PLANNING & MGT OF OPD

OUTPATIENT DEPARTMENT
 Introduction
 Need
 Functions/Scope of service
 Types
 Workload
 Planning of OPD dept
- Planning aspects
- Facility planning
- Human Resource planning
- Equipment and Material planning
- Operational planning
 Problems in OPD
 FLOW CHART
COMMUNITY

RECEPTION AND
REGISTRATION

OUT PATIENT
DEPTT (O.P.D)
CASUALTY

TRIAGE

CONSULTATION
(ONSULTATION
EDUCATION

AND EXAMINATION
WELFARE
FAMILY

HEALTH

& ADVICE)

RESUSCITATION
CLINI CS

TREATMENT &
OBSERVATION
TREATMENT IN PATIENT
ROOM DEPTT DIAGNOSTIC
SERVICES
DIAGNOSTI
C SERVICE MEDICAL
RECORD
PHARMECY
FOLLOWUP
REFERRED TO
MED ANOTHER HOSPITAL
RECORD
COMMUNITY
 OPD
It is an est which is the first point of contact
and provides primary and comprehensive
health care for ambulatory patients who
come for diagnosis, treatment or follow up
care.
 HISTORY

17th Century - Hotel Dien Paris

1850 - U S A
Need For Having a Planned OPD

 Main linkage with community

 Good and effective Public Relations
 Economic considerations for:-
- Patient
- Hospital
- Community
 FUNCTIONS OF OPD
 Provision of comprehensive health care service to
the community.
- Preventive and Promotive services
- Curative services
- Follow up
- Rehabilitative services
 Family welfare services; counselling.
 Health education.
 Education and research.
 TYPES
 Centralised Polyclinic
 Decentralised Speciality clinics
 TYPES OF OUTPATIENTS
 Booked outpatients.
Models of medical contacts
- Individual
- Group sessions
- Health education classes
 Unbooked outpatients.
 Referred outpatients.
 Accidents & Emergency cases
 WORK LOAD
Depends upon:-
 Location.
 Population and their needs.
 Programme and resources.
 Season.
 Traffic and Transport facilities.
 Reputation.
 Other health care facilities.
Rough Criteria
- 5/6 outpatients per hosp bed per day
- Three visits a year
General Planning Aspects
 Estimated work load.
 Accessibility.
 Dignity/Privacy of patients.
 Orderly work pattern.
 Regrouping of function.
 Expansion/Extension.
 Requirements of handicapped.
 Sign posting/Color coding.
 Timings
 Equipment planning.
- Use
- Maintenance
 OPD
 Separate entrance

 Sharing of investigation facilities with inpatients

 Unidirectional flow of patients.

 Liberal parking space.

 Space for future expansion.

 Various Areas
 FUNCTIONAL RELATIONSHIP - OPD

IN

WAITING
ADJUNCTS RECEPTION SERVICES
X-RAY SCREENING MEDICAL
RECORDS
LAB
PHYSIO/OCC CONSULTATION NURSING
THERAPY AND
EXAMINATION

SOCIAL THREATMENT CAFETERIA

SERVICES
FOLLOW UP
PHARMACY
HOME EXTENSION
LAUNDRY
PREVENTION

DISCHARGE ADMISSION
 PHYSICAL FACILITIES
 Public Areas

 Clinical Areas

* Ambulatory Zone
* Diagnostic Zone

 Administrative Zone

 Circulation Area
 Clinical Areas
 Sub Waiting Area

 Consultation Room -

 Special Exam Room

Ancillary Facilities
 Injection Room

 Treatment and dressing room

 Pharmacy
 Auxiliary Facilities
 Lab

 Radio diagnosis

 Screening Clinic

 Medical Social Service

 Health Education Facility

Administrative Areas
 Office

 Storage Facilities

* House Keeping
* General, Pharmacy & Linen
 Facility Planning
• Location
• Functional Zones
Public Zones
• Entrance.
• Foyer.
- Reception enquiry
- Sign boards
- Layout plans
- Trolley bay/Wheel chairs
- Public Telephone
- Toilets
• Registration.
- Centralised counter for new/repeat cases
- Control desk for subregistration at respective service areas
- Retrieval of lost cards.
- Cash counter.
 Facility Planning (cont)
 Health education facilities.
- Posters
- Pamphlets
- Audio-visuals
 Waiting area.
- At foyer
- At each tier of consultation/treatment rooms
Joint Use Zones
 Clinical areas.
 Layout of consultation cubicles
 Configuration of consultation and exam room
- One cons with two exam cubicles/doctor
- Combined consultation/exam cubicle with a curtained
cubicle for pt to undress.
 Facility Planning (cont)
 Rooms for specialised examination .
- Refraction.
- Audiometry.
- ECG.
- Dental chairs.
 Treatment rooms.
- Injections.
- Dressings.
- Minor procedures
- Plaster room.
 Recovery Room.
- Two beds.
- Rehabilitation facilities
Facility Planning (cont)
 Ancillary facilities.

- Medical records
- Combined OP & IP
- Separate OP
- Decentralised for each discipline
 Clinical Lab
- Centralised sample collection area.
 X-Ray and ultra sound
 Pharmacy
Facility Planning (cont)
 Physiotherapy and Occupational therapy
- Gymnasium
- Heat therapy
- Hydrotherapy
 Specialised.
- GI endoscopy lab
- Sigmoidoscopy
- Colonoscopy
- Gastro
 Pulm function Lab.
- Spirometry
- EEG
- EMG
 Cardio Lab.
- ECG
- Stress tests
Facility Planning (cont)
 Adm and support facilities.
- O i/c OPD.
- PRO.
- Security offr
- Medico social workers.
- Cash counters
- Canteen facilities/Refreshment bar.
Staff Zone
 Staff cloakroom and toilets.
 Work room.
 Seminar room.
Human Resource Planning
* Courteous, qualified, well trained and experienced staff.
* No rule of thumb.
* As per workload and peak hours.
- Ideally 10 pts/hr/doctor
- Max 20 pts/hr/doctor
- Dresser for 50 cases/day
- Pharmacist for 150 prescriptions/day
- Nurses in injection room – 1 nurse/200 cases/day
- Nurses for specialist clinics
- Hosp attendants and sanitary staff
- Staffing for medical records.
Operational Planning
SOPs for:-
 OPD timings
 Registration
 Appointment
 House keeping
 Technical Procedure
 Dispensing
 Patients complaints
 Employees grievances
 Maintenance of equipment
 Inventory control
 PROBLEMS IN OPD
 Patient Problems
* Increased waiting time
* Dissatisfaction with:-
- Quality of service
- Amenities
 Doctors complaints
* Increased workload
* Less staff
* Increased clerical work
* Non availability of - Pt records.
- Inv reports.
 PROBLEMS IN OPD(cont)

 Medical Records
* Misplacements.
- Not returned by cons.
- Wrongly filed.
- Taken away by pt.
* Improper filing of records.
 SOLUTIONS
 Appointment system in OPD to reduce
the waiting time.
 Registration system
 Selective attachment of services.
 Filter Clinics
 Starting OPD in time
 Satellite Clinics
 Sufficient waiting area with adequate
resources to cater the load.
 Sufficient space for future expansion
 OPERATIONAL RESEARCH
TECHNIQUES
 Queing theory
 Holding and lifting capacity
 SWOT analysis
 Activity study/Work study
 STRUCTURAL CRITERIA
Physical Facilities
1. Areas
2. Accessibility
3. Sign Posting
4. Waiting Hall
5. Trolley Bay
6. Toilets
7. Staff facilities
8. Cubicles Size
9. Tea/Snacks
10. Records
 HUMAN RESOURCES
Qualifications
 Proper Job

* Description
* Specification
* Analysis
* Responsibility
Staffing Norms
* Doctors 1/40 pts
* Pharmacists 1 per 150 prescriptions
* Nurses
Trg (HRD)
 EQUIPMENT
 Procurement

 Maintenance

 Forecasting

 Usage

 Specification

 Log Book,Utility Index

 PROCESS CRITERIA
 Timings

 Cleaning standards

 Referrals

 Traffic flow

 Lab Reports

 SOPs
Outcome

 Patient satisfaction

 Complaints

 Cost & Revenues

 Strikes
 IMPROVEMENTS
 Screening/Evening OPD
 Appointment Systems
 Medical Audits
 MIS
 Comprehensive Healthcare
 Expansion
 OR Methods
 Continuity /Quality/Evaluation of care