System Audit for Small Hospitals: Suggestions for Following NABH Guidelines for Registration and Out Patients

The NABH guidelines help healthcare organizations to establish objective systems aimed at patient safety and quality of care (1). We describe a system that is applicable to rural and remote hospitals that would improve the quality of care with the limited resources that they have. References to the NABH accreditation standards, such as [AAC 1 b] are mentioned in this text, where applicable.

The Standards and Implementation

1. The Services Provided: Services should be in consonance with the needs of the community. There are various methods for finding out the needs felt by the community, and the following methods are used and recorded. [AAC 1 a]
   1. Surveys are the best method, but they are expensive and time-consuming. Ideally, about 20% of the target population should be surveyed.
   2. Focus group discussions in the target area are a useful tool, and they give a lot of information at a lower cost.
   3. Meeting the leaders of the community.

It is important to prioritize the needs. The healthcare facility should have an administrative committee meeting to define the target population and another meeting to discuss the services provided (2).

2. The available services should be displayed in the following places, and they should be in both English and the local language(s). [AAC 1 b]
   1. At the entrance from the road, so that people can read about them before coming in, and have the choice to come in or not
   2. At the waiting hall near the registration area
3. The available services should be updated and discussed once a year, and the minutes of the discussion should be recorded. The new staff, especially those at the reception, registration, and OPD, should have a record in the personnel file stating that they have received the orientation about the services available at the facility. [AAC 1 c]
4. The relevant services that are not available should also be displayed at the registration counter. Appendix 1 gives a sample display.

The Registration Process: Out Patient Registration

It is important that the out patients are registered in accordance to the services available at the hospital. Hence, at the reception, it is good to have a person welcoming the guests to the hospital and doing triaging, to direct those who could be treated at the facility and those who need...