Rapid Rural Appraisal (RRA) and Participatory Rural Appraisal (PRA)
Rapid Appraisal Tool for Hospital Management
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Transcript of 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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