System Audit for Small Hospitals: Suggestions for Following NABH Guidelines for the In-Patient Department

A smooth system of admission, treatment and discharge of patients is boon to the hospital administration. The following is the system that was followed in one of the rural mission hospitals in Northeast India:

1. A public relations office welcomes the patient and informs them of the various facilities that are available at the hospital. They also inform the patients about the various health care plans that are available. If the patients fall under any low cost heath care plans they also authorize the plan (preferably using barcode printer).
2. The patients then go to the registration counter to register to see the particular doctor. The Interim Deposit plan could be used here but many patients still prefer the traditional way of seeing the doctor first.
3. At the preliminary examination counter the vital signs are checked and entered and preliminary history is recorded (using the software if available).
4. The doctor examines and orders the investigations in the system.
5. Print station or a special counter with senior nurses explains to the patients why the investigations are ordered and what they should do and also tell them about the Interim deposit that helps them to beat the ques.
6. The patients directly go to the places of investigation, tests and get the money deducted through the Interim Deposit plan.
7. If they need admission they pay more money into the Interim Deposit which is then used for getting the medicines and investigations.
8. The billing persons do the final billing on discharge and the Finance Manager or the person delegated for this issues the authorization for final bill payment at the cash counter.
9. The patient then collects the discharge papers etc. from the public relations department after the special counter (Print station) person explains to them the medical follow up.
10. The left over money in the Interim Deposit could either be collect while the patient leaves the hospital or could be carried over for the next visit.

A satisfied patient is the best advertisement for the patient and the first impression generally is the lasting impression. Hence a public relations office plays an important role. We describe how the inpatient services could be provided according to the NABH guidelines.
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