INTERNSHIP REPORT

International Friendship Children’s Hospital

(IFCH)

Maharajgunj, Kathmandu, Nepal

Prepared by:

Rabeendra Basnet

Chapter 1• The introduction• Background of the study• Purpose and objective• Organization of the paper• Methodology• Scope and limitation of the study

Chapter 2 • The history• Promoters• management • vision and mission• location and layout• staffing pattern• services rendered • future plans of IFCH.

Chapter 3 • Introduction of Out Patient Department• Objectives• Functions• location and layout• staffing pattern• Organogram• OPD charge• OPD time

Chapter 4• Introduction of Emergency Department• Objectives• Functions• Organogram• Staffing patterns• Location and layout• Statistics of ED.

Chapter 5

• Introduction to Medical Record Department

• Objective and Function

• Content of MR/Types of data

• Location

• Staffing pattern and work flow

• Finding and critical observation

• Conclusion

Chapter One

Introduction

Hospital is multi-facet complex organization composed of various multi skilled professionals, sensible services with the use of sound technology and high level managerial capabilities.According to WHO According to WHO (1951) ”Hospital is defined as an integral part of a social organization , the function of which is to provide for the population complete healthcare, both curative and preventive, and whose outpatient services reach out to the family in its home environment, the hospital is also a center for the training of health workers and bio social research”.

Objectives of the study

1. General objective• Develop managerial skills in hospital• Figure out operational level functions and challenges

2. Specific objective• To study the nature of services being rendered to

people through medium of ER,OPD and MRD• To enlarge the managerial competency.• To identify the hospital administrative problems and

solution

Methodology• observation with the administration and the hospital

staffs with the motive of learning the best practice towards delivery of health care and hospital management system.

• Several tools and techniques were used for comprehensive management practice study.

Data Collection:

1. Primary data:i. Observation in ED, OPD and MRDii. Consulting with the Hospital Director, Administrator, Department

In chargeiii. Interview with the incharge of each department ED, OPDv. Queries with the patient and patient parties and their

feedback about the health care services being rendered to them.

2. Secondary data:i. Hospital statisticsii. Hospital brochure, websiteiii. Medical records and annual reportsv. Reports and reference books regarding hospital management

Scope

• The practicum is motivated at learning the managerial practices, hospital activity to enhance knowledge in the managerial aspect.

• It helps to increase managerial skills and practices so that management practices being adopted by particular

organization could be studied well along with internal strength and weakness external opportunities and threat

• It is also useful to research personnel for future research useful to student as reference increasing their

knowledge and skill

Limitation of study• The study was limited to the management aspect of an

individual health care organization and few depart only which cannot be generated to other organization.

• time duration is not sufficient for internship. • The confidentially problem of the hospital and syllabus

focused by university most of the things are not allowed to keep in this report.

Chapter Two

Organization under studyHistory• IFCH was registered under cooperative organization “Bal Maitri

Samudayik Sahakari Sanstha” on 27th Kartik 2065 BS (12th Nov 2008 AD) as a specialized 50 bedded pure pediatric hospital by the group of medical professionals. It is the first pediatric community hospital of Nepal.

Promoters• Full responsibility given to Dr. Shanta Chandra Shakya

Management under :Managing director- Dr. Shanta Chandra Shakya (MD, MS, Phd, Er)

Location of IFCH

Philosophy / Vision and Mission“ The Best Care For Your Child”

• to provide quality health facilities to children of different part of the country “ Working together we provide better health care to your children”.

• Location:• In between the Police hospital and Kanti Children’s Hospital

Staffing Pattern • Three shifts for all doctors and health workers;6 hours duty (Morning: 7am- 1pm, Evening: 1pm-7pm) & Night (7pm-7am)Services rendered:• Pediatric General, Emergency, Intensive , Immunization, nutrition

center and Dot’s Clinic facilities

International Friendship Children’s Hospital (IFCH)

Future Plans:

• Upgrading and expansion of the IFCH as per the requirements.

• Educational programs.

• To be actively involved as a health related research center.

• Build own building for hospital and college and its specialized branches to all over the country.

• Participate in children health program with national and international child health related communities.

Chapter Three` Outpatient Department

Introduction of OPD

• a part of the hospital with allotted physical facilities and medical and other staff in sufficient number with regularly scheduled hour, to provide care for the patients who are not registered as inpatients.

• It is a stepping stone for health promotion and disease prevention. • It acts as a filter for inpatient, help to use hospital bed efficiently and help to

earn significant income for hospital.• It can be taken as shopping window of hospital or first contact of care.

Objectives• To provide general medical services to outpatients on

scheduled/unscheduled basis.• To provide Preventive, Promotive, Curative and rehabilative

services.• Rehabilitative (Physiotherapy, Restorative services)• Follow of discharged patients, chronic illness.• Children welfare services/counselling.• Necessary Immunization.• Health education.• Nutritional care.• Medical Nursing and Paramedical education.• To establish good impression of the hospital to the general

public.

Functions

• Early diagnosis• Effective treatment on ambulatory basis.• The admission or referral for admission.• Vaccination, Immunization• Nutrition• Medical rehabilitation.• Promotion and health of the individuals.• Training and research.• Proper record keeping.• Screening and investigation for admission to hospital.

Location • The registration desk of OPD is located at the ground

floor of the main building which is next to the entrance gate.

• It is easily accessible and near to diagnostic .• The clinics, Radiology and other departments are

left of the registration desk and also in first floor.• X-ray room is located to the Right straight corner of

OPD entrance. Laboratory room is located in the first floor .

• Likewise ECHO, EEG, ECG, USG, and Physiotherapy are at other sides of OPD room and which well designed .

Services:

• Pediatric:» Medicine/Surgery

» Neurology

» Orthopedics

» Cardiology

» Nephrology

» ENT

» Ophthalmology

» Dermatology

» Dental

» Psychotherapy

» Physiotherapy

Medical Director

OPD Incharge

Registrar

Consultants

Organogram of the OPD

Medial Officer

Staffing PatternIn Medical and Surgical OPD, one doctor is available all the concerned

time. The other OPD services are made on call basis and the schedule appointments.

OPD charges:Private OPD Rs 450General OPD Rs 195Special OPD Rs 675 (for foreigners)

OPD time:7:00 am to 9:00 pm.

Emergency OPD : On call services

Chapter FourEmergency department

Introduction

EMERGENCY’ is a condition determined clinically or considered by the patient or his relatives as requiring urgent medical or allied services failing which it hold result in loss of life or limb. Emergency is an illness or injury for which the patient requires/desires the immediate attention of a clinical person.

Objectives• To provide treatment for cases requiring emergency measures.• To complete official procedures of medical record.• To be available as an information center for the emergency

medical question of the community.• To provide immediate relief and management of accident victims,

providing first-aid treatment of minor injuries as well.• To provide well organized services during the disaster situation.• To deal with ethical and medical problems that can arise in an

emergency room.• To refer the cases to the specialist after proper screening.• To maintain effective communication and coordination with all

department.• To manage medico-legal cases as per requirement.

Functions• Collection of casualties.• Community oriented infant and child health services.• Education, training and research activities.• Emergency diagnostic services and Information center.• Liaison with the policies and local authority in case of

medical-legal cases.• Provide emergency medical care and facilities.• Referral center for admission and other center.• Early detection, reporting and response.• Transfer to required specialists.

• Staffing Pattern

• Emergency department have qualified and experienced doctor, nurses and auxiliary staff. ER department consists of

• Registrar 1

• Medical officer 1

• Staff nurse 2

• Ward Attendant 1

• Security 1

Total 20 staffs

Duty hour is from 7am to 1pm (morning shift),

1pm to 7pm (evening shift), & 7pm to 7am (night shift).

In each shift, it consists of 4-5 staffs.

ER Consultant

ER Incharge

Medical Off

Staff Nurse

Organogram of the Emergency

0

500

1000

1500

2000

2500

3000

3500

4000

2068 2069 2070

ER Patients

ER Patients

Finding:

• Emergency is easy to access with ambulatory structure.

• Round the clock emergency services.

• Least cost with Medical officer visit to treatment.

• Based on digital and manual recording system.

• Pharmacy, Laboratory, Radiology at door service.

• Good Communication, security services, available trolly, stretcher, lift etc

• Emergency cases are RTA, Pneumonia, fever, RTI etc

• 24 hours of ambulance services.

• Located at ground floor for quick receive of emergency patients.

Critical Observation

• There is no Triage system available emergency due to lack of area.

• Less number of beds for emergency observation care.

• No Medical Record, Cash, Inquiry, Laboratory stations are closely available.

• Small area of lift, no ramp is available.

• Patients are needed to carry for radiological services.

• No waiting room for patient’s party.

• No area in treatment at mass casualties.

• No isolation room, plaster room, available.

• No enough number of baby cot.

Chapter 5Medical Record Department

Introduction:

• A medical record or health record in general is a systematic documentation of a single patient's long-term medical history and care.

• According to B.M Sakharkar, “MR is simply defined as a systematic documentation of a patient’s personal and social data, history of his or her ailment, clinical findings, Investigations, diagnosis, treatment given and an account of follow up and final outcomes.”

Objectives• To provide quality and effective treatment and care to

patient.• To serve as means of communication between the

physicians and the entire professionals group contributing to the care of the patient.

• To provide detail history of the patient.• To save time, effort, and money.• To help in auditing purpose.• To evaluate the hospital performance.• To help for teaching, research and training purpose.• To act as legal proof for patient, physician, institution,

health authorities and so on.• To avoid unnecessary duplication of diagnosis and

treatment.

Functions:

• Patient registration.

• Booking of appointments and initiation of medical record.

• Filing, custody, storage, prompt retrieval, file track in/out, issues and transport of patients files to clinics and wards, collection of the files promptly ate patient disposal.

• Issues and transport of patients files to clinics and wards.

• Collection of files promptly after patients disposal

• Ensuring confidentiality of patient’s data.

• Reporting births and deaths, and notifiable disease to state health authorities.

• Storage of medico-legal data and evidence, liaison with police.

• Issues of birth/death notification certificates, medical reports, coordination and release of sickness and medico-legal certificates.

• Providing data for infection control, risk management, medical audit, quality assurance, utilization review.

MRD Location and Layout

MRD Staffing PatternStaffing Pattern

MRD incharge :1MR staff : 1

Findings

• OPD and emergency medical files, folders and registers are provided to MRD at end of every month.

• Files are submitted to MRD every day after discharge from wards.

• Medical records are manually and digitally stored.

• All available files are categorized at monthly basis.

• Files and folders are stored after the payments are made.

Critical Observations

• There is less available staffs at MRD during office hours.

• Medical records are not systematically stored.• Lack of adequate space for MRD.• No specific orders of files and folders.• Medical records are retrieved with the reference

of report submitted to District Public Health office.

• No enough physical resources for handling, retrieving and disseminating final report.

• No cross check and analysis of duly record handling system.

Conclusion• IFCH in fully functioning Pediatric Hospital.

• It is Nepal first cooperative children’s hospital.

• Equipped with essential life saving features.

• Based upon children affordability prices.

• Run with International donation and free bed charity ward.

• Immunization, Nutrition Home, Mother’s Room, Visitor’s Room available facilities.

• Dedicated, specialized and experience manpower.

• 24/7 pediatric medicine and surgery facilities with ambulance service.

• Focused on hygienic and children friendly environment with playground and playroom.

References:

• Sakharkar B.M. . “ Principle of Hospital Administration and Planning”

• Kaini B.K, “Principles of Hospital Management”

• Brochure of International Friendship Children’s Hospital

• Hospital Practicum Report “National Open College”

Any Queries..