Hospital Operation Chapter 6

Ancillary Services

Learning Objectives

C.S.S.D.
Quality control and hospital infection control
Hospital housekeeping
Generation and Disposal of Bio Medical Waste
Hospital dietary And Food services
Laundry and Linen
Medical Record System

CSSD
Central Sterile Supply
Department

 No Stronger Condemnation of
any hospital or ward could be
pronounced than the simple fact
that ZYMOTIC DISEASE has
originated in it or that such
disease attack other patients than
those brought-in with

- FLORENCE NIGHTINGALE


The CSSD of a hospital receives, stores,
processes, controls and distributes
professional supplies and equipment (both
sterile and non-sterile) to all departments of
the hospital for the care and safety of patients

 1928 American College Of

Surgeons CSSD.
1942 World War II .Cairo, British
SDS Unit .
1955 Cambridge Military Hospital
Regular CSSD in UK.
1962 First CSSD in India
Safadarajang Hospital

Aims
Promote and provide an efficient, economic and
uniform source of sterile and non-sterile
equipment for the care and treatment of sick
Provide valuable assistance to purchase dept. in
the selection of goods and new products by pretesting, quality measurement
Supply equipment to highly specialized units
Organize efficient maintenance and repair of all
equipment
Research for quality of sterilizing processes
Save nursing time
Take active part in hospital infection control
committee

Scope:
1. Syringes and needles
2. Procedure Sets: Lumbar puncture ; sternal puncture ;
venesection ; paracentesis ; aspiration ; catheterization ;
tracheotomy ; suturing ; dressing ; biopsy ; incision &
drainage ; aortography ; cardiac resuscitation ; etc
3. Gloves, catheter tubing, Dressing
4. I. V. Fluids
5. Treatment Trays
6. O.T Instruments, O.T. Linen
7. Infusion Fluids for Renal Dialysis.
8. At times LINEN. (other than O.T)
NB: Diet , drugs , bedpans & urinals are not included by
convention

Working principles
The materials should be subjected to
procedures guaranteeing sterility
Staff Training regarding bacteriological
problems
Simple system of packing sterilized materials
Packs should be economical and easily
available
CSSD should provide products in a form to
save nurses, time

ADVANTAGES
1. Bacteriological safe sterilization.
2. Less expensive.
3. Elimination of unsound practices & establishment of
standard procedures.
4. Assurance of adequate supply of sterile products
immediately and constantly available for sometime as well
as emergency use
5. Conservation of trained staff.
6. Better quality control
7. To assist management of the hosp. in standardization of the
goods
8. Prolonged life by proper care of equipment
9. To provide testing facility to the dept. to ensure asepsis

FLOW PROCESS : CSSD

WARDS/DEPTS
DIRTY RECEIPT

BULK STORES
CLEAN RECEIPT

COTTON & GAUGE

DISASSEMBLY

INSTRUMENT

GLOVES

RUBBERWARE

WASHING AREAS
ASSEMBLY

INSPECTION
PRE STERILE STORAGE

STERILISATION

STERILESTORAGE

DISTRIBUTION

Work Flow
Reserve store

Receiving
Diassembling
area

Cleaning

Condemnation

Processing
Repair
Assembling

Sterilization

Storage

Apparatus and
bulk storae

Issuing counter
ICU
Distribution
Labor room

Wards
Emergency

OT

PLANNING A DEPT ; (COPP)

1. Physical Planning.
2. Functional Planning.
3. Personnel Planning.
4. Equipment Planning.
5. Financial Planning.
6.Quality Control.
7.Preventive Maintenance.

Physical Planning

1. Location & Grouping .

2. Lay Out & Space Reqts.
3. Fixtures & Furniture .

RULE OF THE THUMB

ROUGHLY 10 SQFT / BED

- MCGIBONY

ADM & STORAGE

21 M
(UNSTERILE) AREA
RECEPTION,CLEANING, 35 M
CHECKING,ASSEMBLY
& PACKING AREA
AUTOCLAVING AREA
28 M

STERILE STORAGE &

ISSUE AREA

TOTAL

28 M

SCALES OF
ACCN FOR
ARMED
FORCES
HOSPITALS
AH/CH/ SAY >
700 BEDS
1,320 ft
(COPP)

EQPT IN CSSD
1.Jet water cleaning gadgets.
2.Ultrasonic Washers
3.Glove sharpener
4.Needle sharpener.
5.Gas, Chemical or steam autoclaves.
6.Testing apparatus for efficiency of
sterilization

OTHERS
1.Maint & Repair EQPT
2.Adequate number of cabins &
Furniture
3.Telephone or intercom.
4.Adequate no of syringes &
procedure sets.

NUMBER OF SETS/SYRINGES
A - 1 Daily requirement in use at wards / Departments
B - 1 Daily requirement in sterile state at CSSD, ready
for issue
C - 1 Daily requirement being processed at CSSD
D 1to 1 Daily requirement held in reserve dome
in CSSD, some in medical stores

Total: 4.5 to 5 times of the daily requirement

Methods Of Sterilization / Disinfection

Natural

Chemical

Physical

Sun Light (UV)

Solids

Dry Heat

Air
(Desiccation)

Lime, Bleeching Powder,

KMNO4

Burning or Dry Air

Liquids

Formalin, Phenol , Alcohol ,

Glutaraldehyde
Gases
Formaldehyde, Ethylene
Oxide

(160C for 60 Min)

Moist Heat
Boiling Steam
Radiation
Ionising Radiation
U V Rays

CHEMICAL
CIDEX A Glutaraldehyde derivative is most
effective as it destroys spores too.
ETHYLENE OXIDE (ETO) ;
- Quite effective against spores too.
- Useful for delicate instruments and item which
cant be immersed in liquids
- Low Boiling Point (10 degree C)
- Prolonged Aeration
- Highly Expensive / Explosive / Toxic

Types Of Sterilization Techniques

1.Dry Heat
2.Steam High Pressure Autoclaves operated by Gas, K.oil
or Electricity ( Flash, Pulse)
3. Ethylene Oxide Sterilization.
4. Chemical Sterilization.
5. Radiation Sterilization.

- Infra Red Radiation Syringes

- Ultra Violet Radiation Decontamination of Air
- Ionising Radiation / Gamma Radiation
ISOMED at BARC

STERILISATION .
It is a process of freeing an article from
all living organisms including bacteria
,fungal spores and viruses.
A material is pronounced sterile if it
achieves 99.99% kill of bacterial spores.

STEAM STERILATION
- Water Saturated Wet vapor Dry
saturated Vapor Super Heated Vapor /
Steam
- Steam with <0.95 Dryness Factor is not useful
for Sterilization.
- Superheated Steam acts like Dry Hot Air only . (
Strength Of Steam is its Latent Heat)

MODE OF ACTION.
Dry Heat Oxidation
Steam Denaturation = Coagulation of Proteins
Sterilization Time
(Holding Time + Safety
Time)

2' + 1 = 3'
8' + 2' = 10'
12' + 3' = 15'

Pressure Temperature
(PSI) ( C )
30
20
15

134
126
121

TYPES OF AUTO CLAVING MACHINES

Downward Displacement

Vacuum Assisted.
Pulsed Steam Dilution

TESTS FOR EFFICENCY OF STERILISATION

1. Specially treated paper strip.
2. Pressure sensitive tape to be fixed to the final
fold
3. Brown indicator tubes - (very expensive)
4. Biological. Green strip containing bacteria (Color
must change to black)

5. Cellophane wrapped tablet containing

- Lactose - 75%
- Starch - 24%
- Magnesium Trisilicate 1% (Tablet turns
brown during autoclaving)
6. Microbiological examination of finished
products.
7. Thermo - couples .

ADVANTAGES OF STEAM STERILISATION

Rapid heating & penetration of loads.

Destruction of all forms of microbial life
No residual toxicity
No damage to supplies being sterilized.
Easy Quality Control
Economical & Reliable

This method is unsuitable for heat sensitive and nonpermeable material

RADIATION STERILISATION ;
ISO MED at BARC Trombay; dose - 2.5
Mega Rhontgen; Source Cobalt-60 /Caesium
137/ Electron Beam (generated by linear
accelerator)
Reliable, can penetrate all types of packing.
Large & diverse shaped articles can be
sterilized. No residual radio activity at 2.5
mega rhontgens.
Glass becomes dark, cotton looses tensile
property, food gets undesirable flavor. Not
practicable in hospitals

STAFFING :CSSD
BHATTA CHARJEE RECOMMENDS :
SUPERVISORS (sister/male ward masters)
STAFF NURSES
TECHNICIANS (ORA)
ATTENDANTS
SWEEPER
CLERK
TOTAL

5
6
24
4
1
44

CENTRALISED SUPPLY (RULE OF THUMD 2PER 100 BEDS)

DISTRIBUTION SYSTEMS :
1. Regular issue of one days requirement.
2. Clean for dirty exchange.
3. Milk round system (topping up
predetermined stock level)

4. As on required basis. (Grocery system)

A SUGGESTED LAYOUTOF CSSD

AUTOCLAVE
ROOM

ASSEMBLY
(PARKING)
CLEANING&
WASHING

Clean
storage

clean
recepti
on

disasse
mbly
Dirty
recep
tion

GLASS PARTITION

STERILE
STORAGE

Supervisors
office
Verandah

STERILE
ISSUE

RAMP

INTRA MURAL COMMUNICATION LINE

Thermal Death Time (TDT)

TDT is the time required to kill a known

population of microorganisms in a specific
suspension at a particular temperature
Increasing temperature decreases TDT
Lowering the temperature increases TDT
Acidic or basic PHs decrease TDT
Fats and oils slow penetration and increase
TDT

Quality Control Services and

Hospital Infection Control Team

Quality control in hospital services

Activities that evaluate, monitor or regulate
services rendered to patients/ relatives
Observe the process; identify the variable
characteristics; track variables through
statistical methods

Tools used to deliver quality medical care

Protocols- standard operating procedures
Evidence based medicine; based on
randomized clinical trials, systematic reviews.
Treatment guidelines by panel of experts
Rapid health delivery: door to needle time for
thrombolysis in case of MI, time taken to start
medicines in cerebral malaria, start antibiotics
in sepsis

Medical audit

Good records, clinico-pathological conferences

High standards
Purpose:
Help patients and potential patients by improving
quality of care
Assess competence of medical staff and serve as
an impetus to keep up to date and prevent
mistakes
Bring to notice deficiencies in hospital care and in
correcting the causative factors
Regulatory function, restricting undesirable
procedures
Lay down standards, improve upon them

Infection control team

Thrust areas:
Development of effective surveillance system
Development of policies and procedures to
reduce nosocomial infection
Maintenance of continuing education program
for hospital personnel
Provide system for identification and reporting
Good hospital hygiene
Quality assurance

Infection control committee

Members-representatives from medicine, surgery,
gyaenecology, paediatric, pathology, administration,
nursing staff, microbiology, housekeeping, CSSD,
pharmacy, OT
Hospital epidemiologist, infection control officer, Hosp.
administrator as chairman
Functions of ICC
Determine methods of surveillance, lay down criteria for
reporting
Review occurrence of clusters of infections, trend studies
Review with medical audit committee for use of
antibiotics
Recommend equipment for sterilization, review of
cleaning agents, policy on immunization, isolation,

NABH Structure
Quality Council of India

National Accreditation Board for Hospitals &

Healthcare Providers
Appeals
Committee

Accreditation
Committee

Technical
Committee

Secretarial
Panel of Assessor/
Expert

Housekeeping Services
Clean aesthetic and hygienic
environment plays a great role in
attracting the customers, their
retention and their delight

Functions of Housekeeping services

Desk/control rooms-proper maintenance and
operation of communication system
Clean rooms, clean corridors, clean wards,
clean floors, fixtures, curtains, windows and
toilets
Odour control
Linen-issue of proper uniform and linen to
staff
Hospital waste disposal
Sanitation and environmenta hygiene
Control of pests, flies, rodents and stray
animals

Functions of Housekeeping services

Prevention of fire
Infection control
Hospital equipment maintenance
Replace supplies in utility room
Interior decoration
Gardening
Saving electricity by switching off fans, lights,
when not in use
Management tasks

Qualities of a good housekeeper

Ability work in team
Leadership qualities
Qualities of establishing good support from all
units
Skills of public relationship
Attitude
Knowledge of tasks to be performed.
Ability to conceptualize things
Active interest in the job

Training
Methods of supervision
House keeping procedures like sweeping,
mopping, dusting work
Equipment and supplies-when to use, how to
use, care of equipment
Newer techniques and methods
Practical training under supervision for quality
improvement

Issues and challenges

Maintaining effective interdepartmental
relationship
Effective communication
Absent and responsible person
Time management
Conflict management
To avoid inconvenience to doctors, visitors,
nurses
Retaining sanitary workers

Hospital waste management

Biomedical waste-waste generated during
diagnosis, treatment or immunization of
human beings and are contaminated with
patients body fluids ( such as syringes,
needles, ampoules, organs and body parts,
placenta, dressings, disposable plastics and
microbiological wastes)

Classification of Hospital waste

General waste: from office, kitchen, laundry and stores
Sharps: needles, needles attached to tubing, scalpel blades,
razors, nails, broken glass pieces, etc.
Infected waste: Equipments and instruments used for
diagnostic and therapeutic procedures, waste from surgery
like tissues and organs removed and autopsy
Chemical waste: Formaldehyde, fixers and developers in
radiology dept., solvents like xylene, acetone, ethanol,
methanol used in laboratory
Radio active waste: research, clinical lab., nuclear medicine
dept.
Cytotoxic waste: anti cancer drugs

Categories of health care waste

No

Waste category Description and example

Infectious waste

Pathological waste Human tissues or fluid

Sharps

Sharp waste
Eg. Needles, infusion sets, scalpels,
knives, broken glass.

Pharmaceutical
waste

Waste containing pharmaceutical

Eg. phar. Expired.

Highly infectious
waste

Consists in microbial culture and stock

of highly infectious agent from medical
analysis laboratories. Eg. Body fluids

Waste suspected to contact pathogens.

Exp. Lab culture, tissues, material or
equpiment

e.g body parts, blood, body fluids

Genotoxic waste

Waste containing substances with

genotoxic properties
e.g waste containing cytotoxic drugs,
genotoxic chemicals

Chemical waste

Waste containing chemical

substances
e.g. reagents, desinfectant, solvents

Waste with high

content of heavy
metals

Bateries, broken thermometre,

blood pressure gauges

Pressurized
containers

Gas cylinders, gas cartridge,

aerosol cans

10

Radioactive waste Waste containing radioactive

substance
e.g unused liquids from radiotherapy

Biomedical Waste Rules

Schedule I: Category no., waste category,
treatment and disposal
Schedule II: color coding and typing of container
for disposal of biomedical waste
Schedule III: label for biomedical waste
containers/bags
Schedule IV: Label for transport of biomedical
waste containers/bags
Schedule V: standards for treatment and disposal
of biomedical wastes-standards for incinerators,
autoclaving, liquid wastes
Schedule VI: waste mgt. facilities-incinerator,
autoclaving, micro wave system

Dietary Services

Functions of Dietary services

Selection, procurement, storage of food

Inventory control of food items
Menu planning of different kinds of food
Development of recipes as per the nutritional requirements of
the patients
Preparation and cooking and presentation of food
Distribution of food and serving of food
Planned preventive and maintenance programs for the
equipments
Training and development of the staff
Dietician: Meet every pt., dev. rapport, analyse and translate
practicalities of diet prescribed by physician, assess nutrition
needs and advise, , see biochemical reports esp. CRF pts.

Different types of Diets

Regular balanced diet
Low fat diet: for CABG, cardiac
Renal diet: for CRF-high carbohydrate, low protein ( 30-35 gms),
avoid high potassium fruits, GLVs
Diabetic diet
Salt restricted diet: Hypertension
High protein diet: Malnutrition, cirrhosis
Low protein diet: Liver failure, ARF
Bland diet- no spice, chilly for hyper acidity, vomiting
Fat free diet
Bland diet
Jain diet
Continental diet for NRI pts.
Ryles tube diet: post operative-high CHO, high protein

TYPES OF
FOOD
SERVICES

Centralized-Main kitchen-conveyed to the Decentralized-main kitchenhospital floors by trolleys

transported in bulk to the ward
pantry

Advantages

No need of floor pantry

Lesser expertize required

Less no. of manpower required

Food served hot

Less no. of equipments required

Unused food not wasted

Reduction in error in planning and

serving meals o pts.

Rapport building between

nursing personnel and pts.

Supervision is better
More attractive
Reduction of pilferages
Disadvantages Expertize required at each level-food

More chances of pilferage

selection, preparation, processing,

serving
Food becomes cold

More no. of personnel reqd.

Intramural transportation costs more; More space reqd., nurses

horizontal lay out not preferred
time more, increase errors

Physical facilities
Location: Close proximity to the materials management
department. Cafeteria, dining hall close to the food
preparation room
Space requirement: 50 sq. ft./bed for 50 bedded hosp. 15 sq.
ft. /bed in 500 bedded hosp.
Planning considerations:
No. of hosp. beds
Type of hosp./specialties
No. of meals served per day
Policy-in-house staff, residents, students, visitors, patients
Type of dietary services/food served-veg./nonveg.
Medical tourism, design of hosp., turnover of patients
% of specialized diet, pediatric ward-formula room

Work Flow chart

Perishable
food

Lay out

Non perishable
food

Receipt
and
storage
area

Receiving
Inspection
Quality control
Storage/
refrigeration
Preparation
Room
Main
Sp. Diet
kitchen

Dispatch
area

Lay out of
Dietary
Services

Processing
Dining
hall

Tray assembly,
Transportation
Nursing unit
Garbage
Dish washing

Cafeteria

Pantry

Normal/ sp.
Diet kitchenspreparation,
processing and
cooking areas

Purchase policy
Type of dietary services- centralized/ decentralized
Type of food to be served Veg/non veg./ continental/ international
No. of meals to be served with timing if meals
Menu planning
Whether food to be served to patients only or to visitors, students,
teachers, residents etc.
Staffing, duty rosters, shift planning
Receipt, storage of food, Distribution system of meals
Quality assurance of dietary services
Training and development of staff
Pilferage/ theft control
Record maintenance
Occupational safety measures
Sanitation, dev. of SOPs,
Planned preventive and maintenance program of equipment

Equipments of dietary department

Microwave oven

Gas oven

Food processors

Mixers, grinders

Refrigerators & deep freezer

Meat cutter and meat mincer

Dough kneader

Roti maker

Cooker

Cooking vessels

Idli maker

Dosa plate

Juicer

Toaster

Potato peeler

Boiler

Milk cooker/ warmer

Aqua guard/RO

Dish washer

Water cooler

Cooking range

Soda maker

Coffee maker

Food trolley

Deep fryer/ Shallow fryer

Baking ovens

Linen and Laundry Services

Responsible for providing safe, clean,
adequate and timely supply of linen
to the user units of the hospital at
the right time, right price and right
place

Objectives laundry services

To provide comfortable and pleasing
environment to the patients and visitors of the
hospital by supplying clean linen
To control hospital infections
To make uninterrupted supply of linen to the
user department-break down leads to 3%-4 %
cancellation of Operations schedule
3% to 4%hospital infections are due to
mishandling of infected linen

Objectives laundry services

Improved efficiency and productivity
Improve image of the hospital

Types:
Patients linen-bed linen, body linen, OT linen;
staff linen; housekeeping like curtains
Laundry linen-Infected, soiled, foul and
radioactive linen
Types of linen servicesRental, contractual, co operative and in plant
system

 Method of distribution: Topping up, Exchange

trolley, Requisition system and Quota system
Requirement of linen- OT, labor rooms; ICU,
wards, private wards; for staff
2 to 3.5 kg dry linen per patient per day
If occupancy 100 % -6 set of linen required
One set in patients bed
Use of next time
In process at laundry
En route to laundry
Two sets for work and exigency in stock

Physical facilities

Location: Ground floor . Close proximity to the

CSSD, Dietary department- common requirement of
steam from boiler plant
Space requirement: 10 sq. ft.
Physical lay out- U shaped or rectangular
Ancillary services: Laundry managers office cum
room, tailoring area, workers rest room, toilets,
boiler room, stores
Material and dcor: flooring- non slippery,
washable; walls washable, free from crevices,
corners, edges; ceiling-washable, clear head room
14 feet; doors-wide

Physical facilities

Lighting-daylight
Ventilation-10 air changes/ hour
Power supply-3 phase, stand by generator
Water-15 liters hot, 10 liters cold water per 0.5
kg linen processed
Steam-170 degree C. at 45 kg per sq. cm.
pressure
Fire hazard-provision of detection system with
alarm

Laundry work flow

Reception area
sorting area
Infected linen

Soiled linen
Sluicing

Disinfection

Washing

Washing

Classification and Marking

Classification and Marking

Barrier wall with double door

Washing & hydro-extraction
Conditioning, Drying

Washing & hydro-extraction

Conditioning, Drying

Pressing/ Hand ironing/ Calendaring/ Folding

Packing, storage, Distribution/ Issue

Organizational aspects of Washing in laundry

Breaking ( Adding soap chips, detergents etc.
Sudsing ( soiled linen are thrown inn basket & agitated so
that dirt in settles down)
Bleaching ( adding commercial bleaching agent)

Starching
Sourcing ( to neutralize the alkalinity

Bluing ( commercial blue)

Ironing ( By calendaring machine/ float iron/ hand press)

Equipments of laundry Department

Boilers

Washing machine

Hydro extraction

Sluice machine

Driers

Calendaring machines

Steam bed press

Electric hand press

Sewing machine

Table for ironing

Weighing scale

Fire extinguishers

Air compressor

Trolleys

Policy and procedures

Type of laundry- in plant or contractual

Advantages of in plant: reduced loss and damage of
linen; assured regular supply with limited inventory,
safe handling of infected linen and control on
washing formula
Type of linen- staff, patients
Control of pilferage and theft
System of distribution of linen
Planned preventive maintenance program
Training of operators, staff
Quality assurance programs
Inventory control

Policy and procedures

Condemnation and disposal of unserviceable
linen and equipment
Maintenance of history sheet of equipment
Linen control
Control of laundry processes
Methods of supply: exchange trolley, topping
up, requisitioning and daily quota system
Managerial issuesControl of pilferages and theft; cost control and
occupational safety of the worker

Medical Records Department

Chronological record of care and
treatment-Justify diagnosis, reasons for
treatment and outcome of treatment.
Clinical, scientific, administrative and
legal document relating to patient care in
hospital

Scope of Medical Record

Admission form
Case-sheet :
Presenting complaints
History of present illness, past illness, personal
history, family history, treatment taken etc.
Findings of clinical examination-general and
systemic
Findings of investigations
Treatment instituted

Scope of Medical Record

Progress report on timely basis
Discharge summery or report of final outcome
Consent form, pre-anesthesia check up
Notes on surgery performed

 To the patient:

Purpose

Serves as a document-h/o patients illness,

clinical story
Serves to avoid omissions and repetition of
investigations and treatment procedures esp.
drugs
Helps in continuity of medical care
Serves as evidence in court of law
Provides compensation in case of disability
Helps for certain medical and sickness certificates
for medical, sickness or disability benefits, under
various schemes

Purpose
To the clinicians:
Planning treatment modalities for patients
Quality assurance
Assurance of continuity of care
Evaluation of medical practice
To help in CME and research
Protection of clinician in the event of legal
disputes

Purpose
To the hospital and hospital administration:
Type and quality of work undertaken
Evidence of quantum and quality of care
rendered
Evaluate the work and performance of
clinicians
Planning of hospital, extension of facilities or
introduction of new facilities

Purpose
To the public authorities:
Prevalence rate of disease
Incidence rate
Assurance Disability rate
Death rate

To medical education and research:

Epidemiological studies; randomized control
trials

Medico legal importance of medical

records
For legal purpose-criteria of medical records:
It should be complete in all aspects
Provide adequate information in respect of
medical care rendered to the patient
Information must be accurate, it should not be
based on presumption; factual
Legible-signed by concerned clinicians

Under
registration
of Birth &
Deaths Act
1969
Required
by IT
Dept.

Serve as
patients
will

Ownership
of the Med.
Records
( hospital)

Medicolegal
importance
of records

Required
by LIC

Medical
record as a
personal
document

Med.
Record as
impersonal
document

Documentary
evidence in the
court of law

Retrieval
of
records
Storage
and
retention
of records

Assembling
of the
Med.
Records

Quantitativ
e analysis
of records

Deficiency
check
Functions
of MRD

Completion
of
incomplete
records

Numbering
and filing

Reporting

Analysis
and
statistics

Indexing

Coding

Alphabe
tical
indexing
Disease
Index

Operation
Index

Indexing
Physicians
index

Unit
Indexing

Nursing unit
Discharge
pts.

Census
desk

Incomplete rec.
control desk

Movement
of medical
records

File

Assembling
deficiency
Check desk

Completed
record

Completed
pts. Index
card

Admis. Check
desk

Assembled
discharged
records
Completed
disch. records

Code
indexing
Discharge
analysis desk
and vital
stats

Reports: purposes
For evaluating the quality of medical care
For identification of deficiency in medical care
Increase the effectiveness of hosp.
administration
Prevention and control of diseases
Surveillance of diseases by public health dept.
Collection, recording and reporting of vital
statistics
Provide morbidity, mortality data to public
health authorities

Reports: purposes
Assess the utilization of hospital facilities
Planning of hospital and health care delivery
systems to the community
Prioritization of health problems
Monitoring and evaluation of health care

Types of reports
Admission of pts.-daily, unit wise, total,
distribution of patients-age, sex, race,
geographical; area
Hosp. beds: Daily census, max. pts./day; minimum
pts., average daily attendance, BOR, total patients
day care, bed turn over interval
Discharges: Daily, over a period, days of care to pts.
Discharged, ALS Deaths: Daily no. of deaths, over a
period, total deaths under 48 hours, net death
rate, gross D.R., Fetal D.R., Maternal D.R., Infant
D.R., Post operative D.R., Anesthesia D.R.

Types of reports
Work load: Total no. of outpatients, inpatients, new cases,
follow up cases, operations, X rays, investigations, dept.
wise workload break up
Hosp. care: Postop. Inf. Rate, complication rate, C. section
rate, consultation rate, autopsy rate, rate of normal tissues
removed, rates of disagreement bet. Final and path.,
result of treatment
The Unit Record: each patient has one file only
Format type:
Source oriented
Problem- oriented
Integrated Medical record

Preservation/coding/indexing of
medical record

Master Patient Index

Disease and operation indexes, physician index
Registers
Filing methods; straight numeric, terminal digit,
middle digit
Medical record retention policy: Nursing bed
records-2 years; X rays, OPD five years; IPD 10
Years; Medicolegal-10 years or till result of case

Problems

Adv. of computerized system

High volume of data

Improve efficiency

Illegibility

Improve healthcare delivery

Non-standardization

Quality assurance/ Quality

improvement
Measure physician/ hosp.
performance
Can be used as teaching /
research tool
Force orderliness and
standardization
Increase accountability

Duplication of records
Delay in retrieving of
records
Missing records
Inability of patients to
preserve records

Managerial tool