS / ABDOMINAL VESSELES

BOWEL CLEARANCE & EMPTY STOMACH ( PREFERABLY) WITH ONLY WATER INTAKE

USG T V S

EED OF FULL BLADDER, FOLLOWED BY EMPTY BLADDER.

USG TRUS

GOOD BOWEL CLEARANCE

USG FOLLICULAR STUDY

NO NEED OF FULL BLADDER

C.T. SCAN ABDOMEN / KUB / LOWER ABDOMEN / PELVIS

BOWEL CLEARANCE & EMPTY STOMACH

EMERGENCY- NO PREPARATION

INTRODUCTION :

For research analysis this is very much difficult to know the starting of the exact time of investigation and the end of the investigation. This project is the study of the imaging service in a quicker method.

OBJECTIVES :

Reduce the time of imaging and at so pollution free imaging.

HYPOTHESIS :

To reduce the environment pollution.

METHODOLOGY :

In this project no film or carry bags or chemicals are used.. If we do not use the films X- Ray, CT, M. R. I., Mamography in imaging it can reduce the environmental pollution and give faster services.

SCOPE :

Easy to carry and the record will be kept for a long time. This is the real study where all data and information are given by the patients or the patient relatives visited to the FORTIS Hospital, Anandapur, Kolkata. They gave their valuable opinions and signed the forms by themselves.

LITERATURE REVIEW :

In radiology tests and procedures will take different period of time. So this is difficult to know the exact time of investigation. Moreover after the investigation it will take more time for post processing the image and filming. In Indian culture our radiologist or consultants prefer to film than C. D.

If we use C. D. it will give more information more accuracy and perfection. It can be saved for a long time.

A BRIEF DESCRIPTION OF OPD IN ILS

The floor consist of 8 opd with diagnostic room accordingly Sample Collection, Mammography, Echo,TMT/ Holter , ECG, Endo Gastro, Physiotherapy ,Proccedure room, executive health, Dental, Ent ,One billing desk , One co - ordination desk along with waiting lounge. There is also a floor manager room in front of the billing desk & have a cafeteria too.

THE MAIN PARTS WHICH I HAVE LEARNED THROUGH BILLING DESK

Its all about communication which have to be perform with the patient during the working time of billing. The first & foremost function of any executive is to be query.

1.Ask the patient be politely & softly about the problem. Therefore ask the patient about the purpose, either they want to consult doctors or want to do diagnosis .

2. The second part is to ask patient whether he/she is in the hospital for the 1st time or not. If for the 1st time fill up the registration form with entering name, age, address, phone number .After put all this data into the system through HMIS ,the operator automatically generates a MR no against the individual patient.

3.Next step is to provide information about the fee & make bill to whom the patient may want to consult.

4.After that the duty have to be perform by the co- ordination desk which is behind the billing desk. Their main duty is to adjust the room for the doctors , making the patient to maintain a que to go to the doctors room serially.

5.After consultation patient comes to the billing desk for query is there any test is given by the doctor or not,if yes give about proper information about the tests and also tell about its preparation and about the costs too.

In case of any former patient who have already registered their name ,it will be much easier for us to put the data into the system by entering the MR no in the HMIS system.

FACILITIES WHICH HAVE PROVIDED BY THE HOSPITAL AUTHORITY IN OPD

1.10 % discount for the patient who have crossed the age of 60.It will be applicable only with the diagnosis and for this the patient party have to be provide a identity proof .

2. Sparsh card. i) 15% discount on all opd investigation. ii)10% discount on health check up packages iii)10% discount on IP services excluding medicines, consumables , and doctor's fee. iv)physician visit at home for general check- up and consultation once in two months v)Blood sugar (random), blood pressure & weight check up at home every month.

vi) One free sample collection & delivery of reports at home every month. vii) Free ambulance service,if hospitalized in ILS hospital viii) Cardholders will receive priority in admission.

3.Privilege card i) A handling charge of 100 shall be payable by the customer . ii) The card shall be valid for a period of 1 year from the date of issue. iii) The management reserves the right to issue the card . iv)The cardholders should be entitled for - a)15% discount on outdoor bills for all diagnostic tests done at ILS hospitals .No doiscount shall be allowed on doctors fee ,health check ups, diagnostic packages,medicines etc. b) 10% discount on all indoor bills including diagnostic tests being conducted at ILS hospitals. No discount shall be allowed on doctors fee,medicines,, bought out items and packages for treatment included in indoor bills.

4.Health Check up

VISION

“Globally Respected Healthcare Organization Recognized For Clinical Excellence and Distinctive Patient Care”

MISSION

“To Be The Preferred Super Specialty Healthcare Provider Of International Standards Known For Patient Centric Care And Clinical Excellence Through Continual Improvement Of Processes And Outcomes.”

DYNAMIC LEADERSHIP

MR. MALVINDER MOHAN SINGH -- GROUP CHAIRMAN,

MR. SHIVENDER MOHAN SINGH -- VICE CHAIRMAN,

MR. VISHAL BALI -- CHIEF EXECUTIVE OFFICER,

MR. ADITYA VIJ -- CHIEF EXECUTIVE OFFICER,

MR. ASHISH BHATIA -- CHIEF OPERATING OFFICER,

MR. HARSHVENDRA SOIN -- CHIEF PEOPLE OFFICER

MR. VARUN KHANNA-REGIONAL DIRECTOR (EAST & WEST)

MS. RICHA S DEBGUPTA -- FACILITY DIRECTOR

A BRIEF HISTORY

Fortis Hospitals, Anandapur commissioned on 9th january, 2011. It is a 400 bed super specialty hospital located on EM Bypass road. It is a part of India’s leading health care providers - Fortis healthcare (India) ltd, focusing on the tertiary care of super specialty like Cardiology And Cardiac Surgery, Bone & Joint Care, Brain & Spine Care, Digestive Care, Urology & Nephrology, Emergency Care And Critical Care.

Our amenities include 24 hour accident and emergency service including Trauma Treatment, Ambulance Services, Blood Bank, Fully Functional Operation Theatres, Cat lab, Preventive Health Check Ups, Diagnostic pathLabs,Radiology etc…

OUR VALUES

PATIENT CENTRICITY:

Committed To ‘Best Outcomes And Experience’ For Our Patients.

Treat Patients and Their Care Givers with Compassion, Care and Understanding.

Our Patient Need Will Come First.

INTERGITY:

Be Principled, Open and Honest.

Model And Live Our “Values”.

Demonstrate Moral Courage To Speak Up And Do The Right

Things.

TEAMWORK:

Proactively Support Each Other And Operate As One Team.

Respect and Value People at All Level with Different Opinions, Experiences and Backgrounds.

Put Organization Needs’ Before Department/Self Interest.

OWNERSHIP:

Be Responsible And Take Pride In Our Actions.

Take Initiative And Go Beyond The Call Of Duty.

Deliver Commitment And Agreement Made.

INNOVATION:

Continuously Improve And Innovate To Exceed Expectations.

Adopt A “Can-Do” Attitude.

Challenge Ourselves To Do Things Differently.

INTERNATIONAL PATIENT SAFETY GOALS

GOAL: 1 –

Identify Patients Correctly Use At Least Two Identifiers For Patients Before Giving Medicines, Blood Transfusion, Taking Samples, Etc.

These Can Be:

NAME

UHID No / IP No

YOU CANNOT IDENTIFY A PATIENT BY THE BED NO

GOAL: 2 –

Improve Effective Communication

Improve Process for Verbal Orders

Improving imaging & Reporting Of Critical Test

Improve “Hand Off” Practices

GOAL: 3 –

Improve the Safety of High Alert Medications

Maintain Safe Custody of Concentrated Electrolytes

Beware Of Lasa (Look Alike Sound Alike Drugs)

Know The High Risk Medications.

Read the Medication Management Manual

GOAL: 4 –

Ensure Correct Site, Correct Patient, Correct Procedure / Surgery

Implement”Time Out”

Ensure All Documents Are Present Before Surgery Begins

Practice “Site Marking”

GOAL: 5 –

Reduce the Risk of Health Care Associated Infections

Comply With Hand Hygiene Guidelines

Ensure Proper Waste Management Practices

Ensure Segregation of Waste at the Source

GOAL: 6 –

Reduce The Risk Of Patient Harm Resulting From Fall

Fall Risk Assessment And Re Assessment Of Patients.

Restraint Policy

Monitoring For Fall

PATIENT RIGHTS & RESPONSIBILITIES:

Patient’s Rights and Responsibilities Have Been Defined and Informed to the Patients and Families. Management Requests Strict Compliance with Patient’s Rights and Responsibilities.

PATIENT HAS THE RIGHT TO

APPROPRIATE CARE

VOICE A COMPLAINT

INFORMED CONSENT

RIGHT TO PRIVACY

CONFIDENTIALITY OF INFORMATION

INFORMATION ON EXPECTED COSTS OF TREATMENT

RECEIVE TREATMENT IRRESPECTIVE TO THEIR CASTE, AND CREED AND ECONOMICAL STATUS

TO REFUSE TREATMENT

ASK QUESTIONS AND PARTICIPATE IN CARE DECISIONS

GET ADDRESSED REGARDING THEIR SPECIAL NEEDS

EMERGENCY CARE

GET TRANSFER AND GET DISCHARGED

ACCESS TO MEDICAL RECORDS

TO KNOW OF THIRD-PARTY CARE RELATIONSHIPS

SENSITIVE AND COMPASSIONATE CARE

.TO RECEIVE TIMELY RESPONSE TO CARE NEEDS

TO PAIN MANAGEMENT

PATIENT’S RESPONSIBILITIES

ANSWER QUESTIONS CORRECTLY

PLEASE PROVIDE ACCURATE INFORMATION ABOUT YOUR HEALTH INCLUDING PAST ILLNESSES OR HEALTH PROBLEMS, HOSPITALIZATIONS, ALLERGIES AND THE CURRENT OR PAST USE OF MEDICATION.

MAKE SURE YOU UNDERSTAND

ASK QUESTIONS OR REQUEST AN EXPLANATION FROM YOUR DOCTOR OR HEALTHCARE PROVIDER ABOUT ANY PART OF YOUR MEDICAL CARE THAT YOU DO NOT UNDERSTAND.

READ ALL MEDICAL FORMS INCLUDING CONSENTS THOROUGHLY.ASK TO HAVE THE INFORMATION EXPLAINED TO YOU PRIOR TO SIGNING IF YOU DO NOT UNDERSTAND.

FOLLOW THE TREATMENT PLAN RECOMMENDED BY YOUR HEALTH CARE PROVIDER.

.HELP US TO SERVE YOU BETTER

.BE CONSIDERATE OF THE HOSPITALS PERSONNEL AND PROPERTY

.PLEASE OBSERVE FACILITY POLICIES AND PROCEDURES, INCLUDING THOSE REGARDING SMOKING,NOISE AND NUMBER OF VISITORS.

PROCEDURE

1.FORTIS HOSPITAL HAS A MEDICAL INFORMATION MANAGEMENT PLAN TO MEET THE REQUIREMENT FOR INFORMATION OF THE CLINICAL CARE PROVIDERS,THE MANAGEMENT’S NEED OF SUCH INFORMATION AND ANY OUT SIDE AGENCY REQUIRING SUCH INFORMATION.

2.THIS INFORMATION MANAGEMENT PLAN IS APPLICABLE TO ALL INFORMATION-MEDICAL AND NON MEDICAL INFORMATION PERTAINING TO IN PATIENTS,OUT PATIENTS & HEALTH CHECK UP CANDIDATES.

3.OUTPATIENT RECORDS-EVERY PATIENT WHO AVAILS OF A CONSULTATION WITH ANY CONSULTANT WILL HAVE A UHID NUMBER.

4.THE REGISTRATION AND DEMOGRAPHIC DATA CAPTURE IS AT THE BILLING COUNTER BY THE CUSTOMER CARE FACILITATOR(SOP/CC/OPD BILLING/01 AND REGISTRATION FORM)

5.THE ORIGINAL PRESCRIPTION SHALL BE GIVEN TO THE PATIENT WHILE THE SECOND COPY WILL BE STORED IN THE HOSPITAL RECORD.THIS COPY WILL BE RETAINED FOR 3MONTHS,HIS SHALL BE MAINTAINED AGAINST UHID,PATIENT’S NAME,FINDINGS,ADVISED INSTIGATIONS,AND THE STATUS TO GUIDE THE PATIENT FOR BILLING OR TO HELP FOR PROVIDING ESTIMATES INCASE OF ANY SURFERIES.

6.REPORTS OF ALL INVESTIGATION CONDUCTED AT FORTIS HOSPITALS LTS.ANANDPUR ARE ENTERED,RECORDED AND RETAINED IN THE HIS UNDER PATIENT FOLDER/UHID.

7.PRIMARY DATE LIKE THE ECG RECORDING/X RAY/MRI/CT/ULTRASONOGRAPHY ECHO CARDIOLOGY/DOPPLER STUDIES FILMS/CD WILL BE HANDED OVER TO THE PATIENTS AT REPORT DISPATCH WITH APPROPRIATE SIGN OFF.

8.THE PRIMERY DATE IN MRI/CT AND ECHOCARDIOGRAPHY IS RETAINED IN ELECTRONIC FORM FOR 2 MONTHS.

9.THE CATH LAB PRIMARY DATE IS RETAINED IN CD;S FOR 5 YEARS.

10.THE PATIENT DATA GENERATED AT THE INTERSIVE ARE UNIT MONITORS AND THE CATH LAB IS AVAILABLE VIA A PASSWORD PROTECTED TRANSACTION TO THE CONSULTANTS ON THE SIEMENS WEB VIEWER/PACS WEB.

11.SECURITY OF THE HIS SYSTEM/WIPRO HEALTHCARE IT ENSURES INTEGRITY,EASY RETRIEVAL AND SECURITY OF PATIENT RECORDS AND IT ACCESS TO IT IS CONTROLLED BY THE FORTIS HOSPITALS LTD INFORMATION TECHNOLOGY TEAM.

MAIN BODY :

At present the patient come for X – Ray, C. T. scan or any other investigation we will create a registration number against the patients. Then the bills are made as per prescription. After that the patient / patient’s relatives are to fill up the consent form.

Before the test the patients are to be prepared. After having the preparation, the tests are done. Then the post processing of the films are done. Next the reports are made. At least the

reports and the films are given and kept in a carry bag to the patient or patient’s relatives. Whole process will take at least 24 hours.

In my project at the time of registration the consent

is taken. After that, the patients are sent to the

respective department for test. After the procedure the

patient will get the C. D. which carries the images and

reports within half an hour. It will not only save the time

of the patient but also reduce the cost of the test. In this

way we can also control environmental pollution. The

films and papers which are given to the patients are

destroyed after a long period of time and they pollute

the environment. In stead of film, if we use the C. D. it

will give us a great benefit. A survey has been done

regarding this new method.

RESULTS :

After survey of this project we can come to final results. This no doubt can be helpful to patients.

CONCLUSION

This project had been an excellent piece of practical exposure for me where I came across the complications that often arise in the radiology & imaging process . Further I was also lucky enough to witness the inconveniences faced by the patients as well as the those by hospital staff.