BLOCK INTRODUCTION

In thc first block of tliis course you will learn about four important clinical service areas of
a hospital viz. Out Paticnt Department (OPD), Accident and Emergency Scrvices
Department, Operrition 'rheawe and btensivc Care Unit (ICU).

This Block contains four units.

Unit 1 deals with Outpatient Services. In this unit you will learn about thc planning,
organii-ation and management of Out Patient Department (OPD) of a Hospital.

Unit 2 deals with Accident and Emergency Scrvices. In this unit you will lean1 about
various adrninistrativc aspects of this deparlrncnt including plarming consideration,
equipment requirements, staffing, and policies and procedures governing tlus department.

Unit 3 deids with another iul~portantscrvice area of the llospital i.e. Operation Theatre. You
will learn about pla~ming,orgmizatian and ~nanagelnentof an Operation Thealre including
the concept of zoning.

Unit 4 deals with another v~talarea of a hospital 1.e. Intensivc Care Unit (ICU). This unit
deals with definition, types, staffing, physical Fdcilities, p l m ~ i n gdesigning,
, and eqmpment
requirements of ICU. The unit also discusses policics and proccdurcs, co-ordination and
control mechanisms with regard to ICU.
UNIT 1 OUTPATIENT SERVICES
Structure

1.1 Introduction
1.2 Brief History
1.3 Functions and Types
1 .:{.I liole and Functions
1.3.2 Types
1.4 Planning Considerations

1.4.2 Equipmcnls
1.4.3 Slall'ing
1.5 Organisational u~idManagerial Considerations

1.5-3 Managerial I:onsiclcr;~lions

1.6 Monitoring and Evalualion
1.7 Idel Us Sum U p
1.8 Key Words
1.9 Answers to Check Ynur Progress
1.10 Further Readings

1.0 OBJECTIVES
After going through this nit, you should he ahlc to:
enurncrate the role and functions o l outpatient scivices;
@ list the types ol' outpatient services;
@ describe the physical 1':icilitics. layout, crl~ii~>nlcnt
and sl;~l'Uing rcquircmcnts in
planning of outpatier11services:
@ describc thc policies and proccdurcs adopied in organising and managing
outpatient scrviccs; and
@ list lhc activities and descrihc a plan for monitoring and evaluation ol' outpatient
services.

1.1 INTRODUCTION
In this unit, you will lcarn aboi~tthe planning, organisation and management ol'outpatienl
serviccs as an integral par1 of hospiti~lscrvices. Outpaiicnt services i n hospitals lli~vc
evol.vcd in line with patients' needs demiinds and expectations lrorn a limited scrvicc
ofrering basic and minor clinical services to a highly evolved and organisccl service.
Outpatient serviccs when EunctionaIly intcgrrtted with thc ir~paticntservices of the hospital
lead to continuity of carc.
In this unit you wiIl learn about the roles, Functions and types of outpatient scrviccs. You
shall furthcr learn how through planned development of physical Facilities, cquipnlcnl and
manpower the outpatient services could bc intcgratcd with the inpatient carc. In addition,
it shall be possible Lor you to understand thc principles (if devising policies 2nd procedures
for effective delivcry ol'outpatient seivices. Finally. you shall be able to learn principles of
monitoring and evaluation oi' outpatient scivices.

1.2 BRIEF HISTORY 1

Sir George Clark has suggesied that outpatient department as wc know today originated
in mid seventeenth century when at Hotel Dieu in Paris, six physicians wcrc detailed for
regular sessions on Wednesday or Saturday advising the poor individually. This
I
 introduced the idea of oulpalient clinic. The modern OPD began to emerge in 1850 in
USA from the framework of dispensaries.
Historically, the family doctor or general practitioner(G.P.) referring his patient for
-
specialist opinion had three options the patient's own home, the specialist's room or the
Outpatient Department of the hospital. In the later, the specialist saw the poor offering
free or near free diagnosis and treatment, in his rooms he saw those who could pay and in
the patient's home he saw only the very sick or the very very rich. Thus, the main
function of the Outpatient Department was as a source of charity diagnosis and perhaps
care and medicaments. However, in the 20th century with the growing dependence of the
- consultative specialist on the work of others such as radiologists and pathologists, with
the continued growth of specialisation and refined and complicated techniques, and with
the use of expensive medical diagnostic equipment it became increasingly convenient and
in many cases imperative for the specialist to make use of Outpatient Department for both
charity and paying patients.
The continued growth of the outpatient services was also seen as a dangerous threat
leading to the reduction of the workloads and incomes of non-hospital doctors, a situation
which still exists where the-G.P. operates on a fee-for-service basis.
Despite unease in some quarters, about the trend, the functions of the outpatients service
have gradually widened. Much of the investigational and diagnostic or even the
therapeutic work that formerly necessitated admission to a hospital can now be carried out
in a well-equipped outpatient department, with a saving of expense and avoidance of the
disruption of family life that hospitalisation causes.
Check Your Progress 1
I) Enlist three alternatives that a General Practioner had while referring his patient
for specialist opinion.

2) Write down three developments in the 20th century which have led to the speciillist
making use of Outpatient Department for both the charity and paying patients.

1.3 FUNCTIONS AND TYPES I

Outpatient Department as you know is a very important department of the hospital which
is visited by large section of community. It is a!so the first point of contact between
patients, their relatives and hospital and its staff. The care provided in the OPD and
behaviour of the staff determines the image of hospital and is aptly referred to as 'shops
window of the hospital'. In a properly managed OPD the stay of the patients can also bc
considerably reduced, and the cost of care to the patient, hospital and the government can 1
be brought down.
I
1.3.1 Role and Functions
Outpatient Department is one of the department of the hospital which cares for the
ambulatory patient who come for diagnosis, treatment and follow up.
You must have observed that the roles and functions of Outpatient Services have gradually
widened over the years. Now, the role and functions of outpatient services include:
1) To provide for the community a major source of specialist diagnostic medical
opinion where the knowledge skills and resources of the specialist are backed up
by the resources of the hospital. These include not only the physical resources bul
also the presence of a wide range of other specialists which facilitates early referral
when necessary and of supportive paramedical staff of the allied health professions.
2) To treat on ambulatory and domiciliary basis all cases which can be treated in the
6 Outpatient Department (for example surgery for hernia and varicose veins).
L
 3) To refer patients for admission to the hospital of those who need it.
4) To carry out after care and medical rehabilitation, whcn necessary, after discharge
from hospital.
5) To promote health of the individuals under care in the Outpatient Department by
means of health education.
6) To train medical students, house physicians and other professional staff such as
nurses and technicians with valuable and diversified clinical experiences.
7) To compile, collate and analyse records of patients using outpatient services for
epidemiological, social clinical research and for periodic assessment of clinical
outcorncs.
8) To carry out preventive and promotive services through provision of immunization,
screening, antenatal, well-baby, counselling, family welfare clinics etc.
1.3.2 Types
Outpatient Services could be of two types:
i) Centralized Outpatient Services: In centralized outpatienl services all the
outpatient care relating to all the specialities are provided in a compact area which
includes all diagnostic and therapeutics facilities also being provided in the same
unit. Polyclinic in various hospitals is based on this conccpt.

ii) Decentralized Outpatient Services: In decentralized outpatient service, the

outpatient care is provided in the respective departments. The same holds true for
diagnostic and therapeutic services also. Thc speciality clinics are usually based on
this concept.

Use of one type of outpatient service in a particular hospilal depends on the size variety
and workload of the hospital. Generally larger the hospital more centralizcd the
outpatient services are, This also leads to economy as well as higher patient satisfaction.
Check Your Progress 2
1) List fivc important functions of outpalielit services.

2) List the thrce methods of providing preventive and promotive services in the
outpatienl department.

3) List thc two types hf outpatient services.

1.4 PLANNING CONSIDERATIONS

1.4.1 Physical Facilities and Layout
Location
The outpatient department should be conveniently located adjacent or in close proximity to
vital adjacent services such as registration and medical records, admitting, emergency and
social services. It should be near the main road and close to the main hospital entrance
 Clinical Services-I but wilh sufficient space lo provide for parking etc. and to prevent noise and dust
pollulion. It should be scparale from inpatient wards and other departments bul connccled
with them. Il is preferable 10 havc outpalient departments of all specialities in the same
building so as to tixilitate cn>ss-references beiwcen various specialities.
Principles of Planning Layout
The following principles should be kcpt in view while planning layout of the outpatient
services:
a) 11 should be ensured that patienl flow moves in onc direction, in logical sequcnce
and there is no undue back LratTic.
b) It should be able to share with lhe inpatienl departments, all diagnostic lacilitics,
such as x-ray, and palhology laboratory.
c) I1 should be amenable to expansion without serious dislocation of work.
Layout
Various designs ur layouls can be used, such as:
1) The double loaded single corridor with rooms on each side of the corridor;
2) The double corridor lix entry from the opposite sides ol'the room; and
3) Thc triple corridor which provides two rooms of examir~aliontreatment rooms on
each side of a staff corridor.
Size
Bureau o l Indian SLaridards has recoinmended the following space provisions lor various
zones : 2 square metres per bed for enlronce zonc, 10 square melres per bed for the
ambulatory zone, and 6 square melres per bed for diagnostic zone out ol' a Lola1 of 60
square metrcs per bed lor the lolal hospital arca.
Physical Facilities
Thc physical hcililies may be considered under four groups:
a) Public Arcas (Enlrancc Zone)
I)) Clinical Areas (Ambulalory Zone and Diagnoslic Zone)
c) Administrative Areas

You will now learn about each physical f'acilily in some dolail.
Public Areas
i) Entrance: It should be easily accessible, with wide door and have ramps and sleps.
ii) Reception and Information: A desk or a counter located wilhin the public area
for information and reception.
iii) Registration and Records Area: This area should be located ncar the enlrance.
Railings should bc provided for separate queues - new and old and male and
female palients. A counler 3 00 cm high and with work surface 60 cm wide and
with file drawers is necessary. One desI~should bc provided for 20 palients per
hours. Two sq, metres per bed should be provided for outpatienl records.
iv) Waiting Area: Main waiting area sliould bc adjacent to Rcgislralion area and
sub-waiting area should be provided in each clinical department. Waiting area is
provided at lhe scale of 0.1 sq. metre per patient, with a minimum of 4 sq. mctre
The arca provided in sub-waiting areas adjacenl to various consuItalion, diagnostic
and therapy areas is 0.8 sq. melre per patient.
v) Public Toilets and Washrooms: For males and females at the scale of onc for each
200 patients and visitors should he provided.
vi) Snack Bar: It should be located convenient to the main waiting area. Il should bc
maintained in a hygienic manner.
Clinical Areas
An OPD includes Surgical, Dental, Ophthalmic, ENT, Obstetric and Gynaecological,
i 8
Paedialric, Mcdical, Psychiatric, Dermatology and Venercology, Orthopaedic and
--- -
 Emergency Departments. Depending upon the type of hospital there may be Outpatient Se~vices i
superspcciality clinics such as Cardiology, Neurology, Urology Lo mention a few only. In
addition there arc ancillary facilities like treatment sections ir~cludingminor operations,
injection, drcssing and dispensary and auxilliary services of pathology, blood bank and
radiology. There is also a growing need Ibr instiluting hcalth education programmes to
educate the public in environmental hygiene, family welfare ctc.
General requirements for the above clinics are as follows:

a) Sub-Waiting Area: This area should not have more than one-third of the tola1
number of patients visiting the clinic in a day.

b) Consultation Room: This room should provide for accommodation for a doctor's
chair, table, patient's stool, followcr's seat, wash basin, examination couch and
equipment for examinalion. Area should be about 15-17 sq.mt. Each clinic should
be able lo handlc 100 cases per day.

c) Special Examination Room: Certain departments will need separale room For
special examinalions depending upon the type of equipment being used in he
OPD.
Ancillary Facilities

i) Injection Room; It should have wailing area for about 10-20 patients at the rale
of 06-0.8 sq. metre per patient. Thc area may vary from 12-40 sq. metre
depending on the workload.

ii) Treatment and dressing room: About 12-16 sq.mt. shall be required for each
treatment and dressing room.
iii) Pharmacy: The wailing area should be comfortable in the pharmacy as [he
palienls are quitc lircd when they reach this place. The accommodalion should be
sufficient Lo contain about 5 % of total clinical visits lo Lhc OPD in one session.
Pharmacy will require multiple dispensing windows, conipounding counters with
sink, drug storage cabinet and shelves, the details of which you will learn in Unit 4
of Block 3 of this course.
Auxilliary Facilities

i) Laboratory: It should be able to serve both inpatient and outpatients. A samplc

collecling station for urine, stool and blood spccimens should bc provided
separately in the OPD. It should havc two (male and female) wash rooms and
toilcls (15 sq, metre) and a bleeding room (15-20 sq. metre) with two or more
examination tables. You will lcarn more details of planning and organisation of
laboratory services in Unil 1 of Block 3 of this course.

ii) Radiology: It should be able to serve both inpaticnls as well as outpatients, lhe
details of which have been described in Unil2 of Block 3 this courbe.
iii) Blood Bank: This will include a reception-cum-woitiilg area, bleeding room,
laboratory for grouping, recovery room, and a room fix storage of blood and
ancillaries like washing and sterilization room, office room and toilet hcilities. The
details of planning and organisation of Blood Bank Services of n hospital have
been discussed in Unit 3 of Block 3 of lhis course.

iv) Health Education Facility: This should include an oSfice for the health educator,
conference and lecture room, and space all over the OPD for display oS educational
material. Minimum area required for this I'acility would be 15 sq, mclre. Audio
visual aids such as TV, Video player and health education cassettes should be made
available in this area.

v) Medical Social Service Facility: This facility should be located in he OPD wilh
suilable cubicle for cach social worker/counsellor to provide privacy.

vi) Screening Clinic: This is specially required in a teaching/tertiary hospital. It

should be located near the registration area. It should consist of one or more
cubicles with examination table, stool, table and chair with 12 sq, metre For each
cubicle. This reduces the workload on the speciality clinic and also increases
quality of speciality services.
 vii) Preventive and Promotive Health Facility: An office of size 15 sq. metrc is thc
minimum requirement for this facility. This Sacility provides advice on sanitation,
control of communicable diseases, nutrition, home care, public health nursing.
mental health, occupational hazards, immunization, I'amily wellare counselling,
well baby and wcll adult clinics in addition to morbidity studies.
Administrative Areas
a) Administrative Office: A room of 15 sy. metre for a hospital with 100 beds or
more is required to f~unctionfor housing administrator's office.

b) Business Office: The office for personnel section, requisitions, making reports etc.
is required in OPD area in large and active OPD.

c) House Keeping: A janitor's closet for house keeping and cleansing materials is
required with a size of 4 sq, metre.
d) Storage Facilities:
i) General Stores: It should be with the general stores arca of the OPD.
ii) Drugs Stores: Pharmacy stores should be i n the hospilal drug stores i n a
central place.
iii) Linen Slorcs: Each floor of OPD area will require a closct with shelves, for
storage of daily supplies of linen. An area o f 2 sy. mctrc may be sul'ficient.
Circulation Areas
This includes corridors, slairs, lifts etc. This occupies about 30% ol' the total buildirlg
area, elevators should be easily accessible specially for cardiac and obstetric patients.
Corridors should be at Icast 1.8 metrc wide. Sccurity post should be providcd at strategic
,locations. STDIISD phbnc Sacility also should be made available.
1.4.2 Equipments
Equipments as related to Lhe speciality examination should be available in the concerned
room. Sufficient rtumbers of whcelchairs and stretchers in a conveniently accessible
location should be made available. Each consultation-cum-exalnination room ::hould have
a work table, physicians desk, wall mounted cabinets, x-ray view box, revolving stools and
chairs besides examination couch, wash basin, instrument trolley. All OPDs should have
equipments Sor resuscitation ol' patient collapsing suddenly.
1.4.3 Staffing
Staffing levels for the outpatient services should be dcpendcnt on analysis of thc objectives
o l the department and on the volume of the workload in each ol' its functional areas.
There should be no separation of medical staff into inpatient and outpatient staflso as to
ensure continuity of high quality care. The nursing staff consisting of registered nurses,
ANMs and nursing or hospital aids in sufficient nuiiiber should be provided in the OPD.
Ancillary staff in OPD e.g. X-ray, Laboratory, EEG and ECG technicians also are
required. The clerical stafS carry out registration, patient's billing, cashiering, secretarial
and medical record functions. In teaching hospitals, senior physicians have interns and
residents assisting them in professional care of patients.
Many hospitals use volunteers in a variety of activilies in the outpatient services.
The outpatient departmenl will requirc an,administrator in large hospitals lor planning,
organising, supervising, evaluating, co-ordinating and improving outpatient services.
Receptionists, who make the Sirst contact with the stall are an important members o l
outpatient stalf,
Check Your Progress 3
I) Enumerltte ttie three designs of outpatient service facility.
2) Specify the area required for the following zones in a hospital as recornmended by
the Bureau of Indian Standards.
a) Entrance Zone : ................. sq. n~t. per bed
b) Ambulatory Zone : ................. sq. mt, per bed
C) ~)iagnosticZone : ................. s q mt. per bed

j) List the Sour areas in the physical facilities in the outpatient services.

4) Write True and False :

a) Corridors in the outpatient area should be at least 7 ft. wide. (TIF)
b) Medical staff for outpatient and inpatient care should be sepa~xte. (TIF)
c) The outpatient department should have a full time administrator in a
large hospital. (TIF)
d) 'There is no necd to have sub-waiting area in each speciality clinic,
X-ray. L,nboratory, ECG, injection rooin when therc is already a
main waiting area available. ('TIF)

1.5 ORGANISATION AND MANAGERIAL

CONSIDERATIONS

The policy in the outpatient scrvices should be to achieve continuity of high quality l~atient
care with modern techniques and methods in order to have total patient satisfaction at all
tiines with the willing co-operation of all the health care personnel working in the
outpatient department as well as inpatient departments.

1.5.2 Procedures
There should be a manual of the procedures to be followed by all health care personnel
working in the outpatient services. All the health care personnel should be trained and
retrained in carrying out all or any procedure related to their work area. All the
procedures carried out in the outpatient department should be carefully recorded and
documented in a retrievable format so that the patient can be benefited in future as well as
outcome of treatment could be scientifically evaluated.
It is better to implement appointment system to spread out the reporting time of patients.
This can be either individual or block appointments. The block appointment system calls
for a certain number of patients to be present at a given time so as to provide a sufficient
pool of patients; thus the physician will at no time find hiinself idle and it limits the pool
to the capacity of the waiting room.
Inforn~ationgraphics and signage system, name boards, pictorial representation of services
provided, direction signs, colour coding of different service areas facilitate easy
understanding of hospital procedures and routines by the patients.
1.5.3 Managerial Considerations
Public Relations
For many nleinbers of the community, the OPD will be their first point of contact with the
hospital, Ideally, therefore, it should be something of a showpiece making evident from
the first the warmth and humanity of the hospital, its respect for the patient and his
dignity, its provision of the proper setting for good clinical care, and its good
administration, Many of these things the patient can and will judge for himself and they
Clinical Services-[ may influence unduly his futurc opinions of thc hospital. All efforts must be made that the
impression on the paticnt gets in the OPD is a favourable ones.
Overcrowding and Long Waiting Time
Many hospitals lacc thc problem of overcrowding and long wailing limc. Due to various
reasons, patient after initial waiting for registration waits for cons~~ltatioils,
diagnostics,
treatment or even for collection of mcdicinccs at pharmacy.
Adequatc attcntion by all hospital administrations must be given to resolve this problem.
A simple random study of waiting patterns since the arrival of patients through his final
disposal and reasons thereof must bc carried out and bottlenecks removed. The queuing
lhcory which has bcen dealt in Unit 1 of Block 4 o l this course can be applied to resolve
the problem.
OPD Timings
The timings should he decidedlto suit the local and organisational needs. General OPDs
with basic specialities are usually conducted six days in a weck may be from 0800 111 to
1300 hr or so. All registered patient must be seen irrespective of the timings fixed for
OPDs. .Timings for ancilliary/supporlive facilities must be kept at least one hour after the
OPD timings so that no patient who has been seen in the OPD is denied the treatment,
investigation or drugs. It also must be ensured by the administrator that the timings for
OPD are rigidly followed. Increase in registratioil time, adequate number of doctors,
separate queue for new or old cases may help in reducing waiting time in registration.
Screening clinics help in disposal of paticnts with minor illnesses thus leading to less
crowding and waiting time in speciality clinics. Special clinics at different timings,
specially during afternoon hours, c.g.,well-baby clinic, diabetcs clinic, leprosy/rB, follow
up, super spcciality clinics etc, also prevent overcrowding. Increasing the duration of
OPD services or operating eve~iingOPD services can also prevent overcrowding.
Syncllronizing functioning of ancillary facilities with OPI) workload such that the
laboratory, radiology arid pharmacy are open and adequately staffed during peak hours
when patients referred from the OPD arrive for these sclvices is a managerial technique to
increase patient satisfaction. These departmcnts should remain open f o r a longer duration
as compared to OPD.
The patients records of indoor and outdoor services, investigations and treatmcnt should
be available in an easily retrievable form at each visit by the patient.
Management Stn~cture
'This may vary considerably among hospitaIs. In largcr hospitals, the Medical Director or
the Medical Superintendent may be directly incharge of outpatient department. He may
have assistants in various units such as clinics, outpatient surgery etc. reporting to him. In
smaller hospitals, there may be a co-ordinator to co-ordinate the work of various units of
the department reporting to the Medical Director or the Medical Superintendent.

The nursing side of the OPD should be the responsibility of a well-qualified and
experienced nurse whose primary function should be to see that the work, in the various
clinics proceeds smoothly. She will direct the activities of the nurses and ancillary
personnel who work permanently in the department.
Check Your Progress 4

1) Enumerate two types of appointment system for outpatienl services.

2) List three methods of reducing overcrowding and waiting time in Outpatient

Departments.
 Outpnticnt Services
1.6 MONITORING AND EVALUATION
I.lle quality of outpatient services nced lo be monitored and evaluated on an ongoing basis
in order that areas requiring attention for improvement could be identified as well as
results of efforts made for improvement of quality of patient care could be known. For [his
purpose, data need to be collected, compiled, collated, analyze and acted upon on a regular
basis by a nodal oficer in the hospital. 'The vasious data that is needed fos such a proccss
is as follows:
i) Volume
a) CIinic/depa~.tmenl-wiseslatistics of new and repeat visits on monthly and yearly
basis.
b) Percent changes in new and repeat visits over years in rcli\rion to availability of'
doctors and registration staff:
c) rlucluation in visits by da! s o f the wcelc (or rnunt11)---average, high, low.
d) Detcrminc adccluacy and utilization of clinics from clin~cscl~eciulcso l
preceding yea1 to cletcrminc nunibcl. of hours the cli111c\<la5in session. 11111ltipIy
ni~mberof schslon hours by number of'roon~sto arrive at nun~belol'scheduled
hours, and diviclc. t h ~ sby number of patienls scen or average service time to
evaluate aciecluacy of rooms. Further, by estimating actual room hours
scheduled and dividing by potenlial room hours, it is possiblc to determine the
clil~icelTiciency rate.
ii) Utilization and Vital Statistics
The number 01' people who accounl Sor total i~nnualvisit volume determines
utilization (avcrage nllnlber ol'visits per person per year), This figure should t ~ e
broken down by vital siatistics ol'thc population (age autl sex). Such information
helps in deciding stafing, progralnnle planning etc.
iii) Visit Levcls
Ncw appoinl111~1ts--walk-in, scheciulecl, short 1i)llows-ups, annual physicals,
well-baby, well-child cllecli-up, immunizalion and complex treatments indicate
\vhcther ut~lizalion,slalling, distribution and amount oi'revenues neeci to be
changed or kept al the same Icvcl.
iv) Cost a ~ Revenues
~ d
The cost of each service should be matched with rcvenues from respective servicc.
As far as possible, each service should be self-supporting, else cross-subsidy system
be developed Direct patient carc cosls likc salaries, cost of supplies consumed as
well as indirect patient care costs like utilities, frce-carc should be calculatecl.
Chccli Your Frogrcss 5

i Monitoring and evaluation is a continuous proccss.. ( 'TIF)

b) Monitoring and evaluation of outpatient services is rcquirctl to identify

and punish enant 11ealtl1care pcrsons. ('T/l:j
c) Cosl of each service in the outpatient Siicility should bc matched with
revenucs from respective,services. ('TI F)
d) Salaries and cost of supplies consumed are indirect pntie~ircare costs. IF)
1.7 LET US SUM UP
In this unit you have learnt that outpatient services are an important component of clinical
services in a hospital. You have learnt the functions and types of outpatient services. You
have also learnt how one can plan-physical facilities, equipment and staff-an d'fective
outpatient department.
Further, you have learnt how proble~iisof over-crowding, long waiting time, stnlclural
organisation and policies, PI-oceduresand public relations could be tackled. You have also
learnt the methods of monitoring and evaluation of outpatient services. You liave now
come to know how patient satisfaction from outpatient services could be obtained.
 Ambulatory Care : Outpatient care or scrvices
Block Appointment : Calling for a certain number of patients to bc present at a
given time
Direct Patient Care Cost : Costs directly incurred or attributable to the patient care
e.g., salaries, cost of supplies consumed
Indirect Patient Care Cost : Costs indirectly incurrbd or not directly attributable to thc
patient carc c.g.; l'rcc care costs, cost of utilities c.g., water,
electricity etc.
Individual Appointment : Calling for a certain paticnt to be present at a given time
-
11.9 ANSWERS TO CHECK YOUR PlhlOGmSS
Check Your Progress 1
1) a) The patient's own home,
b) The specialist's room, and
c) The outpatient dcpartmeni

2) a) Continued growth oi' specialization and tefincd and complicated techniques.

b) The 11seolcxpensive medical diagnostic equipment.
c) Growing dependence of lhe consultative specialist on the work of others sucll as
radiologists and palhologists.
Chcck Your Progress 2
1) a) To provide specialist medical opinion.
b) To treat all cases which can be treated on outpatient basis.
c) T o refer patients lor admission to the hospital.
d) To carry out after care and medical rehabilitation.
e) To promote health or Lhc i~ldividualsundcr care by hcaltli education.
2) a) Immunization Clinics
b) Antenatal Clinics
c) Well-baby Clinics
3) a) Centralised outpatient services
b) Dccentraliscd outpatient services
Chcck Your Progress 3
1) a) Double loadcd singlc corridor
b) Double corridor
c) Triplc corridor
2) a) 2
b) 10
c) 6
Check Your. Progress 4 Outpatient Senticcs

1) a) Individual Appoinlrnent
b) Block Appointment
7) a) Screening Clinics
b) Special Cl~nics
c) Increasing duration ol OPD Serviccs/Evening OPDs
Check Your Progress 5
a) True
b) Falsc
C) True
d) Falsc

2.110 FURTHER WEADINGS

and
Davics. R.L. and MaCaulay H.M.C. (1966) Outparierlt Servicc.~in I-lospiial I'lurzt~i~~g
Ad~ninistration,WHO, Geneva, pp. 105-1 1.
Grant, Colin. (1973) C)~itpatierztServices irt Hos~~ital
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