RABINDRANATH TAGORE INTERNATIONAL INSTITUTE OF CARDIAC SCIENCES

PROJECT ON MANAGEMENT OF INPATIENT DEPARTMENT

NAME: DEBLINA DUTTA, BBM ( H )

ROLL NUMBER: 15403315010

SESSION: 2017-18

DINABANDHU ANDREWS INSTITUTE OF TECHNOLOGY & MANAGEMENT

LOCATION:124, EASTERN METROPOLITAN BYPASS, PREMISES NO.1489, MUKUNDAPUR, KOLKATA, WEST BENGAL, 700099.

HOURS: 24 HOURS

PHONE: 1860 208 0208

EMERGENCY DEPARTMENT: 24x7

CARE SYSTEM: PRIVATE

DECLARATION FORM

I declare and inform you that this project entitled “A STUDY ON MANAGEMENT OF INPATIENT DEPARTMENT” has been submitted by me for the partial fulfillment for the requirement of the degree of Bachelor in Hospital Management from Dinabandhu Andrews Institute of Technology and Management under WBUT under the guidance of Mrs. Nivedita Roy of RTIICS Hospital during the academic year of 2017-2018.

1. NAME- Deblina Dutta

2. ROLL NO.- 07

3. REG NO.- 151541310010

4. DURATION OF TRAINING- 3 Months

5. (Signature of the Student)

6. For office use only-

7. The project has been approve/not

ACKNOWLEDGEMENT

I am using this opportunity to express my gratitude to everyone who supported me throughout the course of this training. I am thankful for their aspiring guidance, invaluably constructive criticism and friendly advice during my training and the project work. I am sincerely grateful to them for sharing their truthful and illuminating views on a number of issues related to the project. I express my warm thanks to Mr. Surajit Das, HOD of our stream, Mrs. Anuriya Roy, Mrs. Nivedita Roy, Mrs. Debasree Mitra, Mrs. Krishna Poddar and Ms. Sumana Ghosh of RTIICS Hospital for their support and guidance and all the people who provided me with the facilities being required and conductive conditions for my project.

Thank you, DEBLINA DUTTA

EXECUTIVE SUMMARY

I have done my internship in RTIICS, in which I got training from its INPATIENT DEPARTMENT as a WARD COORDINATOR (ACTC BUILDING 4TH Floor, Ward-2412 and 7 TH Floor, Ward- 2701 – 2705). The internship basically revolved around the product knowledge training. The system, the commitment of employees in RTIICS is really exemplary.

The difference between the success and failure is doing things right and doing things nearly right; RTIICS has always tried for success &; that is why it is known to be one of the leading organizations in India. In this report I have given a brief review of what I have seen during my internship. I have mentioned all these as I have made an internship as according to the schedule. I also mentioned about the job responsibilities of a Ward Coordinator of RTIICS.

I have discussed about my learning in the whole internship. I have made it possible to write each and every thing that I have learnt there. I gave all my practical efforts in the form of this project that’s the asset for my future career.

CONTENTS

1. INTRODUCTION 2. REVIEW OF LITERATURE 3. OBJECTIVE 4. HISTORY OF THE HOSPITAL 5. HOSPITAL PROFILE 6. VISION, MISSION, VALUES & SCOPE OF SERVICES 7. FACILITY LAYOUT OF ACTC BUILDING 8. MANAGEMENT OF INPATIENT DEPARTMENT 9. JOB DESCRIPTION OF A EARD COORDINATOR 10. SAFETY AND SECURITY 11. INPATIENT IDENTIFICATION 12. PATIENT VALUABLE POLICY 13. DISASTER PREPARDNESS 14. METHODOLOGY 15. DATA COLLECTION 16. SUMMARY OF FINDINGS 17. CONCLUSION 18. BIBLIOGRAPHY 19. ANNEXURE

INTRODUCTION

For most of the people hospital means ward. For hospitalization we necessarily need an inpatient Department (IPD). Inpatient care is the care of patients whose condition requires admission to a hospital. Patient enters inpatient care mainly from previous ambulatory care. The patient formally becomes an inpatient at the writing of an admission note and is formally ended by writing a discharge note.

The IPD consists of following components:

 Nursing Station  The beds  Necessary services, storage work  Public areas, needed to carry out the nursing care

The functions of Inpatient Department are:  To provide highest possible quality of medical and nursing care.  To provide essential equipment, drugs and other materials required for patient care.  To provide comfortable environment, substituting temporary home for patients designed to accommodate all their basic needs.  To provide facilities for visitors.  To provide highest possible degree of job satisfaction.  Meticulously maintaining of the medical records from the point of view of patient, faculty and hospital administration and for maintaining continuity of medical care.

REVIEW OF LITERATURE

Sitzia, J. and Wood, N. (1997). Patient Satisfaction: A Review of Issues and Concepts. Social Science and Medicine, 45: 1829-1843. Sitzia and Wood review the literature and suggest that patient satisfaction could be assessed by measuring 1) the degree to which patients believe that care possesses certain attributes and 2) the patient’s evaluation of those attributes. They suggest that satisfaction is no single concept made up of multiple determinants, but that there exist three independent models of satisfaction, each associated with one determinant.

Inui, T. and Carter, W. (1985). Problems and Prospects for Health Services Research on Provider-Patient Communication. Medical Care; 23(5): 521-538. In this review of studies of provider-patient communication, the authors assert that even with the vast knowledge available on biological processes and disease mechanisms, communication between health care provider and patient is an extremely important aspect of health care. Attempting to measure this, however, requires interdisciplinary activities, since merely measuring satisfaction at the conclusion of an interaction cannot measure all the nuances of communication (both verbal and non-verbal).

Andaleeb, Siddiqui & Khandakar (2007) said that the ability to satisfy customers is vital for a number of reasons. For one, today’s buyers of health care services in developed countries are better informed, a condition that is being driven by greater levels of information available to them. These buyers are therefore more discerning, knowing exactly what they need.

Feldman, Novack & Gracely (1998) looked at specific aspects of managed care, such as gate keeping and capitation, to assess physicians’ views. To gain more information about the impact of managed care, they developed a survey to assess the attitudes of primary care physicians on how managed care affects (1) physician patient relationships, (2) their abilities to carry out their ethical obligations to patients and quality of care. There is widespread agreement that trust between patient and physician is important for high-quality health care.

Sultana, Riaz, Rehman & Sabir, (2009) suggested that quality of health care showed that efficient delivery of Primary Health Care through the existing health system will lead to improved health conditions by reducing morbidity, maternal and infant mortality and population growth rate. Nurses need to know the factors influencing the patient satisfaction in order to improve the quality of health care. OBJECTIVE

The basic objective of doing this project is to study and observe the INPATIENT DEPARTMENT of RTIICS Hospital for better knowledge and to understand the workflow of the Department.

Secondly, the objective of doing the project is to know how the services are to be controlled, the quality is maintained thus gaining maximum attention in the provision of the quality services and getting feedback from the patients and relatives of the patients.

HISTORY OF THE HOSPITAL

Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS) Kolkata is a multi-specialty hospital spread over 4 acres on Eastern Metropolitan Bypass at Mukundapur. RTIICS, a unit of Narayana Health has 14 fully equipped operation theatres and 3 state-of-the-art Catheterization Laboratories with 24 hours’ facility.

In the last 14 years, RTIICS has performed over 24500 life-saving adult and paediatric cardiac operations, 93000 cardiac Cath Lab procedures, 1500 Kidney Transplants, 258000 dialysis and over 35600 multispecialty surgeries, including joint replacements, minimally invasive surgeries, neurosurgeries and other general surgeries. Over 80000 senior citizen club members and over 20000 patients received financial assistance through Guest Support Cell. A dedicated team of renowned surgeons, specialist doctors, nurses, technicians and paramedical staff with the most modern equipment and laboratory has made RTIICS one of the leading hospitals of the Narayana Health group.

RTIICS comprises of 34 major clinical departments that cater to the people of West Bengal and neighbouring districts in Eastern India as well as the North Eastern states. The hospital also has many international patients coming - in from Bangladesh, Nepal, Bhutan, Africa and Myanmar for various treatments and returning home with successful remedies.

HOSPITAL PROFILE

Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS) in Mukundapur, Kolkata, West Bengal, India, is multispecialty, tertiary care unit of Narayana Health group. It received accreditation from the NABH in 2014. RTIICS is the group's main hospital in Eastern India, with a primary catchment area of Kolkata. The hospital also treats patients from neighbouring districts, North-Eastern states as well as from neighbouring countries and continents such as Bangladesh, Nepal, Bhutan, Africa and Myanmar. It specialises in cardiology, neurology, neurosurgery, nephrology and urology.

RTIICS, a unit of Asia Heart Foundation, was established in April 2000 by Dr. Devi Prasad Shetty, founder and chairman of Narayana Health. Early in 2016, RTIICS announced the establishment of ‘Stride’, a clinical centre offering multidisciplinary care for vascular diseases and traumas. Apart from vascular surgery, Stride is supported by an endocrinologist, radiologist, physiotherapist, counsellor and other specialists.

VISION

We desire to emerge as a healthcare destination and training hub to everyone all over the world and reach to the masses in the remotest corner of the country and out.

MISSION

We dream to make sophisticated health care facilities available to the masses irrespective of status, class, creed or community with the sole aim of care and service to the sick and unhealthy.

VALUES

Values are represented by the acronym “I care” where

 I stand for Innovation and Efficiency  C stands for Compassionate care  A stands for Accountability  R stands for Respect for all  E stands for Excellence

SCOPE OF SERVICES

Services available are-

 Anesthesiology and Critical care medicine  Cardiology-Diagnostics & Interventional  Cardiac Surgery- Adult, Pediatric& Neonates  Diabetology & Endocrinology  Dentistry  Dermatology  Emergency medicine  ENT  Gastroenterology & Hepatobiliary  General medicine  General surgery & Minimally Invasive Surgery  Hemato-oncology  Laboratory Medicine  Medical Oncology  Nephrology  Neurology  Neuro-surgery  Nuclear medicine  Obstetrics &Gynecology  Ophthalmology  Orthopedics& Joint Replacement  Pediatric Cardiology  Pediatric Surgery  Physiotherapy & Rehabilitation  Plastic Surgery  Psychiatry  Pulmonary/Chest Medicine  Radiology-Diagnostics & Interventional  Renal Transplant  Surgical Oncology  Thoracic Surgery  Transfusion Medicine  Urology & Lithotripsy FACILITY LAYOUT OF ACTC BUILDING

1. GROUND FLOOR-Main OPD, May I Help You Desk, Discharge counter, Billing Counter, Gynecology& Obstetrics Department, Orthopedic Department, Urology Department, Nephrology Department, Neurology Department, ENT, Gastro Department, Psychiatry, Interventional Medicine, 2. FIRST FLOOR- Endoscopy Room, HDU 2103, OBS & Gynae Ward 2102, Conference Room, Biomedical, Operation Theatre.

3. SECOND FLOOR- Neuro HDU 2202, Neuro General Ward 2203, dialysis, General ward 2201, and CCU 1.

4. THIRD FLOOR- General Ward, Renal TX Unit 2306-2311, General Ward 2312, House Keeping Desk.

5. FOURTH FLOOR- Twin Sharing/Semi Private, Department of Academics, General Ward 2412, Server Room, CSSD.

6. FIFTH FLOOR- Cath Lab, CCU 2, 3 &4.

7. SIXTH FLOOR- Operation Theatre, ITU 7, 8 & 9.

8. SEVENTH FOOR- Ward 2701-2705, ITU 1 & 2, NICU, HDU 2706, Department of Clinical Research.

9. EIGHT FLOOR- Private and Deluxe. MANAGEMENT OF INPATIENT SERVICES

DEFINITION- Medical treatment, assessment and the services that are provided to the patient by the HCO (Health Care Organization) after admission can be termed as Inpatient Services.

AIM- The aim of inpatient services is to provide best possible patient care through medical skill combined with compassionate care and continuous improvement and services.

RECEPTION OF PATIENT IN WARD:

 Floor coordinator will receive the patient on arrival on admission to the ward after admission formalities.  She will wish the patient and introduce herself as the Ward-Coordinator.  She will inform the patient that for any assistance he/she should call for her.  Brief the patient about her availability.  Educate the patient and relatives about their rights and responsibilities.  Enter the details of the patient in the Master Register & Allocation board.  Instruct the sister to take the patient to the allocated bed after checking the bed is ready.  Inform the consultant about the patient arrival.  Inform the ward RMO about the new admission.  Provide the patient with a new pair of slippers & take a receiving signature in slipper register.  Inform the patient relative to bring required toilet articles.  If the patient comes from Emergency, then provide the patient with tooth paste & brush.  From ward stock.

DAILY ROUTINE OF WARD COORDINATOR:

 Take rounds of the ward.  Meet all patients in ward at least twice during the tenure of her duty.  Obtain the feedback on the services that are provided to them and enquire of any administrative problems if they have.  Ask the following questions to each patient on arrival at the ward:  Was the dinner served on time?  Was it hot and palatable?  Was the medicine administered to them on time?  Was the nursing staff available when needed?  If case of any complains immediately attend to it.  If need arise refer to the floor manager.  All clinical related problems should be immediately intimated to the concerned nursing staff or the ward RMO as the case maybe.

UPDATING SYSTEMS:

 Update the system after completing the daily round  Generate the current in patient list of the ward  Input the transfer in and transfer out of patients from the ward in the system.  Input the discharge request for the planned discharges.  Update the system after every discharge.  Make necessary changes in Consultant names as & when required.

BED RESERVATION:

 Communicate to sisters regarding the requirement of beds for the day.  Reconfirm with the other wards with regards to bed reservations.  Inform the patient relative of CCU & ITU regarding different tariffs of beds & facilities provided & make them choose their bed category, keep in mind about the category of bed and the gender while booking the bed for every patient.  Maintain correct documentation of bed reservations of the day.  Surrender the reserved beds if not required to the Admission. Department for new admission well on time.

SHIFTING OF PATIENTS FROM ONE WARD TO ANOTHER:

 Inform the concerned ward before shifting the patient.  Reconfirm the availability of the bed.  Check the clearance card before shifting the patient.  After every transfer informs the concerned consultant about the new ward and the bed number to which the patient has been shifted to.  Inform the patient’s relatives about the patient exact location by giving them the bed and the ward number.  Inform the relatives about the visiting time and the formalities of changing the visitors pass from the “May I Help You” counter.  Provide the relatives with the extension number of the ward.  Update the allocation board and the system simultaneously.

PACKAGE AND NON PACKAGE UPDATION:

 Yellow sticker denotes Package Patient and red denotes Regular Paying/Non-package patient.  Change sticker on the patient’s file appropriately for the purpose of correct billing.  For any clarification regarding billing call up the billing department.  Convey all communication about patient billing if suggested by the consultant, to the billing department.

DAY TO DAY MAINTAINANCE:

 Take note of all maintenance requirements including repair/replacement in the ward on daily basis during the rounds.  Maintain record of requirement of maintenance in PEARL register.  Keep in touch with the said department till the work is completed.  In case if the required maintenance is not carried out within 48hrs of reporting, bring it to the notice of the SR.IPD MANAGER directly.

COLLECTING REPORTS FOR THE PATIENTS:

 Send the X-Ray requisitions (I-1)to the radiology department for reporting on daily basis.  After 48hrs contact the department for the reports.  Keep the reports in the patient file.  Send the reports of the discharged patients to the MRD department.  Taking a list from Ward in charge containing all the due reports, contacting with the concerned department & collecting the reports.  In case of any delay of report following up regarding the same.

ADMINISTRATIVE WORK FOR THE WARD:

 Prepare planned discharge list of the ward by 5pm everyday & keep the same in server hence any person can go through the discharge list of a particular ward.  Inform the relatives about the discharge procedure for planned discharge during the visiting time.  Furnish following information to the relatives:  Time of discharge.  To report first at Discharge desk in Admission room & take the Provisional discharge pass if both discharge summary& bill is ready.  Take final bill from cash counter & clear all the billing formalities.  Relatives should get the dress.  Prepare the Patient list in the ward.  Handover one Patient list to the security once in the morning & during the visiting time.  Take rounds during the visiting hours and attend to the queries of patient’s relatives.  Refer to the Senior IPD Manager for any problems.  Check the patient tasting food before the food is served & give a round during lunch & dinner.  Checking the food being served for the patients attendants.

OPERATIONAL DOCUMENTS TO BE MAINTAINED IN THE WARD:

 Photocopy of charge sheet in MRD file  Pearl register  Charge sheet sending register  File sending register  Slipper register  Corporate report sending register  MRD register  Stock Register of ward items less clinical.  Receipt of patient’s medical file handed over the various departments. PROTOCOLS TO SEND PATIENTS OUTSIDE THE HOSPITAL FOR TEST:

 Call up the required hospital and take the booking for the patient.  Note the details about the time, the cost of the test, required preparation of the patient and the documents that the patient need to carry.  Inform the consultant and the sister in charge of the ward.  Check with the consultant whether the patient requires any escort or not.  In case the patient requires a paramedic for escort, and then inform the doctor of the Emergency ward for the needful.  Organize vehicle conveyance of patient with the support services.  Handover details of the patient to the escort accompanying the patient.  Ensure the form for sending a patient outside the hospital for test is completed in all respect before sending the patient.  The form should be duly signed by the Medical Super, Nursing Super, Security Supervisor and the Sister in charge of the ward.  Inform the MOD and the Floor Manager.  The Floor Manager will write an interdepartmental note to the GM Finance for the cash required for the test.  The patient name, ward number, the required cash, the destination and the time of arrival should be given to the hospital escort who will accompany the patient.  All the details should be provided to the patient relatives.  Patient relatives may or may not accompany the patient, however in case the patient is below 14 years of age then relatives will accompany.  Patient to wear the hospital uniform only.  Patient file may be given for reference if the patient is going to R N Tagore Surgical Centre.  If the patient is going to any other hospital, then photocopy of the reports and prescription should be given.  Keep in touch with the hospital driver as or when required.

PROTOCOL-DISCHARGE OF PATIENTS:

 Handover the patient medical file to the ward RMO to write the draft discharge.  Send the file along with the draft discharge to the Discharge Typing Section.  Instruct nursing staff to return back the unconsumed medicines to the store and obtain the return voucher  Received the Return Voucher and keep it in the patient file.  On receipt the return voucher sends the Charge Sheet to the billing department & does MARK FOR DISCHARGE in system to generate the final bill.  Enter the patient’s name, the ID number and the name of the HK in the “Charge Sheet Sending Copy” and send to the billing department.  After receiving the Charge Sheet Sending Copy please check the receiver’s signature.  Inform the patient party about the discharge time and the formalities.  In case the patient is of Corporate/TPA category then only the photocopy is to be given and original sent to the corporate billing desk  In case the patient is an MLC (Medico Legal Case) only photocopy is given and originals are sending to the medical record department.  In case DORB (Discharge on Risk Bond) the relatives have to sign the DORB form declaring reason for taking their patient& intimate the same to the Consultant, IPD manager, Medical Superintendent & the same is kept in the MRD file before the discharge procedure commences.  The RMO has to take the signature of the patient NOK (Next of Kin as recorded in the Admission Form) on the DORB form.  In case of DORB all original documents are given to patient.  Rest of the Discharge Procedure remains the same as enunciated before.  At the time of discharge coordinator must check the discharge I.P. card to confirm the bill clearance, put signature & time in Discharge time tracking card, provide the patient with Feedback form.  After the patient is dressed up & the explanation of discharge sum & medication is done by nursing staff co-coordinator must counter check the patient file & take patient relative signature confirming that they get all the correct reports of their patient.  If the patient relative faces any language problem in understanding the discharge sum she will help them to clarify queries.  Provide the patient a wheel chair & HK girl to escort the patient till the hospital premises. CORPORATE DISCHARGE:

 In case of both planned & unplanned corporate discharge coordinator has to check with corporate desk regarding the discharge time.  Act proactively to make fast the discharge procedure as after the final bill & discharge summary are prepared the Corporate desk send the bill for sanction.  Check minutely the discharge file & hold all the original documents for corporate billing.

SENDING MRD(MEDICAL RECORDS) FILE:

 After every discharge MRD file is prepared.  Enter the details in the MRD record register  Send the files to the MRD department within 48hrs of the discharge.  Check list maintained for MRD file:  C-14  C-15  Discharge card  Sign in admission paper  P.F.E.  Dr. sign in discharge summary  Final bill  Discharge order  Photo copy charge sheet  Consent paper  D.C. & death sum  DORB form  All lab reports signed by Doctor.  Consultants sign in 24 hours

 If a file is returned back from MRD department due to some reasons she has to make the file ready at the earliest & send the file back to MRD.

MANAGEMENT OF STORE:

 Ward coordinators are responsible for intending the general store of wards.  Weekly once the general intends are made in store after thoroughly the stocks are checked. Intends are made keeping in mind the cost factor .

ROLES AND RESPONSIBILITIES OF A DIETICIAN:

 Nutritional assessment of in patients and fixation of their diet plan.  Formulation and regular modification of various hospital diets.  Planning and monitoring of special liquid homogeneous diet plan.  Diet counseling and distribution of diet chart to out-door patients.  Planning diet for each patient through diet sheets and provides information to kitchen staffs well in advance to ensure timely supply.

ROLES AND RESPONSIBILITIES OF F& B INCHARGE:

 Monitoring the overall operation of canteen and kitchen from where food is served to the in-patients.  Planning of menu and kitchen operation.  Looking after the standard of services, cooking method, overall cleaning.  Checking all the billing, accounting and food costing of catering services.  Handling and sorting out in-patient’s complaints regarding quality of food and food services to minimize their inconvenience.  Checking the quality of food and services.  Handling and organizing all outdoor and indoor catering of our hospital.

ROLES AND RESPONSIBILITIES OF CANTEEN INCHARGE AND SUPERVISOR:

 Supervising overall activities of all kitchen staffs.  Follow instruction given by the dietitians and F&B In charge.  To maintain hygiene and cleanliness of the kitchen.  To ensure that the kitchen premises, cooking and serving vessels are maintained in clean and hygienic manner.  Supervising overall activities of all Pantry area and service staffs.  Follow instruction given by the Canteen In charge.  To maintain hygiene and cleanliness of the pantry.  NPM Orders and emergency snacks and beverages order served in priority basis.  To check the food or meal of the patients as per prescribed by the dieticians and doctors.

DIET PLANNING FOR PATIENTS:

1. RESPONSIBILITY-The dietitians are responsible for planning of the patient’s diet and their consolidation for preparation by the kitchen staffs. 2. ASSESSMENT OF PATIENT DIET REQUIREMENT-Dietitians fill up nursing assessment diet record sheet with patients bed number, respective diet advice, clinical conditions and specific requirement during morning ward visit, keeping in mind new admission, change of diet, bed transfer and discharge intimation.

QUALITY ASSURANCE IN DIETARY SERVICES:

1.PURPOSE- To ensure good quality of patient food and achieve a high level of satisfaction of patients and guest regarding the food and beverage services of the hospital. 2.RESPONSIBILITY- The F & B In charge are responsible for ensuring the quality of food provided and ensuring its monitoring through established methods. 3.PROCEDURE- The F & B In charge / Floor coordinators/Sister in charge taste the food prepared for the patients for lunch and dinner to ensure quality in the food being served to the patients. The supply of food to the patient does not commence without approval of them. 4.FEED BACK ABOUT F&B SERVICES- A feedback form is provided to each and every patient before their discharge to get a feedback about the food services and any suggestions. Any complaints / grievances / inputs regarding F & B services are registered through the complaint management system of PEARLS.

PEARLS: Patients and Employee Ailment and Resolution and Learning System, shortly called as PEARLS. All Kinds of complaints can be raised to a single forum. Complaints are tracked and resolved which triggers corrective & preventive actions.  Continual improvement- It provides a basis for continual review and analysis of complaints-handling process, the resolution of complaints and where improvements can be made.  Operational efficiency- It ensures a consistent approach to handling complaints, enabling to identify trends and eliminate the causes of complaints, as well as improve organization’s operations.  Management Information-An effective complaints and feedback management system should provide management information that is essential in identifying problem areas. It can tell which areas need improvement and how you can efficiently plan your resources.  Customer Care- By adopting the complaint management system, ability to retain the loyalty of patients will be enhanced. The organization is committed in managing customer care issues and has processes in place to handle, analyse and review complaints.  Continual Process Improvement- Co-coordinators prepares different trackers in the process of day to day Improvement. They are- 1. PAEDIATRIC LIST:  This list is maintained to track all admitted pediatric patient in hospital  Details of every pts like admission date, consultant, status, diagnosis are maintained in this list  The waiting surgical &post-surgical list is maintained here  Occupancy of pediatric pts is tracked & consultants are informed regarding stopping admission when occupancy is high. 2. EDOD TRACKER:

 This tracker contains the details of a patients expected date of discharge.  With the help of this tracker we come to know the discharge date of a patient & start prepare the necessary arrangements  Can inform the patient relative regarding coming discharge thus helps them to prepare themselves to take their patient home.  Ask them to attend classes provided by nursing staff regarding home care of their patient.

3. ITU TRACKER:  This tracker contains the post-surgical stay of a patient in ITU.  With the help of this list we track the average Length of Stay of a patient in ITU.

4. TR IN AND TR OUT TRACKER:

 This tracker is maintained in critical care areas.  Purpose of this tracker is to see the average Length of stay for any critical care patient both surgical & observation pts.  This tracker contains turnaround time of a patient in critical care units.  The tracker also gives the data of different specialties turn over in different critical care units & diagnosis.

5. MASTER TRACKER:

 Master tracker is based on details of the discharge of all pts in a day.  All area of our hospital is covered in one tracker.  The declared time of discharges for both planned & unplanned pts & the exact time of discharge are reflected in this tracker.  The list helps to track the on time discharge& delayed discharge at one glance.

6. BED VACANT TRACKER:

 Ward coordinators keep a note of daily distribution of beds for NA.  With the help of this list we track the time of a bed is asked for admission, the time we allocate the bed, when the bed is vacant & finally when the patient is received in ward.

7. INVESTIGATION TRACKER:

 Purpose of this list is to track the time taken of a patient s diagnostic investigation.  We track the loopholes of the delay behind & give extra effort to minimize the time for any investigation.

8. PATIENT ROUND TRACKER:

 Ward coordinators keep a note in patient list regarding communication made with pts in morning & evening round.  If any problem a patient faces during hospital stay that is notified thus try not to repeat the same. All the trackers are maintained on daily basis to improvise the day to day activities of support services enhancing towards continuous quality improvement.

JOB DESCRIPTION OF A WARD COORDINATOR

ROLE- To act as a facilitator to ensure highest standard of all round care of the patients of their ward at all times and coordinate all clinical, nursing and operational activities related to care of the patients.

RESPONSIBILITY AS A COORDINATOR-

 Coordinator should be present on time at their respective wards.  Coordinate their respective wards with a smiling gesture, appropriate body language and polite behavior with all.  Coordinate and book beds as per requirement.  Expedite smooth discharge of patients and coordinate with printing, billing, return store & corporate department for it.  Coordinate cleanliness and smooth functioning of the ward in coordination with the HK supervisor and nursing staffs  Coordinate smooth and timely transfer of patient to other wards as per clearance card and inform the patient parties accordingly.  Coordinate with admission room for bed allocation.  Coordinating with different departments for sending a patient outside for any tests.  Coordinate repair of all items (electrical, biomedical, sanitary and civil) with concerned departments through pearls and keep a documentation of the same.  Update the Master register of the ward.  Update the allocation board.  Update the software during the tenure of their duty.  Make the inpatient list and discharge list and circulate as per requirements.  Keep the concerned consultant informed with regards to arrival of their patient to the ward and confirm their discharges.  Answer to administrative queries of patient relatives.  Circulate and collect feedback forms and send them to the respective departments.  Maintain the following documents in the ward related to operation- a) Patient grievance register

b) Patient slipper register c) File sending register

d) Charge sheet register

e) General stock registers of ward

f) Basic health education forms

g) Medical records register

h) Pearls register

i) X-ray reporting register

j) Corporate report sending register

k) Capital items register

 Interact with patients during their tenure of duty and ensure availability for any problem they face.  After admission interact with patients and relatives and give some basic information about the hospital protocol.  To speak with every patient while giving ward round and document the problems and keep a softcopy of the same in respective wards and try to solve the problems with the help of HOD s.  Act as a bridge between patients, doctors, nursing staffs and administrations.  Indent all requirements of the ward through HOD from general store  Change the stickers (package/non-package) on the patient file.  Take rounds of the ward during lunch and dinner and solve problems arising there.  To maintain a count of lunch & dinner plates served for the patient and make an entry in tally of the same daily.  To check the smooth serving of food till the end whether extra food is properly given or not. To check if the crockery s is removed on time.  To make it ensure that the in pediatric wards the attendants have food on proper time.  Co-ordinate for ASSAM and ORISSA GOVT pts to make them easy in wards. Have the proper food arrangements, look after their lodging arrangements when patient is in ITUs and make proper arrangements of their discharge.  Solve any issues regarding the medicine indent & return or clinical items placed by nursing staffs.  Give rounds for corporate patients and send their x-ray plates for reporting as per requirements.  After the discharge of patients collect all the pending reports and send to respective departments.  In case of discharge or expiry of MLC patients, send a Xerox of MLC paper, admission paper and discharge or death certificate to the MOD and also collect a received copy from them and keep in the MRD file.  Taste patient’s food before serving to patients.  Maintain inventory of their ward and account for every item.  Send all relevant medical documents after rechecking to MRD within 48 hours of the discharge of the patients. All the files should have the Final Bill for that particular admission.  MRD files are checked in different criteria as follows- . C-15 . C-14 . Consultant signature within 24 hours . Proper discharge order . Signature of doctor present in all blood reports . PFE paper present in file . All consent paper is properly signed . Photocopy of charge sheet present . For expiry patient to check D.C. & death summary  If the MRD files are not having the Xerox copies of charge sheet, then try to arrange it from the billing department.  If files are returned from MRD for any kind of incompletion to co- ordinate with nursing staff to make the file ready and send back to MRD within 48 hours.  Take classes of the nursing staffs to help them in administrative works  To manage all kinds of problems arising in emergency situations in the ward through the help of their HOD.  Report all lapses and ward incidents in their ward to the Floor Manager.  Response to all emergency codes and acts accordingly.  While giving discharges check all the reports present in patient’s file and final bill of the patient and discharge card.  As doctor confirms the discharges co-ordinate with medicine return store to return the residue medicines and co-ordinate with billing department for Final Bill and inform patient parties also the same. Arranging the discharge summary to be written by concerned doctor & send the pink sheet with file to printing department for preparing discharge summary.  Co-ordinate with discharge printing department time to time for making ready the discharge sum in 3 hours of time to make the discharge happen in between 4 hours and try to make the vacant as early as possible.  Maintain a proper discharge list where the timings are maintained for sending medicine for return in store, after return the time of sending charge sheet, the declared time for patient to come for discharge, time of sending the file for making sum. The discharge list is kept in server for every respective ward & this list is updated till the co-coordinator leaves ward at the end of day.  Co-ordinate with all the investigation rooms to get all the tests done and get the respective reports on time.  Prepare all the corporate files with all the reports as per the final bill and send it to corporate department within 48 hrs.  Co- ordinate with nursing staffs and give support to them to run the ward smoothly.  Co-ordinate with House Keeping department for patient’s linen and send a written document for required linen.  Maintain all the lists of the ward and send it to HOD.  Co-ordinate with doctors for patient’s proper treatment, patient’s transfer, inform referrals.  Inform patient parties about their OT/ CATH timings while taking the patient to OT or CATH lab or any unplanned tests need to be done.  Get the print out of all the blood reports of ITU1/2 and ITU7/8/9 and get it signed by the doctors and keep it in patients file.  Give updated information to MAY I HELP YOU DESK and DISCHARGE desk  Check the green files of patients having printed pre op Echo report, Family Education paper, proper admission paper containing surgeon’s name.  Send day to day X- ray reporting for corporate patients.  In GWs for surgical pts maintain a daily tracker for Expected Date of Discharge and work accordingly.  In ITU s for surgical pts maintain a daily tracker for shifting the pts from ITU to ward in proper time.  In Pediatric GW maintain a daily list of all pediatric pts in hospital for regular updating of pediatric pts.  In CCU & ITU maintain a Transfer in & Transfer out tracker of pts arrival & departure time and send the same to Quality department in every fortnight.  Co-ordinate for minimum usage of resources to maintain the cost.

MAINTAINING DISCHARGE MASTER TRACKER: This tracker is maintained daily to evaluate the causes behind the discharge time taken for every patient in different specialty.  Signing on admission slip mentioning the exact time of the arrival of patient in wards thus cooperating with Admission department to track the PT REPORTING TRACKER & track the time taken from a pts arrival for admission to receiving in the ward.  Signing on provisional discharge card mentioning the time thus cooperating with the Discharge department to track the pts total time of discharge from giving the discharge pass to vacating the ward.  Maintaining BED VACANT TRACKER in patient list where the time is tracked from a bed is allocating to NA & EMG & when the bed is vacated & when the patient is being received.  Taking special care for International patient. There are some particular procedures for Bhutan or Assam or Nigerian patients. Coordinator is supposed to take care of different criteria s of these pts & to look after the comfortable stay of these patients. Co-ordinate with International cell to provide post discharge medicines for Bhutan patient.  To coordinate with the Bed manager to cater maximum beds in every ward& to keep a record in charge sheet if a patient can’t be shifted to require ward or upgraded & take HOD s sign for smooth billing. The same has to be mailed to HOD & nursing manager.  Giving a round during visiting hour & communicate with patient relatives to share their problems & try to help them in every possible way.  Documenting & filing the paper of daily rounds of morning & evening.  Checking the admission criteria of pediatric patient & change the admission paper accordingly if necessary.  To change admission paper whenever necessary in case of surgical reference (joint admission)  To co-ordinate DORB (Discharge on risk bond) with special care. In case of DORB try to make discharge ready by 2 hours. Informing Medical Super, nursing super, HOD regarding DORB. Making the patient relative state the reason of taking their patient on risk bond in a DORB form. Keeping the form in MRD file.  Preparing isolation room when required for isolation patients. The AC duct needs to be covered before making the rooms isolate.  Coordinating with nursing staff to maintain cleanliness of wards thus coordinating with HK department for high level cleaning & fumigation.  Collecting the procedure boxes of corporate patient (like PTCA, PPI) & sending them to corporate office.  Attending all the training classes.  Maintaining PLAY STATION in pediatric ward. Doing all the necessities to maintain the play area.  Coordinating different criteria of different specialties to prepare discharge summary. In addition to the above, the manager may assign responsibilities as necessary from time to time.

SAFETY AND SECURITY

 Coordinators give maintenance rounds daily. Checking of toilets, electrical are done on regular basis. Whenever a fault is found we make Pearls complain is made & the stakeholders are informed verbally to repair the fault at the earliest.  Rounds of calling bell, side rails, safety belts of wheel chairs & trolleys are made regularly. Whenever a fault is found we make Pearls complain is made & the stakeholders are informed verbally to repair the fault at the earliest.  The time of admission we give patient& relative teaching every time. We educate the patient regarding their safety methods, rights &responsibilities. Education of calling us with a bell, lifting up the side rails at the time of rest is important, how to keep babies while sleep, how to walk in wards when a cleaning is going on, in a demand to speak with us, what to do in case of spillage, not to go to toilet without assistance, all these are communicated to the patients.  Everyday rounds are given to patients. We take a feedback from every patient & educate same in our daily rounds.  Dieticians give rounds & keep track of every single patient diet. We supervise the lunch & dinner served. We test the food before serving to secure the patients safety.  We send MRD files of a patient within 48 hours to make sure the file is not lost.  We collect all the reports ready & collect the pending reports too & make sure the reports are sent to MRD to make the patient reports secured.  At the time of discharge, we check the bill & bill no to make sure the final payment is made. We are having papers where patient attendant signs & take the patient. After the patient relative is explained the discharge summary signature is taken in discharge summary to secure his consent in understanding the discharge summary. We take signature when the patient file is handed over after the relative counter check the file that he is receiving all the reports of his own patient to secure his consent in getting all the correct reports.  We countercheck if a patient is wearing ID band as this is the patient’s identification marker after the patient is admitted.

INPATIENT IDENTIFICATION

• Identification band shall be provided to all the patients at the time of admission with the help of which he/she shall be identified during his or her stay irrespective of the condition (conscious / unconscious).

 A tamper-proof, non-transferable identification band shall be affixed to the patient’s wrist.  ID band shall consist of:  Patient’s name, age, sex and blood group in block letters.  Patient’s ID number and date of admission from the admission report.  Diagnosis by seeing the OPD sheet form.  Signature of the nurse who is tying the band  Patients are educated not to remove the ID band.  ID band shall be checked daily before any investigation, procedure and administration of medication. The patient name will also be asked to confirm the patient identification.  The following colors codes shall be used for the patient:  Cardiac patient - Blue  Non cardiac patient – Yellow  Patients falling under the vulnerable group are provided with the same color coded ID bands but with a “V” marked on it.

PATIENT VALUABLE POLICY

 POLICY:  To safeguard the valuables of its patients.  To inform the patient that the hospital cannot assume responsibility for valuables or personal property retained by them.

 SCOPE: All inpatient areas.

 DEFINITION:

Valuables – Items identified by RTIICS staff or the patient as having significant monetary or personal importance. Examples include but are not limited to: Old medical records, Cash, Credit and debit card, Jewelry, document, passport, spectacles, denture, mobile phone.

 PROCEDURE:  The Hospital is not responsible for lost, theft, or breakage of personal items that the patient maintains in their possession while hospitalized.  During admission, the admission room staff and the floor coordinators/ nurse in-charges explains the patient /relatives - the necessary items to be brought by the patient on admission.  On admission the nurse shall handover the jewelry, old medical records, clothes, and any other belongings to the relatives and shall get their signature confirming the handing over.  All old records shall be photocopied before handing over and photocopy shall be kept in the case file.  All the old medication brought by the patient/ relatives shall be returned to them.  Patient shall be informed to take care of the other belongings that they bring along such as mobile phones, spectacles, dentures, etc on admission.  On transferring the patient for Surgery/ any other procedure/ to critical care areas, the nurse shall make sure that the relatives have taken all the patient valuables.

METHODOLOGY

TRAINING DURATION: 04/01/2018 to 03/04/2018 TIMING: Monday to Saturday from 09:00 A.M to 05:00 P.M.

DATA COLLECTION METHOD:

PRIMARY DATA- A questionnaire had been formulated in order to collect the primary data consisting of close ended questions and open ended questions. Questionnaire was mainly objective types based on Inpatient department services, waiting time, facilities, behavior of the staff, and support services.

SECONDARY DATA- The secondary data had been collected directly from the hospital, with the help of hospital yearly records and other reports. Number of samples- I have collected data from 50 samples. The data were mainly collected through observation during the training period and regular interactions with the doctors, employees, and nurses of the hospital.

DATA COLLECTION

DOCTOR’S ENTRY TIME EVALUATION:

>30 MIN 30MIN-1HR 1HR-2HR 2HR-3HR

TIME DOCTOR’S ENTRY >30MIN 8.2 30MIN-1HR 3.2 1HR-2HR 1.4 2HR-3HR 1.2

STAFF WORK EFFICIENCY:

Work Efficiency

50%

45%

40%

35%

30%

25% PERCENTAGE

20%

15%

10%

5%

0% EXCELLENT VERY GOOD GOOD FAIR

WORK EFFICIENCY PERCENTAGE EXCELLENT 50% VERY GOOD 35% GOOD 30% FAIR 10%

INTERPRETATION: From the above data it can be seen that the staff work efficiency is 50% excellent, 35% very good, 30% good and 10% fair.

NO OF ADMISSIONS:

NO. OF ADMISSIONS 900

800

700

600

500

NO. OF ADMISSIONS 400

300

200

100

0 JAN'18 FEB'18 MAR'18

MONTH NO. OF ADMISSIONS JAN’18 652 FEB’18 762 MAR’18 795

INTERPRETATION: From the above data it can be seen that there was 652 admissions in the month of January, 762 admissions in the month of February and 795 admissions in the month of March in general wards. NO OF DISCHARGES:

NO. OF DISCHARGES

790

780

770

760

750 NO. OF DISCHARGES 740

730

720

710

700 JAN'18 FEB'18 MAR'18

MONTH NO. OF DISCHARGES JAN’18 734 FEB’18 750 MAR’18 783

INTERPRETATION: From the above data it can be seen that there was 734 discharges in the month of January, 750 discharges in the month of February and 783 discharges in the month of March in general wards.

QUALITY OF FOOD MAINTAINED:

QUALITY OF FOOD MAINTAINED 80%

70%

60%

50%

40% QUALITY OF FOOD MAINTAINED

30%

20%

10%

0% GOOD FAIR Poor

QUALITY OF FOOD MAINTAINED PERCENTAGE GOOD 75% FAIR 25% POOR 10%

INTERPRETATION: From the above data it can be seen that quality of food maintained was 75% good, 25% fair and 10% poor.

NO. OF SURGERIES PERFORMED IN GENERAL WARDS:

450

440

430

420 JAN'18 410 FEB'18 MAR'18 400

390

380

370

360 No. of surgeries performed

MONTH NO. OF SURGERIES PERFORMED JAN’18 390 FEB’18 420 MAR’18 450

INTERPRETATION: From the above data it can be seen that there were 390 surgeries performed in the month of January, 420 surgeries in the month of February and 450 surgeries in the month of March in general wards.

PERCENTAGE OF SURGICAL SITE INFECTION IN GENERAL WARDS:

0.3

0.25

0.2 JAN'18 FEB'18 0.15 MAR'18

0.1

0.05

0 % of SSI

MONTH % OF SSI JAN’18 0 FEB’18 0.27 MAR’18 0.3

INTERPRETATION: From the above data it can be seen that there was 0% of SSI in the month of January, 0.27% of SSI in the month of February and 0.3% of SSI in the month of March in general wards.

ALOS IN GENERAL WARDS:

ALOS

JAN'18 FEB'18 MAR'18

MONTH ALOS

JAN’18 4.64 FEB’18 4.62 MAR’18 4.85

INTERPRETATION: From the above data it can be seen that the Average length of stay in January was 4.64, in February was 4.62 and in March was 4.85 in general wards.

BED OCCUPANCY IN GENERAL WARDS:

BED OCCUPANCY

MAR'18

FEB'18 BED OCCUPANCY

JAN'18

70.00% 75.00% 80.00% 85.00% 90.00%

MONTH BED OCCUPANCY JAN’18 76.42% FEB’18 83.47% MAR’18 88.91%

INTERPRETATION: From the above data it can be seen that the bed occupancy rate in January was 76.42%, in February was 83.47% and in March was 88.91% in general wards.

TOTAL DEATH IN ITU 1 & 2, NICU:

TOTAL DEATHS

3

2.5

2

TOTAL DEATHS 1.5

1

0.5

0 JAN'18 FEB'18 MAR'18

MONTH TOTAL DEATHS

JAN’18 2

FEB’18 3

MAR’18 1

INTERPRETATION: From the above data it can be seen that the number of total deaths in January was 2, in February was 3 and in March was 1 in ITU 1 & 2.

REASONS FOR DEATH:

NUMBERS

2 1.5 1 0.5 NUMBERS 0 HEART NUMBERS PNEUMONIA FAILURE ARRHYTHMIA UTI

REASONS FOR DEATH NUMBERS HEART FAILURE 2 PNEUMONIA 1 ARRHYTHMIA 2 UTI 1

INTERPRETATION: From the above data it can be seen that the reasons for death was heart failure, pneumonia, arrhythmia and UTI in ITU 1 & 2.

MORTALITY PERCENTAGE IN GENERAL WARDS:

MORTALITY % 2.80%

2.75%

2.70%

2.65%

2.60% MORTALITY % 2.55%

2.50%

2.45%

2.40% JAN'18 FEB'18 MAR'18

MONTH MORTALITY % JAN’18 2.75% FEB’18 2.54% MAR’18 2.62%

INTERPRETATION: From the above data it can be seen that the mortality percentage in January was 2.75%, in February was 2.54% and in March was 2.62% in ITU 1 & 2. SUMMARY OF FINDINGS

PROBLEM AREAS IN THEINPATIENT DEPARTMENT:

 Planned Discharge: - 1. Availability of RMOs to write the pink sheet-  RMOs are looking after more than 1 unit. One RMO is responsible for 7th floor GW & 7th floor HDU as well 8th floor.  If a cardiac surgery patient is being told to be discharged the very next day when the ECHO is not done the summary gets delayed as the adult ECHOs are done after 2PM till evening. The reports get ready next day (no time limit can be after 2 PM). 2. Some of the CATH reports are delayed due to consultant’s unavailability. 3. Last minute correction in the discharge summary by consultants or referrals takes too much time to change the summary. 4. Sometimes Printing Department makes mistakes in summary like medication time error or wrong ID. Changing the summary takes time. 5. Summary are not written properly in the pink sheet. Discharge printing as to clarify many things with the nursing staffs & RMOs.

 Unplanned Discharge: -All above points remain unchanged in case of unplanned discharges.

 Clinical Problems: - 1. Patient relatives have many clinical queries (RMOs are not available to speak to them). 2. Intimation of Discharge- Consultants does not inform the discharge at proper time in wards. 3. We come know from relatives that one particular patient is being asked to discharge.

 Nursing: - 1. When a bulk of discharge comes at the same time the nursing staffs are unable to make the entire patients ready at the same time due to less nursing staffs. 2. Collection of reports by nursing staff is a big problem. At the last moment they ask for X-ray plates or other diagnostic reports which they don’t collect at the proper time. In last hour we have to arrange a HK girl and collect the reports. 3. Discharge files are not kept ready all the times. 4. Sometimes discharge summary is not signed by the nursing staff and the patient relatives as nursing students release the discharges and they didn’t know about the procedures. 5. If a coordinator is not available for any reason they don’t send the file for printing or charge sheet for billing quickly. 6. Medicine returns by nursing staffs are not done properly. Many times medicines are left unreturned in the cupboard. 7. Explaining discharge summary by junior staffs takes a long time as they are unable to explain properly.

 Arranging wheels: -Wheel chairs along with HK girls are a time taking factor for every patient.

 Billing problems: - 1. Patient relatives come to the ward with many billing related problems. Final bill settlement takes a long time.

 Housekeeping problems: - 1. Behavior of some of the housekeeping staffs is very bad. 2. There are always less number of housekeeping staffs which make it difficult for the patients to go for certain tests and discharges.

RECOMMENDATIONS:

1. At least two RMOs should be present during the morning & afternoon shift to cope up with the huge discharges. 2. RMOs should be requested to write the summary properly in the pink sheet so that discharge printing is not delayed. 3. Nursing staffs should be appointed more. 4. Discharge files should be made ready prior to the discharge time. 5. Nursing students must be well trained before giving them duties in the ward. 6. Before returning medicines all cupboards should be checked so that no medicines are left. 7. Senior staffs must explain the discharge summary as junior staffs cannot do it properly. 8. Final bill settlement time must be reduced. 9. Housekeeping staffs should be educated to behave properly with coordinators and the nursing staffs. 10. More HK staffs should be appointed in the GW as it remains busy for the whole day. 11. Need to focus on time management.

12. The staff discipline should be more improved.

13. No of chairs, outside the wards should be increased.

14. Public holidays should be clearly displayed on the notice board for the

convenience of the patient.

15. Better communication should have made between the staffs.

16. Lack of coordination between the staffs, there should be more clarity.

CONCLUSION

The inpatient department is becoming more and more important. Ambulatory care reduces dislocation of work, is cheaper and at the same time gives access to the various investigative and diagnostic facilities of the hospital.

The hospital should have a policy for its inpatient services regarding admission process, discharge process, surgeries, food and cleanliness, VIP patient protocol, and activation of disaster program on the event of disaster, drug distribution system, billing system, contracting system. These are broad guidelines for the IPD administration by the governing board for day to day decisions. Analyses of quality information on patient experiences of inpatient hospital care should not only take the hospital level, but also at the more specific department level into account.

Patients attending the hospital are responsible for spreading the good image of the hospital and therefore satisfaction of patients attending the hospital is equally important for hospital management. Therefore it can be concluded that IPD services form an important component of hospital services and feedback of patients are vital in quality improvement.

BIBLIOGRAPHY

1. HOSPITAL ADMINISTRATION by DC JOSHI and MAMTA JOSHI. 2. https://www.narayanahealth.org 3. https://en.wikipedia.org/wiki/Rabindranath_Tagore_International_Institu te_of_Cardiac_Sciences 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958929/

REFERENCE

1. Academy of Hospital Administration- DM & HM, Module for Paper II, 1992. 2. Chaubey PC, et al. Getting maximum from your hospital bed by reducing pre-operative stay, JAHA, Vol.4, No.1. Jan 1992. 3. Kausal V- A study of visitor’s inpatient area of a teaching hospital beyond visiting hours- JAHA, Vol.7, No.2, July 1995, Vol.8, No.2, Jan 1996. 4. Sarma RK, et al. Work Study of Nurses in Medical ward in a super specialty hospital- JAHA<, Vol.10, No.2, Jan 1996. 5. Vijai R. Emergence of corporate hospitals- JAHA, Vol.3, No.2, July 1991. 6. WHO Monograph Serial No. 54, Hospital Planning and Administration, 1995.