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1. Further to this Dte Gen letter No B/75346/DGMS-3E/PC dt 30 Apr 2008 and letter No
B/75346/DGMS-3E/PC dt 01 Aug 2008, a presentation on standardization of OPD services
of Service hosp was held at this Dte Gen and the following guidelines for OPD and Central
MI Room run by fd med units have emerged which are as follows:-
2. Structural Standards.
(a) The structure of the OPD of service hospitals has been standardized vide
Table-3A of “ Scales of Accn for Armed Forces Hospitals 2003” and Scale of
accn Defence Services 1983, Table 7 III for MI Room, the scope of the structure is
quite liberal and satisfactory. However, majority of service hospitals are still
accommodated in old buildings and will have to dovetail the laid-down structure
within available accn, probably with some addition/alterations.
(i) Separate car-parking with a min space of (3.5m x 3.5m) per car for wide
opening of doors.
(ii) Ramp at the entrance with a gradient of 1:20 with handrails at a height
of 900 mm above ground.
(iii) OPD doors, if present at the entrance must have a min width of 900 mm
with door handles at 800-900 mm above ground and adequate maneuvering
space infront.
(iv) Waiting area seats must be 450 mm high with arm rests at 700 mm
above ground.
(v) One telephone cubicle of a size of (1.7 m x 1.7 m), with the telephone
at a height of 900 mm and an empty space of 600 mm below the telephone.
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(vi) One toilet of (1.7m x 1.7 m) with grab rails at 800 mm height, WC at
0.5m height and wash-basin at 0.7m height.
(vii) One lift with a min area of (1.1 m x 1.4m), door width of 1m and floor
indicators at eye level.
(iii) A comfortable ambience inside the OPD, with separate waiting spaces
for different categories of patients provided with newspaper/magazine stands,
drinking water facilities and sanitary blocks.
(v) Standards of accn – Though accn for the OPD has been standardized
vide Table -3A of “Scale of Accn for Hospitals-2003”, min requirement of
accn in hospital occupying old buildings needs to be laid down. Such a
standardized template is shown below:-
(ag) Dispensary.
(e) Standardized sets of Eqpts – Generic standards for eqpts that will be
necessar y will be shown below:-
(v) Past medical record will be available to the clinicians from the data-
bank, displayed on the computer screen.
(ix) Electronic OPD formats, medical record data-bank and LAN facilities
can be easily developed with the help of signal units of the station.
(x) This flow of operations will significantly reduce waiting time at each
OPD inter face for the patients.
(b) Management of waiting time. One of the major problems plaguing the
OPD service of service hospitals is long waiting time within the system for
patients/visitors. This problem needs to be addressed by a series of steps, as
described below :-
(c) Having a separate Filter Clinic/ separate time for chronic patients
(ESM/dependent parents), many of whom come to collect their monthly quota
of medicines.
(e) Flexi time in OPD management, where a subset of patients, say offrs
may be attended during evening hours.
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(g) Ensuring availability of all OPD staff throughout the duration of OPD by
looking after their administrative requirements.
(j) Deciding upon a ‘Quality Standard’ of waiting time in the system and
continuously tracking random cases of OPD attendance against the standard
for identifying variance.
(d) Method Cards. Every protocol (both clinical and administrative) will be
summarized into a single page format, which wil be prepared in easy-to-use cards,
properly laminated. These set of cards will then be codified, with a ‘Master
List’ of such cards being maintained in the OPD. These cards will be of tremendous
help, as they give concise, sequential course of action against any emergency that
may have to be managed at the OPD. (Sample method card attached as appx ‘A’).
(i) All OPD staff fully trained to operate any and every equipment.
(v) Every equipment be checked every morning by the nominated staff for
its functional status, before commencement of OPD.
(iii) Sample collection room to operate for the entire duration of OPD
service.
(a) Dissemination of vision and values. Every OPD staff must be fully aware
of the vision of the CO about functioning of the dept as well as a set of value system
that will be followed while providing OPD service. The vision and value system will be
prominently displayed in the OPD for consumption of all OPD staff.
(b) Trg of OPD Staff. Already discussed under the heading “Staffing”. Quality
standards need to be laid down for periodic testing of knowledge and skill of every
OPD staff in BLS/ACLS/ATLS protocols and operation of every equipment
available in the OPD.
5. Outcome standards
(i) The protocol will initially be pilot tested for assessing its
validity/reliability.
(ii) The best method is to offer this instrument for anonymous feed-back by
consumers after they return home.
(ii) Confidence among staff that reporting of mistakes will not result in
witch-hunting.
(i) Deciding on Quality Standards for the OPD services, particularly for the
hospital.
(v) Open publication of the audit results for education of the external
environment incl various system stake-holders.
(b) P - Personal interaction of every OPD staff incl MOs with the
consumers to understand their grievances and
appreciations.
(a) Structure. The min structure that will be necessary is given below :-
(ii) Waiting areas - Available space in the OPD may not suffice
and separate waiting area may be necessar y.
(v) Surgical facilities - Space allotted for the surgical facilities may
suffice for smaller hospitals, but for Zonal and Command hospitals,
a major OR will have to be catered for in place of Minor Surgery Room.
(vi) Facilities for diagnostic equipments - Available space will suffice, but a
stat lab/CSR will be necessary for larger hospitals.
(xi) Trauma Care Van for pre-hospitals care and cas evac.
(i) Cross-trained team approach - with staff working in the dept suitably
cross trained to attend to serious casualties as well as handle diagnostic
equipments.
(ii) Devp of capability for pre-hospital care - with devp of “Trauma Care
Vans” with appropriate internal environment and communication facilities.
(v) Training of the dependent community - for life saving first aid of a
casualty on site and also during evacuation.
9. Conclusion. Guidelines have been issued to develop generic standards for OPD
services of service hospitals incl Emergency Services to bring in procedural efficiency and
increased patient satisfaction. The process of standardization in service hospitals will
definitely vary to a greater or lesser degree, depending on the size and type of hospitals.
However, generic standards can very well be laid down, which can be suitably applied by
indl hospitals appropriate to their own needs and requirements. A dedicated effort
towards standardization will definitely bring in substantial benefits in terms of superior
efficiency to the value-chain of OPD services being provided by the service hospitals at
present.
10. This has the approval of DGMS(Army).
11. Please ack. Sd/-x-x-x-x-x
(SKM Rao)
Col
Dir MS (Hosp Proj)
For DGMS (Army)
Encls : As above
Appx ‘A’
A PSYHIATRIC CASE
1. There are various types of psychiatric problems which can result from stress namely:
Agitation, confusion and depression.
2. The following points should be considered to deal with the persons who are under
Psychiatric mania:-
∙ Never compel such persons to talk about something if he doesn’t want to.
∙ Offer reassurance, speak softly and calmly and not in a loud condescending
manner.
∙ Try to orient the patient to reality. Tell the patient what is going to be done and
what is expected out of him.
∙ Provide 1: 3 guard round the clock to avoid threat to the patient as well as to
the care givers.
∙ Administer medications as advised by the physician. Be with the patient till the
medication is swallowed completely.