2. DEPARTMENTAL PLANNING AND
DESIGN
(1) Outermost zone, which is the most community oriented with
• · out-patient department
• · emergency department
• · administration
• · admitting office, reception
(2) Second zone, which receives workload from
• · diagnostic X-ray
• · laboratories
• · pharmacy
(3) Middle zone between outer and inner zones
• · operating department
• · intensive care unit
• · delivery
(4) Inner zone, in the interior but with direct access for the public
• · wards and nursing units
(5) Service zone, disposed around a service yard ~
• · dietary services
• · laundry and housekeeping&· storage
• · maintenance and engineering
• · mortuary·
3. CASUALTY
•ORGANIZATIONAL CHART
CEO
COO
Chief Nursing Officer
CMO Nurse Manager
Clinical Assistants Staff Nurse
Unit Clerk
Housekeeping Staff
4. Staffing Responsibility Matrix ACTIVITY PERSON INITIATING PERSON SUPERVISING
/ATTENDING THE ACTIVITY
Personnel Morning Night Receiving the patient Nurse/ security/House Nurse Manager /CMO
CMO 1 on duty 1 on duty keeping boy
1 on call 1 on call Medico legal case Staff nurses / CMO / Staff CMO / Nurse Manager
Nurse
General M Evening Night Death CMO CMO/Consultant
or Medical orders Staff nurse/CMO Consultant
ni Carrying out Staff nurse /CMO Nurse Manager
n procedures /Consultant
g Urgent Staff nurse /CMO CMO / Blood Bank
Nurse Manager 1 - - - diagnostics/blood officer
Staff Nurse - 2 2 2 transfusion
Ambulance driver - 2 2 2 Patient brought in Staff nurse/CMO CMO / CNO
Ambulance attendant - 1 1 1 dead
Male Attendant - 2 1 1 Indenting medicines Staff nurses Nurse Manager
Requesting for CMO Consultant/CMO
•RECORDS AND REGISTERS MAINTAINED IN diagnostics
THE DEPARTMENT Transfer out of Staff Nurse / CMO CMO / Consultant /
Casualty Register patient Nurse Manager
Laboratory Specimen Dispatch Register Daily inventory Staff nurses Nurse Manager
Daily Inventory Register Nurses records Staff nurses Nurse Manager
Equipment Staff nurses / Nurse Manager
Assignment Register
management
Communication Register Infection control in Staff nurses Nurse Manager / HICC
Medical Record Dispatch Register ward / Procedure
Morgue Register Room
MLC Forms/Register Waste disposal Staff nurses/Housekeeping Nurse Manager
Death Certificate staff /Supervisor
Medical Records CMO/consultant CMO / CNO / MRD
Complaints Staff nurses Nurse Manager / CNO /
PRO
CMO duty schedule -in-Charge
Ambulance driver – Manager Admn Manager Admn
duty schedule
House keeping staff Supervisor house keeping Supervisor house
keeping
5. OPD
•ORGANOGRAM
CEO
DIRECTOR MANAGER DIRECTOR HOD -
NURSING MEDICAL PROFESSIONAL PATHOLOGY
SERVICES SERVICES
EXECUTIVE CONSULTANTS TECHNICIAN
NURSE (Blood
Sample
Collection)
STAFF ATTENDANTS TECHNICIANS
NURSES
FRONT OFFICE
STAFF IN OPD
6. – Staffing – Working Hours
• Customer Relations Staff: • The OPD should be open 12 hours
PRO, Reception and every day from 8 a.m
Enquiry, Registration and The basic requirements of an
Appointments outpatient
• Billing Counter, waiting
lobby. • · reception and waiting areas,
• Nursing Staff : Procedure • · consultation rooms,
Room Staff Nurse
• · examination rooms,
• Housekeeping Staff:
• · treatment rooms, and
Attendants to maintain
cleanliness and to assist • · staff and supply areas. to 8 p.m.
in transporting patients to
emergency, screening or
diagnostics.
7. •PATIENT FLOW CHART
ENTRANCE (arrival of patient) Patient taking prior
appointment
ENQUIRY (received / registered)
Time confirmed to patient
Referred to billing
If investigation required by Consultant Referred to concerned Consultant
Patient to be referred to billing If investigation is not required by Consultant
Patient goes for collection of sample Follow up is explained to the patient
Patient comes for collection of report the next day Patient leaves the hospital
8. • OUT PATIENT OPERATIONS:- 1)OPD Registration 2)Consultation 3)Admissions or
Diagnostic 4)Pharmacy
• OPD DEPARTMENTS :- 1) Pediatric OPD 2)Antenatal Clinic/ Gynaecology 3) Dental
Clinic 4) Ear Nose & Throat 5)Ortho 6)Medicine
• INVENTORY MANAGEMENT:- The OPD will maintain the following Inventory Records.
1)Equipment and Instruments2)Linen3)Emergency
trolley4)Stationery5)Hand wash 6)Dustbins7)Gloves
8)stethoscope9)Hand Towel10)BP apparatus.
• RECORDS AND REGISTERS MAINTAINED:-
• 1) Communication Register
• 2)Laundry Register
• 3)Inventory Register
• 4)Immunization Register
• 5)Consultant Performance Record
• 6)CSSD Book
• 7)Ante Natal Record
• 8)Equipment Register
• 9)Vaccine Stock Register
9. IN PATIENT DEPARTMENT
CEO
•ORGANIZATIONAL CHART
COO
Consultants Chief Nursing
Officer
RMO Nurse Manager
Team Leader
Staff Nurse
Health Care Asst. Unit Clerk
Hospital Attendants
10. – Staffing (Per Shift) – Shifts
• R.M.O. - 2 • R.M.O.s will be on 8 hour shifts. They
• Nurse Manager 2 (Morning & will hand over at 7 am, 2 pm and at 9
Evening One Each) p.m.
• Team Leader - 2 (Morning & • Team Leaders will be on 8 hours shift
Evening One Each) .They will hand Over & Take Over at 7
• Staff nurses -1 : 6 patients am & 2 pm. They will be on duty from
7 am to 3 pm, 2 pm to 10 pm.
• Health Care Assistants - 2
• Staff Nurses will be on 8 hour shifts.
• Female attendant -3 They will hand over and take over at 7
• Male attendant -3 am, 2 p.m. and 9 p.m.
• The Nurse Manager will be on duty
from 7 am to 3 p.m.,2 pm to 10pm.
• The Nurse Manager will be on duty
from 9 pm to 7 am & 2 pm to 10 pm
when deputed by Chief Nursing officer
as Shift Coordinator
•
11. ACTIVITY PERSON INITIATING PERSON SUPERVISING
Admission procedures Doctor/Nurse/Front Office Nurse Manager, Consultant,
Unit Clerk Executive Front Office
Diagnosis RMO / Consultant Consultant
Treatment/ Medication RMO/Consultant Consultant/Nurse Manager
Tests RMO/Consultant Nurse Manager/ Consultant
Records Staff nurse/RMO Nurse Manager/ Consultant
Transfers Staff nurse/RMO Nurse Manager/ Consultant
Discharge Staff nurse/RMO Nurse Manager/ Consultant,
Executive Front Office
Follow-up Nurse Manager Consultant, Chief Nursing Officer
Ward Protocol Nurse Manager Chief Nursing Officer/Shift
Coordinator
Nursing Procedures Staff Nurse Nurse Manager/Educator/Shift
Waste Management /RMO/Health Care Assistant Coordinator
Nurse Manager/Facility Manager
Infection Control Staff Nurse/RMO/Consultants Nurse Manager/Chief Nursing
Officer Infection Control Nurse
Facility Manager/Chairman
Infection Control Committee
12. IPD OPERATIONS
Admission of the Patient in the Ward:-1)Planned 2)Emergency
– registration
– Allotment of room and bed
– Deposits
– Allotment of visitor’s pass
– Schedule Of Planned Procedure/Surgery/Investigations
• Transfer In of Patient Within Hospital
• Transfer Out Within the Hospital
• Patient Transfer to Operation Theatre/Procedure Room
• Consultant / R.M.O. ‘s Rounds
NURSING MANAGEMENT OF PATIENTS IN THE WARD
• Handing Over Process
• Requisition for Emergency Investigations
• Collection of Reports
• INDENTING FROM CSSD
• MAINTENANCE OF EQUIPMENT
• BILLING
• VISITORS POLICY
• DISCHARGE OF THE PATIENT
• DEATH
• MEDICO-LEGAL ASPECT OF PATIENT MANAGEMENT
14. Radiology CEO
COO
IMAGING SERVICES
SL EQUIPMENT MAKE/MODEL
.
N
O.
1 COMPUTERIZED CR 35 / DRYSTAR 5503 CONSULTANT
RADIOLOGY HOD
2 200 MA HF X-RAY UNIT MULTIPHOS
3 100 MA PORTABLE X-RAY X-RAY MULTIMOBILE 2.5 FRONT OFFICE
UNIT SR TECHNICIAN ASSISTANT
4 SONOGRAPHY VOLUSON PRO 730
GE
LOGIQ E (PORTABLE)
GE
5 MAMMOGRAPHY MAMMOMAT 3000 NOVA TECHNICIAN
(SIEMENS)
STAFF
NURSE
•ORGANIZATIONAL CHART
ASSISTANTS
15. RADIOLOGY
Functioning RECORDS AND REGISTERS MAINTAINED IN THE
DEPARTMENT
• Enquiry
• Appointment Scheduling • Appointment Booking Register
• Registration • X – Ray Register
• CT scan Register
• Payments • Sonagraphy Register
• IMAGING REPORTS • Mammography Register
• Inventory Register for X- Ray Film
• Dispatch of Reports • Inventory register for contrast
• QUALITY ASSURANCE PROGRAMME • Inventory Register for Materials
FOR IMAGING SERVICES • Inventory Register For Linen
• Inventory Register For medicine
(VERIFICATION / VALIDATION / • Inventory Register For CSSD
MONITORING / CALIBRATION) • Dispatch Register
• Request for Follicular Study
• Form F - Form for Maintenance of Record
with respect to Pregnant Woman by Genetic
Clinic / Ultrasound / Imaging Centre
(Radiology)
16. LABORATORY
CEO
DIRECTOR Histopathologist/
PATHOLOGY consultant
QUALITY CONTROL
MANAGER
TECHNICAL SUPERVISIOR
SENIOR TECHNICIANS
JUNIOR TECHNICIANS PATHOLOGY
STAFF/FRONT OFFICE HOUSEKEEPING
STAFF
17. Responsibilities and Authorities Quality Manager
• Selection, approval and commencement of test
methods. • Overall control of quality and advising and
• Designing and implementation of internal and external monitoring all aspects of quality in the
Q.C.program.
laboratory.
• Ensure the smooth running of the department .
• Ensure that all equipments are operational • Check all the quality control, record
• Supervise the staff keeping of daily and planned
• Provide Continuous Medical Education maintenance, and calibration of
• Evaluate competency of Staff at regular intervals. equipment.
• To ensure confidentiality
• Ensure the staff follows all SOPs
• Address any complaints, requests or suggestions from
patients / Staff / Doctors. • Planning and organizing audits and
• Ensure good staff morale. reviews.
• Review MIS.
• Ensuring that the details of the reviews
• Manage the overall efficient and effective
administration of the laboratory including approval of are recorded.
the indents/purchase requisitions for the material • Give a feedback to the Director Pathology
raised by the Lab Technical Supervisor.
about the staff performance.
• Define, implement and monitor standards of
performance and quality improvement of the medical • Prepare and maintain a schedule for
laboratory services. continuous training programme for the
• Review the laboratory policies regularly
lab staff.
• Work towards lab improvement in terms of processes,
systems & workload. • Maintain & correlate record of quality
• Review any new examination procedures which are indicators of the lab.
developed in-house.
• Review operational procedures with the
Laboratory Director, once in 6 months.
•
18. MANAGEMENT SYSTEM
IN PATHOLOGY
• The management system of Path-lab is based on the policies and the procedures that
are documented and are for complying to the requirements of ISO-15189.
• The entire documentation of the laboratory is in the form of Quality
Manual,Procedures,Work instructions, forms and formats,charts,check list ,safety
&Regulatory Norms etc.
DOCUMENT STRUCTURE
↓
QUALITY MANUAL
↓
PROCEDURE MANUAL
↓
WORK INSTRUCTIONS
↓
CHARTS ,REPORTS,FORMS ,RECORDS
19. OPERATION THEATRE
•ORGANIZATIONAL CHART
CEO
COO
CHIEF CHIEF NURSING
ANAESTHESIOLOGIST OFFICER
ASSISTANT NURSE
ANAESTHESIOLOGIST MANAGER
ANAESTHESIA TEAM LEADER
TECHNICIAN
STAFF
NURSE
O T ASSISTANT OT HOUSE KEEPING
ATTENDANT STAFF
20. – Staffing
The Operation Theatre will have the following Staff : ACTIVITY PERSON PERSON
INITIATING SUPERVISING
• Anaesthesiologist
OT booking Staff Nurses / Nurse Manager
• Asst Anaesthesiologist Assistant
• Nurse Manager Handing and taking over Staff Nurses Nurse Manager
• Team Leader Equipment management Staff Nurses / Nurse Manager
• Staff Nurses Anaesthesiologist /
Attendant
• Anaesthesia Technician
Information to Consultant Nurse Manager Consultant
• OT Attendant Requesting for diagnostics / Staff Nurses Nurse Manager
• OT Assistant sending samples for
• House keeping staff : histopathology
• Male Key handling. Staff Nurses Nurse Manager
Medical orders RMO Consultant
• Female
Nurses records Staff Nurses Nurse Manager
stores Staff Nurses Nurse Manager
PROCESSES:- OT Anaesthesia stores Anaesthesia
• OT Booking Technician
• OT Timings Daily inventory Staff Nurses Nurse Manager
• Preparation of OT List Nursing procedures Staff Nurses Nurse Manager
Infection control in OT Staff Nurses Nurse Manager
• Cancellation of Surgery
Waste disposal Staff Nurses / Nurse Manager
• Implants Housekeeping Staff
Death RMO/Consultant Manager
Admin/CNO
Complaints Staff Nurses Nurse Manager /
CNO
Indenting CSSD Linen, Staff Nurses Nurse Manager
Consumables.
Responsibility Matrix
21. DAILY TASKS RECORDS AND REGISTERS MAINTAINED IN THE
• Getting the Trolleys Ready DEPARTMENT
• Entry of Patient into OT • Narcotic Register
• On the O.T. Table
• Pathology Register
• Recovery and Transfer to Ward
• Daily Inventory Register
• Disposal of waste
• Daily Cleaning - Prior to Commencement of • OT Consumables Charge Sheet
Surgery • Communication Register
• Cleaning in Between Cases • Booking Register(Hard copy and soft copy)
• Cleaning at the Close of Day • Operation Register
• Weekly Cleaning: to be Done on Sundays
• Fumigation Register
• Fumigation of O.T.
• HISTOPATHOLOGY SAMPLES AND SPECIMENS
• OT Daily Maintenance Register
• Billings • OT Complaint Register
Requirements:- O.T. Tables • OT Implant Register - Ortho
– Boyle’s Apparatus • OT Implant - Ophthalmic Register
– Trolleys • Charge Sheet OT
– C-ARM • Operation Record
– Microscope and other
accessories used in O.T.
• Pre-Operative Anaesthesia Chart
– Cauterizing machines • OT Consumables Charge Sheet Ortho
– X-ray viewing Box • Labour Anaelgesia Chart
– Suction Apparatus • OT Handing Over & Taking Over Patient’s
– Linen Register
22. INTENCIVE CARE UNIT
CEO
COO
CHIEF INTENSIVIST CHIEF NURSING
OFFICER
CLINICAL ASSISTANT NURSE MANAGER
TEAM LEADER
STAFF NURSE
HEALTHCARE ASSISTANT UNIT CLERK
HOSPITAL
ATTENDANTS, HOUSEKEEPING
STAFF
23. Responsibility Matrix
Sr. No. Activity Person Initiating Person Supervising
1 Admission procedures Doctor/Nurse/Front Office Executive Front Office
2 Admission of patient Staff nurses Nurse Manager / Chief Intensivist
3 Handing and taking over Staff nurses/Registrar Chief Intensivist / Nurse Manager
4 Information to Consultant Registrar Chief Intensivist / Nurse Manager
5 Medical orders Registrar/ Chief Intensivist Chief Intensivist / Consultant
6 Carrying out procedures Registrar/staff Nurse Chief Intensivist/Consultant/Executive
Consultant Intensivist
7 Indenting medicines Staff nurses Nurse Manager
8 Requesting for diagnostics Staff nurses Chief Intensivist /Consultant/
9 Transfer in/out of patient Registrar/staff nurse Chief Intensivist/Consultant/Executive
Consultant Intensivist
10 Daily inventory Staff nurses Nurse Manager
11 Nurses records Staff nurses Nurse Manager
12 Equipment management Staff nurses Nurse Manager / Biomedical Engineer
13 Stock Staff nurses Nurse Manager
14 Nursing procedures Staff nurses Nurse Manager
15 Infection control Staff nurses Nurse Manager
16 Waste disposal Staff Nurses/Housekeeping Nurse Manager
staff
17 Medical Records RMO/consultant/unit Nurse Manager /Chief Intensivist
18 Accidents & MLC RMO/consultant/clerk unit Nurse Manager /Chief Intensivist
19 Death RMO/consultant/clerk unit Nurse Manager /Chief Intensivist
2520 Complaints Staff nurses Nurse Manager /Chief Intensivist/CNO
24. TRANSFER FROM TRANSFER FROM CATH TRANSFER FROM WARD /
LAB CASUALTY/OPD
O. T.
Admission of patient in ICU
CRITICAL CARE
MANAGEMENT
RECOVERED EXPIRED
FORMALITIES FOR
TRANSFER TO WARD POST LIFE CARE
25. DIALYSIS UNIT
CEO • ADMISSION OF A PATIENT
• STANDING ORDERS IN THE UNIT
COO • INSTRUCTIONS TO THE PATIENT
• TRAINING
CHIEF OF NEPHROLOGY RECORDS AND REGISTERS MAINTAINED IN
THE DEPARTMENT
• Admission Register
AKD MANAGER
• Procedure Register
• Communication Register
TECHNICI
AN • Daily Inventory Register (only for
Dialysis department)
STAFF
NURSE • Hemodialysis Record
• Dialysis Flow Chart
HOUSE
KEEPING
• Consent Form (Consent for Vein
Catheterization & Hemodialysis)
• Investigation Chart for Renal Dialysis
26. PHYSIOTHERAPY
Sr.No Key Personnel Responsibility Authority
.
CEO 1 Physiotherapist Consultation, Supervise &
assessment maintain
& treatment facilities
COO of patient. available in
Physiothera
py /
SPECIALITY PHYSIOTHERAPIST rehabilitativ
CONSULTANTS e services
Department
TRAINEE
PHYSIOTHERAPISTS 2 Trainee Assisting Handling
Physiotherapist consultant equipments
HOUSEKEEPING physiotherapi
st
3 House Keeping Maintaining NIL
Staff cleanliness of
PHYSIOTHERAPIS PSYCHIATRIST CONCERNED
the
T CONSULTANTS department.
Taking care
of
equipments.
Wheeling
patients to
Responsibility Matrix the
department.
27. Functional and space requirements
in outpatient department
Registration OPD Reception
Enquiry
Waiting
Admin OPD Waiting
OUT
CLINICS
LAB INVESTIGATION
X-ray
Inj &
Wards Pharmacy
Dressing
28. People Involved
• In general, the people involved in this process are:
• · Health planners, functional planners, financial
planners and physical planners.
• · Architects
• · Engineers (such as civil, mechanical and sanitary)
• · Quantity surveyors
• · Finance managers
• · Staff responsible for procurement of supplies
• · Staff members such as doctors/nurses, clients/end
users