Planning and management of clinical service department

PLANNING AND MANAGEMENT OF CLINICAL SERVICE DEPARTMENT

PRESENTED BYDR.PRIYANKA

DEPARTMENTAL PLANNING AND DESIGN(1) Outermost zone, which is the most community oriented with• · out-patient department• · emergency department• · administration• · admitting office, reception

(2) Second zone, which receives workload from• · diagnostic X-ray• · laboratories• · pharmacy

(3) Middle zone between outer and inner zones• · operating department• · intensive care unit• · delivery

(4) Inner zone, in the interior but with direct access for the public• · wards and nursing units

(5) Service zone, disposed around a service yard ~• · dietary services• · laundry and housekeeping&· storage• · maintenance and engineering• · mortuary·

CASUALTY

CEO

COO

Chief Nursing Officer

CMO

Clinical Assistants

Nurse Manager

Staff Nurse

Unit Clerk

Housekeeping Staff

•ORGANIZATIONAL CHART

Personnel Morning NightCMO 1 on duty

1 on call1 on duty1 on call

General Morning

Evening Night

Nurse Manager 1 - - -Staff Nurse - 2 2 2Ambulance driver - 2 2 2Ambulance attendant - 1 1 1Male Attendant - 2 1 1

Staffing ACTIVITY PERSON INITIATING /ATTENDING THE ACTIVITY PERSON SUPERVISING

Receiving the patient Nurse/ security/House keeping boy

Nurse Manager /CMO

Medico legal case Staff nurses / CMO / Staff Nurse

CMO / Nurse Manager

Death CMO CMO/ConsultantMedical orders Staff nurse/CMO ConsultantCarrying out procedures

Staff nurse /CMO Nurse Manager /Consultant

Urgent diagnostics/blood transfusion

Staff nurse /CMO CMO / Blood Bank officer

Patient brought in dead

Staff nurse/CMO CMO / CNO

Indenting medicines Staff nurses Nurse Manager Requesting for diagnostics

CMO Consultant/CMO

Transfer out of patient

Staff Nurse / CMO CMO / Consultant / Nurse Manager

Daily inventory Staff nurses Nurse ManagerNurses records Staff nurses Nurse Manager Equipment management

Staff nurses / Nurse Manager

Infection control in ward / Procedure Room

Staff nurses Nurse Manager / HICC

Waste disposal Staff nurses/Housekeeping staff

Nurse Manager /Supervisor

Medical Records CMO/consultant CMO / CNO / MRDComplaints Staff nurses Nurse Manager / CNO /

PRO CMO duty schedule -in-ChargeAmbulance driver – duty schedule

Manager Admn Manager Admn

House keeping staff Supervisor house keeping Supervisor house keeping

Responsibility Matrix

•RECORDS AND REGISTERS MAINTAINED IN THE DEPARTMENTCasualty RegisterLaboratory Specimen Dispatch RegisterDaily Inventory RegisterAssignment Register Communication RegisterMedical Record Dispatch RegisterMorgue RegisterMLC Forms/RegisterDeath Certificate

CEO

MANAGER MEDICAL SERVICES

DIRECTOR NURSING

DIRECTOR PROFESSIONAL

SERVICES

HOD - PATHOLOGY

TECHNICIAN (Blood Sample

Collection)

CONSULTANTSEXECUTIVE NURSE

TECHNICIANSATTENDANTSSTAFF NURSES

FRONT OFFICESTAFF IN OPD

OPD•ORGANOGRAM

– Staffing • Customer Relations Staff:

PRO, Reception and Enquiry, Registration and Appointments

• Billing Counter, waiting lobby.

• Nursing Staff : Procedure Room Staff Nurse

• Housekeeping Staff: Attendants to maintain cleanliness and to assist in transporting patients to emergency, screening or diagnostics.

– Working Hours• The OPD should be open 12

hours every day from 8 a.m The basic requirements of an

outpatient

• · reception and waiting areas,• · consultation rooms,• · examination rooms,• · treatment rooms, and• · staff and supply areas. to 8 p.m.

ENTRANCE (arrival of patient)

ENQUIRY (received / registered)

Time confirmed to patient

Referred to billing

Referred to concerned ConsultantIf investigation required by Consultant

Patient to be referred to billing

Patient goes for collection of sample

Patient comes for collection of report the next day

If investigation is not required by Consultant

Follow up is explained to the patient

Patient leaves the hospital

Patient taking prior appointment

•PATIENT FLOW CHART

• OUT PATIENT OPERATIONS:- 1)OPD Registration 2)Consultation 3)Admissions or Diagnostic 4)Pharmacy

• OPD DEPARTMENTS :- 1) Pediatric OPD 2)Antenatal Clinic/ Gynaecology 3) Dental Clinic 4) Ear Nose & Throat

5)Ortho 6)Medicine• INVENTORY MANAGEMENT:- The OPD will maintain the following Inventory Records.

1)Equipment and Instruments2)Linen3)Emergency trolley4)Stationery5)Hand wash

6)Dustbins7)Gloves 8)stethoscope9)Hand Towel10)BP apparatus.

• RECORDS AND REGISTERS MAINTAINED:-• 1) Communication Register • 2)Laundry Register • 3)Inventory Register• 4)Immunization Register• 5)Consultant Performance Record• 6)CSSD Book• 7)Ante Natal Record• 8)Equipment Register• 9)Vaccine Stock Register

IN PATIENT DEPARTMENTCEO

Consultants Chief Nursing Officer

RMO

Team Leader

Staff Nurse

Nurse Manager

COO

Health Care Asst. Unit Clerk

Hospital Attendants

•ORGANIZATIONAL CHART

– Staffing (Per Shift) • R.M.O. - 2 • Nurse Manager 2 (Morning

& Evening One Each)

• Team Leader - 2 (Morning & Evening One

Each)• Staff nurses -1 : 6 patients • Health Care Assistants - 2• Female attendant -3• Male attendant -3

– Shifts• R.M.O.s will be on 8 hour shifts. They

will hand over at 7 am, 2 pm and at 9 p.m.

• Team Leaders will be on 8 hours shift .They will hand Over & Take Over at 7 am & 2 pm. They will be on duty from 7 am to 3 pm, 2 pm to 10 pm.

• Staff Nurses will be on 8 hour shifts. They will hand over and take over at 7 am, 2 p.m. and 9 p.m.

• The Nurse Manager will be on duty from 7 am to 3 p.m.,2 pm to 10pm.

• The Nurse Manager will be on duty from 9 pm to 7 am & 2 pm to 10 pm when deputed by Chief Nursing officer as Shift Coordinator

•

ACTIVITY PERSON INITIATING PERSON SUPERVISING

Admission procedures Doctor/Nurse/Front OfficeUnit Clerk

Nurse Manager, Consultant, Executive Front Office

Diagnosis RMO / Consultant Consultant

Treatment/ Medication RMO/Consultant Consultant/Nurse Manager

Tests RMO/Consultant Nurse Manager/ Consultant

Records Staff nurse/RMO Nurse Manager/ Consultant

Transfers Staff nurse/RMO Nurse Manager/ Consultant

Discharge Staff nurse/RMO Nurse Manager/ Consultant, Executive Front Office

Follow-up Nurse Manager Consultant, Chief Nursing Officer

Ward Protocol Nurse Manager Chief Nursing Officer/Shift Coordinator

Nursing ProceduresWaste Management

Staff Nurse /RMO/Health Care Assistant

Nurse Manager/Educator/Shift CoordinatorNurse Manager/Facility Manager

Infection Control Staff Nurse/RMO/Consultants Nurse Manager/Chief Nursing Officer Infection Control Nurse Facility Manager/Chairman Infection Control Committee

IPD OPERATIONSAdmission of the Patient in the Ward:-1)Planned 2)Emergency

– registration– Allotment of room and bed– Deposits– Allotment of visitor’s pass– Schedule Of Planned Procedure/Surgery/Investigations

• Transfer In of Patient Within Hospital• Transfer Out Within the Hospital• Patient Transfer to Operation Theatre/Procedure Room• Consultant / R.M.O. ‘s Rounds

NURSING MANAGEMENT OF PATIENTS IN THE WARD• Handing Over Process • Requisition for Emergency Investigations • Collection of Reports • INDENTING FROM CSSD• MAINTENANCE OF EQUIPMENT• BILLING• VISITORS POLICY• DISCHARGE OF THE PATIENT• DEATH • MEDICO-LEGAL ASPECT OF PATIENT MANAGEMENT

DIAGNOSTIC SERVICES

INVESTIGATIONS

SEROLOGICALRADIOLOGICAL

Radiology

SL. NO.

EQUIPMENT MAKE/MODEL

1 COMPUTERIZED RADIOLOGY

CR 35 / DRYSTAR 5503

2 200 MA HF X-RAY UNIT MULTIPHOS3 100 MA PORTABLE X-RAY

UNITX-RAY MULTIMOBILE 2.5

4 SONOGRAPHY VOLUSON PRO 730 GE

LOGIQ E (PORTABLE) GE

5 MAMMOGRAPHY MAMMOMAT 3000 NOVA(SIEMENS)

IMAGING SERVICES

CEO

COO

CONSULTANT

FRONT OFFICE ASSISTANT

HOD

SR TECHNICIAN

TECHNICIAN

STAFF NURSE

ASSISTANTS

•ORGANIZATIONAL CHART

RADIOLOGYFunctioning• Enquiry• Appointment Scheduling• Registration• Payments• IMAGING REPORTS• Dispatch of Reports • QUALITY ASSURANCE PROGRAMME

FOR IMAGING SERVICES (VERIFICATION / VALIDATION / MONITORING / CALIBRATION)

RECORDS AND REGISTERS MAINTAINED IN THE DEPARTMENT

• Appointment Booking Register• X – Ray Register• CT scan Register• Sonagraphy Register• Mammography Register• Inventory Register for X- Ray Film• Inventory register for contrast• Inventory Register for Materials• Inventory Register For Linen• Inventory Register For medicine • Inventory Register For CSSD• Dispatch Register• Request for Follicular Study• Form F - Form for Maintenance of Record with

respect to Pregnant Woman by Genetic Clinic / Ultrasound / Imaging Centre (Radiology)

LABORATORY

CEO

DIRECTOR PATHOLOGY

Histopathologist/consultant

QUALITY CONTROL MANAGER

TECHNICAL SUPERVISIOR

SENIOR TECHNICIANS

JUNIOR TECHNICIANS PATHOLOGY STAFF/FRONT OFFICE

STAFF

HOUSEKEEPING

Responsibilities and Authorities• Selection, approval and commencement of test

methods.• Designing and implementation of internal and external

Q.C.program. • Ensure the smooth running of the department .• Ensure that all equipments are operational • Supervise the staff • Provide Continuous Medical Education• Evaluate competency of Staff at regular intervals.• To ensure confidentiality • Address any complaints, requests or suggestions from

patients / Staff / Doctors.• Ensure good staff morale.• Review MIS.• Manage the overall efficient and effective

administration of the laboratory including approval of the indents/purchase requisitions for the material raised by the Lab Technical Supervisor.

• Define, implement and monitor standards of performance and quality improvement of the medical laboratory services.

• Review the laboratory policies regularly • Work towards lab improvement in terms of processes,

systems & workload.• Review any new examination procedures which are

developed in-house.

Quality Manager• Overall control of quality and advising and

monitoring all aspects of quality in the laboratory.

• Check all the quality control, record keeping of daily and planned maintenance, and calibration of equipment.

• Ensure the staff follows all SOPs• Planning and organizing audits and

reviews.• Ensuring that the details of the reviews

are recorded.• Give a feedback to the Director Pathology

about the staff performance.• Prepare and maintain a schedule for

continuous training programme for the lab staff.

• Maintain & correlate record of quality indicators of the lab.

• Review operational procedures with the Laboratory Director, once in 6 months.

•

MANAGEMENT SYSTEM IN PATHOLOGY

• The management system of Path-lab is based on the policies and the procedures that are documented and are for complying to the requirements of ISO-15189.

• The entire documentation of the laboratory is in the form of Quality Manual,Procedures,Work instructions, forms and formats,charts,check list ,safety &Regulatory Norms etc.

DOCUMENT STRUCTURE ↓ QUALITY MANUAL ↓ PROCEDURE MANUAL ↓ WORK INSTRUCTIONS ↓ CHARTS ,REPORTS,FORMS ,RECORDS

OPERATION THEATRE

CEO

COO

CHIEF NURSING OFFICER

ASSISTANT ANAESTHESIOLOGIST

CHIEF ANAESTHESIOLOGIST

NURSEMANAGER

HOUSE KEEPING STAFF

O T ATTENDANT

STAFF NURSE

O T ASSISTANT

ANAESTHESIA TECHNICIAN

TEAM LEADER

•ORGANIZATIONAL CHART

– StaffingThe Operation Theatre will have the following Staff :• Anaesthesiologist• Asst Anaesthesiologist• Nurse Manager• Team Leader• Staff Nurses• Anaesthesia Technician• OT Attendant• OT Assistant• House keeping staff :• Male• Female

PROCESSES:- • OT Booking• OT Timings• Preparation of OT List• Cancellation of Surgery• Implants

ACTIVITY PERSON

INITIATINGPERSON

SUPERVISINGOT booking Staff Nurses /

AssistantNurse Manager

Handing and taking over Staff Nurses Nurse ManagerEquipment management Staff Nurses /

Anaesthesiologist / Attendant

Nurse Manager

Information to Consultant Nurse Manager ConsultantRequesting for diagnostics / sending samples for histopathology

Staff Nurses Nurse Manager

Key handling. Staff Nurses Nurse ManagerMedical orders RMO ConsultantNurses records Staff Nurses Nurse Managerstores Staff Nurses Nurse ManagerOT Anaesthesia stores Anaesthesia

TechnicianDaily inventory Staff Nurses Nurse ManagerNursing procedures Staff Nurses Nurse ManagerInfection control in OT Staff Nurses Nurse ManagerWaste disposal Staff Nurses /

Housekeeping StaffNurse Manager

Death RMO/Consultant Manager Admin/CNO

Complaints Staff Nurses Nurse Manager / CNO

Indenting CSSD Linen,Consumables.

Staff Nurses Nurse Manager

Responsibility Matrix

DAILY TASKS• Getting the Trolleys Ready• Entry of Patient into OT• On the O.T. Table • Recovery and Transfer to Ward• Disposal of waste• Daily Cleaning - Prior to Commencement of

Surgery • Cleaning in Between Cases• Cleaning at the Close of Day• Weekly Cleaning: to be Done on Sundays • Fumigation of O.T.• HISTOPATHOLOGY SAMPLES AND SPECIMENS• BillingsRequirements:- O.T. Tables

– Boyle’s Apparatus – Trolleys – C-ARM– Microscope and other

accessories used in O.T.– Cauterizing machines – X-ray viewing Box– Suction Apparatus – Linen

•

RECORDS AND REGISTERS MAINTAINED IN THE DEPARTMENT

• Narcotic Register• Pathology Register• Daily Inventory Register• OT Consumables Charge Sheet • Communication Register• Booking Register(Hard copy and soft copy)• Operation Register• Fumigation Register• OT Daily Maintenance Register• OT Complaint Register• OT Implant Register - Ortho• OT Implant - Ophthalmic Register• Charge Sheet OT• Operation Record• Pre-Operative Anaesthesia Chart• OT Consumables Charge Sheet Ortho• Labour Anaelgesia Chart• OT Handing Over & Taking Over Patient’s

Register

INTENCIVE CARE UNIT

COO

CHIEF INTENSIVIST

CLINICAL ASSISTANT NURSE MANAGER

TEAM LEADER

STAFF NURSE

HOSPITAL ATTENDANTS, HOUSEKEEPING STAFF

CHIEF NURSING OFFICER

HEALTHCARE ASSISTANT UNIT CLERK

CEO

Sr. No. Activity Person Initiating Person Supervising1 Admission procedures Doctor/Nurse/Front Office Executive Front Office2 Admission of patient Staff nurses Nurse Manager / Chief Intensivist3 Handing and taking over Staff nurses/Registrar Chief Intensivist / Nurse Manager4 Information to Consultant Registrar Chief Intensivist / Nurse Manager 5 Medical orders Registrar/ Chief Intensivist Chief Intensivist / Consultant6 Carrying out procedures Registrar/staff Nurse

Consultant IntensivistChief Intensivist/Consultant/Executive

7 Indenting medicines Staff nurses Nurse Manager 8 Requesting for diagnostics Staff nurses Chief Intensivist /Consultant/9 Transfer in/out of patient Registrar/staff nurse

Consultant IntensivistChief Intensivist/Consultant/Executive

10 Daily inventory Staff nurses Nurse Manager11 Nurses records Staff nurses Nurse Manager12 Equipment management Staff nurses Nurse Manager / Biomedical Engineer13 Stock Staff nurses Nurse Manager14 Nursing procedures Staff nurses Nurse Manager15 Infection control Staff nurses Nurse Manager16 Waste disposal Staff Nurses/Housekeeping

staffNurse Manager

17 Medical Records RMO/consultant/unit Nurse Manager /Chief Intensivist18 Accidents & MLC RMO/consultant/clerk unit Nurse Manager /Chief Intensivist19 Death RMO/consultant/clerk unit Nurse Manager /Chief Intensivist

2520 Complaints Staff nurses Nurse Manager /Chief Intensivist/CNO

Responsibility Matrix

TRANSFER FROM

O. T.

TRANSFER FROM CATH LAB

TRANSFER FROM WARD / CASUALTY/OPD

Admission of patient in ICU

CRITICAL CARE MANAGEMENT

RECOVERED EXPIRED

TRANSFER TO WARDFORMALITIES FOR POST LIFE CARE

DIALYSIS UNIT• ADMISSION OF A PATIENT• STANDING ORDERS IN THE UNIT• INSTRUCTIONS TO THE PATIENT• TRAININGRECORDS AND REGISTERS MAINTAINED IN

THE DEPARTMENT• Admission Register• Procedure Register• Communication Register• Daily Inventory Register (only for Dialysis

department)• Hemodialysis Record• Dialysis Flow Chart• Consent Form (Consent for Vein

Catheterization & Hemodialysis)• Investigation Chart for Renal Dialysis

CEO

TECHNICIAN

STAFF NURSE

HOUSE KEEPING

COO

CHIEF OF NEPHROLOGY

AKD MANAGER

PHYSIOTHERAPY CEO

COO

PHYSIOTHERAPIST

TRAINEE PHYSIOTHERAPISTS

SPECIALITY CONSULTANTS

PHYSIOTHERAPIST

HOUSEKEEPING

PSYCHIATRIST CONCERNED CONSULTANTS

Sr.No.

Key Personnel Responsibility Authority

1 Physiotherapist Consultation, assessment & treatment of patient.

Supervise & maintain facilities available in Physiotherapy / rehabilitative services Department

2 Trainee Physiotherapist

Assisting consultant physiotherapist

Handling equipments

3 House Keeping Staff

Maintaining cleanliness of the department.

Taking care of equipments.

Wheeling patients to the department.

NIL

Responsibility Matrix

Functional and space requirements in outpatient department

Registration OPD ReceptionEnquiryWaiting

Admin OPD Waiting

CLINICS

X-ray LAB INVESTIGATION

OUT

Wards Inj & Dressing Pharmacy

People Involved

• In general, the people involved in this process are:• · Health planners, functional planners, financial

planners and physical planners.• · Architects• · Engineers (such as civil, mechanical and sanitary)• · Quantity surveyors• · Finance managers• · Staff responsible for procurement of supplies• · Staff members such as doctors/nurses, clients/end

users

THANK YOU