rapid appraisal tool for hospital management

8/14/2019 Rapid Appraisal Tool for Hospital Management

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Rapid Appraisal Tool for HospitalManagement : A visit to FGSH

IslamabadGroup 3 Dr Malik Ahmed Afzaal Dr Ali Raja Dr Fariha Fatima Dr Harris Habib Dr Rehan Butt Dr Sumaida Dr Tariq


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Introduction

Established in 1966 as a part of Central Govt hospital. A plot of 3.3 acres was allotted. It was not constructed or planned as a secondary care

hospital.

In initially 08 bed hospital with focus on maternal andchild health.

It was mainly an outdoor facility constructed forpopulation of 10,000.

Named FGSH in early 70,s.

Catchment area includes AJK, Gilgit, FANA, UpperPunjab and lower NWFP.

Now it is a 524 bed hospital with exactly the same area atthe time of construction.


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Further planning being done now for verticalutilization of the land.

Remained a subordinate hospital for a long time.Now it is an attached hospital headed by ED ofgrade 21.

Known for its 100% provision of medicines forentitled and 90% provision for non entitledpts.

Negotiations going on with Quaid e azamuniversity for making it a teaching hospital.

Total budget is more than 630 million. 30 million allocated for medicines. From the remaining, 90% budget allocated for

salaries.


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Attending 2.5-2.7 million patients annually.

28 specialties. 32 attached dispensaries in Rawalpindi and

Islamabad.

OPD of 8000-9000 per month.

1700 employees 350 doctors.

600 nurses.

20-24% doctors are on leave, deputation ortransferred.


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Observation

Location In center of city Islamabad, veryclose to Argentina Park, far fromindustrial area and graveyard.

Accessibility Easily accessible from main road.

Sign boards for guidance Present

General state of hospital building. Satisfactory , properly painted, inexpansion phase

Parking Inadequate, no specific siteallocated, congested , no onelooking after the parking area.

No of entry gates 03, no separate exit gates.

Exposure to sunlight and wind Good


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Location and map


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Organo gram


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Emergency department

Location Main emergency separate fromthe hospital across the road.Observation room in the hospitalon the other side of road.

Accessibility Not good as the patients to beretained have to be shifted bycrossing the road.

Civil works Satisfactory condition of wallsand civil works.General cleanliness Satisfactory

CapacityTotal number of beds

Occupied beds at the time ofobservationEmergency dispensary Available

Wheel chairs and stretchers Available


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Emergency incharge

Specialty doctors Have to be called from respective

departments.Waiting area

Emergency OT Available, cleanliness and gencondition satisfactory

Medico legal cases Dealt

Medico legal surgeon Available

Police Available

Emergency lab Available for 24 hours

Training of ER staff for CPR

Separate dressing room Available, condition good,cleanliness satisfactory,

Dressers vaccinated for Hep B andCVenous cut down tray and

emergency tray

Available, all items in tray were

complete.


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Emergency staff

Available Occupied Vacant

Doctors

Nurses

Dispensers

Technicians

Ward boys

Dressers

Sweepers

Security guards


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Emergency preparedness

Disaster management plan Available

Disaster management team Established

Staff trained for disaster

managementResources allocated for disastermanagementRules of triage known by the ERstaffDisaster management cupboards

Separate beds allocated for

disastersContact numbers of disastermanagement team displayed inemergency


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OPD,s

Location All OPD,s located in centre of thehospitalSeparate medical, surgical ,cardiology, gynae and paeds OPD.

Separate entrance Only for cardiology, gynae andpaeds opd.Opd rooms Congested, inadequate for accommodating the pts.Evening OPD Available

Separate rooms for consultants Available

Waiting area Highly congested and inadequatefor accommodating the patientsand attendants.

Free medicine provided Yes

Separate reception for OPD Available

Dressing room for surgical OPD Available but very congested,

small and inadequate


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LaboratoryLocation and accessibility Split into 3 units at different sites

in hospital.Poorly accessibleCivil works Not satisfactory, poor condition of walls and furniture.Condition of equipment Well funded, up to date and stateof the art( as told by ConsultantPathologist)

Temperature Maintained through 24 hours airconditioning.24 hours services Available

Record maintenance Computerized with networking

Lab staff using PPE No

Needles properly crushes Yes

Availability of kits for HepB, C ,LFT, CBC, BSR

Yes

Repair and maintenance of

equipment

No staff available


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Operation theatreLocation First floor

Separate OT for surgery and Gynae

Close from their respective wards.Number of operation rooms

4 general OT4 gynae OT

Number of operation tables One table in each room

General cleanliness Satisfactory

Sterilization method Autoclaving

Fumigation Done but not regularly

SOP,s for operation theatre Available

Separate instruments for Hep B and C pts Available

Air conditioners and heaters Available

Pre op preparation room Available

Central line for anesthesia gases Available

Post op recovery room Available

Civil works Satisfactory


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Radiology departmentLocation and accessibility Just besides the hospital entry

Easily accessibleGeneral condition and civilworks

Satisfactory

Waiting area Spacious and adequate

24 hours USG and X ray facility Available

CT-MRI Not available

Technical staff for repair

Labeling of X ray rooms forhazard

Done

Protective equipment for X ray

technicians

Available and used regularly

Separate radiology reception Available

Condition of X-ray machines andUSG machines


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Radiology staff

Available Vacant filled

Radiologists

MO

Technicians


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Laundry

Number of workers 06 washer menGeneral condition Poor, congested

Cleanliness Poor

Civil works Poor condition of walls withseepage, poor condition of thefloor

Timings 8am to 2:30 pm

Suitably trained staff Not available( all the staff areuntrained)Separation of infectious and non

infectious laundryNot done

Separate washing protocols forinfectious and non infectious

laundry

Not present


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Blood bankLocation and accessibility Poor access from OT and

emergencyGeneral cleanliness and civilworks

Satisfactory

Refrigerators 03 refrigerators available

Screening for Hep B ,C and HIV Available

Blood given on Only on need basis, nopurchasing done

Capacity to store blood bags atone time

1000 blood bags

Record maintenance Manual as well as electronicFacility for separation of blood

productsAvailable except for platelets

Staff vaccination Not done


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Drug storeCivil works Satisfactory

General cleanliness SatisfactoryVentilation Congested

Inventory maintained as FIFO No

Fridge Available

Temperature maintenance Maintained through airconditioningProtected from un authorized

entryYes

Shelving Not arranged by alphabeticalorder or type of medicines.BIN card Not labeled

Timings 8 am to 2:30 pm

Record maintenance Manually in registers


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Record and information system

All admissions discharges and transfers have astandard medical discharge summary.All medical records include SOAP structure. Computerized information system is employed

but no networking done yet. Record information includes patient registration,history, date of admission and discharge, dateof death and death certificate (if applicable).

Billing is cleared and recorded in accountssections.


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Cafeteria

Located outside the hospital. General cleanliness was not satisfactory.

Cleanliness of staff was not satisfactory.

Capacity was in adequate.

No specific hall was available. People were eatingin open area and park.

Screening of cafeteria staff is not done.

Refrigerator was available.


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Utilities PCO was available with acceptable rates.

Un interrupted water and electric supply is available. No load shedding. 3 generators available. Back up system available for water but no main

storage tank available. Only one water filter is available in the whole

hospital. No regular system for cleaning the water tanks. CDA is the main source of water supply. Repair and maintenance for electricity and water by

Pak PWD.


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Preventive servicesFP methods available

Supply sourceStock in advance

Referral site for surgical methods

EPI services

Cold chain maintainanceKnowledge of staff about coldchainVaccination cards given

Evening vaccination services

Tetravalent vaccine

IEC materialSeminars and health promotionworkshopsInternational vaccination Available for meningitis, yellow

fever, typhoid, cholera, allergy

vaccine.


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Patient safetyRisk assessment surveys Not conducted

Pt safety education given toorganization seniors and hospitalstaff

No

Resources allocated for patient

safety initiative?

No specific resources allocated

An adverse event managementcommittee is in place or not

Yes

Reported adverse eventsinvestigated ?

Yes

If yes, any implementationrecommended or not?

Yes


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Waste managementWhat type of container/bags are used to segregatewasteSOP,s for waste management

Color coding used?

Who handles the segregated waste?

Is the waste handler using protective clothing duringwaste handlingWhere is the segregated waste stored while awaitingremoval from hospital

Where the waste is finally disposedPerson responsible for organization and managementof the waste collection handling storage and disposalDoes the waste management staff have jobdescriptions detailing their tasksWaste management team in place?

Who is in the waste management team?

Incinerator available or not


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Out putsNumber of blood grouping tests done in last onemonth

9402

Number of blood donations in last one month 375

Number of cross match done in last one month 534

Number of packed cell preparations in last onemonth

521

Number of FFP preparations in last one month 118

Number of blood bags issued in last one month 399

Number of blood bags screened for Hep B, C andVDRL and MP

382Number of blood bags positive for HBsAg 17

Number of blood bags positive for VDRL 04

Number of blood bags positive for malaria 04

Number of blood bags positive for HIV 00Number of pts screened for Hep c and HBsAg 553


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Out putsTotal number of tests done in hematology section in

last one month

103763

Number of histo pathology tests done in last onemonth

100

FNA done in last one month 25

Number of sputum cytology done in last one month 420

Number of CBC done in last one month 5458

ESR done in last one month 1956

Bleeding time 285

Fibrinogen level 34

PT 547

APTT 412


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Out puts ( chemistry section)Total number of tests done in

chemistry section in last month

287354

Glucose 6999

Urea 3976

Creatinine 955

Cholesterol 770

LFT 1855Albumin 377

Amylase 235

CK-MB 354

Sodium 569Urine RE 3096

Pregnancy test 586

Stool RE 119


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Out puts

Number of trained staff handling the laundry None

Number of training workshops conducted aboutinfection control and sterilization

Data notavailableNumber of kitchen staff screened for infectious

diseasesNone

Number of patients seen in ER in last one month

Number of expiries in ER in last one month

Number of medico legal cases dealt in last one monthNumber of surgeries performed in EOT in last onemonthNumber of trainings given for disaster management inlast 6 monthsNumber of disasters dealt in last 06 months

Number of surgeries done in general OT in last onemonthNumber of on table deaths in OT in last one month


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Out putsNumber of pts seen in medical opd in last one

monthNumber of pts seen in surgical opd in last onemonthNumber of pts seen in orthopedics opd in last onemonthNumber of pts seen in peads opd in last one month

Number of pts seen in ENTopd in last one month

Number of pts seen in EYEopd in last one month

Number of pts seen in Gynae opd in last one month

Number of X Rays done in last one month

Number of USG done in last one month


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Out putsNumber of people who started using FP services in

last one monthNumber of sterilization procedures performed inlast one monthNumber of children immunized in last one month

Number of nurses trained in one batch


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rapid appraisal tool for hospital management

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