final report (1)

Department of Industrial and Systems Engineering

ISYE 605: Healthcare Systems Engineering

Dr. Shi-Jie (Gary) Chen

Course Project I

Obstetrics and Gynecology Department Process Map

October 7, 2015

TEAM MEMBERS:

Hari Ram Varma Datla Z1779926 Nivedha Priyadarsini Punithavathy Vijayakumar Z1783833Prahasith Reddy Gaddam Z1782155Revanth Addagudi Z1783651Salman Khan Z1783095Santhosh Reddy Budda Z1784028

CONTENTS

1. Introduction

1.1 Key terms and definitions

1.2 Key players

1.3 Working of OB/GYN unit

2. Process map for Patient Flow

2.1 Patient Flow in the department of gynecology

2.1.1 In-patient unit

2.1.2 Out-patient unit

2.2 Department of obstetrics

3. Medication flow

3.1 Flow process for medicine

4. Information Flow

5. Work Flow

5.1 Physician

5.2 Nurse

5.3 Lab Technician

5.4 Surgeon

5.5 Anesthesiologist

5.6. Pharmacist

References

Team Work

1. Introduction:

From birth to death, human beings are part of healthcare system. Time is always a valuable

asset for patients in seeking treatment in any healthcare system. The medical and paramedical

staffs have to be quick in giving treatment in emergency situation. The diagnosis and

treatment should be fast because the patients wish to leave hospital as early as possible with

good treatment and also minimum expenditure. The obstetrics and gynecology department,

among other departments in a hospital also deals with the problem of increasing the

efficiency of the department and patient satisfaction.

Obstetrics and Gynecology are two different terminologies in a medical field. The department

of obstetrics deals with pregnancy, childbirth and postpartum period of a patient. The

department of gynecology deals with the health of female reproductive system including

diagnosis, disorders and treatment. This includes preventative care, prenatal care, detection of

sexually transmitted diseases, family planning etc.

1.1 Key terms and definitions:

Ob Obstetrics

Gyn Gynecology

EMR Electronic Medical Record

MIR Medication Information Record

IVR Interactive Voice Response

1.2 Key players:

The department of obstetrics and gynecology is one of the big department in a hospital which

also requires support from other departments such as ICU, radiology, medical and surgery,

internal medicine etc,. The key players in the department include physicians, surgeons and

anesthesiologist, nurses, lab technicians, pediatrician and pharmacist. They all help in

diagnosing and analysing patient's health.

The physician in the department of Ob/Gyn studies, diagnoses treats diseases and is also

present during child birth. A physician does not perform surgery. A physician is primarily

concerned with promoting, maintaining and restoring human health.

Surgical staff and anaesthesiologist play very important role during C-section and other

procedures like laser surgery, diagnostic laparoscopy and operative laparoscopy.

Nurses play crucial part in the department of ob/gyn. They are responsible for all the work

which is not done by the doctor in the department of ob/gyn. They also play a major role in

patient safety, patient care and patient satisfaction.

Lab technicians are responsible for the compilation of lab reports of the patient from the

information collected through blood test, urine test, pressure test etc.

Pediatrician in an ob/gyn unit takes care of the new born child for the first few days and

checks for any abnormalities in the newborn.

1.3 Working of OB/GYN unit:

Figure 1.1 Working of Ob/Gyn unit

The department of obstetrics and gynecology is a very busy unit in a hospital when compared

with other departments because the patient arrival is at random time. The doctors and nurses

have to prepare at all times and also at least one operation theatre should always be available.

The Ob/Gyn staffs take 24-hour shifts. When the shift of an Ob/Gyn staff is over, he/she

gives the update to the next staff that is going take care of the same patient. Usually the

department of Ob/Gyn have multidisciplinary integrated care model, so patients can easily

access other specialities too. Figure 1.1 shows how the department of Ob/Gyn works.

2. Process map for Patient Flow:

Patient flow should be monitored in any department of the hospital in order to increase

patient safety, throughput, improve staff satisfaction, patient satisfaction and to reduce

expenses. The process map for the patient flow in the department of ob/gyn is shown in

Figure 1.The patients who visit the Ob/Gyn department already have an appointment set from

the previous visit. But when a patient visits for the first time, the patient needs to register in

the new patient registration desk in order to fix an appointment with the doctor. The patient

will be given an ID card in which the complete patient history can be saved and monitored

during further visits.

When an appointment is fixed the patient undergoes several tests like blood test, urine test,

weight and height measurement. After the lab test, the patient is guided to consult the doctor

again to confirm the pregnancy result. If the patient is pregnant, the patient is then taken care

by the department of obstetrics. If the patient is not pregnant then the patient is continued in

the department of gynecology itself. When the lab results show that the patient is not pregnant

and that the patient may have some other problem, then the patient is treated in the department

of gynecology.

When the patient revisits the hospital with an appointment, then the nurse checks the patient

history and asks the patient for the purpose of visit. If the purpose of visit was a follow up

visit, then the nurse directs the patient to the department of obstetrics else the patient is

directed to the department of gynecology.

In case of emergency, the paramedics give first aid to the patient and also give instruction to

the nurse whether the patient should go to department of obstetrics or gynecology.

Patient Arrival

First Visit?

Triage checks for

the problemNo

Registration Counter

Yes

Fix appointment

Patient consults the doctor

Lab tests

Other Problems Pregnant?

Emergency

Paramedics give instruction to nurse whether the patient

should be taken to obstetrics or gynecology department

No

Yes


2 3

4 5

4 - Patient is directed to department of obstetrics5 - Patient is directed to department of gynecology

Figure 1. Process map for patient flow in the department of Ob /Gyn

2.1 Patient flow in the department of gynecology:

The department of gynecology not only deals with the pregnancy of the patient, it also deals

with the treatment of the reproductive system. The patient flow in the department of

gynecology is shown in Figure 2.

When a patient is directed to department of gynecology, the patient is tested for further

problems to identify the particular problem. If the results show that the patient does not have

any problem, then the patient leaves the hospital after paying the consulting charges in the

payment counter. If the patient encounters further problems then the patient is either admitted

in the hospital (In-patient unit) or treated with medication and asked to come for follow-up

visits.

2.1.1. In-patient unit:

In the in-patient unit, the patient is consulted by the doctor and then the doctor decides

whether surgery is required for the patient according to the complication of the problem.

When the complication is higher, doctors suggest for surgeries. During surgeries, the surgeons

give instructions to the nurse regarding the pre-operative and post-operative care of the

patient. Once the surgery is successful, the patient is asked to come for follow-up visit in

order to make sure that the surgery was a success and the patient is in good condition. If the

patient does not need surgery then the patient is treated with the help of medicines. Here is

where the internal medicines play a major role. These medicines should be given to the

patient in the right amount at the right time. So it is mostly done by the nurses.

2.1.2 Out-patient unit:

In the out-patient unit, the patients are asked to come to the hospital for treatment. They are

not admitted in the hospital. In the out-patient unit, every time when the patient comes for

visit, lab tests are done and then the doctor consults the patient and gives treatment and

medication. The patient flow in an out-patient unit is more when compared to the patient flow

in the in-patient unit.

General Problems

Check for any other problems ANo

Out-Patient

Yes

In-Patient

Yes

Further lab tests are done


Treatment and medication is given

Payment Counter

Pharmacy

Pharmacy Counter

Check whether

surgery is required?

Treatment and

medication is given

No

A

Surgery is performed

Yes

Post-operative

care is given

Patient is given instruction for follow up visit

A

2

Patient leaves the hospital

4

A

Figure 2. Process map for patient flow in the department of gynecology

2.2 Department of Obstetrics:

The department of obstetrics deals with the pregnancy, childbirth and the postpartum period,

chiefly at risk situations requiring surgical interventions. The process map for the patient flow

in the department of obstetrics is shown in Figure 3.

Once the patient arrives in the department of obstetrics, the doctor consults the patient and if

the patient is pregnant, then the doctor gives instructions for follow-up visit. If the patient's

due date for delivery is on the day of the patient visit, then the doctor gives instruction to the

nurse to admit the patient. The c-section is performed only when the normal delivery is risky.

The c-section is also done when the patient is expecting twins or if there is any complication

during the middle of normal delivery. After the child is born, the post-operative care is take

care by the nurse and the child is monitored for first few days by pediatrician. If the health of

both mother and baby is good, then they are discharged from the hospital.

Obstetrics

Doctor consults the patient

Doctor gives instruction for follow up visit

Patient is admitted for delivery (Due date is already given)

Payment Counter

Pharmacy

Pharmacy Counter

Patient leaves the hospital

Normal or C-section

Surgery is performed

C-section

B

4

Child birthNormal

Post operative Care

3

B

Figure 3. Process map for patient flow in the department of obstetrics

3. Medication Flow:

The major task for a hospital management is to ensure patient safety and reducing

preventable medical errors, if not completely eliminating them, is an important initiative in

any healthcare industry. More so in OB/GYN department since any minor mishap would lead

to fatal consequences.

The flow process of medication varies from hospital to hospital, however ensuring 5R’s

namely, right dose of right medicine to right person at right time through right

route/procedure. Whenever a new medication is prescribed for a patient, it sets in motion a

complex series of interrelated supply chain and a workflow process aimed at providing the

patient this medication as quickly, efficiently, accurately and cost-effectively as possible.

The physician prescribes medicine for the patient electronically, the prescription is sent to the

pharmacy store directly by the physician. And before these medications can be dispensed,

pharmacists are required by regulations and professional standards to review medication

orders for patients while also assuring the medications are secure and available for the nurse

when needed.

Medication errors can happen anywhere, including own home and in doctors' offices,

hospitals, pharmacies and senior living facilities. The most common causes of medication

errors are classified into three types. They are,

Poor communication between health care providers

Poor communication between providers and their patients

Sound-alike medication names and medical abbreviations

Common Causes of Medication Errors are

Ambiguous strength designation on labels or in packaging

Drug product nomenclature (look-alike or sound-alike names, use of lettered or

numbered prefixes and suffixes in drug names)

Equipment failure or malfunction

Illegible handwriting

Improper transcription

Inaccurate dosage calculation

Inadequately trained personnel

Inappropriate abbreviations used in prescribing

Labelling errors

Excessive workload

Lapses in individual performance

Medication unavailable

According to ASHP Guidelines on Preventing Medication Errors in Hospitals (2014), the

different types of medication errors are:

Prescribing error - Incorrect drug selection (based on indications, contraindications,

known allergies, existing drug therapy, and other factors), dose, dosage form,

quantity, route, concentration, rate of administration, or instructions for use of a drug

product ordered or authorized by physician (or other legitimate prescriber); illegible

prescriptions or medication orders that lead to errors that reach the patient.

Omission error - The failure to administer an ordered dose to a patient before the

next scheduled dose, if any

Wrong time error - Administration of medication outside a predefined time interval

from its scheduled administration time (this interval should be established by each

individual health care facility)

Unauthorized drug error - Administration to the patient of medication not

authorized by a legitimate prescriber for the patient

Improper dose error - Administration to the patient of a dose that is greater than or

less than the amount ordered by the prescriber or administration of duplicate doses to

the patient, i.e., one or more dosage units in addition to those that were ordered

Wrong dosage-form error - Administration to the patient of a drug product in a

different dosage form than ordered by the prescriber

Wrong drug-preparation error - Drug product incorrectly formulated or

manipulated before administration

Wrong administration-technique error - Inappropriate procedure or improper

technique in the administration of a drug

Deteriorated drug error - Administration of a drug that has expired or for which the

physical or chemical dosage-form integrity has been compromised

Monitoring error - Failure to review a prescribed regimen for appropriateness and

detection of problems, or failure to use appropriate clinical or laboratory data for

adequate assessment of patient response to prescribed therapy

Compliance error - Inappropriate patient behavior regarding adherence to a

prescribed medication regimen

Other medication error - Any medication error that does not fall into one of above

predefined categories

These entire medication errors can have various effects on the patients and sometimes can

even be fatal.

3.1. Flow Process for Medicine:

With proper medication flow, the delay in a patient receiving medication can be reduced,

human error while reading a prescription is significantly reduced due to computerized

prescription. Clear understanding of a drug name while looking through it at a storage

location is increased with an integrated computerized environment.

The physician prescribes the medicine electronically. It is then sent to pharmacy directly.

Pharmacist reviews order and enters into pharmacy system. The order that is received by the

pharmacy is made ready to dispatch. Nurse clarifies the medicine with the prescribed one. If

the nurse finds any incorrectness in the medicine then the medicine is again sent to pharmacy

for replacement. After confirming the right medicine is obtained, it is then sent to patient.

Nurse updates every time when she uses the medicine in the patient wristband. The type of

medicine, time and dose of medicine is saved in patient’s data base.

Figure 3.1. Process map for medication flow

4. Information Flow:Figure 4.1 explains the flow of information from the patient arrival till departure from the

hospital. The flow starts with checking the registration status of the patient in the hospital if

registered and the patient medical history is updated then the patient is forward to pre-

treatment with all the medical history. In the pre-treatment the patient is given an EMR and

the required lab tests are recorded in EMR. Later the lab report updates and the appointment is

booked to consult the physician, in case of emergency the appointment is auto booked by IVR

system and the patient consults the doctor and the doctor updates the prescription and

diagnosis report in the EMR. If a surgery is required the triages confirms with the required

support staff which includes surgeon, anaesthesiologist, nurses, etc. There would be

paperwork undergoing before the surgery and then the surgeon updates the EMR with the

surgery details. After the surgery proper medication and observations information is collected

in EMR which updates the medical history of the patient. Then the patient will hand out the

discharge paperwork and goes to the pharmacy and here his pharmaceutical records gets

updated. The patient goes down to pay his bills and leaves the hospital.

Figure 4.1.Process map for Information flow

5. Work Flow:

Work flow department plays a vital role in the whole medication process of individual. Work flow department mainly deals with a specific software designed to increase the efficiency of a health care system.The workflow mainly consists of patients, caregivers, staff, equipment and supplies.

5.1. Physician:

A physician is a general doctor who starts the initial medical record check for the patients. He is the one who will ask the patient and takes his information from the nurse and cross checks it with the lab tests and analyses the problem. He then diagnosis the patient and suggests him further if any checkups are required. The physician updates the medical record with the health issue and diagnosis received by the patient in his EMR. He even suggests the surgeon about patient’s medical record during the surgery.

Figure 5.1. Process map for work flow of physician

5.2. Nurse:

The nurse play a significant role in work flow department. The nurse provides the right dose of the right medication to the right person at the

right time with the right procedure. The patient is guided along the medical process by a NURSE. IF the doctors are so

called operating dots, nurses are the connecting dots in a surgical process .They are the helping hand behind the doctors, pharmacists, aestheticians.

They provide their guidance in the health maintenance and disease prevention of patient.

Look after the inventory on regular, monthly basis thereby maintaining the inventory level and place orders if the demand increases.

The patients are guided by the nurse to a required physician, if the patient needs certain lab test the patient records are intern carried my caretakers to lab test and the result is again carried back to the physicians to convey results to patient.

The patients needing advanced care like surgeries, then they are consulted to surgical staff

The reports of patients are maintained, medical histories and monitor the conditions of the patients accordingly

They educate families if it’s a rare disease the patient is suffering. Post-surgical process: nurses give their services like preparing the patient, moving the

patient to the surgery room. During the surgical process nurses play a key role in assisting the doctors,

aestheticians, surgeons. Past surgical process: The nurses monitor patient and accordingly give the records to

the concerned doctor and the pharmacists .The pharmacists intern give required medication to the patient.

Figure 5.2. Process map for work flow of nurse

5.3. Lab Technician:

Lab technician is a person who performs certain tests prescribed by the doctor. Initially a patient is brought to the lab then the lab technician checks the EMR of the patient. Then performs tests and collects the samples of the patient and then updates the EMR of the patient. Later the results are again updated and reported to the physician.

Figure 5.3. Process map for work flow of lab technician

5.4. Surgeon:

The surgeons are basically doctors that are trained to provide surgical, diagnostic, preventive care in addition they act as researcher, supplier and surgical equipment supply or surgical representive and much more. They the key players in the obstetrics and gynaecology department in a medical process. They work as part of medical team that has both surgical nurses and assistant, as well as anaesthesiologist. Surgeons have many types, general surgeons, pediatric surgeons, critical care surgeons, neurologic surgeons, obstetrics and gynaecological surgeons, eye surgeons, orthopaedic surgeons, plastic surgeons include the list.

Obstetrics and gynaecological surgeons are the one who specialize in women’s health are our main objective

Surgeon has many duties they could be divided into three major types Educating patients and counselling patients about the type of medication patients have

to take, preventive measures one has to take. They perform first hand duties in a surgery Diagnosing and treating patients depending about the illness and injuries Perform minor as well as major surgeries like laser procedures Although many physicians specialize in either gynaecology or obstetrics many work

as an obstetrician or gynaecologist. Conduct daily hospital rounds Order appropriate laboratory and radiographic tests Formulate and implement treatment plant for patients and therapeutics plans for

special hospitalized patients

5.5 Anesthesiologist:

Anesthesiologists have the primary responsibility for monitoring the patient's vital signs during surgery. In addition to basic measurements, such as pulse, blood pressure and temperature, anaesthesiologists also measure the patient's respiration. If the patient is under a general anaesthetic, the anaesthesiologist measures the volume the patient inhales and the carbon dioxide level exhaled.

During surgery, patients typically receive intravenous fluids to help control dehydration and to allow the administration of medications through the drip.

Figure 5.5. Process map for the work flow of anaesthesiologist

5.6. Pharmacist:

Pharmacist is a person who maintains all kinds of medicines and needles in a hospital. Pharmacist gets EMR from a physician. He checks for the required medication form the EMR. If there is no required medication is available then he orders’ the medicines and notifies the patient about the lack of medication. If there is availability of medicines then pack the medicines according to the EMR, then updates the records of the medicines and patient then generates receipt and delivers the medicines.

Figure 5.6. Process map for the work flow of pharmacist

ReferencesArmony, M., Israelit, S., Mandelbaum, A., Marmor, Y. N., Tseytlin, Y., & Galit, Y.-T. B.

(2013, March). On Patient Flow In Hospitals: A Data-Based Queueing-Science Perspective.

Bowdler, N. C., & Elson, M. (2008, July). The Gynecologic History and Examination. Retrieved from Glowm: http://www.glowm.com/section_view/heading/TheGynecologicHistoryandExamination/item/3

Hall, R., Belson, D., Murali, P., & Dessouky, M. (2005). Modeling Patient Flows Through The Healthcare System. California .

Najmuddin, A. F., Ibrahim, I. M., & S., I. R. (2003). Simulation Modeling and Analysis of Multiphase Patient Flow in Obstetrics and Gynecology Department (O&G Department) in Specialist Center. Latest Trends on Applied Mathematics, Simulation, Modelling, 125-130.

Prep, V. (2012, May 29). Follow a Day in the Life of an OB-GYN. Retrieved from U.S. News & World Report Education: http://www.usnews.com/education/blogs/medical-school-admissions-doctor/2012/05/29/follow-a-day-in-the-life-of-an-ob-gyn

R, D., & HTO, D. (1994). Modelling Patient Flows and Resource Provision in Health Systems. Omega International Journal for Management Science, 22(2), 123-131.

Sarani, B., Toevs, C., Mayglothling, J., & Kaplan, L. J. (2015, January). The Burden of the U.S. Crisis in the Surgical Critical Care Workforce and Workflow. The Americian Surgeon, 81.

Team Work:

Revanth Salman Hari Prahasith Nivedha Santhosh

Medication Flow

Work Flow Information Flow

Work Flow Patient Flow Patient Flow

References and proof reading

PPT design & Preparation

Contents Data gathering from web

Data gatheringfrom books

Data gatheringjournals

Flow chart preparation






Consulted Doctor

Team Meeting arrangement

PPT design & preparation





Report preparation

Report preparation

Report preparation

Report preparation

Report preparation

Report preparation

Data gathering journals

Data gathering and proof reading

Process mapping

Process mapping

Process mapping

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