1.Access, Assessment and Continuity of care

AAC.1.a) SERVICES OFFERED BY HOPE HOSPITAL

OPD AND IPD SERVICES FOR FOLLOWING DEPARTMENTS

1)Department of Bone and joint surgery

  • Fractures
  • Re-constructive surgery of complex fractures 
  • Total Knee Replacement
  • Total Hip Replacement
  •  Revision Joint Replacement 
  •  Knee Arthroscopy
  •  Shoulder Arthroscopy
  • Simple & Complex Trauma Services,
  • Pediatric Orthopedics,
  • Medical Surgical management of Arthritis,
  • Rehabilitation Program


2) Trauma Care Center

  • General trauma Surgery
  • Vascular / Microvascular Surgeries
  • Neuro trauma surgery 
  • Spine  trauma surgery


4) Diagnostic Services

  • X Ray
  • Pathology
  • (C.T.Scan, MRI, are available on tie-up basis)

5)Physiotherapy

6)Pharmacy


7) Intensive Care Unit

8)Operation Theater

9) Special Rooms

10)Twin Sharing

11)General ward





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AAC.2.a)Procedure for registration

1.    Aim:

This terminal deals with the registration of the patient. In this process a Registration No. is given to the patient. The file is created for the patient and it is continued for any  OPD process consultation / procedure .The registration no. is mandatory for any treatment or investigation in the hospital.

 

2.    Responsible personnel in the department:

1.    Front office assistants

 

3.    Rationale:

1.    To make a unique identity no for the patient  in the hospital for treatment

2.    All the demographic information is captured for statistics.

 

3.    Procedure:

This involves filling up the patient’s details in the registration module.

Registration is mandatory for all patients

 

·         Patient’s details are written the in the IPD/OPD register.

·         Patient’s particulars like name, age, address, phone no, payment category, family physician and consulting doctors name.

·         The fields which are mandatory are marked as red in the software.

·         The patient’s data is fed in the system and registration no. is generated.

·         After doing registration, that patient’s profile is generated in the software.

 

Other duties

1.    Ensure registration numbers and other details are accurately written in the IPD register and patient’s file..

2.    Educate the patient’s relative about patient’s registration and further process. 

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AAC.2.a)Procedure for Admission


1. Aim: 

This terminal deals with the formalities related to admission. Any patient who comes for admission should be registered with the hospital. If the patient comes back for admission in few days then his discharge summary is retrieved from the system, (and file if needed) 




2.   Responsible personnel in the department:

1. Front office assistants



3. Rationale: 

1. To make an account in the hospital for treatment. 

2. To allot a bed for patient’s stay during the hospitalization. 

3.To Ensure Smooth management of treatment at entry level.



3. Procedure: 

This involves the admission of the patient by the admission staff based on the information given by patient/ relative. 


· The different categories of bed and the tariffs are explained to the relative. 

· With the help of occupancy chart, if The room of choice/ward is available ,is allotted to the patient. 

· Facilities are explained to the patient/relative. 

· Registration is done 

All the patient's details are written in the IPD register (Pvt and WCL) with compulsory two mobile and one landline no.

· An IPD  file is made. 

· A general  consent for treatment is taken, form is filled up by the relatives, in that at least 2 relatives mobile no. is taken. The declaration is to be signed by the patient or his relative / next of kin with the full name written clearly on the consent. 

· Once the Performa is completed, it should be filed in the patient’s record. The person on duty at admission counter must sign on the admission form for identification of originator, if the requirement arises. 

· The patient’s relative is then sent to the I.P billing department, with details of admission and the bed/ room allotted, for counselling  payment of deposit. 

· A call is made to the ward regarding the new admission to make the room ready. 




Other Duties- 

· Patients are often admitted in emergency situation. Ensure that the admission procedures are quickly completed, consent is taken and the patient’s record is delivered to the emergency department as speedily as possible. 

· Contact various wards from time to time, (2 hourly) And keep yourself updated with the bed situation and expected discharges. 

· The occupancy chart has to be updated and kept handy. 

· Responding to enquiries regarding admission is duty of front office staff at this counter. Correct information expeditiously given, is of paramount importance. 

· In case of out station enquiries for admission, it is advisable to counter check with wards before confirming bed availability. This is even more significant when a patient is being transferred under emergency circumstances.



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AAC.2.d) Procedure to address managing the patients during non availability of beds.


1. Scope: To provide information and establish guidelines in non availability of beds in the hospital. 



2. Objective: 

1. To provide the patients and their relatives the alternate arrangements in the situation when the beds are not available. 


2.   Responsible personnel in the department:

  • Front office Assistants 
  • Casualty medical officer/casualty sister 
  • Transportation team (Patient assistants)



4) Procedure 

Type of admission 

4.1)Stable admission: 
If a bed is not available at the time of admission, the patient’s relative are made aware of the alternative choices in the hospital. 
The staff should make a call to the nearest hospital and ask whether the bed is available or not. 
If the Patient is ready to go to the hospital , inform the hospital that the patient is being referred (tell name of the patient) 
Guide the patient about how to go to the hospital, make sure that one relative accompany the patient while going. 
Give the OPD assessment sheet to the patient. 


4.2) Unstable admission: 
Emergency patient should be taken in the casualty immediately. 
Give the patient resuscitation needed for life saving. 
Arrange the hospital ambulance and refer the patient immediately to the other hospital. 
Give the patient summary and reports if any. 
Make a call to the hospital that the patient is coming ( tell name of the patient) 

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AAC.3.a)Procedure guide for transferring stable and unstable patients outside

1. Aim: 

To provide guidelines for the transfer of a patient from ward to outside for diagnostic/treatment purpose. 



2. Rationale: 

1. To ensure that the transfer of the patient takes place smoothly. 

2. To ensure patient’s safety & comfort during transfer. 



3. Procedure: 
The ward staff would confirm the physician’s order for the procedure/ transfer. 
Take appointment for the procedure. 
Patient and Relatives are explained about the procedure and the time of appointment. 
Consent is taken by the doctor on duty. 
The staff would confirm the same with respective hospital/ center before transfer. 
Family /relatives should be notified about the procedure. 
As per the appointment the transportation team/ward boy is called. 
Arrange ambulance according to the condition of the patient. If the patient is critical arrange critical resuscitation ambulance, it stable then a service van or any other vehicle. 
Send the patient to the outside centre along with the housekeeping personnel. 
Patient to be accompanied by patient assistant and a relative.
Send the required documents along with the patient. 



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AAC.14. a) Procedure for Discharge ( Private/ TPA/ MLC)



1. Aim: 

To provide guidelines to the ward staff on how to discharge the patient . 


Rationale:

1. To ensure that the discharge of the patient takes place smoothly. 

2. To ensure patient’s safety, satisfaction & comfort during discharge. 

3. To reduce the time involved in planned discharge & physical discharge. 

4. To protect the hospital from medico legal issues involved in DAMA. 



2. Procedure: 

1) Consultants write a discharge orders after the consultant finds the patient fit to get discharge. 

2) The resident doctor on duty put  the discharge notes and then ward nurse checks the billing activity , updates it and then send it for billing and summary . 

3. Resident doctors check the discharge summary & sign on it  & obtain the signature of the consultant also.  

5. Return all required medications to the pharmacy .  

10. Remove all blank documents.  Collect all pending investigation reports. 

If the patient is Pvt then handover all Original copies of investigations to the patient and keep photocopies in the IPD file.
If the patient is TPA then handover all photocopies of investigations to the patient and keep  Original copies in the IPD file.
(In TPA case all originals are faxed to the TPA)
If the patient is MLC  then handover all photocopies of investigations to the patient and keep Original copies in the IPD file.



13. After receiving a call from IP billing about the readiness of the bill, inform patient to clear all pending bills. 

14. After the full and final stamp is put , Director will sign on 3 bills, 2 receipts and occupancy. 

15. Ward staff records the bill no. and the receipt number ( only after seeing the full and final and sign is done)

16. Check for the hospital property i.e. linen, crockery etc. 

17. Handover the discharge summary to the patient and/ or relative only after checking the final settlement of the bill. 

18. Obtain signature of the person to whom you are handing over all the documents in the IP register & Report Acknowledgement Form along with their name & relationship. 

19. If there are any pending reports of the investigations, if the patient party requests then inform them that the reports would be couriered to them. 

20.The on duty doctor will explain the discharge instructions to the patient &/ or relative & take a feedback. 

1. Relieve the patient. If required the patient would be transferred via wheel chair or stretcher. 

2. If required arrangement for transportation would be done through reception. 



21. IN CASE OF MEDICO LEGAL CASE (MLC PATIENT DISCHARGE): 
Consultants put the discharge order after he finds the patient is  fit to get discharge. 
Ward RMO prepare return MLC and send it to Dhantoli police station. If the patient is stable and getting discharge  police sign on it and allow to discharge the patient  BUT IF THE PATIENT IS DEATH THEN BODY IS HANDED OVER TO THE POLICE ONLY. 
Document the police officer’s name buckle and name of police station. 
DO NOT HANDOVER any original documents to patient including original discharge summary, original printed reports, original X – Ray, C.T. scan, MRI films & CDs. 
The photocopy of printed reports to be handed over to the patient or his relative. 
Obtain signature of the person to whom you are handing over all the documents in the admission register along with date, their name & relationship. 



22. IN CASE THIRD PARTY ADMINISTRATOR (TPA PATIENT DISCHARGE): 
DO NOT HANDOVER any original documents to patient including original discharge summary, original printed reports, original X – Ray, C.T. scan, MRI films, ECGS & CDs. 
The photocopy/ XEROX of only printed reports to be handed over to the patient or his relative. 
Obtain signature of the person to whom you are handing over all the documents in the admission register along with their name & relationship. 





23. IN CASE OF DAMA ( DISCHARGE AGAINST MEDICAL ADVICE)


1. Procedure:

(FOLLOW THE POLICY AND PROCEDURE FOR FOR NORMAL DISCHARGE PATIENT BUT FOLLOW THE ADDITIONAL INSTRUCTIONS GIVEN BELOW)

Consultant put the discharge order  after the patient expresses his/her wish to get DAMA. 

The consultant or RMO explain  the patient/ relative about the condition of the patient in their own language.

Obtain the consent for DAMA from patient./ relative.

Obtain the High Risk consent from two relatives in case of life threatening condition.( NEGATIVE COUNSELLING)

Resident prepares the discharge summary stating this discharge as DISCHARGE AGAINST MEDICAL ADVICE.

Send file for the discharge summary.

RMO checks the discharge summary & sign the same & obtain the signature of the consultant on it. 

Handover the reports to the relatives( if its not MLC case)





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