Survey on Hospital Equipment

8/3/2019 Survey on Hospital Equipment

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Republic of the PhilippinesDepartment of HealthOFFICE OF THE SECRETARY25 April2}ll

DEPARTMENT MEMORANDUMNo.2011 - 0l?5FOR:

SUBJECT: ''ANationwideo'

For strict compliance.

ilable

The DOH through the Bureau of Health Facilities and Services (BHFS), StandardsDevelopment Division (SDD) is currently conducting a study entitled "A Survey of Servicesand Equipment Available in Hospitals Nationwide.'i The study focuses on the distributionof services and equipment in each hospital.This would enable the DOH management to view and, analyze what particular health

services are utilized and needed in a specific community as well as provide insights on theclassification of hospitals and other hoipital-based facilities. Furthermore, it empowers theh:u]ft Tency in planning activities whilh would improve access to medical services in linewith Ao No' 2010 - 0036 "The Aquino Health Agenda: Achieving Universal Health Carefor All Filipinos."In view of the above, heads of hospitals are required to participate in the study bysubmitting, not later than 15 July 201I, the duly u.ro*plirhed survey questionnaire postedat the DoH website rrayw.doh.gov.ph to personnel fromjhe BHFS nu-.iy' Atty. Nicolas B.Lutero III, Director IV, BHFS, Di. Cynthia R. Rosuman, Chief Standards DevelopmentDivision (SDD), BHFS, Ms Aida Cuadra, Nursing Adviser, SDD, BHFS. The same may bereached at 7119572 (direct line),65r7gb0 locai 2525 (trunk line), [email protected], [email protected], or @.

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/z&,ft,tNruq%o4. oNA, MD, Fpcs, FAcsSecretary of Health

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Bui|ding|,SanLazaroCompo.u.nd,Rizr|Avenue,Sta.Cruz,l003Manila.r.unt.lffiFaxt 743-1829;743-1786 o URL: httn://wrvw..Ooh.eo;.;h, ._."ii, SCgg@d"!.gy,pb


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A SURVEY ON THE SERVICES AND EQUIPMENT AVAILABLE INHOSPITALS NATIONWIDE

GENERAL INSTRUCTIONS

1. Check to make sure that you have the complete questionnaire with a total of ten (10) pages.

2. This self-administered questionnaire is composed of two (2) parts. Part I is about the hospital profile.Part II is the survey on the services and equipment available in the health facility.

a) Contents of Part I: Hospital Profile1) General Information2) Hospital Classification3) Hospital Ancillary and Other Clinical Services4) Hospital Accreditation and/ or ISO Certification5) For Level 4 Hospitals Accredited Residency Training Program(s)

b) Contents of Part II: Survey on Services and Equipment Available in the HospitalMedicine PediatricsSurgery Obstetrics and Gynecology

Neurology RadiologyOphthalmology LaboratoryOtorhinolaryngology Outsourced Hospital SerivcesPsychiatry Critical CareOrthopedics Emergency Room ServicesRehabilitation Medicine Ecumenical Services

3. The Chief of Hospital/ Medical Director, Chief of Clinics/ Chief of Professional Medical Services,Department Heads, Chief Nurse and/ or concerned professional hospital staff knowledgeable on theservices and equipment available in the hospital facility, shall properly fill-out this questionnaire toensure the accuracy and reliability of the data presented in this tool.

4. In Part I of the questionnaire from pages 2 to 3, enter the data called for and put a check () mark inthe appropriate box [ ].

5. In Part II of the questionnaire from pages 4 to 10, shade the ticker ( ) in the appropriate columnalongside each corresponding item. Under column B, YES means the services and equipment inyour hospital are present and functional. Provide additional sheets whenever necessary forremarks and/ or further information on other hospital services and equipment not enumerated inthe questionnaire. It is essential to capture all the services your hospital is capable of providing.

6. Make sure to fill-in the blanks with the needed information. Do not leave any items blank.

7. The concerned hospital staff who accomplished the questionnaire shall write down his/ her printed

name, position, affix his/ her signature and indicate the date the tool has been accomplished on thelast page of this questionnaire. The medical director or the head of the hospital shall likewise affixhis/ her signature to attest to the completeness and truthfulness of the information provided herein.

8. Submit the duly accomplished questionnaire on or before 15 July 2011 at the StandardsDevelopment Division (SDD), Bureau of Health Facilities and Services (BHFS), DOH San LazaroCompound, Rizal Avenue, Manila. You can get in touch with Dr. Cynthia R. Rosuman, Chief, SDD,BHFS and/ or Ms. Aida Cuadra, Nursing Adviser, SDD, BHFS at the following numbers: 711-9572direct line, trunk line 651-7800 local 2525 and email addresses: [email protected] or

[email protected].
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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A SURVEY ON THE SERVICES AND EQUIPMENT AVAILABLE IN HOSPITALS

PART I: HOSPITAL PROFILE

Name of Hospital :

Complete Address No. & Street :City/ MunicipalityRegion

Telephone and/or Fax Number :Name of Owner :Chief of Hospital/Medical Director :Chairman of the Board (If Corporation) :Authorized Bed Capacity :

Classification:Ownership Function Service Capability[ ] Government

[ ] DOH [ ] LGU [ ] Military

[ ] Private

Others, pls. specify________

[ ] General[ ] Special

[ ] Level 1[ ] Level 2[ ] Level 3[ ] Level 4

Ancillary and Other Clinical Services:[ ] Clinical Laboratory [ ] Diagnostic X-ray Services

[ ] Primary [ ] Level 1[ ] Secondary [ ] Level 2[ ] Tertiary [ ] Level 3

[ ] Blood Bank [ ] Specialized Diagnostic X-ray Services[ ] Blood Collection Unit [ ] Blood Station [ ] Computed Tomography[ ] Apheresis Facility [ ] Mammography[ ] HIV Testing Laboratory [ ] Digital Subtraction Angiography[ ] Laboratory for Drinking Water Analysis [ ] Cardiac Catheterization[ ] Drug Testing Laboratory [ ] Angiocardiography

[ ] Screening [ ] Percutaneous Transluminal Angioplasties[ ] Confirmatory [ ] Bone Densitometry

[ ] Pharmacy[ ] Tumor Localization and Simulation[ ] Cephalometric

No. of satellite, please specify__________ [ ] Others, please specify[ ] Dental

[ ] Dialysis Clinic [ ] Panoramic[ ] Peri-apical

[ ] Kidney Transplant Facility [ ] Radiation Oncology[ ] Conventional Radiation Therapy

[ ] Birthing Home [ ] BEmONC [ ] CEmONC [ ] Stereotactic Radiosurgery (SRS)[ ] Intensity Modulated Radiation Therapy (IMRT)

[ ] Ambulatory Surgical Clinic [ ] 3D Conformal Radiation Therapy

[ ] Dental Clinic[ ] Total Body Irradiation (TBI)[ ] Image Guided Radiation Therapy (IGRT)

Hospital Accreditation: [ ] International Specify accrediting body________________________________

[ ] Local Philhealth Accredited: [ ] Center of Safety[ ] Center of Quality[ ] Center of Excellence

[ ] Non-Philhealth Accredited

Mother Baby Friendly Hospital Initiative (MBFHI) Certification: [ ] Yes [ ] No

Hospital ISO Certification: [ ] Yes [ ] No

If yes, specify ISO certifying body______________________________________

Specify ISO certified areas in the hospital ________________________________


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For Level 4 Hospitals : Residency training program(s) for physicians accredited by the medicalspecialty and/or subspecialty societies

[ ] Teaching hospital with a medical school, specify medical school _________________________________

[ ] Hospital with affiliation to medical school(s), specify medical school(s) ____________________________

[ ] Anesthesiology

[ ] Dermatology

[ ] Emergency Medicine

[ ] Family Medicine

[ ] Internal Medicine (Please check if only General Medicine)[ ] Cardiology

[ ] Endocrinology[ ] Pulmonology

[ ] Gastroenterology

[ ] Geriatric

[ ] Hematology

[ ] Immunology

[ ] Infectious Diseases

[ ] Nephrology

[ ] Oncology

[ ] Rheumatology

[ ] Neurology

[ ] Obstetrics and Gynecology

[ ] Ophthalmology

[ ] Otolaryngology

[ ] Pathology

[ ] Anatomic Pathology

[ ] Clinical Pathology

[ ] Pediatrics (Please check if only General Pediatrics)[ ] Ambulatory Pediatrics

[ ] Adolescent Medicine

[ ] Cardiology

[ ] Endocrinology

[ ] Pulmonology

[ ] Gastroenterology[ ] Genetics

[ ] Hematology/Oncology

[ ] Allergology/ Immunology

[ ] Infectious Diseases

[ ] Neonatology

[ ] Nephrology

[ ] Rheumatology

[ ] Developmental Pediatrics

[ ] Psychiatry

[ ] Radiology and Radio-Oncology

[ ] Rehabilitation Medicine

[ ] Surgery (Please check if only General Surgery)[ ] Cardiothoracic/ Thoracovascular Surgery

[ ] Laparoscopic Surgery

[ ] Pediatric Surgery

[ ] Plastic and Reconstructive Surgery

[ ] Neurosurgery

[ ] Oncology/Cancer Surgery

[ ] Transplant Surgery

[ ] Urologic Surgery

[ ] Orthopedic Surgery

[ ] Others, specify: ___________________


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PART II: SURVEY ON THE SERVICES AND EQUIPMENT AVAILABLE IN THE HOSPITAL

AServices/ Equipment

BYES

CNO

1. MEDICINE

1.1. Services available in the hospital1.1.1. General Medicine

1.1.2. Cardiology

1.1.2.1. Interventional Cardiology 1.1.2.2. Coronary Angiography

1.1.2.3. 2D-Echo

1.1.2.4. Others, specify1.1.3. Pulmonology

1.1.4. Nephrology

1.1.5. Gastroenterology

1.1.6. Geriatrics

1.1.7. Endocrinology

1.1.8. Diabetology only1.1.9. Infectious Diseases

1.1.9.1. Infection Control Committee

1.1.10. Allergology/ Immnunology

1.1.11. Rheumatology

1.1.12. Hematology

1.1.13. Oncology

1.1.14. Stem Cell Unit

1.1.15. Hyperbaric Oxygen Therapy

1.1.16. Pain Management Center

1.1.17. Extra Shock Wave Lithotripsy (ESWL)

1.1.18. Others, specify1.2. Facilities/equipment available in the hospital

1.2.1. Esophagogastroduodenoscopy (EGD) or upper endoscopy

1.2.2. Percutaneous Endoscopic Gastrostomy (PEG)

1.2.3. Echocardiogram (2D Echo)

1.2.4. Treadmill/ Stress ECG test 1.2.5. Holter Monitor

1.2.6. Hemodialysis machine

1.2.7. Others, specify2. SURGERY

2.1. Services available in the hospital2.1.1. General Surgery

2.1.2. Thoracic and Cardiovascular Surgery

2.1.3. Urologic Surgery

2.1.4. Plastic Surgery

2.1.5. Neurosurgery

2.1.6. Laparoscopic Surgery

2.1.7. Microsurgery 2.1.8. Colorectal Surgery


2.2.1. Rigid Bronchoscope

2.2.2. Fiberoptic Bronchoscope

2.2.3. Colonoscope

2.2.4. Proctoscope

2.2.5. Laparoscopic Surgery Equipment

2.2.6. Laparotomy Set

2.2.7. Tracheostomy Set

2.2.8. Others, specify

3. NEUROLOGY3.1. Services available in the hospital3.1.1. Stroke Unit

3.1.2. Sleep Center



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BYES

CNO

3.2. Facilities/equipment available in the hospital3.2.1. Arterial Doppler Study

3.2.2. Arterial/ Venous Duplex Scan

3.2.3. Brain Perfusion Study

3.2.4. Others, specify4. OPHTHALMOLOGY

4.1. Services Available in the hospital

4.1.1. Extracapsular Cataract Extraction 4.1.2. Phacoemulsification

4.1.3. LASIK


4.2.1. Ophthalmoscope

4.2.2. Slit Lamp

4.2.3. Phacoemulsification Machine

4.2.4. Eye Laser Surgery Equipment

4.2.5. Others, specify5. OTORHINOLARYNGOLOGY

5.1. Services available in the hospital

5.1.1. Ear/Audiology Unit


5.2. Facilities/equipment available in the hospital5.2.1. Otoscope

5.2.2. Audiometer

5.2.3. Others, specify6. PSYCHIATRY

6.1. Services available in the hospital6.1.1. Psychiatry Unit/Ward

6.2. Facilities/equipment available in the hospital6.2.1. Recreational/treatment facilities

7. ORTHOPEDICS

7.1. Services available in the hospital7.1.1. Spine Unit

7.1.2. Arthroplasty


7.2.1. Basic Orthopedic Surgical Equipment (e.g. Bone Saw)

7.2.2. Others, specify8. REHABILITATION MEDICINE

8.1. Services available in the hospital8.1.1. Physical Therapy

8.1.2. Occupational Therapy

8.1.3. Speech Therapy


8.2. Facilities/equipment available in the hospital8.2.1. Bicycle Ergonometer

8.2.2. Electrical Stimulator

8.2.3. Exercise Plinth/Bed

8.2.4. Exercise Stair with Rail

8.2.5. Overhead Pulley

8.2.6. Paraffin Wax

8.2.7. Parallel Bars with Postural Mirror

8.2.8. Trans-electrical Nerve Stimulator (TENS)

8.2.9. Ultrasound for physical therapy

8.2.10. Others, specify9. PEDIATRICS

9.1. Services available in the hospital9.1.1. General Pediatrics

9.1.2. Essential Newborn Care (ENC)

9.1.2.1. Four Core Steps in Immediate Newborn Care

9.1.2.2. Newborn Resuscitation


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BYES

CNO

9.1.2.3. Kangaroo Mother Care

9.1.2.4. Newborn Hearing Screening

9.1.3. Ambulatory Pediatrics

9.1.4. Developmental Pediatrics

9.1.5. Cardiology

9.1.6. Pulmonology

9.1.7. Nephrology

9.1.8. Gastroenterology 9.1.9. Genetics

9.1.10. Endocrinology

9.1.11. Infectious Diseases

9.1.12. Allergology/Immunology

9.1.13. Hematology

9.1.14. Child Protection Unit


9.2.1. Incubator(s)

9.2.2. Transport incubator(s)

9.2.3. Self-inflating (Ambu) bag, neonatal

9.2.4. Self-inflating (Ambu) bag, infant

9.2.5. Infant weighing scale

9.2.6. Bassinet(s)

9.2.7. Phototherapy units

9.2.8. Stethoscopes, neonatal

9.2.9. Stethoscopes, infant

9.2.10. Stethoscopes, pediatrics

9.2.11. Sphygmomanometer(s)

9.2.12. Neonatal cuff(s)

9.2.13. Pediatric cuff(s)

9.2.14. Nebulizer

9.2.15. Piped-in Oxygen

9.2.16. Suction apparatus

9.2.17. Pediatric laryngoscope

9.2.18. Neonatal blade 0

9.2.19. Neonatal blade 1

9.2.20. Pediatric blades

9.2.21. Pulse oximeter(s)

9.2.22. Radiant warmer(s)

9.2.23. Others, specify10. OBSTETRICS AND GYNECOLOGY

10.1. Services available in the hospital10.1.1. Normal deliveries

10.1.2. Cesarean section

10.1.3. Forceps deliveries

10.1.4. Vacuum extraction 10.1.5. Breastfeeding or MBFHI Committee

10.1.6. Essential and Intrapartum Newborn Care (EINC) WorkingGroup

10.1.7. STD clinic

10.1.8. HIV Clinic

10.1.9. 24-hour social service coverage


10.2.1. OB normal

10.2.2. Adjustable delivery beds

10.2.3. CS kit

10.2.4. Doppler ultrasound

10.2.5. Fetal monitor

10.2.6. Foetoscope

10.2.7. Hysteroscope

10.2.8. Transvaginal Sonogram (TVS)


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BYES

CNO

10.2.9. Pelvic ultrasound

10.2.10. Others, specify11. RADIOLOGY

11.1. Services available in the hospital11.1.1. Interventional radiology

11.1.2. Radiotherapy

11.1.3. Mammography

11.1.4. CT scan 11.1.5. PET scan

11.1.6. MRI


11.2.1. X-Ray

11.2.2. Portable x-ray machines

11.2.3. Ultrasound

11.2.4. 7.5 mHz transducer for neonatal cranial ultrasound

11.2.5. Angiogram

11.2.6. Fluoroscopy Machine

11.2.7. Cobalt Treatment Machine

11.2.8. LINAC

11.2.9. Conventional Computerized Tomography (CT) scan

11.2.10. Spiral CT scan

11.2.11. Magnetic Resonance Imaging (MRI)

11.2.12. Magnetic Resonance Angiography (MRA)

11.2.13. DEXA

11.2.14. Mammogram

11.2.15. PET Scan

11.2.16. Bone Scan

11.2.17. Radioactive Iodine Uptake

11.2.18. Others, specify12. LABORATORY

12.1. Services available in the hospital12.1.1. General

12.1.1.1. Complete Blood Count (CBC) with quantitativeplatelet count

12.1.1.2. Electrolytes

12.1.1.3. Electrolytes, micro-method

12.1.1.4. Gram Stain

12.1.1.5. Aerobic Culture

BHI for neonatal

BHI for pediatric

12.1.1.6. Anaerobic Culture

12.1.1.7. Blood typing and cross matching

12.1.1.8. Stool examination

12.1.1.9. Urinalysis 12.1.1.10. Arterial Blood Gases

12.1.1.11. Others, specify12.1.2. Pulmonary

12.1.2.1. Pulmonary Function Tests

12.1.2.2. Arterial Blood Gases

12.1.2.3. Others, specify12.1.3. Gastroenterology

12.1.3.1. AST, ALT

12.1.3.2. Alkaline Phosphatase

12.1.3.3. Albumin

12.1.3.4. Amylase

12.1.3.5. Complete Hepatitis Profile

12.1.3.6. Others, specify12.1.4. Hematology

12.1.4.1. Prothrombin Time (PT)

12.1.4.2. Partial Thromboplastin Time (PTT)


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BYES

CNO

12.1.4.3. Bleeding Time

12.1.4.4. Clotting Time

12.1.4.5. Bone Marrow Aspiration Biopsy

12.1.4.6. Lead levels

12.1.4.7. Others, specify12.1.5. Endocrine

12.1.5.1. Serum Glucose

12.1.5.2. HbA1c 12.1.5.3. Free T4

12.1.5.4. T3

12.1.5.5. Thyroid Stimulating Hormone (TSH)

12.1.5.6. Others, specify12.1.6. Rheumatology

12.1.6.1. Anti-Nuclear Antibodies (ANA)

12.1.6.2. Anti-Smith Antibodies

12.1.6.3. Anti-double Stranded DNA Antibodies

12.1.6.4. Others, specify12.1.7. Nephrology

12.1.7.1. Blood Urea Nitrogen (BUN)

12.1.7.2. Blood Uric Acid

12.1.7.3. Creatinine

12.1.7.4. Kidney Biopsy

12.1.7.5. Others, specify12.1.8. Cardiology

12.1.8.1. CK-MB

12.1.8.2. CK-Total

12.1.8.3. Lipid Profile

12.1.8.4. Troponin T/I

12.1.8.5. Others, specify12.1.9. Infectious Diseases

12.1.9.1. Malaria thick and thin smears

12.1.9.2. Dengue serologic tests

12.1.9.3. Typhoid fever serologic tests

12.1.9.4. Kato-katz smear

12.1.9.5. Others, specify12.1.10. Oncology

12.1.10.1. Carcinoembryonic Antigen (CEA)

12.1.10.2. BRCA

12.1.10.3. Alpha-fetoprotein (AFP)

12.1.10.4. Prostate Specific Antigen (PSA)

12.1.10.5. Others, specify12.1.11. OB-GYNE

12.1.11.1. Pregnancy Test

12.1.11.2. OGCT/OGTT

12.1.11.3. Pap Smear 12.1.11.4. HIV-AIDS serologic tests

12.1.11.5. VDRL test

12.1.11.6. RPR test

12.1.11.7. Chlamydia culture

12.1.11.8. Gonorrhea culture

12.1.11.9. Others, specify12.1.12. Pediatrics

12.1.12.1. Newborn Screening for the 5 metabolic disorders

12.1.12.2. Others, specify12.2. Facilities/equipment available in the hospital

12.2.1. Clinical centrifuge

12.2.2. Microhematocrit centrifuge

12.2.3. Microscope with oil immersion objective

12.2.4. Hemoglobinometer or its equivalent

12.2.5. Differential blood cell counter or its equivalent

12.2.6. Refrigerator exclusively used for specimens


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BYES

CNO

12.2.7. Photometer or its equivalent

12.2.8. Water bath or its equivalent

12.2.9. Serofuge or its equivalent

12.2.10. Blood Bank refrigerator (exclusive for blood bank use)

12.2.11. Platelet rotator

12.2.12. Automated hematology analyzer

12.2.13. Incubator

12.2.14. Balance, trip/ analytical 12.2.15. Rotator

12.2.16. Autoclave

12.2.17. Drying oven

12.2.18. Biosafety cabinet or its equivalent

12.2.19. ELISA reader or automated immunology equipment

12.2.20. Semi- or fully automated chemistry analyzer

12.2.21. Others, specify13. OUTSOURCED HOSPITAL SERVICES

Outsourced means the service is provided by externalcontractor/s. The hospital management shall ensure thatdocumented agreements and/ or contracts covering external

service providers shall be updated, valid and shall specify thatthe quality of services provided must be consistent withappropriate set standards.

13.1. Hospital Management Information System

13.2. Maintenance Services

13.3. Leased Medical Devices

13.4. Patient Directory Services

13.5. Magnetic Imaging Devices

13.6. CT Scan Imaging Devices

13.7. Other Imaging and Laboratory Services

13.8. Pharmacy Services

13.9. Security Services

13.10. Laundry Services

13.11. Accounting Services 13.12. Ambulance Services

13.13. Rehabilitation Services

13.14. Dietary Services

13.15. Hospital Waste Management

13.16. Others, specify14. CRITICAL CARE

14.1. General ICU/CCU

14.2. CCU (separate from General ICU)

14.3. Pediatric ICU (separate from General ICU)

14.4. Neonatal ICU (separate from General and Pediatric ICU)

14.4.1. Ventilator(s)

14.4.2. Infusion pumps micro-volume 14.4.3. Pulse oximeter(s)

14.4.4. Umbilical cannulation set(s)

14.4.5. Radiant warmer(s)

14.4.6. Surfactant administration

14.4.7. Others, specify14.5. Surgical ICU (separate from General ICU)

14.6. Facilities/equipment exclusive to the ICU (not being shared)

14.6.1. Ventilator(s) 14.6.2. Cardiac monitors 14.6.3. Infusion pumps 14.6.4. Defibrillator 14.6.5. Pulse oximeter

14.6.6. Cut-down set 14.6.7. Others, specify

15. EMERGENCY ROOM SERVICES

15.1. Emergency Cart with basic medicines, equipment and supplies

15.2. Facilities/equipment exclusive to the ER (not being shared)


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BYES

CNO

15.2.1. Oxygen 15.2.2. Laryngoscope with endotracheal tubes 15.2.3. Suture set 15.2.4. Defibrillator 15.2.5. Glucometer 15.2.6. Nebulizer 15.2.7. ECG Machine

15.2.8. Pulse oximeter 15.2.9. Cut-down set 15.2.10. Others, specify

16. ECUMENICAL SERVICES

Ecumenical Prayer Room

Hospital staff who accomplished the questionnaire(if not the medical director):

______________________________Signature over printed name

______________________________Position

__________________________________

Date

Concurred by the medical director/ head of hospital:

______________________________Signature over printed name

______________________________Medical Director/ Head of Hospital

__________________________________

Date

Documents

Survey on Hospital Equipment