Hospital and Its Organization — pa A hospital is an orga inations of specialized scientific equipmen. and functioning through qualified and trained persorinel for restoration and maintenance of good health: The hospital is also serves as medium through which the medics} steriment of public health. In this institction professional staff pools their efforts for the be! Int 5 are provided to patients for regaining health. The provision of medical facilitated by the medical and associated technical staff of nurses, dietitians ele. The character and extent of hospital services are adjusted continuously to keep abreast of changes and advances in medical science : The palicnt is a focal ‘point about which all the activities of a hospital revolve. This paticnt may be an in-patient (cloistered within the hospital and occupy @ bed for some period) or an out-patient (utilizing the. hospital facility by not occupying its bed). The _ extent of medical services is largely depends on the nature of the institution. More usually. primary emphasis is placed on the care of in-patients. Recently. hospitals are uuming, more responsibility for preventive medicine programs for improvement of the overall public health, Under this program, the scope “of medical services has been extended from the care of in-patient, to the potentially sick person in his normal living situation. ‘An additional point regarding hospitals is that it is a working environment for hospital pharmacist. The objective of this chapter is to-familiarize the pharmacists who want to adopt hospital pharmacy as @ career so as they will not feel its environment strange. HOSPTIAL snization utilizing com! med CLASSIFICATION OF HOSPITALS . Hospitals nay be classified in number of ways. However, it is worthy to note that a single institution may tall into more than one grouping. The folowing is a general classification of hospitals. Based on services I General hospitals 2 Speciality 24 Medicine Internal Medicine Psychiatric and nervous disenses ‘Tuberculosis Communicable disease Pediatrics_ Plospital Phirrmacy 22 Surgery a ae Orthopedic Gynecologic od Otolarynyologic Cardiology 2.3. .Matemity Based on ownership and control 3 Governmental . W Amied forces (Naval, Combined w/Federal Goverumental Hospitals V Provincial Hospitals (Head . Hospitals, units etc.) Teaching hospitals 2 32 Non-governmental 33+ Private for profit | 3.4 Private charity - . A teaching hospital provides clinical instruction to Niedical college students. In these -hospitals, a medical graduate undergoes one year of compulsory hospital training as house job. Some “non-governmental hospitals also maintain intern and residency pro-, grams'for the traiving of the medical graduates in various specialties. After graduation. most of the physicians look for positions in teaching hospitals because these institutions offer further educational’ opportunities’ and broad éxperiences in ‘clinical care of the patients. byt Numerically, about 15 teaching hospitals of country can care for a little of total hospitalized patients in country However. since teaching hospitals act as referral centers for the more -seriously “ill patients, third party payers give more preference for reimbursement to these hospitals than private institutions. Furthermore, due fo economy of services provided, mass seeks treatment from these institutions. Ideally, a teaching hospital should support educational and research programs but the National teaching hospitals have no or very litle research program's yet in real sense. Military Hospitals etc) Os Quarter Hospitals. Social Security Civil Dispensary, Rural dispensary. Basic health IRGANIZATIONAL PATTERN Only the general view of the complex organizational structure of hospital will be presented here in this text. The organizational pattern of a hospital resembles with that of “pharmaceutical industries, The only difference is of positions and titles assigned in hospitals. «- * ‘ : : Figure 1, 2 and 3 illustrate the organizational patems for government teaching, private and military hospitals, respectively. The smaller the hospital the fewer the administrative © positions of associate or assistant director and conversely, the large institutions may , _ further subdivide the general areas of clinical units tinder the aexis of assistant directors. ~ The board of trustee is standard for all private hospitals. MANAGEMENT wo The government, military and privatc hospitals have different management Systems. A _ err 1SHaspital & Us Or medical superintendent who is appoimed by ue of beet ngoages the for military hospital is managed by commanding officer. While @ pil a : pit Usual ai organized governing body which is responsible for the on Meio he hospital i. ner consistent wilh its objective of making available high quality patient care Gers in governing body will vary from hospital to hospital, ist of a large number of people from wigy hospitals may cons! r of peop tative group from within the membership, is elected for a toa, iso known as the governing board. board of governors, bua, erally the representatives are selected for they mi total number of mem The partnership of some | scattercd areas, a represen of trustees. This yroup is al of managers or board of directors. Ger ability to contribute to its effective management. . the governing body elects its officers one of whieg ‘As part of the organizational process, ; y f ta wide varicty of committees necessary fey acts as chief executive and causes to appoin i s the discharge of its duties. These may include an Executive Committee, Build and Finance Committee and a Joint Conference Committee, Committee, Investinent The governing body is responsible for defining, of the: ; [Powers and duties of the governing body officers, commitices and chief executive officer. © . Qualifications for overning body membership. Method of selection for membership. - Tenure. _ Comniittees—kinds, appointment and membership tenure. Evaluation of performance of employees. apa DMINISTRATION ; a The board of trustee ofa hospital delegates ‘hospital's. active management to an administrator and his staff of associates, assistants, supervisors and departmental heads. The administrator of a hospital is responsible for Operation of the entire institution assuring institutional staffs and patients of highest possible standards of services and economy by planning, directii rdirialion of Wie activittes. Thus the future of an institution depends on the capabilities of its administrator. The administrator of a hospital is described as specialist in administration and must specially be qualified and trained for his position, Usually an administrator holds the degree of Master of Hospital Administration. However, qualified individuals holding other degrees can also be appointed as administrator. The main functions of the administrator are to; 1. Enforce trustee policy in the daily management. * Establish organizational structure to carry out programs of the hospital and to mee! * needs of the to’paticnts, . 3. Implement the governing body's policy on the financial management of the hospit2! Develop and implement a comprehensive management reporting system throug’ the hospital. 5. Provide, maintain, and safeguard appropriate physical resources in the institution 6. Look-at the weakness influencing any aspect of institution, 2DICAL STAFF oY « “Medical staff is the group of individuals who are fully licensed to practice medicine : Ceeee _ Hospital Pharmacy dentistry. The medical staf is the bickhon very well organized and controlte peroranices nized! ond ccutrolet 80 U8 can perform At an optinal level of profession ceforminge, The orgunlzed witeal sf is ecouniaby to the hospital powering, body and has overall responsibility for quality of medical care, professivnt ye eee body and the ethical conduct in the hospital, + Professional services provided The structure of medical stall will n i vary from hospital to hospi ing i es of the hospital andits stuff dlowever, Typlealy. tls aig fay Beane ae various categories. The active medical sta is at the forefiont af henge waa delivers dominanily the medical service, Most of members of this att Need a the organizational and administrative duties pertaining to the medical salt ‘voted n The associate medical staff fi for ive Wie social ‘ HT functions for the advancement to the active medical staff. Whereas the courtesy medical staff consists of practitioners given rights 10 admit an occasional patient (0 a hospital, The consulting medical staff comprised of medical practitioners of recognized professional abilities but are not members of the preceding categories. . ° The honorary medical staff consists of former staff inembers. retired or emeritus, and of -other practitioners whom the medical staff chooses to honor. ne of aly healthcare institution, thus it must be ‘ARTMENTALIZATION fee : Departmentalization is the grouping of various sections and divisions according to the same nature of services provided. The’ degree of departmentalization of the hospital depends entirely upon the extent of specilization of the staff. Typically, the department categories mentioned in proceeding sectio’’ can be observed in.a hospital, CLINICAL DEPARTMENTS * : . ‘ The extetit of departmentalization of clinical: services‘in a hospital depends upon the degree of specialization of the medical ‘staff. Jn small hospitals, only two departments - medicine and surgery will provide all the clinical services. Other significant services may either offered on a limited basis or sought externally from the outside facility. Supportive services such as radiology and pathology .are usually acquired externally. In a large hospital, hospital staff is highly’ specialized and therefore there are greater subdivisions within a clinical department: Clinical department is broadly divided into medicine and surgery. Generally, the department of medicine includes the fotlowing subdivisions: - Internal Medicine Allergy Infectious Diseases s Cardiolouy . . Endocrinology, Dermatology Immunology Geriatrics. ; Nephrology - Pediatrics : 2 Psychiatry , Neurology = -- Rheumatology ~ 1 Gastroenterology Pulmonary Diseases ally divided into the following: Orthopedic Surgery Neurologic Surgery. Obstetrics & Gynecology Ophthalmology Dental & Oral Surgery a The department of surgery is gener General Surgery —— 1920 __-_ Hospital & Its Organizay aioe y ‘Thoracic Surgery : St Signe Proctology ‘ rology / Plastic surgery : sat ; a teaching hospital. Each of these subdiy : ivisions can be observed in a iI ising, Such subdtespieFof service who in tra, Is responsible to the departmental chic aad me the medical staffis organized-in such a inanner as to provide fair representaty, sreach individual on the staff through to.the administration and.the governing body SUPPORT SERVIC The ‘functioning of c! depart services; The supportive services i dictary service, laboratory service, p i ¢ sterile supply, social service “department, biomedical department (for cli instrumentation), mainteitance and engineering division. . cal department is facilitated by “supportive -or ron clinica clude pharmacy department, nursing departme inedical records ‘department, blood bank, cent ‘ical Pharmacy department . . 7 - ; The pharmacy department is staffed with pharmacists and is supervised by director of jpharmacy or pharmacist-in-chief. This departinent offers the following services; 1. Drug distribution, including floor-stock and unit dose distribution 2... Dispensing of drugs to out-patients : 3. The intravenous admixture program : . 4. The clinical services provided from the hospital pharmacy may include therapeutic consultation. drug information. for physicians, nurses, and other allied health personnel and for patients. Clinical pharmacy practice also encompasses preparation of patient drug profiles, recording patient drug history. advising physicians of possible drug-drug interactions and drug effects on clinical laboratory test results. It also: inyolves ‘preparstion of patient drug use review, collection of the pharmacy- patient dats base, therapeutic monitoring, and auditing of therapeutic regimens, “monitoring of :specific ‘adverse ‘drug reactions to- decrease. their incidences -and management of chronic care patients. . o_o ~ 5. “Purchasing and inventory control of drugs and allied ifems. 6. Conduct and support of pharmaceutical and clinical research, respectively 7, Education service for pharmacy pe: res patients.- na : 8. Serving function for vital committees such as phannac rsonnel, medical profession, nursing staff and for Baas 'y and therapeuti . infection control, research review, - antibiotics, ambul Peuties committee, ? lato " “committees. *Y and standardization -9. Special services may include the provision of radiophan nl ; i Maceutical parenteral preparation, central sterile service and poison co - Setvi ntrol Centre, ies, total Pharmacy's rale in the hospital The pharmacy department is one of the many departments of a hospital th at deal of influence on professional position of the institution as Well as ygent SNPS a great of the total operational costs. Wt is all duc 10 its interrelation wie" economies dependency of other services upon it 80d the inter. —— aee Hospital Pharmacy Ina haspital setting, the doctor ; hos §, the doctor dingnoses and prose i medication anit the nurse advnistes the drags to the poem Conte age aepenses the d 3 Salrinealcailen restwiony 185 10 the pationt (unless the patient Is on a Clearly thei, the pharmacist who pra t ly thei, tices his profession i i th t s nan institutional eny nat be avats of the: forces operating around tim, and he mist’ (earn Monn understand them, bat to assist marshalling them towards the ultimate goal of ler eaeaue ' I ite yoal of better Ina teaching hospital a hospital pharmacist has innumerable oj in and to develop educational programs for pharmacy, medi patients. . PPOTUUNIties to participate ical, nursing staff and for Nursing service : Nurse is an ndividual who attends, helps, teaches, counsels and takes care of the patients, particularly who acquire beds in hospital. Nursing care is an integral part of total health care system and necessary for regaining and maintaining health.“A nursing team is made up of workers with varying degrees of nursing skill and directed by a professional nurse. Helping the patients to help themselves is a new clement’of nursing practice. ‘This is because encouraging selfcare by the patient helps to an early recovery. Another element is diversification and specialization of nursing individuals.” Nowy a nurse may be specialized in oncology, blood bank, night nursing care, floor nursing care etc. Nursing is a noble job and a nurse must Fespect individuality, dignity, and rights of every patient, regardless of race, color, national origin, and social or economic status. The nursing service is organized similarly to other service in the hospital and is headed by Director of Nursing with administrative authority. The director of nursing must be an experienced nurse with administrative talent. eat : As an administrative staff, the director nursing participates in formulating policies and devising procedures required for achicvement of objectives; and, in developing and appraisal of the quality of nursing’services. In some institutions, the director of oursing, service is also responsible for administration and operation of the school of nursing. Dietetic services Dietetic service is one of the essential services in an institution, It is staffed by adequate -numbers-of dietitians, technical and clerical personnel and is directed by a person with professional qualifications in nutrition. “This is. responsible for repair of palatable _ and appropriate food by applying effectively the principles OF nuirition sci nee, In -—pakisian, only establishments of larger private hospitals have instituted this service. The dietetic service, if existed is responsible for: . . ‘ 1, Purchasing, planning and preparation of menus for both patients and employees. 2. Recording of dietary histories of patients such as those unable to accept a limited diet regimen. “3, Interviewing patients regarding their food habits. F . 4. Counseling patients and their families concerning normal of modified food regimens. $. Encouraging patients to participate in planning their own normal. or modified regimens, ‘ 6. Participate In appropriate ward rounds, research activities and conferences. e ee emma, FtHospital & Its Organ, ea, Medical records department = > Patient record keeping is the responsibility of medical records department Of the hey, This department is staffed by technically skilled personnel and is headeq by aft qualified individual. Every hospital Is.required, by law to,maintain adequate meting ords of their patients. . é & The purposes of the medical record are to: ; 1. Serve asa basis for planning and for continuity of patient care. 2. Provide a. means of communication among the physician and Professcn contributing to the patient's care. : | vi 3. Furnish documentary evidence for course of a patient's illness and treatmen or, each hospital stay. : 4 4, Serve as a basis for review, study and evaluation of the care rendered to the patiey: $. Assist in protecting the legal interest of the patient, hospital and respons, practitioner. 6. Provide data for use in retrospective research, education and for legal issues, A sufficiently detailed medical record includes: (a) Identification of patient. 3 (b) ‘Patient's sociological data. . z (c) Personal family-history. . (d) History of present illness. (e) Physical examination. : () Special examination such as consultations, clinical laboratory data, x-ray etc. (g) Provision of working diagnosis. © (h) Medical or surgical treatment. (i) Gross and microscopic pathological findings. (j) Progress notes. : (k) Final diagnosis. (1) Conditions on discharge. (in) Follow-up. : : (n) Autopsy findings in case of the death of patient. 3 Parts of Medical Record Admission sheet: This sheet generally is used: pi data. {t contains unit record pnberpaiehte reatcing of the patient icon home telephone number, name and address of referring physician, . a OS a date and time of admission, and destination within the hospital, ‘Admission shee! ® attaches consent forms for authorization for medical or ng tal. Admission sl sg Information to other physicians and for release of informatio gical treatment, reless! any. tse nto reimbursing author’ i ist sheet: On the admissi ‘ informant’s name, name of individual ten fstry sheet gi description of present illness. A provisional Or admitting , patlen which is usually made on every patient at the time of admis i illness, with their subsequent diagnosis, operations and mabe inluike Bias lncindes | ie igen*. clinical chemisiry, microbiology, clinical microscopy, hematology, serology and the Hospital Pharmacy nicdications, diet, height, welght, occupational history, health of spouse, in cuse of female patients the pregnancies, thelr outcomes and complications and family history. ‘al examination sheet: Physical examination sheot consists of a routine systematic review of skin, head and neck, breast gastrointestinal, genitalia, lymph nodes, muscular skeletal and extremities and allergy. This information helps the physician to ‘proceeds for ‘a suggested treatment prograin on medical record to be followed during hospitalization of the patient. : . . % al sheet: The laboratory sheets are entered into the patient's medical record after cach laboratory test during patient's hospitalization. This includes reports ‘on preprinted forms obtained from chemistry, hematology, microbiology, serology, pathology as well as radiology. Some reports, instead of recording are directly pasted as original on to the medical records. . . : Medical record sheet: The medical record sheet provides the space for recording of all Ireatment procedures performed upon the patient. 1t also includes’ the operative notes “ containing. description of findings. detailed account of techniques used and tissue removed, Progress notes are made in the medical record for the purpose of providing the physician with a chronological picture and analysis of the clinical course of the patient. A definitive final diagnosis can also be. entered in the same sheet of patient's medical record after the completion of all of the diagnostic procedures, — Discharge summary sheet: Upon discharge from the hospital, a discharge summary sheet is entered into the patient’s medical record as an outlines of patient's hospitalization. This sheet contains a brief history, results of the physical examination, laboratory data, . description of patient’s hospital course, diagnosis, operation performed, complications, disposition, present condition, medications prescribed during ‘and after hospitalization, and an estimated length of disabitity If any. * Autopsy sheet: The autopsy report sheet is included if the patient dies during hospitalization. ‘This contains complete protocol ofthe findings resulted from the autopsy. 4 5 A complete afid ideal medical record has the following features: 1. ‘Accurately documented so as an effective patient care can be provided at another time. 4 Pte . 2. Readily accessible as this will facilitate the easy consultation with other physicians and enable an emergency treatment, 2 3. Easily used for retrieving and compiling information. This helps in the retrospective, data analysis etc, nO, oa i 4, Containing all significant and detailed clinical information to enable an effective continuing care to patient in the same institution at another time, another practitioner can assume the care of patlent at any.time and a consultant can give opinion afer the examination of medical record of the patient. + 3 Pathology services . The department of pathology services has personnel who are adequately: trained and experienced in laboratory work, This department is supervised by a qualified physician with training in pathology and is able to assume professional, organization and administrative responsibility for the services rendered. The cytologic section, clinical lab, 237 __ Hospital & tr, o; —— 4 bk be the subdivisi Jood samples may slong sis In bI blood bank is also inchided ues hg ie A section for drug analyst ions, department. In some services. Blood bank se their own blood bank because of the essential Nature g Most hospitals oper to get ensured quality. In some hospitals, this serves therapeutic ie ote in other, it function as a subsection of pathology deparin, % independently peration. If operating independently, this departments tory-like operation. If of ‘ i iy se oe echofelans and supervised by a licensed physician having basic x N Me hematology. Tae depanaval of radiology is a vital department for the aierostc Applicaton energy particularly in the form of x-rays. This department is under the Sup ity qualified physician who has also obtained an adequate training and experience ag] radiology. An adequate number of radiology technologists are staffed to prog | from this department. This service-is provided only after a written direction, fy entitled physician. Nuclear medicine . oo ae , Nuclear medicine department is an integral part of an institution which Provides ees | service, The services of this department include the. use of radiopharmaceuticas 4 | diagnosis, palliation and treatment. This department is staffed with physician specialization of nuclear medicine, health/medical physicist, nuclear pam technologisis, and qncology nurse, “i Radiotherapy department The: radiotherapy . department generally. consists of physicians who are tid radiotherapist, medical physicists, radialion technologists, radiopharmacisl, 1 secretarial personnel. A physician adequately trained and experienced in general Principles supervise this department. The services provided from the reds + department are performed only on the written order of medical staff member® been entitled to direct for such services, Radiation department provides the therapeutic services of the radioactive rit*>| for the treatment of tumors:‘and Carcinomas. An appropriate dose is cil" ep of the patient with isotope, particularly cobalt-60, Recently brachyi een introduced in which a radioactive Source is.inserted with .incision in tht; carcinonia for a calculated peri is and 1192 ( a et aa of time to treat them.-For this Purpose, Diagnostic services - none nai computerized tomography, (Ct), ultrasound, uc! institution. Due w theirs nBiNs Are the ‘dingnostic. services. flee) be és cir different basic Principles, techniques and obviows!Y pe these cannot Be grouped under one department Sa :