CHAPTER-1 INTRODUCTION

The English words hospitals , hostels , hotels and hospice are all, according to
etymology, related to the Latin noun hospes —a word having the opposite meaning “a
guest or visitor ” and “ one who provides lodging or entertainment for a guest or
visitor.” ( A place where guest is received ). From its gradual evolution through the
eighteenth and nineteenth centuries ,the Hospitals in the eastern and western world has
come of age only newly during the past 50 years or so-the concept of today’s hospitals
contrasting basically from the old idea of a hospital as no more than a place for the
treatment of the sick.

Currently,the hospitals are not just seen as healing centres, but also as a place that
actually promote healthful [Link] general public would prefer to visit hospital that
offers many facilities rather than going to a hospital that only satisfies to the patient’s
care. With this concept,the image of the hospitals gradually became good and they are
being arisen again from just being the centres for medical care and treatment to a
facility providing comprehensive, preventive, curative and rehabilitation services.

DEFINITION OF HOSPITAL
Hospitals are institutions providing medical and surgical treatment and nursing care
for any ill or injured people.

“An INSTITUTION, that makes use of PHYSICIANS,SURGEONS & team of

TECHNICAL STAFF , in order to provide facilities for DIAGNOSIS,THERAPY
REHABILITATION ,PREVENTION, EDUCATION & RESEARCH”

Professionally & technically skilled people apply their knowledge and skill with the
help of complicated equipment and appliances - to provide quality care for the patient.
Hospital is a place for the diagnosis and treatment of human ills and bringing back of
health and well-being of those temporarily prevented from enjoying these.

World Health Organization (WHO) DEFINITION

“A Hospitals is an integral part of a medical and social organization, the
function of which is to provide for the population complete health care, both
curative and preventive , and whose out patient services reach out to the family and
its home environment, the hospital is also a centre for the training of health workers
and biosocial research.”(WHO1957)
 CHAPTER -2 HISTORY OF HOSPITALS
A. HOSPITAL OF EARLY ERA BC-500AD
Early medical treatment was always recognized as religious services and ceremonies.
priests were also physicians or medicine men,caring for spirits, mind and body.
priests/doctors came under the ruling class with great political influence.
Temples/hospitals were also meeting places.

1. Mesopotamian Hospitals:- Medicine as an organized being, first appeared

4000 years ago in the ancient region of Southwest Asia known as
mesopotamia. Hummurabi’s code (1728-1686 BC) was the rule for the
practice of doctors .First recorded prescription came from sumer in ancient
Babylon.
2. Greek hospitals (period 460 136 BC):- Treatment was based on
magic,religious rituals. Hippocrates(460-370 BC) - The father of medicine ,
used logical, non-religious approach to medicine.
3. Roman hospitals:- By first century BC The Roman was the first to make
institutional the care of the sick and the injured .Military and the slave hospitals
existed then.
4. Arabic Hospitals:- The Roman military hospitals and the few Christian
hospitals were no match for the number, organization and excellence of the
Arabic hospitals.
5. Indian hospitals:- Historical records show that efficient hospitals were built in
india by 600 BC. During the gorgeous reign of King Asoka (273-232 BC),
Indian hospitals started to look like modern hospitals. They followed principles
of sanitation and Caesarean sections were [Link] were appointed -
one for every ten villages -to serve the health care needs of the populations and
the regional hospitals for the infirm and the destitute were built by Buddha.
B. HOSPITALS OF MIDDLE AGES (500-1500 AD)
Hospitals construction increased in Europe during the Middle ages for the following
reasons:-
[Link] Innocent III in 1198 advised and persuaded wealthy Christians to build
hospitals in every town.
[Link] revenues were made available from the commerce with the crusaders.
In contrast,in Asia and Africa ,during the same period, construction of effective and
efficient hospitals was pressed forward by the rule and the crusades.
[Link] AGE (1500-1700 AD)
The renaissance period lasted from the fourteenth to the sixteenth centuries. Toward
the end of the 15th century, many cities and towns supported some kind of
institutional healthcare.
[Link] PERIOD (1750-1950 AD)
The first incorporated hospital in America was the Pennsylvania hospital, in
Philadelphia. Massive government involvement in healthcare began in 1926 with the
return of war-heroes from world war I.

HOSPITAL EVOLUTION :INDIAN SCENARIO PRE-INDEPENDENCE

[Link] of institutional care to the sick was considered as provisional and spiritual
by early rulers
[Link] - The first indian physician and teacher who lived in the university of
Takshashila
[Link] (6th century B.C) Charaka (200AD)
[Link]- Father of surgery , ancient indian surgeon known for his outstanding
operation and techniques and for his influential dissertation Sushura-samhita, the
main origin of knowledge about surgery in ancient india.
5. Charaka was one of the main contributors to Ayurveda, a system of medicine and
lifestyle developed in ancient india. He is known as the editor of medical treatise
named Charaka samhita , one of the basic text of classical indian medicine and
Ayurveda
[Link] be traced back to Buddha & Asoka (273-232 A.D)
[Link] Asoka’s reign, principles of hygiene were followed and C-sections were
performed.
[Link] hospitals for the infirm and destitute were built by the Buddhas.
[Link]’s period - Unani medicine

17th CENTURY
● Modern system of medicine by arrival christian missionaries in south indian
● East india company - established first hospital in 1664 in chennai for its
soldiers and in 1668 for civilians
● Constant growth during the 18th and early 19th Century
● First medical college in calcutta in 1835
● Mumbai in 1845 and chennai in 1850
● In 1885,1250 hospitals and dispensaries,only reaching 10% of population
EMERGENCE OF HOSPITAL IN INDEPENDENT INDIA:

● BED TO POPULATION RATIO, 1:4000

● DOCTOR TO POPULATION RATIO 1:6300
● NURSE POPULATION RATIO, 1:40000
● Disparity in facilities in urban and rural
● At independence, 11000 hospitals bed, 7400 hospitals
● SINCE PAST 50 YEARS - CONCEPT OF TODAY’S HOSPITAL
CHAPTER 3:- HEALTHCARE SYSTEM IN INDIA
TRADITIONAL HEALTHCARE SYSTEM IN INDIA
In India, besides the existence of modern medicine ,traditional medical
practitioners continue to practice throughout the country. Popular native
healthcare tradition consists of Ayurveda Yoga,Unani ,Siddha,Homeopathy &
Naturopathy (AYUSH)

[Link] Ayurveda (meaning science of life) system deals with causes,

symptoms ,diagnosis and treatment based all aspects of
well-being(mental,physical and spiritual)
[Link] is both a science and an art that promotes healthy living ,physically,
mentally ,morally and spiritually
[Link] system of medicine tries in promotion of health ,prevention of
diseases and cure
[Link] Siddha system attempts to define disease as the condition in which the
normal equilibrium of the five elements in human beings is that result in
different forms of discomfort.
[Link] believes that all diseases arise owing to accumulation of
morbid matter in the body and if scope is given for its removal, it provides cure
or relief.

MODERN (ALLOPATHIC) HEALTHCARE SYSTEM IN INDIA

The modern (allopathic) health care system in India includes a public sector
,private sector, and an informal network of care providers.

India’s health system can be categorized into three distinct phases:

1) In the initial phase of 1947-1983 :- Health policy was thought to be
based on two board on two broad principle:
i) None should be denied healthcare because of the lack of pay
ii) It was the moral duty of the state to provide healthcare to the
People. This phase saw moderate achievements.
2)In the second phase of 1983-2000:-A National Health Policy was
proclaimed for the first time 1983, which pronounced clearly the need to
encourage private initiative in healthcare service delivery. The policy also
intensified the access to publicly funded primary healthcare. Facilitating
 expansion of health facilities in rural areas through National Health
Programmes (NHPs)
3)The third phase, post -2000:- witnessing a further shift and widening
of focus; the current phase addresses main issues such as public-private
partnership , liberalization of insurance sector,and the government as a
financier.

The health care infrastructure in rural areas been developed as a three-tier

system:
a. Sub-centres:-In rural areas, health sub-centres make up the
institutional basis of primary [Link] typically performs basic
medical services , immunizations,and referrals Sub-Centres are
usually temporary structures, employing 1-2 care workers in most
locations. Each sub-centre is supposed to provide indispensable for
up to 5000 [Link] sub-centres are complemented by
community health workers under supervision of the sub-centre.
b. Primary health centres:- PHCs are usually small (about 5
beds)1-2 qualified doctors, and 14 paramedics and support staff
PHC is typically a referral unit for a sub-centre cluster of about
[Link] primary health care centre (PHC) are in charge of six
sub-centre each. In addition to outpatient treatment ,most PHCs
facilitate inpatient treatment with four to six [Link] per the
plan,PHC serves 30000 people
c. Community Health Centers:-The secondary sector of the Indian
health care system contains rural hospitals and community health
centres (CHC) Serving four PHCs , the CHC’s specialised medical
services are meant for 120000 people. Community health centres
are supposed to have at least 30 beds,an operation theatre,a
laboratory,X-ray facilities ,as well as a team of four medical
specialists.
THE HEALTH SYSTEM INFRASTRUCTURE IN INDIA

National level (ministry of health and family welfare )

State level and UTs

District level

Rural areas Urban areas-(hospital and dispensaries)

CHC
PHC
sub centre

HOSPITAL FUNCTION
[Link] :Service within the wall of hospital
[Link] :Services outside the wall of hospital
INTRA MURAL FUNCTION
1) Restorative
[Link]-These consists of the inpatient service involving
medical,surgical and other specialties ,and special diagnostics.
[Link]- Treatment of all illness
[Link] -Physical,mental and social rehabilitation
[Link] of Emergencies-Accidents as well as diseases
2)Preventive
[Link] of normal pregnancies and childbirth
[Link] of normal growth and development of children
[Link] of communicable diseases prevention of prolonged
Illness.
[Link] education
[Link]
3) education
[Link] Undergraduates
[Link] and post graduates
[Link] and midwives
[Link] social workers
[Link] staff
f. Community -health education
4)Research
[Link],psychological and social aspects of health and disease
[Link] medicine
[Link] practice and Administration
EXTRA MURAL FUNCTION
a. Outpatient services
b. Home care services
c. Mobile clinics
d. Day care centre
e. Night hospitals
f. Medical care camps
CHAPTER 4:- CLASSIFICATION OF HOSPITALS
There are different types of hospital and each type has its own characteristics,
strengths and limitations. Owing to variation in types, it is necessary to classify
to understand its type.
Hospital can classified on following basis:-
-Size
-Level of care
-Clinical specialities
-Ownership
-System of medicine
-Length of stay
[Link]:-
Size of a hospital is generally measured by the number of in-patient beds it
offers. On the basis of size, a hospital can be classified as, small hospital,mid-sized
hospital or a large hospital.

a)Small hospital
The hospital with approximately 30 or less beds are generally recognised as
small hospital. Small hospitals have limited resources and do not offer highly
end-care, Majority of the hospitals in India are small hospitals,especially in
sub-urban and rural areas. It is a common practice in small hospital to outsource
various services such as laboratory, radiology and [Link] care,
intensive care and surgical care facilities are usually at a very basic level in
small hospitals.
b) Mid-sized hospitals
Mid sized hospitals ,typically having 30 to 100 beds are also very popular in
[Link] have more resource then small hospitals and are better equipped to
provide complex services ; however ,they are not so comprehensive as , large
[Link] generally offer reasonable level of emergency and intensive care
and will have most of the clinical support service such as diagnostics as
in-house service. Non -clinical services such as food service, laundry,
housekeeping etc. are usually outsourced in a mid-sized hospital.
c)Large hospitals
Hospitals with more than 100 beds are recognised as large hospitals.
Very often these hospitals offer multiple speciality and super speciality
[Link] hospitals have plentiful resources to handle large number of
patients and complex health issues. They typically have completely
developed ICU, operation theatre complex, emergency care units and all
other clinical support units such as laboratory and laboratory and
radiology.

[Link] of care
Another basis of classifying hospitals is level of care ,which are basically three
Primary care, secondary care and tertiary care.
a)Primary care
The hospitals that provide basic medical care such as out-patient
consultation,vaccination,medicine for simple ailment or seasonal infection,
normal deliveries etc. are called primary care hospitals, In government system
primary health centres (PHC) are the hospitals that provide primary care.
Primary care hospitals are simple organizations with limited resources.
b)secondary care
These are hospitals that offer medical care which is one level higher
than primary care. Such hospitals will offer treatment such as general surgery
,non-complex speciality surgeries,basic intensive care clinical
procedure,caesarean delivery etc. In government system, Community Health
Centre (CHC) and Divisional & District hospitals are considered as secondary
care level hospitals. Secondary care hospitals are better resourced than primary
hospitals and can handle a large number of emergency cases. Most of the small
and mid-sized private hospitals described in earlier section generally offer
secondary care.
c)Tertiary care
These are hospitals with most advanced level of [Link],they offer
super-speciality care which is required in the field of
Cardiac,Neauro,Nephro,Cancer etc. Tertiary care hospitals will have most
advanced equipment and doctors level of qualification and [Link]
operation theatres and ICU of such hospitals will typically be
[Link] system, the medical college hospitals are tertiary care
level.

[Link] specialities:-
Hospitals can also be classified on the basis of clinical speciality they
offer. For example,hospitals which offer cardiac care are classified as cardiac
hospitals,which provide cancer care are classified as Onco hospital. A hospital
can offer one or more speciality, namely single-speciality or multi-speciality
hospital. Also, depending upon the speciality that a hospital offers, the type of
resources and its organization is determined.
For example, a cardiac hospital will need Cath-lab and a cardiac ICU,while an
Onco hospital will require Radiation therapy unit.

[Link] - On the basis of ownership, a hospital can be classified as

follows:-
i) Public hospital (Hospital owned by government)
❖ Central Government Hospital - Hospital managed by central government
such as AIIMS, PGIs etc .
❖ State Government Hospital- Those managed by state government, such as
district hospitals.
❖ Municipal Hospitals- Those managed by district administration.
❖ PSU hospital- Those managed by specific PSU like railway, Coal India
Ltd etc.
ii) Private Hospitals (Hospitals owned by private individual/organization)
❖ For profit private hospitals (Hospital that have the business purpose)
❖ Individual /Partnership (Hospital that are owned by individual or in
partnership)
❖ Corporate hospital (Hospitals owned by private company
❖ Not-for-profit hospitals(Hospitals owned by NGO/charitable
organisation,that do not have a business purpose connected with it)

5. System of medicine -
In the modern world Allopathy , as a system of medicine, is mainly used as
a system of medicine, however in India Ayurveda, Homeopathy and Unani are
also acknowledged system of medicine and preferred by many people.
Depending upon their prominent system of medicine, hospitals can be classified
as Homeopathy hospital, Ayurveda hospital or Unani hospital. Even Though
such hospitals are few in numbers, there is an increasing interest of people in
availing treatment of these systems of medicine.
[Link] of stay-
On the basis of length of stay generally needed for a patient in a hospitals can be
classified as long-stay hospitals and short-stay hospitals.
1)Short-stay hospitals:-Patients in short-stay hospitals are required to be
admitted for a relatively shorter period such as 1 or 2 days up to 20 days. Most
hospitals that we see in our locality are short-stay hospitals.
2)Long stay hospitals:-These hospitals offer care that generally requires its
patients to stay for a long-term ,such as months or years in the
[Link], such hospitals will be mental hospital, rehabilitation
centre, geriatric care centres, palliative care units etc. Due to long-term
residential needs , these hospitals are built in such a manner that gives it a
feel of a home-like environment rather than a hospital.

ABBREVIATION
● PHC - Primary Healthcare centre
● FHC Family health centre
● CPHC- Comprehensive primary healthcare
● SWAAJ- Stepwise Approach to Airway diseases
● COPD- chronic obstructive pulmonary disease
● ASHA Accredited Social Health activist
● Aww - Aganwadi worker
● WHSNC - Ward Health Sanitation and Nutrition Committee.
 CHAPTER 5:-DIFFERENT DEPARTMENTS IN A HOSPITAL

HOSPITAL DEPARTMENT

1 Medical department
(a) OPD

(b) IPD

2 Supportive Department
(I) Therapeutic Pharmacy
Physiotherapy
Dietetics
(II)General CSSD
Housekeeping
Kitchen
Laundry
Security
Maintenance
Mortuary
(III) Diagnostics Laboratory
Radiology
(IV) Informative Medical Resources
IT
3 Administrative
(I) Administrative
(II)Finance
(III)Human resources
ADMINISTRATIVE DEPT MEDICAL DEPT SUPPORTIVE DEPT

MEDICAL DEPARTMENT
INPATIENT SERVICES OUTPATIENT SERVICES

● PATIENT ROOMS ● CASUALTY

● PATIENT WARDS ● CARDIOLOGY
● INTENSIVE CARE UNIT ● DERMATOLOGY
● OPERATION THEATRES ● EAR,NOSE AND THROAT
● LABOUR ROOMS ● GERIATRICS
● MATERNITY WARDS ● GASTROENTEROLOGY
● GENERAL SURGERY
● HAEMATOLOGY
● OBSTETRICS
● PAEDIATRICS
● NEUROLOGY
● ONCOLOGY
● OPHTHALMOLOGY

MEDICAL DEPARTMENT

OUTPATIENT DEPARTMENT (OPD):-In this department people come

to the hospital only for a consultation and not admission. The patients seek for
medical advice from a medication for them to take for a certain period of time.
Patients are then asked to come back for a follow up. Patient’s treatment within
the boundaries of the hospital lasts only a day. Outpatient department runs for
specific time during the day. Consultation doctors are usually appointed to
handle OPD.

CASUALTY/EMERGENCY DEPARTMENT:-The department ,also

knows the accident and emergency department, handles the problem of patients
who have brought by an ambulance in an emergency [Link] department
works around the clock and is equipped to deal with all kinds of emergencies.
The patients are assessed according to the degree of injury or emergency and
then given immediate treatment before being sent to a specialized department
for further treatment.

CARDIOLOGY:-The department as the same indicates deals with problems

of the human heart or circulation. Cardiology is the medical speciality that deals
with the diagnosis and treatment of diseases and disorders of the heart. It treats
people both on an inpatient and outpatient basis. The biggest area of heart
disease treated is coronary artery disease eg., Angina, Coronary Artery Bypass
Grafting. Cardiovascular surgery deals with surgical treatment of heart and
blood vessels.
Cardiac surgery involves procedures like bypass surgeries, valve repairs,valve
replacement and surgery for congenital defects, vascular deals with disease of
blood vessels. Pacemaker implantation, treatment, treatment for myocardial
infarction is also done in this department.

ANESTHESIOLOGY:- Doctors in this department administer anaesthesia

for patients for procedures and surgeries. The anaesthesiology will administer

a)General Anaesthesia–General anaesthesia is medicine that is administered by

an anaesthesiologist, a medical doctor, through a mask or an IV Cannula placed
in the vein. While the anaesthesia is working patient will become unconscious
b) Local anaesthesia – A local anaesthesia blocks sensation in small areas.
Dentists use local anaesthesia when numbering a jaw or gums.
c)Regional anaesthesia – Regional anaesthesia numbs a specific portion of the
body. Caesarean sections are done with a regional anaesthesia.
During the surgery,the anaesthesiologist will monitor the patient’s blood
pressure, heart rhythm, temperature, level of consciousness, and amount of
oxygen in the blood.

CRITICAL CARE UNIT (CCU)/INTENSIVE CARE UNITS(ICU):-

Critical Care Units is a specialty that cares for patients with acute
life-threatening illness. Critical Care is delivered through a highly specialized
Intensive Care Unit, also known as Intensive treatment Unit/Critical Care Unit.
Patients are usually transferred to ICU after initial stabilization at emergency
room, operation theatre or recovery room. Certain patients need to be isolated
and need close and individual medical attention. The ICU has very few beds and
is usually handled by specialist doctors and nurses as well as consultant
anaesthetics physiotherapists and dieticians.

DERMATOLOGY:- Dermatology is the science that deals with the diagnosis

and treatment of diseases of the skin, hair and nails. It offers specialized
treatment for all clinical general dermatological problems including disorders of
the skin ,hair and nail and venereal diseases and also advanced cosmetics
dermatology services for management of problems like acne, scars ,
pigmentation, vitiligo, hair loss/ hair fall, unwanted hair, moles, warts wrinkling
and ageing skin.

EARS ,NOSE AND THROAT (ENT) :- As the name indicates this department
deals with ailments concerned with the Ear, Nose and Throat. A Doctor who is
trained in the medical and surgical treatment of the ears, nose, throat, and
related structures of the head and neck is generally referred to an ENT
Surgeon/Specialist./Otolaryngologists. The parts covered under this specialty
includes ears, nose and nasal passages, sinuses larynx (voice box), oral cavity
and mouth and throat, as well as structure of the neck and face. It includes
treatment of a variety of ailment like:

● General ear, nose and throat diseases

● Neck lumps
● Cancers of the head and neck area
● Cancers of the head and neck area
● Tear duct problems
● Balancing and hearing disorders
● Snoring
● ENT allergy problems
● Salivary gland diseases
● Voice disorders

ENDOCRINOLOGY:-Endocrinology is the study of medicine that relates to

the endocrine system. The body endocrine system includes the pancreas, the
thyroid parathyroid, pineal, hypothalamus, adrenal and pituitary glands, and the
ovaries and testes. Endocrinology is a medical super speciality that deals with
the study of hormones and hormones related to the [Link] work closely
with specialists in ophthalmology, radiation oncology, surgery obstetrics,
transplantation and other speciality areas to provide a multi- disciplinary
approach to a person’s medical problem, including
● Diabetes
● Nutrition
● Osteoporosis-calcium (bone) disorders
● Pituitary-gonad-adrenal disorders
● Thyroid disorders
● Transgender and intersex medicine
● Transplantation.

GERIATRICS:- This department is usually equipped with doctors specialized

in geriatric medicine since the elderly suffer from a wide range of illnesses and
seek treatment for :
● Stroke
● Gastroenterology
● Diabetes
● Locomotors problems
● Syncope
● Bone disease

This department also provides a range of community services such as home

mobile therapy units, palliative care , and this department is often connected
with other community centres.

GENERAL MEDICINE:-Internal medicine or general medicine is the medical

speciality that deals with the prevention, diagnosis, and treatment of adult
diseases. A general practitioner, GP, is a physician who is not specilaised in one
particular area of medicine.

Routine health care (e.g, physical examinations, immunizations ) and assess and
treat many different conditions, including illnesses and injuries MBBS with MD
(General Medicine) is usually a general physician.
GASTROENTEROLOGY:- This department deals with abdominal related-
[Link] diagnosis and treatment of conditions that affect the oesophagus,
stomach, small intestine, large intestine (colon), liver pancreas, gallbladder,
colon and rectum. It also involves endoscopy. Special nurses are often posted in
this department and they are capable of performing a wide range of bowel
investigations.
Hepatology is a super specialty that deals with the diagnosis and
management of patients suffering from disorders of the liver.

GYNAECOLOGY:- This department deals with the investigation and

treatment of problems of the female reproductive system.A women’s life is
marked by unique changes that occur with time: from attaining menarche,
conception, pregnancy, childbirth and menopause. These changes do bring
about problems, directly or indirectly connected with the reproductive system
and so requires a separate branch of medicine that focuses on these areas. These
three specialties are
● Gynaecology
● Obstetrics
● Infertility

Gynaecology consists of medical and surgical therapies, for the complete

spectrum of disorders that involves the female reproductive system.

OBSTETRICS:- Obstetrics is the surgical specialty dealing with the care of

mother and child, before, during and after [Link] Reproductive is
the special branch of medicine that deals with infertility issues in both men and
women and involves diagnosis of infertility therapeutic technique to improve
fertility and embryology services such as in vitro fertilization.
NEUROLOGY:-Neurology deals with the human nervous [Link] doctors
in this department investigate and treat patients for problems affecting their
brain and spinal cord. Neurologists examine patients who have been referred to
them by other physicians in both the inpatient and outpatient settings. A
neurologist will begin their interaction with a patient by taking a comprehensive
medical history, and then perform a physical examination focusing on
evaluating the nervous system. Components of the neurological examination
include assessment of the patient’s cognitive function,motor strength, sensation
reflexes, coordination, and gait. Neurologists do not perform surgery. If one of
their patients requires surgery, they refer them to a neurosurgeon. That requires
surgical intervention.
NEPHROLOGY:- Nephrology focuses on the diagnosis and treatment of
diseases that affect the kidney, including electrolyte disturbance and
hypertension. Renal replacement therapy including dialysis and transplant are
also carried out by Nephrologists.
NUCLEAR MEDICINE:-Nuclear medicine is a branch of medical imaging
that uses small amount of radioactive material to diagnose and ascertain the
severity of or treat a variety of disease, including many type of cancers, heart
disease gastrointestinal endocrine, neurological disorders and other
abnormalities within the body. Nuclear use radioactive material called
radiopharmaceuticals. Examples of diseases treated with nuclear medicine
procedures are hyperthyroidism, thyroid cancer, lymphomas, and bone pain
from some types of cancer. Specially designed cameras allow doctors to track
the path of these radioactive tracers. For the most diagnostic studies in nuclear
medicine; the radioactive tracer is administered to a patient by intravenous
injections Single Photon Emission Computed Tomography or SPECT and
Positron Emission Tomography or PET scans are the two most common
imaging modalities in nuclear medicine.

ONCOLOGY:- This department inquires and treats all kinds of cancers and
provides a wide range of chemotherapy treatment and radiotherapy for
cancerous tumours and blood disorders. This department is usually connected
with all the other departments as referrals can’t be made when one department
cannot diagnose the patient’s problem. Doctors also carry out tumour removal
procedures which are then sent for biopsy to verify whether the tumour is
harmful or not. The field of oncology has three major areas:
❖ Medical Oncology:- The treatment of cancer with medicine, including
chemotherapy
❖ Surgical Oncology :-The surgical aspects of cancer including biopsy, and
surgical resection of tumours
❖ Radiation Oncology:-Radiation therapy uses carefully targeted and
regulated doses of high- energy radiation to kill cancer cells.

OPHTHALMOLOGY:- This department deals with the investigation and

treatment of eye problems of adults and children. Their services include:
❖ General eye clinic appointments
❖ Laser treatments
❖ Optometry
❖ Orthoptists are the experts in diagnosing and treating defects in eye
movement and problems with how the eye work together, called
 binocular vision. The word Orthoptic comes from the Greek words
orthos, which means ‘straight’, optikos, which means ‘relating to sight’.
❖ Ophthalmic Imaging is the use of specialist equipment to create detailed
images to support the diagnosis and treatment of a range of eye
conditions.

ORTHOPAEDICS:-This department handles problems that affect the

musculoskeletal system. That includes treating bonus, muscles, tendons,
ligaments or tendons, replacing bones like hip replacement, knee cap
replacement. Other outpatient services also include treating fractures and
dislocated joints.

PEDIATRICS AND NEONATOLOGY:- The department of General

paediatrics provided comprehensive outpatient and inpatient care for sick
infants and children. Neonatology is a subspecialty of paediatrics that provides
medical care to the new born child especially the ill or premature newborn
infant. It is hospital-based specially and is usually practiced in Neonatal
Intensive Care Units (NICU). Medical care is given to babies who are premature
and low birth weight, with intrauterine growth retardation, birth defects.
Paediatric surgery is the department that deals with all surgical conditions from
birth to the age of 15 years.

PSYCHIATRY:-Psychiatry is the branch of medicine that deals with the

diagnosis, treatment and prevention of emotional, behavioural or cognitive
disturbance. This department deals with investigating and treating patients with
a wide range of mental illnesses and disorders. Some services include:-
❖ Providing psychosocial counselling
❖ Investigating, diagnosing and treating psychiatric illnesses
❖ Conducting IQ tests
❖ De-addiction services

PULMONOLOGY:-Pulmonology is the medical speciality that deals with

diagnosis and treatment of diseases of lungs or respiratory system. It is also
known as respirology, respiratory medicine, or chest medicine. It deals with
common diseases like allergy, bronchitis, lungs cancer etc. Pulmonologists are
specially trained in disease and conditions of the chest, particularly pneumonia,
asthma, tuberculosis and complicated chest infection.
PLASTIC SURGERY:- It is a surgical speciality in Medicine that focuses on
surgical repair of defects of form or function of any of the human body. This
speciality is further classified into two sub-specialities:-
❖ Reconstructive Plastic Surgery corrects structural and functional defects.
❖ Cosmetic Surgery enhances the appearance of body through medical and
surgical procedures.

UROLOGY AND ANDROLOGY:-The branch of medicine that focuses on

surgical and medical disease of the male and female urinary-tract system and
male reproductive organs. Organs under the domain of urology include the
kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male
reproductive organs Urology combines the management of medical conditions,
such as urinary -tract infections and, with the management of surgical condition
such as bladder or prostate cancer, kidney stones, congenital abnormalities,
traumatic injury.

SUPPORTIVE DEPARTMENT IN A HOSPITAL

● Clinical Laboratories
● Radio-Diagnosis Services
● Central sterile Supply Department
● Hospital Pharmacy
● Medical Records
● Housekeeping
● Dietary Service Department
● IT and Communication
● Medical Social Service
● Physiotherapy
● Medical Maintenance & engineering
● Purchasing Department- Material Management

[Link] Laboratories:- The primary function of clinical laboratory is to

perform lab test in the six main fields of bacteriology, Biochemistry, Histology,
Serology, Haematology , and Cytology. Assist medical staff in making and
confirming diagnosis in the treatment and prevention of disease.
[Link]:- The main function of this department is to assist the physician in
the diagnosis and treatment of a patient’s disease by the use of radiography,
fluoroscopy, radioisotopes and high voltage acceleration. The Various
diagnostic equipments are :-
❖ X-ray machine
❖ CT Scan machine
❖ MRI machine
❖ Echocardiogram
❖ Ultrasound-Colour Doppler
3. Central Sterile Supply Department (C.S.S.D):- This department is in
charge of keeping all the instruments used in the hospital clean and sterilized to
avoid spreading of infections throughout the hospital. They follow a strict
procedure for sterilizing medical and surgical instruments.
[Link]:-This department takes the charge of keeping the hospital
clean and [Link] involves doing the laundry and cleaning all the rooms of
hospital and effectively disposing of medical waste according to strict hospital
disposal procedures.
[Link] Department (Catering):-This department provides food services to
inpatients, their families and staff of the hospital based on a nutritional menu
provided by the Nutrition department. The dietician is a member of the health
team and works closely with nursing services personnels in meeting the
patient’s nutritional needs and in teaching. He/she is responsible for the ordering
of supplies and the supervision of all staffs engaged in the preparation and
delivery of food.
[Link] Social Work:-This department manned with medical, social workers
helps patients and their families deals with a broad range of psychosocial issues
and stresses related to coping with illness and maintaining health. This
department addresses the challenges families face,
Increase accessibility to healthcare, and serves as a bridge between the doctors
and the individual, family, and community.
[Link]:-This department aims at rehabilitation patients. Mostly linked
to the orthopaedics department, This department offers a wide range of body
healing therapy that will help a patient resume normal functioning. This
department offers outpatient as well as inpatient services.
[Link]:-Every hospital must be equipped with a pharmacy which provides
drugs for the entire hospital. It not only provides medication for patients but
also provides other drugs and instruments used by all the departments in the
hospital for patient’s care or surgeries. Run by a pharmacist, pharmacy provides
the following services:
 ❖ Purchase, supply and distribution of medication and pharmaceuticals
❖ Inpatient and outpatient dispensing
❖ Clinical and ward pharmacy
❖ Doctors are usually given a set of procedures of medication by the
pharmacy to use as guide.

[Link] Record Department (MRD):- This department handles recording,

and maintaining all the records/files of inpatients as well as outpatients. It is
with these records that medical statistics can be formulated and it serves as a
reference for future purpose.
[Link] Maintenance & Engineering:- This department ensures that the
hospital is in operable condition. It makes plans and performs various projects
for the hospital. This department makes sure that all electrical facilities are in
perfect condition, performs repair and replacement work for air-conditioning
units, plumbing, steel works.
[Link] Department - Material Management:-This department is
responsible for purchasing all supplies and equipment for the hospital.
[Link] Technology & Communication:-All hospitals today use
computers to keep track of patient records and other medically related affairs.
Therefore, this department provides technical support as and when needed and
keep the systems updated and provides support when systems fail. They also
aim to provide effective online services for patients and help to keep the entire
hospital informed of certain events that take place within the hospital.
ADMINISTRATIVE DEPARTMENTS IN A HOSPITAL

[Link] RESOURCES:- This department is given the aim of recruiting efficient

human resources for the hospital. It also creates policies and procedures that the staffs
have to follow in the hospital. It aims at ensuring employee satisfaction, good
working conditions and provision of monetary and non-monetary benefits for the
employees. It is also responsible for providing compensation for the services rendered
by the employees .

[Link]:- This department handles the financial aspects of the hospital. They
make budgets, financial plans for the future and distribute financial resources to the
various departments of the hospital for their up-gradation. They also provide wage
statements for the staff and oversee purchases of medical supplies and pharmaceutical
for the hospital.

[Link]:- This department is having the powers of looking after the

day-to-day operations of the hospital. They look after all the paper work of hospital
and ensure that every department follows administrative procedures of the hospital.
Hospital administration also contains organizing and supporting the patient’s total
medical care during an episode of illness in the hospital, and is responsible for
integrating various functions and services.
 CHAPTER 6:- OUTPATIENT DEPARTMENT

INTRODUCTION
OPD means outpatient department, where patients come to the hospital to
consult their health issues with the doctors to start the treatment: OPD services
are medical care provided on an outpatient basis, that includes diagnosis,
observation, consultation, treatment, intervention and rehabilitation services.

❖ Diagnosis:- The identification of the nature of an illness or other problem

by examination of symptoms.
❖ Observation:-The action of closely monitoring someone.
❖ Consultation:-A meeting with an expert, medical officer, in order to seek
advice.
❖ Treatment:-The medical care given to a patient for an illness or injury.
❖ Intervention:-Action taken to improve a medical disorder.
❖ Rehabilitation:- The action of restoring someone to health or normal life
through training and therapy after illness.

Objective of OPD
● Providing Quality of care
● Modern techniques for investigation and treatment
● Facilities for total patient satisfaction
● Good public relations

These scope of OPD includes the following:

[Link], investigation, procedures, speciality services.
[Link] and promotive health care: Clinic, which include:diabetic,
antenatal.
[Link] services (physiotherapy, occupational therapy etc)
[Link] education

Location of OPD
● On ground floor
● Should share with IPD, diagnostic and therapeutic facilities
● Unidirectional Flow
● Scope of Expansion
 Area of OPD

PATIENT AREA ADMINISTRATIVE CLINICAL AREA

AREA
● Entrance ● Administrator office ● Consultation
● Reception ● Public Relation office ● Examination room
● Registration ● Accounts ● Dressing room
● Record room ● Billing ● Physiotherapy
● Waiting are ● Security ● Blood bank
● Snack bar ● Transport ● Radiology
● ATM machine ● Store room
etc.,

Flow Pattern of clients in OPD

Equipment
DIAGNOSTIC THERAPEUTIC MONITORING INSTRUMENTS

● BP apparatus ● Nebulizer ● Pulse ● IV set

● Endoscope ● Laryngoscope Oximeter ● Tracheostomy
● Portable X ray ● Bronchoscope ● Cardiac ● Instrument
● Portable USG Monitor trolly
● ECHO ● ECG
machine
Functions of OPD
● Early Diagnosis, Curative, Preventive and rehabilitative care on
ambulatory basis.
● Effective treatment on ambulatory basis
● Screening for admission to Hospital
● Follow up care and care after discharge
● Promotion of health-by-health education
● Rendering of preventive healthcare
● Promotion of health through Health education

Preventive Health Activities

● Well baby clinics
● ANC, Marriage counselling, planned parenthood etc
● School Health clinic
● Control of communicable diseases
● Early diagnosis & detection of chronic diseases like Cancer, TB etc
● Health education and nutritional advice
Rehabilitation & prevention of disabilities and Handicap

TYPES OF OPD
Two types of OP services
1) Centralized outpatient services:- All services are provided in a concise
area which includes all diagnostic and therapeutic facilities are being
provided in same place.
2) Decentralized outpatient services:- Services are provided in respective
departments.

Based on type of patient

1) General OutPatient:- All patients other than emergencies who
report directly to OPD
2) Emergency Outpatient:- A person given emergency medical care
for a condition
3) Referred OutPatient:- A patient referred to OPD by his practitioner
for specific treatment.
Managerial Consideration
● Public Relation
● Warmth
● Respect
● Minimum waiting
● Cleanliness
● Good Ambience
● Canteen
● Patient Hearing
● Ventilation
● Water Supply
● OPD Timings
Management structure
● Flow of patient should be smooth, easy and quick
● Provision of sufficient number of staff
● Parking

Organizational Components of OPD

● Medical staff:- Central to Organization
● Nursing staff:- Nurses and ANMs
● Subservient staff:- radiology, laboratory and ECG
● Clerical staff

Problems at OPD

[Link] Problems
1. Insufficient number of doctors: It is found that there are a large
number of patients waiting in front of the doctor’s room. This is
mainly due to insufficient number of doctors to serve as compared
to the number of patients who arrive the clinic.
2. Inappropriate appointment system: Appointment-patient has no
priority over non appointment-patient This creates congestion in
the clinic during the beginning of the day.
3. Long waiting time at Medicine room: After patients receive the
prescription from the clinic counter, patients are directed to
medicine room to remit the fee and receive the medicines.
4. Shortage of facilities.
5. Insufficient training of medical personnel concerning ambulatory
care.
6. Fragmentation of care, poor communication and inadequate
understanding of their demands.
7. An organizational structure geared to traditional preference and
needs of the providers.
8. Resistance to change.
B. Specific problems
1. Duties undertaken by the auxiliaries are done hurriedly in order to keep
pace with consultation of doctors. This creates inappropriate
documentation.
 2. Auxiliary staff sometimes misbehave with the patients.
3. In absence of appointment system, patients start accumulating even
before office time starts; creating a long queue of patients even before the
arrival of doctors.
4. Interruption of consultation or investigation.
5. Lack of privacy
6. Illegible hand-writing of the doctors.
7. Poly-pharmacy.
8. Queues are not properly maintained.
9. Prescribed medicines are not always available at pharmacy.
[Link] of trade-name of medicines by the doctors, create confusion to
patients, when different-named medicines of same genera is supplied to
the patients.
[Link] clear advice about when, how long to take the medicines.
[Link], wrong medicines are given by the pharmacists.
[Link] and un-cleaned toilets.

Methods to solve
● Adequate directional sign
● Quick computerized registrations and electronic record keeping for
quick retrieval
● Multiple and multipurpose fee collection zone
● Adequate number of doctors as per patient volumes
● Token display system
● Multiple blood collection/diagnostics facilities, staffing them based
on needs
● Adequate seating capacity, entertainment with TV, magazine or
health education measures through leaflets, posters,magazines
● Screening of OP by Junior doctors
● Queuing theory is a scientific and mathematical way of solving
problem of overcrowding.
● Avoid Queue jumping -the act of going ahead of other people
waiting in a line something instead of waiting one’s turn
● Maintain Punctuality
● Redressal of Grievances
● Proper Appointment system
 Clinical records kept in an OPD
● OPD registration form
● Admission form
● Medication record
● Treatment record
● Investigations record
● Consent forms

Every hospital must maintain the medical records relating to

his/her indoor patients, or a period of 3 years from the date of
commencement of the treatment.

JOB DESCRIPTION OPD ASSISTANT

● Arrangements of necessary instruments for OPD.
● Directing patients from one place to other place inside the hospital.
● Translating in case of requirement.
● Passing Case Sheets to other departments.
● Explaining basic details (Like medicines, treatment & reason for waiting)
to the patients
● Assist to open new medical record
● Ensure customer satisfaction

Example of registration system

GUEST RELATION OFFICER-
A Guest Relation Officer, also known as a Guest Relation Coordinator or
Guest Relation specialist, is a customer service-centered employee who
essentially greets.

Job responsibilities
● Guest Relation representatives are available to assist patients and families
by answering questions, explaining hospital policies, customer service
and helping to resolve issues related to hospital services.
● Attend to inquiries requested by the guests (customers or foreign patients)
regarding facilities provided and everything else.
● Check if adequate welcome facilities are available for everyone whose
arrival is on the list.
● Attend to VIPs (Very Important Person) with more attention
● Maintain a polite and humble personality while attending to the guests.
● Provide a detailed description of all the information that can be
potentially asked for along with the document needed.
● Take care of each and everything the guest might need and for, to avoid a
last minute rush.
● Check the amenities for their quality and proper provision to leave no
ground for complaints.
● Ensure maintenance of proper information in the database.
● Work in close contact with the manager and get in touch with him
whenever needed.
● Have a thorough knowledge of hospital medical and non-medical
departments and its functioning.
 CHAPTER 7:- ACCIDENT & EMERGENCY DEPARTMENT

INTRODUCTION
The Accident and Emergency department (A&E) assesses and treats people with
major trauma, serious injuries and illnesses, and those in need of emergency
treatment. It is open 24 hours a day. In emergencies patient with loss of
consciousness, confusion, persistent severe chest or abdominal pain, a stroke,
breathing difficulties are also treated. It has alternative names:
● Casualty
● Emergency Department (ED)
● Emergency Room (ER)

LOCATION OF EMERGENCY DEPARTMENT

● Located on the ground floor

● Separate entrance or emergency entrance away from main entrance
● Ambulance parking area should be available
● Well-marked,proper lighting and signs
● Easily visible and accessible from the streets
● Close to medical records dept, elevators, Radiology, laboratory
(reduced operational cost and critical time)

DESIGN
● Entrance to the emergency department should be sheltered to protect
ambulance patients from the weather while unloading
● Adequate reserved parking space for ambulance and cars of patients
● Adequate space for accommodating stretchers
● Ramps for wheelchairs and pedestrian access in case of raised platform
MAJOR SPACE DETERMINANTS FOR PLANNING

Functional Areas:
Ambulance and ambulatory entrance
Reception/Triage/waiting areas
Administrative area
Resuscitation area
Acute treatment area (of non-ambulant patients)
 Consultation area
Staff work stations

Other Areas:
Procedure room
Plaster room
Pharmacy/Drug preparation
Isolation room(s)
Decontamination areas
Storage
Clean and dirty utility
Linen room
Mobile equipment bays like trolly, wheel chair etc
Mobile X-ray equipment bay
Cleaner’s room

PATIENT FLOW
1. Triage
● All patients should be triaged through a single point
● Aim of triage is to “sort” patients for providing optimum care consistent
with their medical need and ensuring efficient utilization of available
resources.
2. Reception
● Close operational relationship exists with triage
● After triage, patients’ details are recorded by the clerical staff
● A new medical record is either raised or the old one retrieved
3. Treatment
● Patients may be directed to: Resuscitation area, Acute Treatment Area,
Consultation/fast track Area, Medical Imaging or Waiting Area. Based on
Emergency treatment is initiated.
4. Re-evaluation
● An ED physician will re-evaluate patient condition after treatment and
assess test results because the results may give them additional insight
into the type of treatment you need.

5. Discharge
● Based on treatment patient to be removed after stabilization
 ● All patients receive written home-care instructions to follow when
discharged. Referral can be made based on facilities of hospital and
patient condition if needed

EMERGENCY DEPARTMENT WORKFORCE

● Casualty medical officer
● Consultants should be available
● RN with trained EMT at triage section
● Skilled nursing team
● Diagnostic technicians
● Patient care assistant and executives

ADMINISTRATIVE STAFF
● Medical Record clerk
● Registration clerk at Admission clerk

RECORDS
➢ Patients record
➢ Casualty death register
➢ Observation and follow up record
➢ Referral record
➢ Treatment record
➢ Minor OT records
➢ Incident Report forms and Register
➢ Attendance registers of all categories of staff
➢ Register of Duty doctors, Specialist etc
➢ All documents e.g., Admission card, case sheet, drug charts,death certificate
forms
➢ MLC record with all the diagnostic and investigation results and kept under
lock and key under C.M.O Casually
➢ Medico legal cases like accident and Trauma, assault, Rape, Poisoning,
unconscious brought dead should be stamped as MLC
➢ Police Intimation Book
Functions of the accident and emergency services which are:
1. To provide immediate and correct lifesaving medical care
2. To liaise with the courts and police in medico legal cases whenever
required.
3. To provide ambulance services for pre hospital care and transportation of
patients to and from the hospital.
4. To fulfil the role of information and communication centre, especially
during disasters.
5. Education, training and research activities of medical staff

Hospital Administration must ensure

● The ED must be organized and administered to meet the health care

needs of its population
● Operation of ED must be guided by written policies and procedures
● Medical and the Nursing Director of hospital along with appropriate
integration of ancillary services must ensure Quality and safety in ED
● Appropriateness of emergency care are continually monitored and
evaluated
● The Medical Director should oversee all aspects of the practice of
emergency medicine in ED
● All new staff members should get a formal orientation program that
addresses:
● The mission of the institution
● Standard operating procedures of the ED
● Responsibilities of each member of the ED staff
● Staff must improve their professional knowledge and skill
● Triage and screening of each patient must be performed by a physician or
trained R with EMT
● A legible and appropriate medical record must be established for each
individual
● The minimum set of SOPs should be available for:

a. Receiving of the patient

b. Registration of the patient
c. Triage of the patient
d. Shifting /Transfer within hospital
 e. Referral of the patient
f. Discharge of the patient
g. Brought in dead cases
h. Code Blue
i. Medico-legal cases
j. Clinical protocols

QUALITY INDICATORS
● Unplanned re-attendance rate
● Total time spent in emergency department
● Left without being seen
● Time to initial assessment
● Time to treatment
● Service Experience.

ROLE OF EMERGENCY ROOM CLERK OR SECRETARY

● Interview patients to obtain biographic, demographic, and financial data
for registration purposes and enter information so gathered into hospital
computer system.
● Register emergency room patients, file, retriev medical records for the
emergency room physician, responsible for processing emergency room
admissions
● Provide exceptional customer service.
● Coordinate activities in connection with admission of patients in the
hospital or other medical facility
● Assess patient’s other needs from health care professionals like need of
ambulance services or referrals
● Grievance redressal
● Coordinate with other health care executives for bed arrangement
● Make sure that MLC cases are registered
● Maintenance of records like DAMA patients.
● Medico Legal Case is made based on the patient’s condition/unnatural
cause of injury, RTA etc. Records of such cases are entered in the Medico
Legal Register with details of patients and accident, and the patient case
file is stamped as “Medico legal”. The local police station is informed
immediately. Casualty in charge/ will be informing the police. Based on
the Casualty in charge or treating consultant’s instructions.
 CHAPTER-8 FRONT OFFICE DEPARTMENT-
WORKFLOW & FUNCTIONS

WORKFLOW

"Customers are Kings and Kings never unattended”.

A medical receptionist is an inevitable part of a well functioning healthcare
team. Doctors, nurses, and other medical and administrative staff members
depend upon the medical receptionist to create a friendly, welcoming and
well-organized front office for patients and to facilitate the well-functioning of
the hospital.

PRINCIPLE FUNCTION OF FRONT OFFICE

The Need for Professionally Trained Hospital Front Office Executives

Different from other service industry, the hospital is where people come to visit
when either or their close ones are unwell. This makes the people come to the
hospitals impatient, anxious and curious. Here comes the importance or
necessity of handling such patients or their family members with more
professionalism, sympathy, empathy and courtesy following all hospital
operational protocols.

The Front Office is a department of the hospital which directly makes contacts
with the patients where they first arrive. The staffs of this department are
directly family members. It functions as a central point of contact across the
organization. The department maintains information and records of all the
patients of the hospital. It also plays an important role in forming overall
impressions of the services provided by the organization.

The front desk position is often the first person that patients or their
well-wishers interact while contacting with the hospital. So, they are essentially
the face and voice of the hospital and for this reason,they play an important role
in the representing the organization.

What does the term ‘Customer’ mean?

● A customer is referred to as individuals or households that purchase
goods and services generated within the economy.
 ● The word is historically derived from “custom,” meaning “habit”; a
customer is someone who frequently consists a particular shop, and
makes it a habit to purchases good from there, and with whom the
shopkeeper had to maintain a relationship to keep his or her “custom,”
which means expected purchases in the future.
● Customer needs may be defined as the goods or services a customer
needs to achieve specific goals. Different needs are of varying importance
to the customer.
● Customer expectations are influenced by cultural values, advertising,
marketing, and other communications, both with the supplier and with
other sources.

Customer Service:
Customer service ( also known Client Service ) is the provision of service to
customers before, during and after a purchase.
According to Turban et al, 2002, “Customer service is a series of activities
designed to improve the level of customer satisfaction - that is, the feeling that a
product or service has met the customer expectation.” Customer services can be
given by salesman or hospital executives. Also through automated internet
services. The medical receptionist is often the first person with whom patient
has with the medical facility. Giving patients individual attention can go a long
way in establishing their positive experience with the facility.

What is CRM?
CRM stands for Customer Relationship Management. As the name indicates,
CRM software is a system for managing relationships with customers.

What is Healthcare CRM?

Healthcare Customer Relationship Management can manage a complete
database on patients that are recorded securely and cannot be accessed by third
parties.
The CRM Medical software can easily provide the information required to the
patients through text, phone calls, or email from anywhere ,at any time.
Furthermore, this information can also be used by hospitals to keep them
informed on personalized care as a type of marketing measure
CRM in healthcare not only stores patients’ contact information; but it also
gives a comprehensive overview of their medical history, appointments, and
prescriptions. As well in short, the availability of medical CRM helps the
healthcare industry to offer instant services, solutions, and improve the overall
performance of the hospitals.

Advantage
1. Comprehensive Patient Management software can do all the tasks in
relation with managing appointments.
2. Multi-Department Collaboration- A hospital or private practice has many
departments that must work in agreement to provide the best patient
experience
3. CRM system can also collect and organise reports that will be beneficial
is a healthcare organization. These reports can be regarding patient
requests or complaints, referrals, or internal issues like medical
equipment malfunctioning.
4. Save Time & Resources- Each doctor and nurse at your hospital or
private practice can automate their calendars with CRM software.
5. Reduce Errors in Medical Bills.
6. Improve Communication- Email automation or SMS makes sure that
timely responses are sent to a patient’s inbox after they take action in
some way.
7. CRM software will allow you to segment your patients based on their
health issues location,age,gender.
8. It also connects front office and back-office functions.

CRM software- sample

Vital Functions of the front office
● To identify and analyze customer needs and problems.
● Recognize the most common reasons for customer complaints.
● Discover techniques to cultivate and maintain special customer
relationships.
● Assess your communication style and use two-way communication skills
to level with people, to accept feedback from them, and to discuss
problems.
● Identify specific problems in your customer service program and apply
treatment.

Functions of Front Office - Hospital

1. Registration:- The Patient/Guest coming for treatment or willing to show a
Consultant.
● Registering guests: The hospital needs to keep a complete register of
guests essential for other departments as well:
➢ Medical Record
➢ Admission
➢ Billing
➢ Ward/Diagnostic
➢ Others
 ● Data needed for registration:- Personal data - any information relating to
an identified or identifiable natural person. E.g., Name, address, Phone
No.
2. Information to the Guest
➢ Tariff
➢ Senior Citizen Club
➢ Other Packages
➢ Other Investigation - Laboratory / Diagnostic
➢ Emergency / In-Patients

3. Cash Collection:- The registered amount to be collected from the guest and
Should be deposited to the cash at the end of the day/ before closing the
counter handover to another person.

4. Information/Enquiry-Handling
“Rudeness is a weak person’s attempt at strength.”
➢ Be considerate, friendly & courteous.
➢ Practice [Link]- please
➢ Explain. Do it patiently.
➢ Accommodate the other viewpoints.
➢ Allow criticism.

5. Report Making
➢ Census report
➢ Other reports

Do You Know Why Customer Leave?

➢ 1% die.
➢ 3% move away.
➢ 5% develop other relationships.
➢ 9% leave for competitive reasons.
➢ 14% are dissatisfied with the product or service.
➢ 68% leave because of rude or discourteous service.
THE CUSTOMER WANTS YOU TO
➢ GREET
➢ VALUE
➢ HELP
➢ LISTEN
➢ INVITE BACK

Areas coming under Front Offices /Out Patient Area (OPD) are:-
● Main Reception
● Consultation Room
● Diagnostic - ECG,ECHO,MRI,CT-SCAN Sample Collection

Understand the Challenges Faced by Front Desk Staff

● Managing patient emotions…
● Handling call volume and maintaining phone etiquette…
● Managing patient wait times and patient flow…
● Complaint resolution.

MAIN GOAL
Your Main Goal is to have each patient leave with a smile/ satisfaction on their
face and feeling of having been well take care of by you and your
employees/colleagues.

Dealing with Upset Customers

● Listen first and then offer solution
● If you cannot solve the problem, ask your supervisor/Superior to solve the
problem, offer alternatives.

Role of Healthcare Resource Desk

➢ Greet the caller with a positive approaching attitude
➢ Respond instantly to their queries
➢ Know the number of departments of the hospital
➢ Have a list of doctors and employees along with their numbers
➢ Should never be haughty, while receiving a call
➢ Optimizes patients’ satisfaction, provider time, and treatment room
utilization by scheduling appointments in person or by telephone.
Role of Health Check Desk
➢ Provide assistance and facilitate customer
➢ Handling Corporate/walk in inquiries
➢ Appointment and Scheduling of Health Check up
➢ Coordinating with concerned department
➢ Dispatch of report after health check up

Report Dispatch Desk

➢ Storage of reports received from various departments
➢ Provides Reports on the time to the client
➢ Maintaining record of the reports received and hand over

Timing
➢ The Front office provides patient care round the clock i.e.24 hrs. Service
➢ The Staff works in three shifts.

Hospital Front Desk Executive OR Hospital receptionist

A Hospital Front Office Executive is a person who works in the hospital front
office and manages various tasks.
He or she is responsible for basic clerical tasks such as answering phones,
greeting patients and visitors, and scheduling appointments in a professional and
timely manner. Most medical receptionists work in a physician’s office, dentist’s
office, hospital or another medical facility.
In smaller offices, medical receptionists will be responsible for both
administrative and clinical duties. In larges offices, they may only be
responsible for administrative or clerical duties. The position is referred to as a
medical office assistant, medical assistant, receptionist, or healthcare
administrative profession.

Main Job, Duties and Responsibilities

➢ Welcomes and greets all patients and visitors, personally or over the
phone
➢ The receptionist, even if you can’t verbally greet the patient, getting eye
contact with them lets them know you are aware of their presence and
will get to them as soon as possible
➢ Respond to inquiries by patients, prospective patients, and visitors in a
courteous manner
 ➢ Register new patients according to established protocols
➢ Register new patients and updates existing patient demographics by
collecting detailed patient information that includes personal and
financial information
➢ Assist patients to complete all necessary forms and documentation
including medical insurance
➢ Ensure patients to complete all necessary forms and documentation
including medical insurance
➢ Ensure patients information is accurate including billing information
➢ Inform patients of medical office procedures and policy
➢ Maintain and manage patient records
➢ Move patients through appointments as scheduled
➢ Facilitate patient flow by notifying the provider the patients’ arrival,
being aware of delays, and communicating with patients and clinical staff
➢ Answer incoming calls and deal with inquiries. Answers the phone while
maintaining polite, consistent phone manner using proper telephone
etiquette
➢ Transfer calls as required
➢ Collect co-pays and payments
➢ Report statistics as required
➢ Schedule hospital admissions, tests, scans and outside appointments for
patients
➢ Obtain external medical reports as required by medical professionals
➢ Respond and comply to requests for information
➢ Deal with incoming and outgoing post
➢ Complete other clerical duties as assigned
➢ Maintain, stock of forms and keep medical office supplies adequately
stocked by expecting inventory needs, placing orders, and monitoring
office equipment
➢ Ensure that reception area is well maintained, neat and clean
➢ Safeguard patient privacy and confidentiality- Protect patient
confidentiality, making sure that protected health information is secured
by not leaving PHI in plain sight and logging off the computer before
leaving it unattended.

SKILLS: Telephone etiquette, customer service, basic word and excel

programs, the management, multi-tasking, organization, scheduling.
 ➢ Communication skills - able to listen effectively and express oneself in a
clear, articulate manner
➢ Information collection and management - able to collect, organize and
monitor data efficiently
➢ Planning and organizing - able to multi- task, prioritize and schedule
tasks and activities
➢ Attention to detail - able to produce accurate and high - quality work
through concern for all areas involved
➢ Customer service skills - able to develop good customer relationships
focusing on achieving customer satisfaction
➢ Adaptability - able to adjust approach to meet changing demands and
situations that includes in dealing with diverse people
➢ Confidentiality - able to maintain confidentiality and adhere to ethical
standards

The most critical skills include:

Telephone Etiquette: When a patient calls in, the way in which the front desk
personnel handles the telephone call determines how the facility is perceived.
The medical office receptionist must be a good listener and maintain
confidentiality besides having good phone manners.
DO’S DONT’ S
Smile & Pleasant talk Distract
Speak Clearly Shout or Whisper
Make them welcome Hold for too long
 CHAPTER- 9 IN PATIENT DEPARTMENT

INPATIENT DEPARTMENT

❖ Indoor Patients Department (IPD) mentions the areas of the hospital

where patients are accommodated after being admitted, based on
doctor’s/ specialist’s assessment, from the Out - Patient Department,
Emergency Services and Ambulatory Care.
❖ An IPD is a part of a healthcare facility or hospital where patients are
admitted for over 24 hours. An IPD of the hospital is generally equipped
with beds, medical equipment and 24* 7 availability of doctors and
nurses.
❖ The duration of stay will relay on severity of the patient’s illness.

WHAT IS ADMISSION?
It means allowing a client to stay in the hospital for observation, investigation
and treatment of disease he is suffering from.

Purpose of admission procedure

● To provide immediate care
● To provide comfort and safety to the patient.
● To receive the patient in ward for admission as per his condition.
● To be ready for any emergency
● To obtain information about the client so as to establish therapeutic nurse
patient relationship.
● To involve patient and family in care.
● To assist patient and family in care

TYPES OF ADMISSION

1. Emergency Admission: Clients are admitted with acute conditions

requiring immediate treatment. EX: Client with heart attack, accidents,
poisoning etc.
2. Routine Admission: Clients are admitted for investigations and planned
treatment and surgeries: Ex: Client with hypertension, diabetes,
bronchitis etc
ADMISSION PROCEDURE - THROUGH OPD
I. Receiving the patient:- The personnel in admitting department should
greet and make the patient feel comfortable.
In emergency condition, no time should be wasted to start the
treatment. The manner in which doctor or nurse receives the client is
most the important aspect of reception in case of emergency.
II. Recording of Social data: Clerk in record section records data essential
for identification of client. Social data: name, age, sex, education,
address, occupation, religion, income, marital status, telephone no. etc.

Responsibilities of the admission department

a. Gather patient information (name,age,sex,address,mobile no etc)
b. Prepare medical record
c. Prepare patient identification bracelet
d. Consent form signed
e. Initial orders obtained
f. Inform to floor ward nurse
g. Issue the visitor’s pass at the time of admission.
h. A minimum deposit amount is advised by the admission desk staff to be
deposited at the accounts cash counter. They will also draw out an
estimate and guide you for selecting the relevant category of room. This
amount varies depending upon the area/ward in which patient is being
admitted. The advance shall be adjusted against the final bill at the time
of discharge. Those seeking the cashless route would have to visit the
insurance desk /TPA desk for the hospitalization of the patient.

III. Medical Examination in OPD :

● A detailed social and medical history of the patient is taken by
physician and recorded. Patient’s temperature, BP, Pulse,
respiration etc are recorded.
● The necessary investigation such as x ray, lab test is done to
diagnose the disease and prescribe treatment .
● Those who are admitted to hospital for further investigations and
treatment to the concerned ward on the advice of the treating
doctor. The ward is designated by the staff at the admission desk
and entered in the case sheet.
IV. Transporting the client from O.P.D to I.P.D
● Clients who are not very ill and are able to walk are accompined to
ward by a nurse of attendant.
● Wheel chairs should be available for those who are too sick, weak,
not able to walk.
● Clients who are bought to hospital on ambulance should be carried
to their respective wards on stretchers
V. Receive the patient by ward sister

Responsibilities of the nurse

1. Prepare room
● Prepare a clean and neat admission room with all the necessary
items according to the needs of the patient
● Prepare an appropriate type of bed with adequate adjusted height of
the bed
2. Identify self
● Welcome patient and his family with warm approach.
● Make the patient comfortable in bed and provide him with hospital
clothes and ensure adequate privacy.
● Lessen anxiety/fear
3. Orient patient
● Location of nurse’s station
● Room boundaries
● Clothes storage
● Call light
● Bed controls
● Light switches
● Telephone policy
● Tv controls
● Meal times
● Visiting hours
● Diet
● Safety measures- side rails
● Time for doctor’s visit
● What tests are scheduled
 4. Gather information related to:
● Medical Orders
● Treatment
● Lab Results
● Tests
● Diet
● Activity
VI. Preliminary Observation of patient:
● The first few moments with patient, facial expressions will denote his
emotional reactions and presence of pain, fatigue.
● Any discoloration of skin such as jaundice, cyanosis, facial paralysis
should be noted. Further observations can be made giving care to the
client.
VII. Charting
● Record all the basic information in patients record.
● Clearly mention admission date, time patients’ detail, complains of the
clients, any allergies, patients’ mental status.
● Record in admission register , treatment book, report book, medical legal
case (MLC) register, update ward census and nurse’s notes.
● Physical Assessment by reviewing system
● Patients Comfort
● Collect information for database
● Obtain physician order for the Lab, Tests, Medical activity
VIII. Follow Orders by the Consultant
If any tests are prescribed by doctor; the nurse must make arrangements to
carry out. Carry out other procedures prescribed by doctor, if any.
XI. Care of valuables and clothing: If patient is wearing hospital dress, patient’s
clothes should be handed over to relatives. In case of absence of relatives,
clothing is numbered, labelled and kept in store until such time it is handed over
to relatives. Encourage the client to send jewellery, money and other valuables
such as watch to home with relatives. Make him understand if he keeps
something with himself, it is on his own risk.
ADMISSION FROM EMERGENCY DEPT
1. When they get confirmation that a patient has arrived with an emergency
to the hospital campus, the first thing they do is give a call to ward boys
and patient attendants to shift the patient from ambulance to stretcher.
2. Give a call to medical officer.
3. After the medical officer examines the patient, they ask him as to where
they have to shift a patient.
4. Generally they shift the patient to the ICU and after patient becomes
stable, only then shift the patient to the concerned ward.
5. After counselling with the Consultants and permission of the same they
do registration patient in IPD register and in their software too.
6. Fill the patient’s consent form and after telling them the purpose and
meaning of the form get it signed by the patient’s relatives.
7. Send the file of patient to the corresponding ward where the Medical
Officer has asked the patient to be shifted
8. Confirming that the file of patient is received by MO of the
corresponding ward.
 CHAPTER- 10 HOSPITAL WARD
DEFINITION
A ward is a room in a hospital where beds are arranged for many people,
often people who need similar treatment. Stay can be long term or
short-term depending upon the severity of condition.

THE PURPOSE OF ANY HOSPITAL WARD

● Diagnosis and treatment
● Promoting health
● Teaching
● Research
● Render professional nursing and medical care to patients
● Provide necessary equipment’s, essential drugs and all other stores
requirements for patient care in an organized manner

Constituents of ward space

❖ Patients’ s space
❖ Nursing space
❖ Corridors

Types of wards
❖ General wards
❖ Specialized wards

Specialized wards examples

❖ Gynaecology, Maternity ward
❖ Oncology (Medicine, Surgery)
❖ Nephrology/ Dialysis Cardiology & CTVS
❖ Neurology (Medicine, Surgery)
❖ Ophthalmology

Main components of Ward

❖ Clinical area (patient, nursing area, nursing counter)
❖ Auxiliary area (nurse’s room, doctor’s room etc)
❖ Ancillary area (pantry, day room, trolley bay)
❖ Sanitary area (toilets, dirty utility)
Factors involved in Good Ward Management
❖ Follow policies and protocols
❖ Knowledge of all duties to be performed in the ward
❖ A planned program for each day’s work
❖ Beginning the day on time
❖ Preventing interruptions Establishment of ward routine
❖ Use of democratic methods in the establishment of ward policy
❖ Orientation of new staff members
❖ Maintenance of a suitable environment
❖ Provision of supplies and equipment for efficient work
❖ Clear-cut doctors and nurses’ orders
❖ Accurate records Full reports
❖ Maintenance of high morale among all staff members
❖ Establishment of good working relationships within the ward and with
other associates
❖ Delegation of responsibility
❖ Well-planned assignments
❖ Well-arranged time for personnel
❖ Good teaching and supervision

DUTIES OF WARD CLERK/ SECRETARY

❖ Compiling and recording medical charts, reports, and correspondence.
❖ Customers needs assessment, meeting quality standards for services, and
evaluation of customer satisfaction.
❖ Provide support to health care staff and ensure appropriate maintenance
of patience care unit.
❖ Administer efficient communication network and manage flow of traffic.
❖ Provide assistance to all nurses and ensure appropriate cleanliness of all
units.
❖ Maintain and update patient database on computers and notify nursing
staff on all diagnosis.
❖ Coordinate with various departments and ensure proper services and
supplies of unit.
❖ Prepare and update patient charts with ancillary reports and forms from
various departments.
 ❖ Maintain discharge summary reports for all patients and keeps records of
all patients. And send medical records to MRD after the discharge of
patient
❖ Administer medical records for all physicians and medical staff and
maintain records of attendance
❖ Monitor all emergency calls and evacuate facilities when required.
❖ Placing doctors visit, ECG, echo etc in medical record.

PATIENT CARE EXECUTIVE/ FLOOR MANAGER (In ward)

A Patient Care Executive is a professional who is specialised in helping people
who are recovering from disease or disability. He or she monitors the
performance of patient care services, compares it to government agency
standards, and makes adjustments if necessary.

JOB DESCRIPTION:
[Link] proper discipline of staff in Wards/ Floors
● Checks Noise levels
● Ensures Availability of Doctors
● Ensures abrupt Response to nursing calls
● Monitors Staff behaviour and attitude
[Link] duties related to Hospital Information System:
● Makes sure that new admissions received in the system:
● Ensures that discharges are completed on time in the system
● Resolves Issues related to Bed Management
[Link] Patient care
● Addresses patient problem
● Provides information in case of any inquiries
● Checking completeness of Medical Record File
4. Coordinating ward unit performance.
5. Feedback to chairman/ HOD in compliance with quality standards, Medical
records audit and significant incidence.
6. Supervise the duties of ward secretaries on the respective floor Ensures that
ward secretaries are placing doctors visits, beside procedures like beside ECHO,
ECG/any
PATIENT RELATION OFFICER
Patient relations officers are responsible for managing the relationship between
healthcare providers and [Link] work with doctors, nurses, hospitals,
pharmaceutical companies etc., to make sure that all parties involved in a
patient’s care pleased with their experience.

Patient Relation Officer Job Duties

A patient relations manager typically has an expensive range of responsibilities,
which include
● Ensuring that patients are comfortable during their visit by greeting them
warmly
● Making sure that patients are aware of any changes in their treatment
plans or medical conditions and informing them of any imminent
appointments.
● Arranging for transportation to from appointments, as needed
● Providing emotional backup to patients, including answering patient
questions and offering reassurance
● Coordinating with physicians and other healthcare professionals to make
sure that all needs are met during patient visits
● Maintaining exact records of patient meetings with physicians, nurses,
and other staff members
● Setting patients complaints, concerns, and questions about treatment
plans diagnoses
● Making patients aware of health services and facilities available for
patients at Hospital
● Investigate and convey complaints or problems to appropriate head
department of the hospital.
● Assist in setting conflicts and act as an intermediary between patients,
families and staff
● Collect data and information about patients feedback and make
recommendations appropriately
● Explaining policies, procedures or services to unknown patients by using
medical administrative knowledge.
● Monitoring and analysing the patient’s rights and responsibilities.
 CHAPTER 11:- DISCHARGE PROCESS
INTRODUCTION
A discharge from hospital is the formal release of patients from a hospital after a
procedure of a course of treatment. A discharge happens whenever a patient
leaves hospital on the completion of treatment , signing out against medical
advice, transferring to another healthcare institution , or on death.

TYPE OF HOSPITAL DISCHARGE PROCEDURES

Routine discharge , AMA discharge, Transfer to another healthcare facility,
Discharge to hospice palliative care.
1. Routine discharge-A Planned discharge on the advice doctors
Routine discharge is referred to as the process of a patient being
discharged from a hospital or healthcare facility after getting medical
treatment or care. The healthcare team will then provide the patient with
information about their condition, medications,follow- up care and any
lifestyle changes necessary for them.
2. AMA discharge
AMA discharge indicates “Against Medical Advice” discharge,
which occurs when a patient takes decision to leave a hospital or
healthcare facility before their treatment is complete, against the advice
of their healthcare provider. AMA discharge may occur for a variety of
reasons, including a desire to leave the hospital early, disagreement with
the recommended treatment plan, or defect with the quality of care.

AMA FORM CONTAINS

“I am leaving the hospital ward against the medical [Link] explained to
me about my disease condition and ill effects of discharge medical advice.
Doctors, hospital and staff will not be responsible for any ill-effects that may
happen after my departure”.
Name of the patient/relative:-
Relation:-
Signature:-
Date:
Time:
3. Transfers to another healthcare facility
either as a referral or as by patient request Transfer to another healthcare
facility refer to the process of moving a patient from one hospital or
 healthcare facility to another, usually for the purpose of getting
specialized medical care or services that are not available at the present
facility. The transfer may be arranged by the healthcare provider or
hospital where the patient is presently receiving care, or it may be
requested by the patient or their family due to valid reasons. A
physician’s referral form is used to refer patients to a specialist for
medical treatment while transferring to another hospital.
4. Discharge to hospice or palliative care
Discharge to hospice or palliative care means the process of transferring a
patient from a hospital or healthcare facility to a specialized program or
facility that provides end-of-life care for patients with serious or terminal
illnesses.

Things you can implement right away to remove the obstacles in your
discharge process and improve revenues.
The administration must ensure
1. Efficient billing system
2. Electronic charts and medical records
3. Discharge planning during admission
4. Improve care coordination
5. Better bed management
6. Ensure Discharge Medication Reaches the Ward ASAP

POLICY AND PROCEDURE ON DISCHARGE

➢ PURPOSE
To provide guidelines for the discharge of in-patients from Hospital.
➢ POLICY
1. Discharge procedures shall be followed to make sure that patients
are discharged effectively and efficiently, allowing the most
favourable resources.
2. An authorized hospital discharge shall only be made by an order
from the primary consultant. However, a patient may discharge
himself/ herself against medical advice.
3. The Consultant or his designee shall document discharge
instructions in the patient's medical record at the time of
anticipated discharge.
 4. A Discharge Summary shall be prepared and all the patients are
provided with a discharge summary at the time of discharge
5. The Ward Sister shall be the responsible person to ensure
compliance with this policy like billing, duration to finish a
discharge process etc.
6. The discharge summary shall contain all patient details.
7. Incase of death, the discharge summary must include the cause of
death
8. The nurse shall be responsible for completing the discharge
checklist and explaining the discharge summary to the
patient/family understanding shall be recorded in document on the
discharge checklist by getting signed by the patient /family.
9. Patients who request discharge against medical advice shall be
explained the risks and informed consent policy.
10. Patients who leave hospital against medical advice are to be
explained on the consequences of LAMA and signature to be
obtained in LAMA form in Inpatient Record.
11. A Patient who comes to casualty, take treatment and leave hospital
with CMO consent as OP consultations are given prescription
based on patient’s condition.
12. The hospital administration must make sure that every hospital
has an organized discharge planning and that can increase patient
satisfaction.
DISCHARGE PROCESS FLOW CHART
What is aDischarge summary?
A discharge summary is a clinical report prepared by a health professional at the
conclusion of a hospital stay. It is often the primary mode of communication
between the hospital care team and aftercare providers.
The Discharge summary shall include-
❖ The reasons for admission, significant findings, diagnosis and patient’s
condition at discharge.
❖ The investigation results,’ laboratory results
❖ The medications given and the procedure done (if any).
❖ Follow up advice,
❖ Medications and other instructions and how to obtain urgent care in an
understandable manner
 CHAPTER-12 TRANSFER OF PATIENTS
INTRODUCTION
The intra- and inter-hospital patient transfer is an important aspect of patient
care which is often handled to enhance the existing management of the patient.
It may involve carrying a patient within the same facility for any diagnostic
procedure or shift to another facility with more well-developed care. The main
aim in all such shifting is to maintain the continuity of medical care . As the
transfer of sick patient may produce various physiological changes which may
negatively affect the prognosis of the patient, it should be initiate safe transfer
consists of decision to transfer and communication, pre-transfer stabilisation
and preparation, choosing the appropriate mode of transfer, i.e., land transfer or
air transport personnel going along with the patient, equipment and monitoring
needed in the course transfer and finally, the documentation and handover of the
patient at the receiving facility.

DEFINITION
● Transfer is defined as preparing patient, completing requisite records and
shifting patient to another department within the hospital or to another
hospital/ home.

Purpose
● To get necessary diagnostic tests and procedure
● To provide treatment and nursing care
● To provide specialized care
● To place the most suitable utilization or available personnel and services
● To match severity of nursing care based on patients’ level of needs and
problems.

Types of Transfer of the Patient

● Internal transfer: to transfer the patient in a unit that provides special care
or care suited to his requirements, e,g., from general ward to ICU
● External transfer: to transfer the patient from one hospital to another
hospital for the purpose of special care, e.g., from general hospital to
specialized hospital- cancer centre.
1. Transfer within the Facility
● Check the doctor’s order for transfer of patient, A written declaration is
required from the doctor.
● Intimate the patient and relatives to be free from anxiety
● Intimate the ward sister where the patient is transferred
● Check the chart for the complete recording of important signs, nursing
care and treatment given
● Gather the patient’s X-ray, medicine and other belongings
● Call off the hospital diet or transfer to the new ward the patient is going
● Aid the relatives to gather other belongings
● Make arrangement to pay off due bills if going to another hospital
● Record time, mode of transfer and general condition of the patient
● Assist in transferring risk patients to wheelchair/ stretcher and going
along with the patients to the new area
● Deliver patient documents, belongings and report orally to the in-charge
nurse/and sister
● Gather the ward articles
● Evaluate the method for transport, inform the receiving nurse
● Maintain the patient’s physical welfare the during the transport to a new
nursing unit
● Provide oral report about patient’s condition to the receiving unit nurse
● Make it sure that all documentation including care plan is completed
● Assist the patient’s arrival to the new unit
● Transport the patient to a new room and assist in transferring to bed.
● Exchange the belongings, medical records and reports
● In the new unit, procedure is similar to that of admission procedure
● Clean the unit where patient is admitted and keep ready for the next
patient after transferring .

Equipment necessary for the transfer of a patient

● Wheelchair/ stretcher
● Identification labels
● Patient’s belongings
● X-rays, investigation reports, patient’s record and file.
● Cardiac monitoring if required
2. Transfer to an Extended-Care Facility
● Make sure that the patient’s physician has written the transfer order on his
chart and has completed the special transfer from. This form should
consist of the patient's diagnostic care summary, drug regimen, and
special care instructions, such as diet and physiotherapy.
● Complete the nursing summary, that includes the patient’s assessment,
progress, needed nursing treatments, and special needs, to make sure the
continuity of care.
● Settlement of hospital bills
● Retain one copy of the transfer from and the nursing summary with the
patient’s chart and pass on the other copie to the receiving facility

KEY ELEMENTS FOR TRANSFER OF CRITICALLY ILL-PATIENT

[Link] to transfer and communication

● The decision to shift the patient is important vulnerability of exposure of
the patient and the staff to extra risk and extra expense for the relatives
and the hospital.
● The decision to transfer the patient is decided by a senior consultant level
doctor by way of discussion with the patient’s relatives about the benefits
and risks involved.
● A written and informed consent of patient’s relatives along with the
reason to transfer is compulsory before the transfer.
● A direct communication between the shifting and receiving facility
should be by sharing of complete information on the patient's clinical
condition, treatment being given, reasons for transfer, method of transfer
and timeline of transfer, in a written document.

B. Pre- transfer stabilisation and preparation

A proper and clear preparation and equilibrium of patient should be done
prior to transfer to prevent any hastile events or deterioration worsening of the
patient’s clinical condition. The patient should be properly revived and
balanced to the maximum extent possible without wasting undue time. In the
course of the preparation, patient’s A, B, C and D, i.e., airway, breathing,
circulation and disability, should be examined, and any connected curable
problems should be rectified. In this context, the use of pre-transfer checklist
helpful

Airway
The patients with possibility of airway compromise in the course of transfer
should be electively intubated with endotracheal tube (ETT) with a cuff which
should be fixed properly after verifying its exact position. Some patients need a
properly placed nasogastric tube in order to prevent aspiration of gastric
contents during transfer. The cervical spine stabilisation may be needed in some
trauma patients.

Breathing
The ventilation should be sufficiently regulated with optimisation of the arterial
blood gas values. In the suspected pneumothorax, chest drain should be installed
before transfer, especially before air transport.

Circulation
The patient should have at least two wide bore intravenous working cannulas in
place before shifting. External haemorrhage, if any, should be regulated
controlled, and any shock should be treated with intravenous fluids and/or
vasopressors. The availability of cross-matched blood may be needed in the
course of the transport.

Disability or neurological status

Patients with head injury should have their Glasgow coma scale (GCS)
adequately monitored and recorded in document before and in the course of
transfer and before the administration of any sedative or paralytic agent.

The patient should be protected from cold by providing suitable blankets apart
from the above pre-transfer checklist, on the day transfer itself all basic
investigations should be performed to reflect the present condition of the patient

C. Mode of transfer
The two most commonly employed methods of transfer of patients are
ground transport by including ambulances and Mobile Intensive Care Units
(MICYs), and air transport including helicopter or aeroplane ambulances.
 a. Ground transport: Different types of ambulance are used in this mode
of transfer of patients
● Basic life-support ambulance: These ambulance are conditioned with
adequate staff and monitoring devices to shift patients
without-life-threatening conditions and these can only provide basic life-
support services
● Advanced life-support ambulance: These ambulances can provide
modern life support services like endotracheal intubation, cardiac
monitoring, defibrillation administration of intravenous fluids or
vasopressors . These are adequately staffed and made ready for shifting
patients with life-threatening conditions
● MICU : These are specialised vehicles with all the equipment and staff to
transfer patients who are critically ill. and are usually used in combination
with specialist retrieval teams in few developed countries

b. Air transport:- The use of air transport has been increasing in

developed countries because of advantage of swift transport by including
specialised medical care. There has been an improved prognosis of
patients with trauma, severe myocardial infarction and severe stroke
owing to rapid provision of suitable medical care by the use of air
transport.

The patients who are more likely to get benefit from air transport are;
● Patients with severe trauma and penetrating chest injuries, multisystem
injuries, crush injuries, or patients with unstable vital signs
● Patients with acute coronary syndrome in crucial need of
revascularisation procedure, cardiac tamponade with haemodynamic
compromise, cardiogenic shock in need of intra-aortic balloon pump or
other assist devices.
● Patients due to receive organ transplant
● Critically ill high risk medical or surgical patients.

D. Accompanying the patient- It is normally suggested to have at least two

proficient personnel accompanying the patient to be shifted. The care needed by
each patient in the course of transfer relays on the level of patient's critical care
dependency and correspondingly are divided into:
 ● Level 0: It consist of the patients who can be managed at the ward level
of ward in a hospital and are normally not needed to be accompanied by
any specialised personnel
● Level 1: It consists of those patients who are at deteriorating condition in
the course of the transfer but can be managed in an acute ward setting by
the support of critical care team. These usually should be accompanied by
a paramedic ui a trained nurse
● Level 2: It consists of patients who are in need of observation or
intervention for failure of single organ system and have to be
accompanied by trained and proficient personnel
● Level 3: It consists of patients with need of advanced respiratory care
during the transport with the support of at least two failing organ systems
These patients must be accompanied by a competent doctor along with a
nurse and a paramedic.

The accompanying person should be aptly trained, competent and experienced

and preferably should have done training in patient transfer and should have
enough training in advanced cardiac life support, airway management and
critical care. If the physician is not available to shift unstable patients, then
the provision of contacting the physician concerned by the transport tram
should certainly be ready for service

E. Equipment, drugs, and monitoring

● A proper inspection with the provision of all life saving drugs is
compulsory for transfer of all patients with level 1,2 and 3 critical care
needs. The transfer ambulance should be prepared with all the drugs and
devices needed for airway operation, oxygenation, ventilation,
haemodynamic monitoring and resuscitation.
● All the inspection needs to be confirmed before the beginning of transfer
together with the starting of infusion drugs. The drugs required for
patient transfer involve muscle relaxants, sedatives, analgesics, inotropes
and resuscitation drugs. The person responsible to patient transfer should
assure correct supplies of these emergency drugs. Some of these drugs
may be needed to be prepared in pre-filled syringes before the transfer.
● The minimal standard of inspection suggested for patient transfer include
uninterrupted electrocardiogram inspection, non-invasive blood pressure,
oxygen saturation, and temperature. The non-invasive blood pressure may
 be notably affected by the motion artefacts, so it may be cautious to use
invasive blood pressure inspection in selected subset of patients.
● All the inspection equipment should be secured accurately at and should
be placed at below the level of the patient for uninterrupted inspection.
The electrical devices must be functional on battery power with the
provision of extra batteries during transfer.
● Patients on ventilator must be shifted on portable transport ventilators
with the provision of display of alarms associated with tidal volume,
airway pressure, inspiratory expiratory ratio, inspired oxygen fraction
and respiratory rate

Special considerations: If the patient requires an ambulance to take him to

another facility, make arrangements for transportation with the social services
administration. Make sure that the necessary equipment is gathered to provide
care in the course of transport.
Documentation
○ The authentication of patient transfer is most significant but often missed
as part of transfer.
○ The authentication should always be obvious at all stages of transfer.
Since it was the only legal report that the patient was transferred, so it
must consist of the patient’s condition,reason to transfer names and
designation of referring and receiving clinicians, details and status of
important signs before the transfer, clinical events during the transfer and
the treatment given.
○ A standardised testimony should be used and sustained both for intra- and
inter- hospital transfer. These legal papers should be used for audit
purposes for investigating the defects in the patient transfer.
○ There should be an official handing over at the receiving facility between
the transferring team and the receiving team who include the doctors and
nurses. The different reports of clinical investigations and diagnostic
studies should be transferred to the acquiring team.
 CHAPTER-13 INTENSIVE CARE UNIT
INTRODUCTION
A unit in a hospital that provides intensive care for critically ill or injured
patients which is operated by specially trained medical staff and has equipment
that allows for continuous monitoring and life support. Patients may be referred
either directly from an emergency department or from a ward if their condition
rapidly, or immediately after surgery if the surgery is very invasive and the
patient is at high risk of complications.

Who are cared for in the ICU?

Patients may have a planned admission after surgery, an unexpected admission
after an accident or be admitted due to a sudden and critical worsening of their
health. Some hospital ICUs specialise in providing care for particular health
conditions or injuries that include
➢ severe burns
➢ respiratory failure
➢ cardiothoracic surgery.
➢ complex spinal surgery
➢ major trauma
➢ organ transplants
➢ Sepsis
➢ Cardiac arrest
Common types of ICU
1. Cardiac Intensive Care Unit (CICU)
2. Cardiovascular Thoracic Intensive Care Unit (CVTS ICU)
3. Gastro Intensive Care Unit (GICU)
4. Medical Intensive Care Unit (MICU)
5. Neonatal Intensive Care Unit (NICU)
 6. Neuro Intensive Care Unit
7. Paediatric Intensive Care Unit (PICU)
8. Surgical Intensive Care Unit (SICU)
9. Trauma Intensive Care Unit (TICU)

CLASSIFICATION OF ICU ON ORGANISATIONAL STRUCTURE

1. Open Unit: All attending Physicians may admit and care for patients.
Triage decision falls on director of ICU when there is bed or staff
shortage.
The major drawback of this concept is That these physicians might not
have received specialised training for managing critically ill [Link]
the major drawback of this concept.
2. Closed unit: The Directors and /or associates are accountable for all
admissions and discharges. Once the patient is admitted, the unit team
takes case of by collaborating with admitting team for efficient patient
care. Closed units may be helpful for the following reasons:
● more timely patient evaluation and treatment initiation
● intensivists are specifically skilled in treating critically ill patients

STAFFING
1. Medical staff
● ICU In charge /Intensivists
● Resident Doctors (senior and junior)
2. The respiratory therapist is essential part of an ICU team
3. Nursing staff
● Highly trained and of above average competence
● Recommended Nurse patient ratio 1:1 or 1:2
4. Auxiliary personnel
● ICU Technicians
● Nursing aids (ward boys female attendants) and Sweepers

Registrar in ICU
■ One Senior Resident who becomes registrar (Post MD) will always be on
duty. He/she can be a consultant later after few years of attaining
experience.
■ Shift duties of Senior and Junior staff (12 hours duty)
 ■ The Senior resident has the right to start and perform emergency
treatment which may be inevitable without permission, later consultants
must be informed.

Junior Resident in ICU

➢ One doctor in training (during post-graduation) will be on duty in unit
day and night
➢ The duty would include keeping patients records while in ICU &
preparing summaries.

ICU admission criteria

To optimise ICU resources and enhance outcomes, ICU admissions should be
guided on the basis of a combination of factors:
● Prioritisation in accordance with to the patient's severity of illness
● Specific patient needs such as life-supportive therapies
● Diagnosis
● Prognosis
● Potential benefit from interventions
● Bed availability

DAY TO DAY CARE PROCEDURES

● Connection with the parent unit is necessary for proper treatment of
patients in ICU
● Routine ICU rounds shall be held in morning at 9-11 am under whom
patient is admitted. The main decision regarding treatments is taken in
these rounds.
● The treatment initiated to patients is written by the senior resident posted
in ICU extensive care is given to patient.

DISCHARGE PROCEDURES
➢ Patients who are recovered and are steady can be discharged
➢ Patients in whom immediate threat is lessened but needs close
observation can either be discharged to wards or in intermediate care
areas, depending on need for ICU beds.
➢ Patients in whom death is agreed to be impending even if intensive care is
continued again kept in ICU depending on availability of resources.
Responsibilities of In-charge of ICUS:
➢ Is representative for unit in administrative
➢ Provides continuity of clinical care
➢ Arrange teaching and supervision of junior staff who needed
comprehensive instructions, not only regarding patient care but also for
use of unfamiliar equipment
➢ Is responsible for purchasing and servicing of ICU equipment
➢ Should initiate research and be recognised as an authority
➢ Should review all treatment regimen with staff

The hospital administration should ensure

1. An suitable environment for patient safety
2. Sufficient resources in good working condition
3. Ample number of skilled medical and nursing team
4. Standards of care, that include proper referral system
5. Ensure quality assurance programmes
6. Proper Policy for admission discharge procedure

Duties of ICU Secretary

➢ A unit secretary in the ICU is normally the first person whom family
members and visitors meet when coming to the ICU.
➢ Attend calls and pass on messages properly.
➢ Accountable for greeting them and listening to determine what the client
requires.
➢ The secretary is liable to answer basic questions and provide general
information, such as the visiting hours for the ICU
➢ If cannot provide information concerning the medical status of a patient,
it is the secretary who helps point the customers in the right direction, and
refers them to other staff members if needed.
➢ Perform clerical tasks, update bed status in computer.
➢ Maintains, files and organise patient records.
➢ Work with other departments to coordinate care services
CHAPTER–14 OPERATION THEATRE ( OT )
INTRODUCTION
An operation theatre is a place where certain intrusive surgical procedures -
which means operations that involve cutting into and working inside a patient's
body take place. This may contain either minimally invasive procedures such as
keyhole surgery - where cameras and a laparoscope are inserted through small
incisions - or open surgery where surgeons make larger cuts to reach the internal
organs. Robot-assisted surgery allows surgeons to perform certain procedures
through small incisions. Operation theatre is otherwise known as OR ( operating
rooms )

OR environment
Operating rooms are germ-free environments. All personnel should wear
protective clothing named scrubs, as well as shoe covers, masks, caps, eye
shields, and other coverings to prevent the spread of germs. The operating room
should be luminous and the temperature should be very cool; operating rooms
should be air- conditioned to help prevent infection through bacterial filtration
system.

OR equipment
An operating room has special equipment like respiratory and cardiac support,
emergency resuscitative devices, patient monitors, and diagnostic tools etc

Some of the staff who work in operating theatres consists of the following:
● Surgeons who perform the operation

● Anaesthetists who give anaesthetics to restrain pain both before and

during the operation

● Theatre nurses who take care of patients throughout all four stages of the

operation
● Theatre support workers who shift patients between the wards and the

operating theatre
● Cardiographers to monitor the ECG machine

● Radiographers to take X - rays if they are required

Policy to enter in an OT
■ State the aim of your visit to OR personnel and show your ID.

■ Artificial nails, extenders, and chipped nail polish protect more

microorganisms than hands and can possibly tain the sterile [Link] avoid
it
■ Remove all jewellery.

■ Put on surgical clothes (top and bottom). Surgical clothes must be worn

only in the surgical area

■ Cover shoes as per agency policy. Also, to cover head, caps are used,

surgical masks also as per policy

■ Perform a surgical hand scrub as per agency policy. Surgical hand scrubs

reduce bacterial count on hands before applying sterile gloves.

■ Asepsis denotes absence of disease-causing microorganisms. Aseptic

(sterile) technique is a method used to avert contamination from

infectious agents, and it is used to keep alive a germ-free environment in
the operating room.

Each operating room varies depending on the type of surgery being done:
○ The operating table in the centre of the room should be able to raise,
lower and tilt in any direction.
○ The operating room lamps allow for brilliant illumination without
shadows in the case of surgery.
○ Patient will be linked to different monitors that keep track of vital signs.
These consist of your heart rate and blood pressure.
○ A ventilator or breathing machine stands close to the head of the
operating table . If the procedure is done under general anaesthesia, a
ventilator will breathe for you in the course of the procedure moving
oxygen and air in and out of your lungs.
○ Germ free instruments to be used during surgery
○ A diathermy machine, to control bleeding, usually is present.
○ If the surgery requires it, a heart- lung machine, or other specialized tool,
may be brought into the room.
○ The operating room will likely be cold to reduce bacterial growth.
Zoning the Operation Theatre
The OT suite is a potential source of hospital infection in general and wound
infection in particular. The suite should be planned with the aim of reducing the
risk of hospital infection being brought into the suite.

General principles:
1. Clean from dirty traffic - flow within the OT suite should be kept apart as
best as possible. Spaces in the suite have to be arranged in such a way
that while moving from one space to another, there should be a constant
progression of cleanliness from entrance of OT suite to the operating
room.
2. Staff who are working in the OT department should be able to move from
one clean area to the other without having to pass through unprotected
areas.
3. Soiled materials and waste have to be eliminated from the operating
rooms without passing through clean areas.
4. OT ventilation should be free of the air movement of the rest of the
hospital. Hence, the direction of airflow within the OT suite should be
from cleaner to less clean areas.
5. Therefore, the whole OT suite is designed on the concept of four zones
➢ Protective Zone
➢ Clean Zone
➢ Sterile Zone
➢ Disposal Zone

PROTECTIVE CLEAN ZONE STERILE-ASEPTIC DISPOSAL

ZONE ZONE ZONE
reception pre operating operating room dirty wash up
Waiting area room room
relatives
changing room Recovery room scrub room disposal
corridor
pre anaesthesia plaster room anaesthesia janitor closet
induction room
stores-records Staff room instant instrument
sterilization
autoclave- TSSU aesthetic store instrument trolly area
room
trolly bay x-ray unit-dark
room
auto processor
control area of
electricity

Usual areas of deficiency in OTs

1 ) No reception area.
2 ) No separate rooms for
a. Surgeons
b. Anaesthesiologist
c. Jr. doctor
d. OT attendants
3 ) Not enough number of change rooms for different class of people.
4 ) Inappropriate size & type of doors etc.,
5 ) Lack of laminar flow & mandatory air exchange systems in OT.
6 ) Lack of standard OT protocol.
7 ) No separate Central Sterile Supply Department (CSSD)
8 ) Waiting Area- Recovery
a. Not well equipped
b. Lack of basic facilities

TYPES OF OPERATION THEATRE

[Link] OT
Pre - fabricated Modular OT is a finished steel structure with joint less sterile
coating that provides a high-quality finish. These OTs provide the benefit of a
1. Rapid construction
2. Prevention of contamination build-up
3. Long durability
4. Strong and flexible for future expansion
5. Ease of maintenance
6. Installation & support of equipment
7. Provision of opening needed for the installation without effecting
hardness of structure.
2. Integrated OT
Functionally linking the OT environment. This consists of patient information,
audio, video, surgical lights, room lights, AC and medical equipment.
3. Hybrid OT
A surgical theatre that is equipped with modern medical imaging devices like C
arms, CT scanners, MRI scanners. This allows slightly invasive surgery (less
incision)

Preventive measures against hazards in operation theatre

○ Put on shoes prepared for nurses, with non - slip soles.
○ Handle sharp objects with utmost care., proper waste disposal also
○ Install ground fault circuit interrupters; call a skilled electrician to test
and repair damaged equipment.
○ Put on a radiation dosimeter ( badge or other ) when exposed to radiation;
follow all safety instructions to lessen exposure to a minimum.
○ Install air conditioning with effective general ventilation in the operating
room to lessen heat stress and remove odours, gases, and vapours.
○ Nurses' sensitive to natural rubber latex must use non- latex or powder-
free latex gloves and avert contact with other latex products.
○ Follow established and appropriate infection control precautions
assuming blood, body fluids
○ Wash hands and other exposed skin surfaces after coming into contact
with blood or body fluids
○ Provide lifting aids for the lifting and shift of heavy patients; consult an
occupational safety specialist on the safe handling of heavy patients.
○ Checking for anaesthetic & oxygen gas leakages.
○ Control of fire danger

Emergency Equipment associated duties are:

➢ Cardiac Trolley with defibrillator has to be readily available.
➢ Do all personnel know its location.
➢ Specific duties of each person to be performed in connection with
emergency equipment checking of medicines which are expired and
preventive maintenance of equipment.
Administration must involve standard policies for Protection of patients in
operation theatre
➢ Methods of patient Identification.
➢ Restraining of patients during movement.
➢ Protection of patients on operating table while turning or transferring
➢ Infection prevention protocols
In Recovery Room :
➢ Patient observation to be performed every 15 mints after the surgery
including Vital signs, level of consciousness, bleeding etc
➢ All Equipment should be ready on demand
➢ Restriction of visitors to prevent infection

Responsibilities of an Operating Room Executive Secretary

➢ Operating room executive secretaries keep the department running
smoothly and effectively by greeting and welcoming patients.
➢ Answering questions and clear doubts.
➢ These workers operate office equipment, that includes voicemail and
phone system, machines, copiers and scanners, and also maintain and
organize department supplies
➢ They accept and route messages and transfer correspondence verbally or
through write form.
➢ Additional duties consist of taking specimens to the lab, help in
scheduling procedures supporting the department through updating bed
statuses.
➢ Maintaining cleanliness and orderliness, like cleaning nurses' stations.
➢ Executive secretaries may also be responsible for managing and training
new clerical within the operating room department.