A Study on OPD, Emergency& MRD Of Kanti Children's Hospital Maharajgang , Kathmandu, Nepal

A Study on

OPD, Emergency& MRD

Of

Kanti Children's Hospital

Maharajgang , Kathmandu

Prepared By:

Thakur Prasad Lamsal

An internship report submitted towards partial fulfillment

of the requirement of

Bachelor of Health Care Management (BHCM)

"Awarded by Pokhara University"

National Open College

Lalitpur

May 2008

Acknowledgement

This is a great pleasure to submit a Hospital Practicum on Kanti Children's Hospital

through National Open College, affiliated to Pokhara University in partial fulfillment

of the requirement, for semester III of Bachelors in Health Care Management.

With a deep sense of gratitude, I express my sincere thanks to Administrative Officer,

Mr. Suman Dahal; Section Officer, Bishop Joshi; In-charge of Medical Record

Department, Mrs.Bindu Shrestha;In-charge of Maintenance Department,Mr.Roshan

Bajracharya; Mrs. Urmila Sharma and other staffs of different departments for their

kind co-operation by providing information and data as possible as they could are

sufficient for completion of this report.

I would like to express my gratitude thanks to Er.Sital Karki,the Managing Director

of National College, Mrs. Ranjana Shrestha ,the principle of National Open

College.Similary the gratitude thanks to our program coordinator ,Mr. Sagaraj

Simkhada ,and M . Bishnu Bahadur Bagai ,who made our practiced possible by

providing guidelines in the course of report preparation .They shared their knowledge

and an experience that helped me to bring out this report in the way.

Sincerely


Faculty of Management Studies

Pokhara University

Recommendation

This is to certify that the Hospital internship report tilted

A study on OPD, Emergency and MRD of Kanti Children’s Hospital

Maharajgung, Katmandu

Prepared By:


Has been prepared and submitted as approved by this college. This

internship report is forwarded to Pokhara University.

Place: Kathmandu Co-coordinator

Date: May, 2008 BHCM Program

National Open College

Lalitpur, Nepal

Ii

Faculty of Management Studies

Pokhara University

Approval

The Internship Report Tilted

A study on OPD, Emergency and MRD of Kanti Children’s Hospital

Maharajgung, Katmandu

Prepared By: -


Submitted towards partial fulfilled to the requirement for the degree "Bachelor of

Healthcare Management” The following panel of has approved of Healthcare

Management” The following panel of Examiners.

S.N Name Designation Signature /Date

1.

2.

3.

iii

Tables of Contents

Contents Page No:

Acknowledgement i

Certification of authority i

Recommendation ii

Approval Letters iii

Tables of Content iv-vii

List of Illustration viii

Abbreviations x

Abstract xi

Chapter 1

Introduction and Methodology Page No.

1.1 Introduction 1

1.2 Background Of study 2

1.3 Purpose and objectives 2

1.4 Organization of the Paper 2

1.5 Methodology 3

1.6 Scope of the Study 3

Chapter 2

Introduction of Kanti Children’s Hospital

2.1 History 5

2.2 Location of Hospital 9

2.3 Staffing 9

iv

2.4 Mission/Statement 9

2.5 Vision/Philosophy 10

2.6 Promoters of Kanti Children's Hospital 11

2.7 Management (Composition of Governing Board/Executive Board)11

2.8 Departments of Facilities available in KCH 12-13

2.9 Organization Structure of KCH 14

Chapter: 3

Out Patients Department

3.1 Introduction 15

3.2 Objectives 17

3.3 Functions 17

3.4 Locations: Design and Layout 17

3.5 Equipment and physical Facilities 19

3.6 Staffing Pattern 20

3.7 Hierarchy of Staffs 20

3.8 Flow Chart of OPD Patient 21

3.9 Work Flow Diagram 22

3.10 Written Policies 28

3.11 Daily Planning and Scheduling 29

3.12 Critical Analysis of Finding 30

v

Chapter 4

Emergency Department

4.1 Introduction 31

4.2 Objectives 32

4.3 Functions 33

4.4 Locations/Layout 33

4.5 Equipment and Physical Facilities 35


4.7 Flow Chart of Emergency Department 36

4.8 Work Flow of Diagram 37


4.10 Daily Planning & Scheduling 38


Chapter 5

Medical Records Department

5.1 Introduction 40

5.2 Objectives 42

5.3 Functions 42

5.4 Locations: Design and Layout 43

5.5 Equipment and Physical Facilities 44


5.7 Staffing Hierarchy 45

5.8 Flow Chart of MRD 46

vi

5.9 Work Flow Diagram 47


5.11 Daily Planning and Scheduling 48


6. Conclusion 50

Reference 52

Appendix 53

vii

List of Illustration

List of Tables Page No:

1 The Staffing Pattern of KCH 9

2 Demographic Presentation of KCH, OPD 16

3 Staffing Pattern Of OPD 20

4 Demographic Presentation of Emergency Patients 34

5 Staffing Pattern Of Emergency Department 35

6 Staffing Of Medical Record Department 45

List of Figures

1. Organization Structure of KCH 14

2. Design and Layout of OPD 18

3. Hierarchy of OPD 20

4. Flow Chart of OPD 21

5. Work Flow of OPD 22

6. Design and Layout of ER 34

7. Flow Chart of ER 36

8. Work Flow ER 37

9. Design and Layout of MRD 43

10. Hierarchy of Staffs 45

11. Flow Chart of MRD 46

12. Work Flow Diagram Of MRD 47

viii

Abbreviation

KCH: Kanti Children’s Hospital

OPD: Out Patient Department

IPD: Inpatient Department

ER: Emergency Department

OT: Operation Theater

ICU: Intensive Care Unit

CCU: Critical Care Unit

SICU: Surgical Intensive Care Unit

NICU: Neonatal Intensive Care Unit\

PICU: Pediatric Intensive Care Unit

NIMCU: Neonatal Intermediate Care Unit

PIMCU: Pediatric Intermediate Care Unit

CSSD: Centrally Sterile Supply Department

MRD: Medical Record Department

GP: General Patient

BU: Burn Unit

MIS: Management Information System

MOHP: Ministry Of Health And Population

GO: Government Organization

WHO: World Health Organization

EEG: Electroencephogram

ix

USG: Ultrasonography

ECHO: Echocardiography

ORT: Oral Re-hydration Therapy

ARI: Acute Respiratory Infection

Lab: laboratory

SW: Surgical Ward

PW: Pediatric Ward

CW: Cardiology Ward

OW: Oncology Ward

PW: Paying Ward

RAMS: Repair And Maintenance Section

KGH: Kanti General Hospital

NOC: National Open College

BHCM: Bachelor Of Healthcare Management

TUTH: Trihuvan University Teaching Hospital

x

Abstract

Kanti Children Hospital was established in 1963 A.D. as a general hospital with

50 bedded named as Kanti Hospital. Being a semi-autonomous institution owned

by Government serving for children from newborn to the age 14 years. All the

policies and decisions of the hospital are fully handled by the government through

the Ministry of Health and Population (MOHP). It is operated through the

Development Committee Act and has to submit reports of all its works and

achievements to the Ministry Of Health And Population on regular basis.

The hospital was built by donation from the Government of U.S.S.R. to the

kingdom of Nepal. In 1970 AD, Kanti Hospital has changed the name as Kanti

Children's Hospital adding 100 beds acting as totally devoted hospital for serving

children only. Gradually, in 2002 A.D., Kanti Children Hospital built 300 bedded

through the effort of the government by adding 50 beds to it.

A visit in 1984 AD by the former Rt. Honorable Prime Ministed oF Japan , Late

Mr. Ryutrao Hasimoto was a milestone in the history o Kanti Children's Hospital.

The Japanese aid was come in two stages. The fist stage was a large consignment

of modern equipment and the second stage was the present building. After a

large grant assistant from the Japanese Government Kanti Children Hospital truly

become a modern center for childcare.

xi

14

Out Patients Department of KCH well facilitated with qualified in both

administrative as well as medical department. There are about 23 staffs in OPD.

Staffs are given their duty on the rotation basis. There are 9 staffs in MRD who

works as the Kanti Children’s Hospital rules.

There is manual system of maintaining the record .The emergency department of

hospital is located at the

ground floor with the easy access of the transportation. The health services

provided in the department is good and faster which help to save the patients at

the correct time. There is good communication and collaboration among the staffs

between the different departments. The department has to provide 24-hour service

to the patients.

Xii

15

CHAPTER ONE

1. Introduction and Methodology

1.1 Introduction

Health is not mainly an issue of doctors, social services and hospital it's an issue

of Social justice. Doctors are human beings, and human being runs the hospital.

Thus we human being are the social justices and we are responsible to promote

the health status. Good health is the indicator of health status of the nation. Health

is the fundamental human right, as we know health is worldwide social goal.

It has been started from the ancient time when ill patients were treated in church,

temples and hospices and later on developed as morden hospitals to provide

primary, secondary, tertiary and rehabilitative care. “Health is a state of

complete physical, mental and social well being and not merely an absence of

diseases or infirmity"-WHO (1948) A hospital is an integral part of social and

medical organization. To be the manager of the hospital an individual required

both the practical and theoretical knowledge to reflect upon the experiences,

training in new skills and understanding the basic management. Hospital is a part

of a social system. It is the most important institution, which provides heath care

services to the sick people. “A Hospital is a part of a social and medical

organization, the function of which is to provide for the population complete

health care, both curative and preventive, and whose outpatient services reach out

to the family and its home environment; the hospital is also a center for the

training of health workers and bio-social research."

-WHO definition of Hospital (1951)

16

1.2 Background of the study

Health care is being indispensable part of every human being. The management

of hospital is necessary for effective, efficient and comprehensive health services.

We came to know about the functioning of Kanti Children's Hospital and through

the observation; we learnt the knowledge of how to handle the hospital activities.

Since our visit was just only for six weeks, all the essential information about the

hospital was explained in short as much information as we got.

1.3 Purpose and Objectives

The main purpose and the objectives of the observation of Kanti Children's

Hospital are as follows:

To observe the activities of patient flow in OPD and Emergency

department of the hospital.

To study the management process of out patient department, emergency

department and medical record department of the hospital.

To find out the problems related with patient in OPD, Emergency and

MRD of the hospital.

1.4 Organization of Paper

This whole study was summarized into five chapters.

The First chapter deals with the Information, Background of Study, Purpose and

Objectives, Methodology and Scope of the Study.

The Second chapter deals with the Introduction of Kanti Children's Hospital. It

has guided the History, Mission Statement, Vision Statement / Philosophy,

Promoters, Management of Kanti Children's Hospital, List of Department or

17

Various Service Facilities, the Organization Structure of Kanti Children's

Hospital.

The Third chapter is related with Introduction of OPD, Objectives, Functions,

Location: Design & Layout, Equipment and Physical Facilities, Staffing Pattern,

Flow Chart of OPD Patient, Work Flow Diagram, Written Policies, Daily

Planning & Scheduling, and Critical Analysis of Finding.

The Fourth chapter is related with Introduction of ERD, Objectives, Functions,

Location: Design & Layout, Equipment and Physical Facilities, Staffing Pattern,

Flow Chart of emergency Patient Work Flow Diagram, Written Policies, Daily

Planning & Scheduling, and Critical Analysis of Finding.

The Fifth chapter deals with MRD. It consists of Introduction of MRD,

Objectives, Functions, Location: Design & Layout, Equipment and Physical

Facilities, Staffing Pattern, Flow Chart of MRD, Work Flow Diagram, Written

Policies, Daily Planning & Scheduling, and Critical Analysis of Finding.

1.5 Methodology

The present internship study has adopted primary and secondary data collection.

All the information gathered in this report of Kanti Children's Hospital, based on

discussion with staffs of the hospital. Close cite observation as primary data

collection. Secondary information is collected from Kanti Children's Hospital

souvenir, brochure, journals as well as Internet web page.

Since the study is concerned with describing the three departments (OPD, EMR,

MRD) of Kanti Children's Hospital with it's overall information.

18

1.6 Scope of the study

Being the student of Health Care Management, we have to attend our internship

to any hospital. So we choose Kanti Children's Hospital, which is fruitful for our

Practicum. During the hospital Practicum, we visited all the departments of Kanti

Children's Hospital for six weeks and collected the necessary information about

different departments, management system of the hospital, organization structure,

staffing pattern, patients flow etc.

With the study made on hospital not only the student, who studied are benefited

but the entire mass is benefited such as trainers and trainees etc by providing

better feedback for the future concern. It helps the trainers and trainees to deal

with the circumstances, helps to know about the managerial aspects, help to

provide knowledge and skills etc by this study student are guided for their focus

in health programme running in the country .By this study the working procedure

in hospitals are found out such as services provided to patients. Availability and

utilization of resources, polilices and procedures followed, which will in build

knowledge in students about the program.

CHAPTER TWO

Introduction of Hospital

2.1History of KCH

19

Kanti Children's Hospital is remarkable for serving as the only pediatric hospital

in Nepal. His Majesty Late King Mahendra inaugurated it in the year 2020 B.S.,

22nd Poush (1963 A.D.).Under the auspicious name of his late Majesty the Queen

Grandmother Kanti Rajya Laxmi Devi Shah. This hospital was build through

patronage received from the Government of U.S.S.R. the Kingdom of Nepal as a

general hospital with 50 beds. The Soviet Government's patronage including few

Russian doctors, nurses and other technicians in number.

From 1968 AD, Kanti General Hospital was totally run by HMG Nepal. Shortly

after, the transfer of the pediatric department of Bir Hospital having 10 beds

converted Kanti Children's Hospital, as we know it today. In 1970, the Ministry of

Health making it 150-bedded pediatric hospital added 100 beds.

The formal Soviet Union was responsible for the initial building and for partial

equipping of the initial building of the hospital. Aid was also forthcoming from

the German Nepal Assistance Association. At the same time donations were

received from individuals, and others offering their personal service. A number or

specialized individual visiting the doctors brought expertise in the areas of

anesthesiology and surgery (from Britain).

In 1983 AD, the hospital received a budget of 1.3 million rupees, which was used

by the hospital for overall procedures, and requirements of the hospital and on the

same year semi-autonomous Kanti Children's Hospital Development Board was

formed. Between 1986 AD and 1993 AD the Japanese Government, become a

particularly significant patron of the hospital. Late King Mr.Ryutaro Hashimoto

in 1989 AD procured first phase as a major Japanese Grant Aid award, which

enable all out-of-date equipment to be replaced, and consignment of modern

equipment. An oxygen plant and a surgical I.C.U were also established. In

20

addition, upgrading of several units was also established like the NICU, the

pathology services with Diagnostics department; the CSSD; the OT; the

anesthesiology department; the emergency department and the physiotherapy unit

including the burns sectors.

In 1993 AD, a second phase of Japanese patronage brought benefits both in terms

of construction of buildings and addition of more equipment or facilities. Vast

improvement was effected in the surgical and medical sectors.

The old termite infested surgical building was demolished to make rooms for new

buildings. The facilities listed were upgraded.

i) OT (2 major, 1 septic, 1 minor OT)

ii) Surgical ICU (SICU)

iii) Surgical wards

iv) CSSD

v) Pediatric ICU (PICU)

vi) Neonatal ICU (NICU)

vii) Milk kitchen

viii) Clinical laboratory

ix) Pathology laboratory

x) Medical OPD (with follow up)

xi) Surgical OPD (with dressing room)

xii) Dental OPD (with X-ray)

Apart from this an oxygen supply room and a baby weighing room (dispensary)

were created. A lift, cash and registration counter, telephone exchange, and

waiting room with two sets of televisions (for public health information) were

also build, and an improved Repairs and Maintenance Sector was established. A

21

stand-by electricity generator was installed and the drainage system and water

supply to the building was upgraded. These rebuilding improvements were

accompanied by the acquisition of an X-ray machine and ultra sonogram, and

echocardiogram, and EEG for the ground floor Radiology and Diagnostic

Department.

In the Medical sector, it was found necessary to renovate the old medical building

to create more space for patients and new facilities.

Important improvements were made in several areas in 1993 AD. They are:

The speech and physiotherapy unit of the surgical department was

upgraded and refurbished.

Book was added to the medical library.

The medical records section was enlarged

The laundry, which was moved to more spacious region to the west of the

hospital was connected to the water mains, and supplied with new

automatic washing machines.

The main drainage system for the entire hospital was constructed

Later through Nepal Government's effort, 50 beds were adopted in Kanti

Children's Hospital making it 300-bedded pediatric hospital serving as the

nation's one and only children's hospital. And, thus at present, Kanti Children's

Hospital offers 300 beds in the hospital peripheral with various services rendered

within itself as much as it could.

Under Kanti Children's Hospital, special care is provided for particularly poor and

needy patients through the action of Social Action Volunteers (SAV) Kanti

Children's Hospital unit. These auxiliaries offer help on a variety of levels from

providing blood or medicine to feeding or transporting the patient home after

22

treatment. Special care is provided particularly poor and needy patients through

the Social Action Volunteers (SAV) of KCH unit. These volunteer often help on a

variety of level from providing blood or medicine to feeding or transporting the

patients to home after treatment. They also run playroom for sick children.

Transportation of patients between KCH and other hospital or private nursing

home is provided free of charged. Immunization (including BCG, polio, DPT and

Measles) and formal family planning services are provided free of charge.

Kanti children's Hospital at present offers 250 beds. As increasing number of

children are visiting for hospital for specialized treatment, for example at attends

a neurological OPD clinic staffed by a visiting doctor from the Teaching Hospital.

Most come from poor or middle class families. They travel great distance and

their parents often need somewhere to stay with the help of donations from

various organization (including the Social Services National Co-ordination

Council, Nepal German Help Association) a " patients sector home " has been set

up with sleeping, cooking an washing facilities.

2.2 Location

Kanti Children's Hospital is situated on the northern side of Kathmandu Valley,

Maharjgunj, Chakrapath, nearly 3.5 km from the center of Kathmandu valley,

Rani Pokhari, adjacent to the Institute of Medicine (IOM) and the Tribhuban

23

University Teaching Hospital (TUTH).

2.3 Staffing Pattern

The development board runs the hospital and the director acts as the member

secretary of the hospital board. At present around 525 staffs are employed in the

hospital working under the development board of the hospital.

There are two types of staffing patterns. They are shown in table as under:

Table No. 1 Staffing Pattern of Kanti Children's Hospital

2.4 Mission Statement Of KCH

It is planned to convert KCH into 500-bed institute of child health in the future.

Government of Nepal has given the mandate to the Kanti Children’s Hospital

Development Board for the development of infrastructure of institute of child

health.

The implicit mission of Kanti Children’s Hospital is as follows:

i. To provide health services to all the children of any age, sex, and race at

affordable cost.

ii.To upgrade the status of health services

S.N. Staffing Pattern No. of Staffs

1. Regular Staffs 258

2. Hospital Board Staffs 267

Total Staffs 525

24

iii.To work as a referral center

iv.To upgrade the health status of children

v.To help the poor patients by treating them at free of cost

vi.To provide optimum health care services to the children up to the age of 14

rendered within the hospital peripherals to the local area and in cast

terms thought the country.

2.5 Vision Statement /Philosophy

" The child care the precious seed of the future the object of all our affections, is

the hope of tomorrow For it is the child that will carry out our aspirations

forward, that will dream and will transform the dream into a meaningful reality

for the entire world to enjoy. Thus is to the child our efforts are singularly

dedicated. Where disease lurks and the child is endangered, the full might of our

concern will be to uphold life more than any other does. Hope is the message that

we give, cure and prevention our weapons .For the child's sake and to the child

alone we dedicated ourselves."

-Statement of the Kanti Children's Hospital

2.6 Promoters of Kanti Children's Hospital

25

Kanti Children's Hospital has get many promoters from past to till now. The

USSR Government was its initial promoter likewise Ministry of Health and

Population is another too. Similarly Japanese aid for Japanese Government was

great promoter of This Hospital. Apart from this, Elective student who came for

their internship are also promoter of This Hospital.

The Various funds, Associations, Free Volunteering Body like The Hasimoto

Trust Fund, Oncology Fund, and Kanti Children’s Hospital Appeal Fund are

social promoters of KCH.

2.7 Management /Governing Board / Executive Director

At present, Kanti Children’s Hospital Development Board (Board) manages

KCH, which is an autonomous corporate body under the Ministry of Health and

Population (M0HP), Government of Nepal (GoN). Members of the board are

drawn from civil society and hospital management itself. The Board is heavily

depended on GoN for human, material and financial resources. The Board plans

to convert KCH into an independent full-fledged institute of child health in the

future.

The Board abides by the GoN guidelines to provide free medical treatments for

poor patients coming from all over Nepal.

The Board expresses immense gratitude to all organizations and individuals who

joined us in the past for the growth and development of KCH and wish that such

cooperation be continued in the future.

2.8 Departments & Facilities Available In KCH

Emergency: - 24 hour services

26

10 bed observation ward/30 bed ORT /ARI

Minor Operation Theatre

Laboratory Services

Radiology (x-ray) Services

Blood Bank Services

Out Patient Service:

Surgical with dressing cum minor operation Theatre

Medical + Follow Up

Dental with Dental x-ray

Neuro Surgery (once week supported by TUTH)

Cardiac OPD (Twice a week)

Nephrology (Once a week)

Physiotherapy

Family planning and immunization

Nutrition counseling cell

Play Room for children

Pharmacy

Theatre and Anesthesiology:

2 major operation theatres

1 septic operation theatre

1 minor operation theatre

Anesthesiology Department (Operation theatres can be opened in

emergency cases at any time (24 hours)

Wards:

General pediatric ward

27

Oncology ward

Cardiac ward

Malnutrition ward

Paying /Special cabin (with 1 isolated bed)

Surgical ward

Burn ward

SICU (Surgical Intensive Care Unit)

Neonatal /Pediatric care unit (NICU /PICU)

Supportive Services:

Central Sterile Supply Department (CSSD)

Enquiry /Telephone Counter

Milk Kitchen

Oxygen plant

Laundry

Water supply and treatment plan

Chemist shops open 24 hours

Canteen

Repair and Maintenance Sections (RAMS)

Facility/Accommodation for Young Mothers

Volunteer Service Section for poor and helpless visitors

28

Medical Dept

Chief Consultant

Consultant

Registrar

Sen. MedicalOfficer

Duty

/Medical

Officer

Dark Room Asst.

ANM

Medical Officer

Technical Supportive Staffs

2.9 Organization Structure of Kanti Children’s Hospital

Nepal Government

Ministry Of Health & Population

Kanti Children’s Hospital

KCH Development Board

Director

MedicalImgingDept

.

Pathology Dept. Anesthesia

Dept.Nursing Dept.

SurgicalDept.

Administrative Dept.

Finance Dept.

Chief Consultant Chief

Consultant

MedicalOfficer

MatronChief

ConsultantAdministrative Officer

Accountant

Finance Officer

Official

Non-OfficialAss. Accountant

Consultant

Registrar

Ass. Matron

Sister InCharge

Chief Consultant

ConsultantMedical Technologist

Lab Tech.

Consultant

Radiographer

Ass. Lab Tech.

Staff Nurse

Sen. MedicalOfficer

29

CHAPTER THREE

Outpatient Department

3.1 Introduction

Out patient department is defined as part of the hospital with giving physical

facilities and medical and other staffs in sufficient numbers, giving with regularly

scheduled hours, to provide care for patients who are not registered as inpatient.

The outpatient services progressively becoming an integral part of the hospital

An outpatient is the patient’s first point of the contact with the hospital an entry

points the health care delivery system. It is an inseparable link in the hierarchical

chain of health care facilities. It contributes to reduction morbidity and mortality.

It is the "Shop Window" of the hospital.

Out patients can be group under the following three categories: -

1. Emergency OPD

2. Referred OPD

3. General OPD

The out patients department of the Kanti Children's Hospital was started from 8

rooms and now it has 19 rooms .The OPD and MRD are within the same working

area. OPD of the Kanti Children's Hospital is handled by six consultant doctors (4

from Kanti Children’s Hospital and 2 from Teaching Hospital) who have

specialized in several medical and surgical fields. In this hospital, there

insufficient waiting hall with adequate sitting materials to patients and their

parents considering their easy. In addition, there are two sets of TU and

AASMAN garden (Playing area) for waiting patients and theirs parents for

entertainment so that they may not feel boredom while they are waiting for theirs

names to be called for check -up. Separate toilets, adequate ventilation and

30

lightening are facilitated at the outpatient check-up rooms and waiting hall. Here

at OPD all the physical facilities are available as required.

Here is 3 years OPD department demographic presentation of KCH.

Category 2061/2062 2062/2063 2063/2064

Total OPD Visit 95966 119609 106967

Proportion of Female

Patient on OPD

45021 64746 40670

Doctor Patients Ratio

(OPD)

186.5 239.4 1414.6

Table No. 2 Demographic Presentation of KCH, OPD

Procedure

Initially, the patients should take the OPD ticket paying Rs.10 for treatment, and

then only according to the ticket number, the OPD medical staffs will do checkup.

If the patients are new, he/she should pay Rs.10 & if they are old patients, then

they pay Rs.5 for OPD tickets as follow up. The OPD time scheduling of KCH

starts from 8:30AM to 1 PM.Apart from this time, those who came to check-up

are considered as Emergency patients.

The services provided by OPD are as follows:

a) Medical OPD services

b) Surgical OPD services

c) Dental OPD services

d) Neuro OPD services

e) Follow-up OPD services

31

3.2 Objective

The main objectives of OPD in Kanti Children's Hospital are as follows

i) To provide services in minimum cost

ii) To conduct diagnostic, preventive and restorative health program

iii) To provide medical, nursing and paramedical education

iv) To devote all achievements for the care of children health

v) To help hospital become a true focal point of community and nation's health,

meeting and serving them with their needs and demands

3.3 Function

The functions of OPD are as follows

i) Early diagnosis and treatment

ii) Effective treatment on ambulatory basis

iii) The admission or referral for admission

iv) Afterence and medical rehabilitation

v) Training and research

vi) Proper record keeping

vii) Promotion and health of the individuals

3.4 Location: Design and Layout

Location of OPD

OPD of Kant Children's Hospital is located in the ground floor of new complex

constructed as a token of friendship and cooperation between Japan and The

Kingdom of Nepal in 1995.It is near the main entrance of the hospital and in close

proximity to vital adjunct services such as emergency, X-ray /radiology

department, MRD / Out Patient registration counter, dispensary distribution

counter, reception, clinical pathology, information desk, etc.

32

Design and Layout:

Fig. No. 2 Design and Layout of OPD

Eight Consultant Room for old patients

Aasman Garden

Surgical OPD

Dental OPD

WAITING

HALL

Space

OPERIPCashCounter

Record Keeping room

Med Dist.Room

InchargeRoommmm

7

6

5

4

3

2

1 consultant Room for new patient

Lab

Report

Station

Information desk

33

3.5 Equipment and physical facilities

In OPD, all the necessary equipment is adopted separately for all the cabinets

with reference to adequate lightening and ventilation services:

The equipments in OPD are as follows:

Weighing machine

Stethoscope

BP Instrument

Torch light

Thermometer

Height scale

X-ray view box

Different forms

The physical facilities in OPD are as follows:

Air cooler

Well ventilated

Working tables

Beds

Cupboards

Hand washing basin

34


The staffing pattern of OPD:

Table No. 3 Staffing Pattern of OPD

3.7 The hierarchy of Out Patient Department

Fig No. 3 Hierarchy of OPD Department

S.N. Staffs if Various OPD No. Of Staffs

1. Medical/Surgical/Dental/Nephrology

OPD

6

2. Immunization/Family

Planning/DOTS

2

3. Radiology Department 13

4. Peon 2

Total 23

Chief Consultant

Consultant

Senior Medical Officer

Medical Officer

35

3.8 Flow Chart

The Flow Chart of Out Patient Department:

Fig. No.4 Flow Chart of OPD

Chief Consultant

Consultant

Senior Medical Officer

Medical Officer

36

3.9 Work Flow Diagram

The work Flow of OPD:

Fig No: 5 Work Flow of OPD

Registration

Waiting

Check Up

Investigation

Diagnosis

Dispensary

Treatment

Inpatient

Discharge

37

The OPD services provided by Kanti Children's Hospital are as follows:

Radiology Department:

The present radiology department of Kanti Children's Hospital is a new

department with new equipment from grant aid of Japan at 1993.The hospital

charges to the patients are reasonable for those who can afford but there are free

services to the poor patients. The major services provided from this department

are:

X-ray Services:

X-ray services deals with different types of cases referred by doctors from OPD

clinic and Inpatient ward. The services available are General X-ray and Special

X-ray. It provides services to the patients round the clock. Patients who cannot

come to the X-ray room are facilitated with mobile/portable X-ray machine. In

general, X-ray room, bunky, elder's chest X-ray machine and X-ray machine (for

children) are adopted. Provision of dark room for bringing out the X-ray film for

both General and X-ray are facilitated. The special X-ray consists of IVU

(Intervenes Eurography) for abnormal cases Barium swallow (checks food

product in patients, abdomen, throat through Image Intensive Fire Screen (IIFS)

and distal loop gram for cholesterol patient. The X-ray room consists of 9 inched

lead protection walls for blocking radiation to the X-ray technicians. The average

patient flow of both X-ray rooms is about 100 within 24 hours

USG and ECHO Services

USG Services

Diagnostic Ultrasound is an imaging technology, which is becoming increasingly

popular because it does not require potentially harmful radiation. The ultrasound

services of kanti Children's Hospital does different type of USG such as USG of

38

throat, eye, abdomen, etc.besides bone. There are 2 sets of USG machine. The old

one is now out of use that as donated by Japanese Government and new one is

called color Doppler. The average patient flow here is about 15-20 per day.

ECHO Services

Electro Cardiograph machine shows heart (video X-ray) structures contractions,

change in value and defects are also shown. ECHO room consist ECHO machine-

ray view box and computer for recording patient's data. It needs dark room and

facilitated with air cooler, wooden cabinet for keeping reports chains for visitors

waiting bench. The average patient flow per day is 6-12.Patients are usually

referred through Observation ward.

EEG Services

Electro Encephalon Graph (EEG) machine diagnonizes.It is the most sensitive

machine in the whole radiology department where the walls including windows

are lead proof. Here the report of a patient is prepared and distributed on

alternative days.

Physiotherapy

KCH provides treatment of diseases of patients by the means of message the use

of light heat, electricity and other natural forces including physical

exercises.Thus,KCH provides relieve to the patient through different physical

mental exercises.KCH facilitates physiotherapy as a part of OPD.KCH provides

treatments by the mean of exercise, soft tissue technique(massage)

electrotherapy,cryotherapy(ice therapy)and other natural forces in physiotherapy.

39

Clinical Pathology

Kanti Children's Hospital facilitates highly sophisticated modern machines and

equipments in clinical health laboratory. The laboratory services include

emergency lab and blood banks services (room1), paracitylogy lab services

(room2),biochemistry lab services(room3),microbiology and serology lab

services(room4)and hematology and FNAC lab services(room5).The lab services

from room number 1(ground floor)is available round the clock whereas the

remaining lab services in first floor of new complex are available only at day

hour.

Immunization

Immunization clinic is a prominent part of KCH providing immunization, family

planning services and counseling as well as functioning as a DOTS clinic. This

clinic functioning as a clinic for babies, provides lactation advice and acts as

nutrition center. The vaccines provided by this clinic are BCG, Hepatitis with

DPT(Diphtheria , Pertussis ,Tetanus) and Measles on every Sunday, Tuesday and

Friday without any hospital charges. District Public Health Office, Teku, provides

the required medicines and equipments.

Family Planning

Immunization clinic acts itself as family planning clinics too. It facilitates

services like provision of condoms, oral contraceptive pills and Depo-Provera and

in addition counseling services are facilitated for family planning on every

Monday, Wednesday and Friday. The required medicines and equipments are

provided by DPHO, Teku.

40

DOTS Clinic

Unlike family planning, DOTS clinic is also served within the immunization

clinic, which provides DOTS medicine to the patients attending KCH. The

required medicines and equipments are provided by DPHO, Teku.

Malnutrition OPD

Nutrition OPD of Kanti Children's Hospital provides information about the

nutrition diet that a child must have. Generally, patients are referred by medical

and surgical wards, immunization OPD and ORT, for counseling according to the

diseases like diabetes, kidney failure, TB, Hypertension under weight etc. Only

mild and moderate patients are given counseling according to the need of

nutrition diet. The dietician gives counseling to the parents to the misconception

about the food and gives focus on the preparation about the different nature of

diet food. Average flow of patient is 20-25 per week.

Medical OPD

The medical OPD consists of cardiology, nephrology, oncology, TB clinic, and

follow-up (NICU) services for both old and new patients. Althogether there are 8

separate cubic for all the concerned medical staffs and the required instruments.

Out of 8 cubic, two of them are consultant rooms; one for old and the other for

new patients and the remaining 6 cubic are for general treatment. The OPD is

well managed and ventilated with sophisticated equipments.

Surgical OPD

The surgical OPD of Kanti Children's Hospital facilitates various services like

cardiology, nephrology, oncology, TB clinic and follow-up services for both old

and new patients. This OPD is well managed equipped and ventilated with a

separate dressing room.

41

Dental OPD

Kanti Children's Hospital has a regular dental OPD six days a week i.e. Sunday to

Friday except national holidays. It also provides education about oral hygiene,

eating habits, brushing habits, etc to the children and their parents /guardians

other than providing dental services.

Nephrology OPD

Nephrology OPD in kanti Children's Hospital is facilitated on every Thursday

acts as a separate Nephrology OPD. Here are two types of patients, new patients,

new patients and follow-up patients.

Other services provided by Kanti Children's Hospital are as follows

Repair and Maintenance Services (RAMS)

In Kanti Children's Hospital, Rams provides one of the major departments, which

provide maintenance facilities. This department is referred as biomedical

equipment and helps doctors to perform the activities. It plays a vital role to

assure that the patients are receiving the correct diagnostic and treatment. This

usually includes installation calibration inspection and prevention maintenance of

the equipment.

LAB

Lab is important part of Kanti Children's Hospital where it is classified into four

categories. They are Microbiology, Biochemistry, Hematology and Paracitylogy.

This Department supplies the laboratory test to the patients. It gives 24 hours

services for emergency patients. Lab is facilitated with well and modern

equipment with qualified technicians. As possible many lab test are done.

42

Central Sterilized Supply Department (CSSD)

In Kanti Children's Hospital, CSSD plays vital role to keep the various materials

uninfected. It is main department to look over the health and hygiene of overall

patients. It is indispensable to OT, surgical and medical units. This department

prevents the various infections that can easily contaminate with patient's health. It

supplies sterilized instruments linen and supplies to the various units. All the sets

and instruments are sterilized with Japanese autoclave machine that is granted by

Government of Japan.

Operation Theatre (OT)

In Kanti Children's Hospital, OT is fully equipped and sophisticated. Here, OT is

divided into two types one is major and another is minor. In OT neonatal to 14

years child operation is done. It provides 24-hour emergency services, regular 2-

day operation and 6 days OPD surgical services. Every year 1500 operation is

done. Some cases might be referral from other hospital add this hospital is one

where the operation is done with successfully.

3.10 Written Policies

The written policies of OPD

a) Medical staffs should provide accurate diagnosis and reduce infection rate

b) Adequate time to be spent by the doctors with the patients

c) Try to ensure high safety of patients

d) The services should be provided in such a manner that high % of revisit will

occur

e) Try to reduce the total time spend by the patients in the hospital

f) Try to ensure that checked patient would have high % of follow-up rate

43

3.11 Daily Planning and scheduling

The major OPD of Kanti Children's Hospital (especially medical, surgical, dental

And follow-up) consists of 6 major units for its daily planning and scheduling, out

of which 4 units belong to Kanti Children's Hospital and the remaining 2 units

belong to Teaching Hospital. Each unit of major OPD of Kanti Children's

Hospital is assigned a consultant. The OPD hour starts from 8:30AM to 1:00PM

where the tickets are distributed for the patients to the related consultant doctors

are per their diseases by the MRD staffs since their working area is same as that

of OPD.Moreover, on every Tuesday and Friday, Nutrition OPD and on every

Thursday, Nephrology OPD are run. Rather then other services Kanti Children's

Hospital serves simple dressing services, immunizing services, dispensary

services, laboratory services and finally radiology services to its patients to the

consultant's suggestions. Children less than 2 months are first taken their weights

and then only take them to OP room directly as they are considered more

sensible. The other effective daily planning and scheduling of Kanti Children's

Hospital is to provide immediate checkup services to those patients who are

considered more serious than other general outpatients are.

The daily planning and scheduling of OPD of Kanti Children's Hospital are also

consulted from TUTH too.

According to their work schedule as per assigned day, they perform their work

where each patient checked by them has to come for follow-up after two days of

interval after the first check-up. For example: if a patient had check-up on

Sunday, then s/he should come for follow-up on Wednesday.

44

3.12 Finding /Critical Analysis

Being a student of health care and hospital management, we were glad to see the

waiting and working area well managed and equipped that we learnt during our

study courses.

Findings

People become unaware about using toilets direction, OPD departments etc.

Parents throw garbage and dirty linen everywhere though the OPD consists of

playing area, called as AASMAN GARDEN; it is closed due to destruction and

lost of playing tools. Waiting area is not sufficient .No provision of drinking

water supplies

Critical Analysis

Many people came from rural area as well as from urban area. Therefore, they

are unaware of using toilet’s direction in proper way... Due to the care less of the

patients, garbage is thrown on the floor. Therefore, for increasing awareness

about clean environment, posters can be hung on the wall. In OPD there is a

playing garden named Aasman Garden that is recently closed due to loss of

playing materials. If parents and staffs are conscious to that, then it could run

again smoothly. Moreover, there is also another playing room at separate area.

Considering this into account, Aasman Garden can be merge in that room with

more care. In OPD, the patient flow is high but the waiting hall is not sufficient to

the ratio of the patients. So, the hospital should consider that part of

inconvenience of visitors by expanding more sitting materials. Since there is no

sufficient provision of drinking water facilities available at the hospital periphery

in terms of OPD, it would be appreciable to facilities the drinking water supplies.

45

CHAPTER FOUR

Emergency Department

4.1 Introduction

Hospital offers services to victims depending upon the people's conditions. Every

Hospital more or less provides wide range of services like OPD, Emergency.

Rehabilitative etc. as they are categorized as specialized as cardiology,

pulmonary, Renal or Mental hospital .All hospital should have established

separately an Emergency Department where all critical patient are treated .An

Emergency Department is a mandatory department and their available staffs as

well as equipment.

“Emergency may be defined as condition determined clinically or considered

by the patient or his relative as requiring urgent medical or allied services

falling which it would result in loss of life or limb”

An Emergency medical service is an important aspect of acute medical care

provided by the hospital. This is an essential element in the contribution of the

hospital towards the total health care of the community. The emergency medical

services serve the community during any time of need 365 days, 12 months and

24 hour.

Emergency services (ER) at Kanti Children’s Hospital are found 24 hourly for all

day. This service is round the clock system with care of the patients with qualified

staffs personnel and required equipments in pediatric sector.

46

Emergency Department of Kanti Children’s Hospital can be categorized into two

wards viz.

(i) Emergency Wards;

(ii) Observation Wards;

Emergency Ward Emergency ward in Kanti Children’s Hospital consist of 3

beds each having well equipped IV set with qualified and skilled doctors for the

patients in need round the clock having duties in shift.

Observation In the observation wards, KCH patients are observed who needs

observation for evaluation. After evaluation, these patients are either discharged

on medications or admitted in different wards. Different specialist also consults

them if needed. Consultant does the rounds in this ward twice, in the morning and

evening after the check ups of the patients finished in the outpatient department.

A team of consisting of a nursing in charge with her subordinates and on duty

doctor gives care to the patients in this ward. There are 11 beds, 2 cots with

radiant heaters for the care of newborn babies, nebulizer and oxygen cylinders.

4.2 Objectives

The main objectives of Emergency Services (ER) at Kanti Children’s Hospital

are as following:

(i) Provision of immediate relief and management of the patient arriving at the

hospital with acute medical and surgical emergencies with trained staffs and well

equipped emergencies reception room

47

(ii) Managing accident victims, providing first and treatment of minor injuries and

referral to appropriate specialty hospital i.e. Cardiology, Oncology Neurology etc.

(iii) Attending to patient coming outside the routine outpatient working hours and

screening them for admission, observing them for short period for determining

weather they need admission etc.

4.3 Function

The following are the main functions of Emergency Department of Kanti

Children’s Hospital:

i. Work as reception center in case of disaster

ii. Collection of casualties

iii. Liaison with the police and local authority in case of medico-legal cases

iv. Work as information center

v. Education, Training and Research

4.4 Location of Emergency Department

Emergency department of Kanti Children's Hospital is situated at front side of

ground of new complex, which was donated for its completion as a token of

friendship and co-operation from the Late Former Prime Minister of Japan, Mr.

Ryutaro Hashimoto. There is separate or alternative entrance for emergency

department. This Emergency department of KCH is nearly located to it main gate

for easily get accessible to victims.

48

Design and Layout

Fig. No: 6 Design and Layout of Emergency Department

Category 2061/2062 2062/2063 2063/2064

Total No of

Emergency

Patients

28989 40821 42252

Table No 4 Three year’s demographic presentation of ER Dep. KCH.

49

4.5 Equipment and Physical Facilities

Following are the main equipment used by the Emergency Department of KCH:

Suction Pump

Nebulizer

Emergency Trolley

Iv stand

Neonatal beds

Warmer cards

X-ray view box

Oxygen cylinder

Cupboards containing all necessary drugs and equipment


The Kanti Children's Hospital, Emergency department has following staffing No

staffs and Patterns

Table No. 5 Staffing Pattern of Emergency Dept. of KCH

4.7 Flow Chart of Emergency Patient

S.N. Staffing Pattern No. Of Staffs

1. Ward In Charge Officer 1

2. Staff Nurses 9

3. Nurse Aid 1

4. Ward Attendance 4

5. Sweeper 4

Total 19

50

Fig No. 7 Flow Chart of Emergency Department


Consultant

Duty /Medical Officer

51

Fig: 8 The work flow diagram of Emergency Department:

Patients

Referred Back to Home

Emergency Ward

Investigation

Diagnosis

Observation Ward

Admission

52


The written policies of Emergency Department are as follows:

i) Treatment of cases requiring emergency measures.

ii) To be available as an information center for the emergency medical

questions of the community

iii) Liaison with the police and local authority in case of medical legal

cases.

iv) Act as an education, training and research centering

v) Provide adequate physical facilities, equipment and disposable

facilities.

4.10 Daily Planning and Schedule

i) Determination of surgical and medical cases, then patients are referred

to observation ward

ii) Re-evaluation is done in observation ward and then finalized (after

diagnosing) and refer as per the necessity.

iii) Always acts as information center to attendance authorities and

concerned persons.

iv) Acting as an education, training and research center

v) Cope up with the ethical and medical problem which can arise in

emergency room

vi) Treatment of various cares requiring emergency services.

53

4.11 Finding/Critical Analysis

Findings

Insufficiency of beds as high patients flow in emergency department. Patients

from various wards cover beds of ER wards due to insufficiency. Visitors made

so crowd in the Emergency Department.

Critical Analysis

In the Emergency Department of KCH, there are insufficient beds to the ratio of

the patient's .To see the patients, many relatives came there so it makes this ward

which made overcrowd .It is better to formulate routine scheduling of patients

visiting time.

54

CHAPTER FIVE

Medical Record Department

5.1 Introduction

Introduction of Medical Records Department:- In simple language, medical

records is a assembly of notes ,forms , reports and summaries of patient during

the treatment of illness .Medical records are those records which deals with the

patients previous clinical history ,age, sex , investigations ,diagnosis and

treatment summaries etc. The Major definition of, Medical Record according to

different persons is as follows: -

Dr. Mach. Eacherman, who was the “father of the Medical Record “ define as “

Medical Record is clear, concise and accurate history of the patient’s life and

illness, written from medical point of view and its true form is a complete

compilations of scientific data derived from many sources, coordinated into

an orderly document by the medical uses, personal and impersonal. “

Likewise, Mc Gibony, “ Medical record is a clinical, scientific, administrative

and legal document relating to patient care in which are recorded sufficient

data written in the sequence of events to justify diagnosis and warrant

treatment

And the results “

Similarly, B M Sakhar, “ Medical Record is defined as a systematic

documentation of a patient’s personal and social data history of his /her

ailment, clinical findings, Investigations, diagnosis, treatment given and

account of follow –up and final outcome “

55

Medical Record have main there components i.e. social data which consists of

general information, administrations data which consists of patient’s OPD

registration number, name of the patients and clinical data which may be OPD or

ward patient’s clinical information .The three basic principle are that they must be

accurately written, properly filled and easily accessible.

The necessity for maintaining proper medical records by a hospital can be broadly

grouped as follows:

a) Patient’s Needs

b) Physicians Needs

c) Institution’s Needs

d) Health Authorities Needs

In Kanti Children's Hospital, the registration counter and outpatient medical

record room is conveniently located at one end of the main waiting hall. Since the

OPD and Emergency, ticket registration counter and admission counter are

handled by the staffs of MRD, the working area of registration counters are also

considered as the working area of MRD itself at Kanti Children's Hospital. Thus

during the ticket registration procedure, the staffs ask the patient about their

disease or condition and keep the name of the consultant doctor and required

stamps and give it to the patient.

The process of MRD is done after the end of the outpatient time all patient

records are calculated. Patients flow is evaluated, categories, classified and finally

total patients numbers is recorded by its patients are stored in computer taking

advancement over the files or registers. Hence, OPD and MRD are inter-related to

each other at kanti Children's Hospital.

There are two units of medical record section of Kanti Children's Hospital. They

56

are mentioned as under:

Out Door Unit

It is classified into three counters as follows:

a) Out Patient's Care Ticket Counter

b) In-patient's Registration Desk

c) Emergency Ticket Counter

ii) In Door Unit (Medical Record Section)

5.2 Objectives

The Objectives of MRD at Kanti Children's Hospital are as below

i) To keep record of all the patients who came to the hospital

ii) To help hospital become a true focal point of community health meeting

community needs and demands

iii) To prepare the daily, monthly and yearly statistics of hospital

iv) To report the hospital services to department of health, MIS Development and

hospital authority

v) To carry out research activities

vi) To control and manage the out door and admission desk

vii) To retrieve patient records for follow-up, therapeutic follow-up study,

research purpose, group study, others

5.3 Functions

The main functions of the medical record department in Kanti Children's

Hospital are as follows:

a) To generate hospital statistics

b) To develop a good medical records system

c) Reporting to state and health agencies

57

d) Develop new record system in newer departments

e) Quality assurance

5.4 Location Design and Layout

Location of Medical Record Department

MRD of Kanti Children's Hospital is situated in ground floor of new complex

which was donated for its completion as a token of friendship and co-operation

from Late Former Prime Minister of Japan, Mr.Ryutaro Hashimoto.

Design and layout of Medical Record Department

Fig. No. 9 Layout & Design of MRD of KCH

5.5 Equipment and Physical Facilities

Working table+

Computer

Working table

+Computer

Working table+

Computer

Working table+

Computer

Bench MRDIn charge Room

OLD RECORD

Working table+

Computer

58

Equipment used in Medical Record Department

Computers

Printers

Accessories

Fan

Date stamp

Doctors stamps

Punching machine

Stapler

Pepper Cutter

Physical facilities at Medical Record Department

Sufficient lightening and ventilation

Sufficient filing racks and cabinets

Store room for records keeping

Comfortable working tables and chairs

Separate office / room for in charge

5.6 Staff Pattern

59

The Staff Pattern of Medical Record Department is as follows:

S.N. Post Staffs No

1. Medical Record Officer 2

2. Junior Medical Record

Officer

1

3. Administration Staffs 5

4. Peon 1

Total 9

Table No. 6 Staffing Pattern of MRD

5.7 The Hierarchy of the Staff

Fig. No: 10 Hierarchies of the Staff

5.8 The Flow Chart of MRD

Medical Record Officer

Assistant Medical Officer

Junior Medical Officer

Peon

60

Fig. No: 11 Flow Chart of MRD


Medical Record Officer

Assistant Medical Officer

Junior Medical Officer

Peon

61

The work flow diagram of medical record department at kanti children's

hospital is as follows:

Fig. No.12 Work Flow Diagram of MRD of KCH


Medical Record Section

OPD Ticket Counter

Admission and Information

Emergency Ticket Counter

Indexing

Reports

Completion

Coding

Data Entry

Retrieval

Review

Analyses

62

The Written Policies of MRD in Kanti Children's Hospital are as follows:

i) Record of each patient are kept up to 5 years and then disposed off.

ii) Discharge file of patient is kept in the bundle of 7 days according to discharge

day.

iii) Flashing out or giving the copy of patient's records in case of referral or

fulfilling legal requirements.

iv) Keeping of confidentiality of patient records

5.11 Daily Planning and scheduling

i) To keep record of patient inflow, admission, discharge on the daily basis.

ii) Maintenance of patients name indexes.

iii) Authorized release of Medical Records for patient care, education research,

and administrative and legal purpose.

5.12 Critical Analysis of Findings

Finding in MRD

Medical Record Department (MRD) of KCH has two rooms for it’s office and

medical record management .The office room of MRD are not enough for official

purpose .The records are stored manually which is time consuming for searching

old records .The OPD ticket counter and MRD are jointed which is beneficial for

staffs to search any records

63

Critical Analysis

Medical Record Department (MRD) of KCH seeks more spacious room for

official purpose .The Date achieving system will be easily and convenient when

computerized system adopted .The Department seeks more official equipment and

accessories if possible medical record store room should be ventilated.

64

CHAPATER SIX

Conclusion

Kanti Children’s Hospital (KCH) has a history of forty-five years of devotion to

the nation in the field of child health care. It was established in the year 1963 AD

under Soviet aid as a general hospital and was converted into Kanti Children's

Hospital in the year 1970. Today KCH is 300-bed children’s hospital and it is

planned to convert KCH into 500-bed institute of child health in the future.

Government of Nepal has given the mandate to the Kanti Children’s Hospital

Development Board for the development of infrastructure of institute of child

health.

At present, Kanti Children’s Hospital Development Board (Board) manages

KCH, which is an autonomous corporate body under the Ministry of Health and

Population (M0HP), Government of Nepal (GoN). Members of the board are

drawn from civil society and hospital management itself. The Board is heavily

depended on GoN for human, material and financial resources. The Board plans

to convert KCH into an independent full-fledged institute of child health in the

future.

The Board abides by the GoN guidelines to provide free medical treatments for

poor patients coming from all over Nepal. At present Kanti Hospital have 5

departments, 10 divisions, and 14 wards.

The services provided in the OPD and Emergency is impressive for the patients

visiting the hospital The OPD of KCH is quite successful in providing quality

65

services. The OPD of hospital is located at the first and ground floor of the

hospital. The registration is done at the ground floor located near the entrance of

hospital.

Emergency Department is the critical department so it is located at the ground

floor with the accessible of the transportation of the ambulance due to which

emergency department can provide quick service to the patients. The emergency

department consists of the advanced machinery and has fulfilled the physical

facilities that are needed to provide for the patient party.

Regarding the MRD is not well managed as other Department of KCH.

In a conclusion KCH is very reputed as only pediatric hospital in Nepal, which

provide standard services at the reasonable cost.

66

Reference

1. Sakharkar, B.M; “Principle of Hospital Administration and Planning, Jaypee

Brothers, New Delhi, 110002 India, 1998, Fifth Edition.

2. Brochures of Kanti Children’s Hospital

3 Web Page of KCH: http://www.kantihospital.org.np/

67

Appendix

Forms/used in KCH

1 .Out Patient Ticket

2. Emergency Ticket

3. Pathology Specimen Request Form

4. Pathology Stool Report Form

5. Pathology Urine Report Form

6. Pathology serology Report Form

7.Pathology Microbiology Report Form

8. Radiology (USG) Request Form

9. Blood Requisition, Report, Cross Match & Transfusion Form

10. Radiology (x-ray) Requisition Form

11.Consent Form

12. Graphich (T.P. R. ) Chart

13. Nurse's Daily Record

14. Diet Order Form

15. Ward Daily Census Form

16. Treatment Cardex Form

17. State & S. O. S. Drug Only

18. Continuation Form

19. Discharge Summary Form

68

Photos From KCH

Fig. 1 Kanti Children’s Hospital

Fig. No. 2 Kanti Children’s Hospital

Fig. No 3 Gate of Kanti Children’s Hospital

69

Fig No. 4 Waiting Wall of KCH, OPD

Fig. No. 5 Department of KCH

70

Fig. No 6 Emergency Ward of KCH

71

Date post:	07-May-2015
Category:	Education
Upload:	thakur-prasad-lamsal
View:	2,396 times
Download:	5 times