Medical Record Department and Front office

“Men May Come, Men May Go, but the

Record Stays”
 Introduction
• A medical record is a systematic documentation of a patient’s medical history and course of care provided in a
hospital which is compiled and stored by the health care providers for future care of the patient and for medico-
legal uses

• It provides important clinical information from inpatient to

outpatient settings and between hospital admissions and is
important in maintaining the continuity of care.
 Definition
• A clinical, scientific, administrative, and legal document
related to patient care which is recorded sufficient data in a
sequence of events to justify the diagnosis and warrant the
treatment and the end result
• It is a clear, concise, correct, complete, and chronological
record of patient illness, the course of the disease, the
investigation done, the result, the diagnosis, the treatment
measures instituted, and the extent of recovery therefrom
 Contents of Medical record


Demographic Details
Consents
Nursing Notes
 Reason for hospitalization Treatment charts
 Clinical History of Patients
 Significant findings Forms (Antibiotic
stewardship forms,
 Provisional and Final Transfusion form)
Diagnosis Diagnostic Report


Procedures and Treatment provided
Patient’s discharge condition
Dietary services
 Patient and family instructions(as appropriate)
Special Care
 Attending physician’s signature.
 Usage of Medical Records
 Medium of communication among Attending Physician for current episodes of
illness and future illness.

 Training of physicians and other persons.

 Follow-up care to patients with long-term illnesses.

 To communicate between the physician and other health providers.
 Financial Reimbursement: Medical bill claims, Insurance claim, death claim etc.
 Legal affairs: To assist the courts in fair judgment.

 Education: To provide actual case studies for the education of health professionals.
 Research: To provide data to expand the body of medical knowledge.
 Public Health: To identify the disease and for prevention planning overall health of the nation and
world.
 Planning and marketing: To identify data necessary for selecting an promoting facility services.
 Importance of Medical Records
 Continuity for his follow-up treatment.
 Follow up.
 It helps in repetition of irksome tests are avoided which further saves financial burden for the
patient as well as time saver for the patient and physician.
 Re-admission
 Communication between doctors.
 Filling of Insurance Claim Forms.
 Medico-Legal safe guard.
 Medical Certificate.
 Birth and Death Certificates
 Importance of Medical Records
for Doctors For The Hospital
 Patient follow-up purposes  Quality of care
 Re-admission – Diagnosis period  Planning
 Medico-legal safeguard a) Budget
b)Additional facilities
 Patients statistics for Community c) Staff
Medicine d)Space and equipment
 Trial of New Medicines / Equipment  Cost Analysis
 Research purposes  Hospital Statistics
 Administrative Control
 Publication.  Medical Legal Safeguard
 Thesis work  Community Medicine (for
preventive measures)
 Function of Medical record Department
 Storage & Retrieval  Training
 Incomplete Record Control
 Medical record Committee
 Retention Policy
 Health Statistics  Providing Medical records to the
 Quality & Quantity Analysis Patient on Request
 Classification, Coding & Indexing  Insurance claim
 Legal Aspects  Audit
 Confidentiality
 Medical Record Forms Control
 Disposal of Medical records
 Birth and Death certification with Adhaar Enrolment
 New Cases Revisit Cases
Issue of
investigation
reports
Treating Treating
Doctor’s room Doctor’s room

After treatment files

received back in OPD
record room for filling and
retrieval for revisit
patients
Patients referred to
different department Patients advised for
admission, if required
 OPD CASUALTY

ADMISSION COUNTER

WARD

MRD
Receipt of files
within 24-48 hours
after discharge / Assembling ICD-11
Indexing
death (Reminders & punching Coding
are issued to the
wards thereafter)

Complete Area Issue of files to the Doctors / Patients for

various purposes (Reminders are also
(Medical Record Library) issued to doctors on non-receipt of files)
 Time period for maintaining hard
copy of Medical Record.

Patients health record (Adults) 3 years ( some

hospital 7, 10 years)

Patients health record (Children) Age of majority

Diagnostic images Five Years
Medicolegal cases Ten Years or till case is
been trialed

Registers of Births Permanently

Registers of Deaths Permanently
Registers of surgical procedures Permanently
 Types of Medical records
 Paper-based medical records: These are traditional medical records that are
kept on paper.
 Electronic medical records (EMRs): EMRs are digital medical records that
are stored on computers.

Advantages of EMR
 They are more efficient and easier to access.
 They are more secure and less prone to loss or damage.
 They can be shared more easily with other healthcare providers
 Planning of MRD Medical record office
• Areas: • Office of Medical Record
a) Admission and enquiry office Officer
(hospital entrance) • Office of Medical Record
b) Nursing units (in wards) Officer
c) Medical Record office (near
• Waiting area
administrative office)
d) Medical record storage area (away • Conference or seminar room
from hospital building) • Photocopying and scanning
Equipment
• communication
 Key planning
Space Requirment
parameters
• Spacious, ventilated, proper • Admission and Enquiry : 15-20m sq
lighting (200- 300 lux), CCTV • Waiting area 0.5 m sq / bed
• Protection from pests and rodents • Medical record office 1.0m sq/bed
• Wall floor and ceiling should be • Storage area 15-50m sq with
leak and seepage-proofed compactors
• Availability of workstations and
computers
• Fire protection
• Sewage system and toilets to be
planned away from storage area
 Quality indicators of
MRD
Front Office
• No. of records found incorrect in Audit  First point of contact for patients
• No. of records found damage and visitors
• Percentage of records found missing  Patients' check-in for
• Time taken in retrieval of records appointments
• Complaints on MRD  Registration
• Observation by court and insurance  Admission
agencies  Pay bills
• Timely availability of statistics  Answer queries about the facility's
• Observation of Audit team services and policies.
• Instance of breach of confidenciality
 Importance of Front
Duties of Front Office
Office
Greeting and welcoming patients and visitors
• The front office plays an 

 Checking in patients for appointments

important role in creating a
 Scheduling new appointments
positive first impression for  Verifying insurance information
patients and visitors. It is also  Collecting payments
responsible for ensuring that  Answering questions about the facility's services
patients have a smooth and and policies
 Directing patients to the appropriate
efficient experience at the facility. departments
The front office staff must be  Maintaining patient records
knowledgeable, professional, and  Processing paperwork
compassionate.  Providing administrative support to the medical
staff
 Advantages of Front
Quality of Front office
office
• Soft skill of employes
 Improved patient satisfaction • Promptness
• Completeness, correctness, relevance and clarity of
 Increased efficiency and information
productivity • Waiting period
• Location
 Reduced costs • Equipment and Furniture
• Communication system
 Enhanced reputation of the • Staffing
facility • Quality manual
• Separate counters
• Simplification of forms
• Display of scope of services
• Availability of rate list
• Separate counseling room
 Public Addressal and
Communication System
Enhancing Communication and
Efficiency in Healthcare
 Introduction
• Public address systems (PAS) in hospitals are
essential tools for communication, ensuring
that critical information is disseminated
quickly and efficiently to staff, patients, and
visitors. These systems come in various forms,
each suited to different purposes and
environments within the hospital.
 Usage of Public Address Systems in
Hospitals
• Emergency Announcements
• Critical Information Dissemination:
– Ensures immediate communication of life-saving information.
– Guides staff, patients, and visitors to safety.
• Rapid Response:
– Facilitates quick and coordinated emergency response.
– Reduces response times in critical situations.
• Enhanced Safety:
– Provides clear instructions during emergencies (e.g., evacuations,
lockdowns).
– Minimizes confusion and panic.
• Visuals:
• Diagram showing communication flow during an emergency.
• Image of a hospital PA system in use during an emergency.
 Types of Emergency Announcements
• Code Blue (Medical Emergency):
– Alerts medical teams to critical patient situations.
– Ensures rapid mobilization of necessary personnel.
• Code Red (Fire):
– Notifies everyone of a fire hazard.
– Provides evacuation routes and safety instructions.
• Code Yellow (Hazardous Material):
– Warns about hazardous material spills.
– Instructs on containment and safety measures.
• Code Black (Bomb Threat):
– Alerts about potential bomb threats.
– Guides on evacuation and safety protocols.
• Visuals:
• Color-coded chart of emergency codes and their meanings.
• Icons representing different types of emergencies.
 Benefits of Effective Emergency
Announcements
• Life-Saving Communication:
– Ensures critical information reaches all necessary parties promptly.
– Can significantly improve survival rates and outcomes.
• Improved Coordination:
– Enables better coordination between different departments.
– Streamlines emergency procedures and protocols.
• Reduced Panic:
– Provides clear and concise instructions to avoid confusion.
– Helps maintain calm and order during emergencies.
• Compliance and Training:
– Ensures compliance with safety regulations.
– Aids in regular training and drills for emergency preparedness.
• Visuals:
• Before-and-after scenario demonstrating improved outcomes with
effective announcements.
 Types of PA Systems:
• Analog PA Systems
• Digital PA Systems
• IP-Based PA Systems
• Wireless PA Systems
• Intercom Systems
 Analog PA Systems

additional system using wired connections to transmit audio signals.

• Components:
– Microphones
– Amplifiers
– Speakers
– Control panels
• Usage:
– General announcements
– Emergency alerts
• Benefits:
• Reliable and easy to use
• Cost-effective for smaller facilities
 Digital PA Systems
Utilizes digital technology for transmitting audio, offering better sound
quality and advanced features.
• Components:
– Digital microphones
– Networked amplifiers
– Speakers
– Digital control interfaces
• Usage:
– Targeted announcements
– Integration with other hospital systems
– Remote management
• Benefits:
• Enhanced audio quality
• Greater control and customization
 IP-Based PA Systems
Operates over the hospital's existing IP network, allowing for flexible and
scalable communication.
• Components:
– IP microphones
– Network switches
– PoE (Power over Ethernet) speakers
– Software control panels
• Usage:
– Zone-specific announcements
– Integration with hospital management systems
– Scalable for large hospitals
• Benefits:
• High scalability and flexibility
• Easy integration with other systems
 Wireless PA Systems and Intercom
Systems
• Wireless PA Systems:
• Description: Utilize wireless technology, suitable for temporary setups or
areas where cabling is impractical.
• Components: Wireless microphones, transmitters, receivers, and
speakers.
• Usage: Temporary or expanding hospital facilities, outdoor
announcements.
• Benefits: Flexible, easy to deploy, and ideal for mobile needs.
• Intercom Systems:
• Description: Allow two-way communication between different parts of the
hospital.
• Components: Intercom stations, master control units, and speakers.
• Usage: Direct communication between departments, staff coordination,
and emergency response.
• Benefits: Enhanced staff communication and coordination
 Nurse call system
– Enables patients to communicate with nurses and
healthcare staff efficiently.
– Enhances patient safety and care by ensuring timely
responses to patient needs.
• Components:
– Patient call buttons
– Nurse station consoles
– Corridor lights
– Integration with hospital communication systems
• Benefits:
• Improves response times
• Enhances patient satisfaction
• Streamlines workflow for healthcare staff
 Types of Nurse Call Systems
• Wired Nurse Call Systems:
• Description: Uses physical wiring to connect patient rooms with nurse
stations.
• Advantages: Reliable, consistent performance, and cost-effective for
smaller facilities.
• Disadvantages: Limited flexibility and higher installation costs.
• Wireless Nurse Call Systems:
• Description: Uses wireless technology for communication.
• Advantages: Greater flexibility, easier to install and expand, ideal for large
or temporary setups.
• Disadvantages: Potential for interference and requires battery
maintenance.
• IP-Based Nurse Call Systems:
• Description: Operates over the hospital's IP network, allowing for
advanced features and integration.
• Advantages: Scalable, integrates with other hospital systems, supports
remote monitoring.
• Disadvantages: Requires robust IT infrastructure and higher initial costs.
 Benefits and Features of Modern
Nurse Call Systems
• Enhanced Communication:
• Real-time communication between patients and healthcare staff.
• Integration with mobile devices and hospital communication
systems.
• Improved Patient Safety:
• Immediate alerts for emergencies.
• Monitoring of patient conditions and quick response to calls.
• Workflow Efficiency:
• Streamlines tasks and reduces response times.
• Allows for better resource allocation and staff management.
• Advanced Features:
• Integration with electronic health records (EHRs).
• Customizable alerts and reporting.
• Voice and video communication capabilities.
 Introduction to IEC in Hospitals
• IEC stands for Information, Education, and Communication.
• It is a strategic approach to disseminate information and
promote health behaviors.
• Purpose:
• Educate patients, staff, and the community about health
issues.
• Promote positive health behaviors and practices.
• Enhance patient care and safety.
• Components:
• Printed materials (brochures, posters)
• Digital media (videos, websites)
• Interactive sessions (workshops, seminars)
 Information Dissemination
• Printed Materials:
• Brochures, pamphlets, posters, and flyers.
• Placed in common areas like waiting rooms, patient
rooms, and lobbies.
• Digital Media:
• Hospital websites, social media platforms, and email
newsletters.
• Video displays in patient waiting areas.
• Importance:
• Provides accessible and understandable health
information.
• Keeps patients and visitors informed about hospital
policies and health guidelines.
 Education Programs
• Patient Education:
• Informs patients about their conditions, treatments, and
preventive measures.
• Uses tools like patient education videos, bedside teaching,
and informational brochures.
• Staff Training:
• Ongoing education for medical and non-medical staff.
• Includes workshops, seminars, and e-learning modules.
• Community Outreach:
• Health camps, awareness campaigns, and public health
seminars.
• Collaboration with local schools, community centers, and
NGOs.
 Communication Strategies
• Interactive Sessions:
• Workshops, seminars, and Q&A sessions with healthcare
professionals.
• Provides a platform for patients and staff to ask questions
and get detailed answers.
• Feedback Mechanisms:
• Patient feedback forms, suggestion boxes, and online
surveys.
• Helps in improving services and addressing patient
concerns.
• Multilingual Communication:
• Ensuring information is available in multiple languages.
• Uses interpreters and translated materials to cater to
diverse patient populations.
 Benefits of IEC in Hospitals
• Improved Patient Outcomes:
• Educated patients are more likely to adhere to treatment
plans.
• Better understanding of health conditions and preventive
measures.
• Enhanced Patient Safety:
• Clear communication reduces misunderstandings and medical
errors.
• Patients are more aware of their rights and hospital
procedures.
• Empowered Healthcare Staff:
• Continuous education improves staff knowledge and skills.
• Better equipped to handle patient queries and provide high-
 Citizen Charter in Hospitals
• Definition: A Citizen Charter is a document that
outlines the services provided by an organization,
the standards of these services, the information
about the grievance redressal mechanism, and
the expectations from the citizens.
• Purpose: To enhance transparency,
accountability, and responsiveness in the delivery
of hospital services.
• Relevance in Healthcare: Ensures patients' rights,
provides clear information on services, and
establishes standards for quality care.
 Objectives of Citizen Charter in
Hospitals
• Transparency: To make hospital services more
transparent.
• Accountability: To hold the hospital accountable
for its services.
• Quality of Service: To improve the quality of
healthcare services.
• Patient Rights: To inform patients about their
rights and responsibilities.
• Grievance Redressal: To provide a clear
mechanism for addressing complaints and
feedback.
 Components of a Citizen Charter
• Service Standards: Expected levels of service and
timelines.
• Information on Services: Detailed information
about the hospital’s services and facilities.
• Grievance Mechanism: Process for lodging
complaints and seeking redressal.
• Rights and Responsibilities: Rights of patients
and responsibilities of both patients and hospital
staff.
• Performance Monitoring: Methods for assessing
and monitoring service quality.
 Service Standards
• Timeliness: Expected time frames for various
services (e.g., waiting times, response times).
• Quality Indicators: Metrics for assessing the
quality of care (e.g., infection rates, patient
satisfaction).
• Efficiency: Standards for the efficient delivery
of services (e.g., throughput, resource
utilization)
 Information on Hospital Services
• Available Services: List of medical, surgical,
and diagnostic services.
• Facilities: Information about inpatient and
outpatient facilities.
• Special Departments: Details about
specialized departments and units (e.g., ICU,
emergency services).
• Operational Hours: Timings of various
departments and services.
 Grievance Redressal Mechanism
• Complaint Process: Steps for lodging
complaints (e.g., contact points, forms).
• Response Time: Time frame for
acknowledging and resolving complaints.
• Escalation: Procedures for escalating
unresolved issues.
• Feedback Mechanism: Channels for providing
feedback and suggestions.
 Patients' Rights
• Right to Information: Access to complete
information about diagnosis and treatment.
• Right to Privacy: Confidential handling of
personal and medical information.
• Right to Consent: Informed consent for
treatments and procedures.
• Right to Respect: Dignified and respectful
treatment by all hospital staff.
 Patients' Responsibilities
• Honest Information: Providing accurate and
complete health information.
• Compliance: Following prescribed treatment
plans and instructions.
• Respect: Respecting the rights of other
patients and hospital staff.
• Timely Payments: Adhering to hospital
payment policies and procedures.
 Performance Monitoring and
Evaluation
• Regular Audits: Conducting regular audits to
assess service quality and adherence to
standards.
• Patient Surveys: Collecting patient feedback
through surveys and questionnaires.
• Performance Indicators: Tracking key
performance indicators (KPIs) to monitor
improvements.
• Continuous Improvement: Implementing
changes based on feedback and audit results.
 Benefits of Citizen Charter in
Hospitals
• Enhanced Trust: Building trust between patients
and healthcare providers.
• Improved Satisfaction: Higher patient satisfaction
through better service delivery.
• Increased Accountability: Clear accountability for
hospital staff and management.
• Transparency: Transparent processes and
operations within the hospital.
• Better Healthcare Outcomes: Improved overall
healthcare outcomes through quality care and
effective grievance redressal.
Medical Gas
Pipeline
System
BY: DR. AMIT CHAUDHARY (MBBS, MD)
SENIOR RESIDENT AIIMS JAMMU
Introduction

▪ Medical Gases are vital life support system in hospitals

▪ Types: Oxygen, Nitrous Oxide, Medical Air, Surgical Air, Carbon
Dioxide, Nitrogen
▪ Year 1860: Starting of oxygen therapy using cylinders
▪ Year 1935: introduction of MGPS in Saint Mary’s hospital London
▪ Highly sophisticated life support system
Medical Gases

▪ A medical gas is defined as one that is manufactured, packaged,

and intended for administration to a patient for in therapy,
anesthesia or diagnosis
▪ Any gaseous substance meeting medical purity standards and has
application in a medical environment
▪ Gases that are required for patient care activity in the hospital
▪ Supply via Cylinders or centralized system
 Medical oxygen Nitrous Oxide

▪ Ubiquitous drug ▪ Used in general anesthesia

▪ Hypoxic conditions ▪ Induction and maintenance of
▪ Cardiac, Pulmonary, and other diseases inhalational anesthesia

▪ Drive anesthesia machine and ventilators ▪ Analgesic effects (OBGY, Dental)

▪ Purity 99.5 % ▪ Cylinder: Blue shoulder, Blue body

▪ Cylinder: white shoulder, Black body ▪ Gas pipeline: ISO Light Blue, USA Light
blue
▪ Gas pipeline: ISO white, USA green
▪ Pin Index: 3,5
▪ Pin Index: 2,5
 Medical Air Carbon Dioxide

▪ Two Types: Medical Air (4 bar) and

Surgical Air (7 bar) ▪ Insufflation gas for laparoscopy,
▪ Surgical Air: operates surgical endoscopy, arthroscopy
instruments, drying of Instruments ▪ Cryotherapy (-76 degree cel)
in CSSD
▪ Local analgesia
▪ Medical Air: run ventilators and carrier
gas in anesthesia ▪ Cylinder: Grey shoulder, Grey body
▪ Cylinder: White shoulder, Grey body ▪ Gas pipeline: ISO Grey, USA Grey
▪ Gas pipeline: ISO Black and white, USA ▪ Pin Index: less than 7.5% 2,6 or
Yellow more than 7.5% 1,6
▪ Pin Index: 1,5
Vacuum Suction Gas Flow Rates & pressure

▪ Suction of
blood and body
fluids Medical Gas Flow rate Pressure at
(l/m) terminal
▪ Negative unit
pressure used Oxygen 40 4 bar
▪ Anesthetic gas N2O 15 4 bar
scavenging Medical Air 50 4 bar
system (AGSS)
Surgical Air 250 7 bar
Vacuum - 0.53 bar
 Medical gas Pipeline system

▪ MGPS is a method of delivering the required medical gas from the

supply source through a pipeline system to the patient via a
terminal unit.
▪ Safe, effective, convenient, and cost-effective system
▪ It reduces the problems associated with the use of gas cylinders,
such as safety, porterage, storage, and noise
 Manifold system

▪ A device for connecting the outlets of one or more gas cylinders to the central piping
system for a specific gas through a control panel
▪ Ensures continuity of medical gas supply

Precautions
 Each medical gas must be supplied from a separate system

 No cross-connection.

 Not be used to supply pathology departments, general workshops, or mechanical services. ( 400 KPa)

 Manned round the clock

 Use of alarm system

 Regular delivery schedules for refilling

 Regular maintenance
Why we need MGPS Objectives

▪ Adequate quantity ▪ Enhanced safety and reliability due to strict

adherence to
▪ Safety established standards, codes, and regulations
▪ Purity ▪ Quality control and pressure regulation by
centralized pump, compressors, or
▪ Appropriate pressure
cylinder manifold system
▪ AGSS
▪ Easy filling up and removal of cylinders
▪ Cost effective without access to direct patient care area

▪ Does away transportation of bulky and dangerous

cylinders to and
from patient’s bedside
 Location Basics

▪ Designated cordoned off area away from patient  Generation unit

care area Gas / service specific; 100% backup; reserve

▪ Proper ventilation  Distribution system

Copper pipeline network
▪ Easy access by delivery vehicle and transportation
 Dispensing units
of cylinder
Terminal wall units & pendants
▪ Convenient for loading and unloading  Alarm system
Pressure Monitoring
▪ Monitoring and maintenance
 Safety devices
▪ Temperature below 54degree cel Flow meters, Pressure regulators, Isolation valves,
safety valves
▪ Avoid nearby fire hazards •Medical Grade Copper Tubes fully compliant with the
latest BS: EN 13348:2008.
▪ Soundproof encloser • KITE CERTIFIED
• KITE certification.
Oxygen PSA Plant
 Key parameters of Design and construction

▪ Prevent unauthorized entries ▪ LMO capacity of at least 6 days

▪ Fire safety ▪ Poured concrete pad for load

bearing and seismic requirements
▪ Electrical devices at or above 5ft
▪ Sunken area trench manholes
▪ Indirect means of heating e.g steam pits drains 8 ft away from the pad
▪ Racks, chains should be provided to ▪ Fencing of 2m height with double
secure from falling gates
▪ Ventilation ▪ In the case of multiple
▪ Signages LMO, they should be
categorized as primary,
secondary and reserved
Standards

Item Standard

Distribution Piping System

Material (Copper Pipe) ASTMB 819.00; 2002

Fittings BS EN 1254-1: 1998 Part 1
Copper to copper joints silve BS 1845 / BS 1044
copper-phosphorous brazing alloy

Pipeline isolation and lockable line HTM 2022 / EN737 / NFPA 99

valve
Rigid retractable pendant HTM 2022 / EN 737 / NFPA 99
Terminal outlets (PB Type NFPA 99 compliant. Imported
compatible) products to be CE marked / UL
Listed
34
Standards

Item Standard
Anesthetic gases scavenging NFPA 99
system
(AGSS)
Master and area alarm IEC 60601-1-8:2006
Ward Vacuum Unit Wall Mounted ISO 9000 certified / HTM-2022
Type
Theatre vacuum unit ISO 9000 certified / HTM 2022

Flow meter with humidifier ISO 9000 certified / HTM 2022

35
Rules & Regulations

▪ Gas Cylinders Rules 1981

▪ Static & Mobile pressure Vessels (Unfired) Rules 1981

36
 STATUTORY
REQUIREMENT
▪ PESO (Petroleum and Explosives Safety Organization)
Department of Industrial Policy and Promotion Ministry Of
Commerce And Industry
▪ To administer the responsibilities delegated under the Explosives Act 1884 and
Petroleum Act 1934

▪ Explosives Act, 1884

▪ Static and Mobile Pressure Vessels (Unfired) Rules, 2016
▪ Gas Cylinder Rules, 2016
 Post Installation Tests

 Pressure drop test to ensure that there is no leakage in the system.

 Valve tightness and correct valve zoning.
 Satisfactory mechanical operation and non-interchangeability of each
• terminal outlet by means of probes.
 Anti-confusion test for checking cross connection.
 Flow rate and pressure at each terminal outlet.
 Change over mechanism of Gas Control panels.
 Satisfactory performance of compressors, vacuum pumps and AGSS.
 Performance of alarm system

38
Planning of MGPS
Challanges
Phase Challenges Anticipated/ Actual solutions
Adherence to statutory Prior approval sought; tank shifted to
Planning
requirements center
On-site round to explore alternate
Handing over of site
space; alternate entry
Clearing the Standby cylinders; emergency repair
Damage to the pipeline
area
Manned by Security Guard round the
Security of premises
clock
Installation of
Switch over for connection Standby cylinders
vaporizers
Vehicular movement Cordoning of area
Breakdown of vehicle Alternate arrangement
Replacement of
LMO tank Switch over for connection Standby LMO truck & cylinder bank –
Cooling of tank both used during different stages
Gas outlet configuration location wise

▪ General Ward Bed: O2 -1 & Vc-1 for each bed

▪ Super Speciality General Bed: O -1 & Vc-1 for each bed and MA4-1 for 2 each
Cubicle
▪ Private Room & Isolation Room/Special Ward(like- Dialysis,etc ): O -2 1, Vc-1
and MA4-1 for each bed
▪ ICU/CCU Bed: O -2, Vc-2 & MA4-2 for each bed. 2
▪ Pre-Op Bed/Emergency: O -1, Vc-1 & MA4-1 for each bed. 2
▪ HDU/Post-Op Bed: O -2, Vc-2 & MA4-1 for each bed. 2
▪ Treatment/Procedure Room (On Wall): O -1, Vc-1 and MA4-1 for each bed. 2
▪ Endoscopy/Etc: O -1, Vc-1, MA4-1, CO -1, N O-1
▪ Minor OT/Cath Lab/CT/LINAC/Etc (On BHP): O -2, Vc-2, MA4-1, N O-1 for each
Room (For MRI/LINAC/ETC)
DESIGN FLOW RATES FOR OXYGEN

▪ Wards: 5-6 Litres per minute, per patient.

▪ Each terminal should be capable of passing 10 LPM Oxygen at
standard temperature and pressure
▪ Operating Rooms and Ventilation stations shall be 100 Liters per
minute, per patient. d.
▪ Labor cum Delivery Room (LDR) Rooms and New-born Care
Stations shall be 10 Liters per minute.
▪ Emergency Ward, Recovery Ward: 100 Liters per minute.
▪ Bio-medical Equipment Service Stations: 100 Liters per minute.
 Staffing Quality parameters

▪ 6 technicians including supervisor, ▪ Avability of manual

and 25% leave reserves
▪ Qualification, training and experience
▪ Work in 3 shifts
▪ Manpower working in all three shifts
▪ Repair and maintenance by the
biomedical engineering team ▪ Precautions of Fire Safety
▪ Overall supervision under chief ▪ 6 days reserves for uninterrupted supply
engineer
▪ Color coding of cylinder and gas pipelines
▪ Pin index system
Quality parameters

▪ Adequatre lighting and ventilation

▪ Periodic check of pressure
▪ Regular preventive maintenance and breakdown maintenance
▪ Procedure and schedule to check all terminal units
▪ Documentation
▪ Procedure for investigation and CAPA
Welfare services in
Hospital
By Dr Amit Chaudhary
MBBS MD
Senior resident AIIMS JAMMU
Introduction

Help
Care
support
Happiness
prosperity
Definition

Any of numerous publicly or privately provided services

intended to aid disadvantaged, distressed, or vulnerable
persons or groups.
Various support programs and resources to assist
patients and their families
 Help with people's living conditions and financial
problems
Types of Welfare services

Social work
Counseling
Financial assistance
 Patient-friendly infrastructure
Types of Welfare services

Nutritional support
Palliative care
Hospice care
Support groups
Types of Welfare services

Transportation and lodging

Spiritual care
Language interpretation
Child life services
Types of Welfare services

Patient Education
Occupational therapy
Physical therapy
Rehabilitation services
Types of Welfare services

Art and music therapy

Pet therapy
Patient satisfaction programs
Using digital methods
Financial welfare

Government schemes
Poor patient funds
Free medications
Insurance schemes for hospital
Welfare services for HCW

Respite therapy
Counseling
Music
Meditation area
Group fun activities
Welfare services for HCW

Plan trips for HCW

Play zone
Gardening and landscaping
Awards and recognition
Impact of Welfare services

Improve patient satisfaction

Increase turnover of patient
Speedy recovery of patient
Spreading awareness in society
Lowering the burden of diseases from
society
Challenges

Required extra budget

Manpower
Infrastructure constrains
Changing the mindset of healthcare
workers
Extra effort from hospital
THANK YOU
Hospital Engineering Services
 Introduction
• The engineering services of a healthcare facility support the
delivery of patient care and help to maintain a healing and safe
environment.
• Engineering services are integral part of hospital infrastructure
• Engineering services account for approximately 35-40% of the
capital costs in the construction of health care facilities
• The requirement for the healthcare design is that it facilitates
high quality patient care for the most cost effective capital and
recurrent cost
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 Introduction (Contd.)
• Engineering services have large contribution towards
shaping the environment of care
• The goal of Environment of Care is to provide a safe,
functional and supportive environment for patients,
staff and visitors
• The environment of care is composed of the building,
the equipment and the people
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 Components of Engineering Services
• Engineering services of a hospital include:
– The civil assets - Includes:
• Building, Roads, Storm Water Drainage, Waste water drainage,
Sewage Treatment Plant
– Electricity supply
– Water supply including plumbing and fixture
– Steam supply
– Acoustics and Lighting
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 Components of Engineering Services
– Piped medical gas and vacuum system (PMGV)
– Air conditioning and refrigeration
– Lifts, pneumatic tube system and dumbwaiters
– Public health services
• Solid Waste Disposal System
– Communication system, paging, CCTV
– Building management system
– Workshop facilities for repair and maintenance

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 Civil Assets
• Hospital building is a complex structure
– The layout, space, circulation should conform to national and
international guidelines
– The form of the buildingshould follow function
– The design and construction of the building should be environmentally
sustainable
– It should provide a safe, patient friendly and healing environment
– The design should be evidenced based

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 Communication
• Communication services required are:
– Assistance Call system
– Building services monitoring
– Data Communication
– Door call
– Radio paging
– Public Address
– Duress Alarm System
– Voice Communication System

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 Maintenance Services
• Objective of building maintenance is to provide an optimum
medical and operational environment at all times
• The maintenance service may be in-house or outsourced with
an on-call repair service
• Following areas require 24 hour per day, 7 day per week on-call
maintenance service:
– Medical gases and suction system
– Lifts

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 Maintenance Services
– Fire systems
– Bio-electronic equipment
– Any life-support systems
– Boiler plant
– Telecommunication system including:
• Paging
• Emergency warning and Intercommunication system
• Nurse call

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 Electrical Services
• Electricity is vital to hospital operation and patient
safety
• Electrical services shall include:
– Provision of normal, vital (30 sec.), instantaneous (1 sec.),
and uninterruptible (no break) electricity supplies
– Switchgear and circuit protection to safely operate and
control the supplies

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24
 Electrical Services
– Distribution arrangements to supply electricity to each end
use
– Equipment to transform and condition voltage from supply
voltage to end use voltage and within voltage and
frequency tolerances
– Equipment to use the electricity for lighting, heating and
motive power

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 Electrical Services
• High Voltage Installation
– Where there are high voltage transformers and switch gear on site it
shall:
• Either be housed in buildings or structures remote from patient areas or be
located in a fire isolated part of the main building
• Only be accessible to authorised persons
• Provided with instantaneous lighting served from the vital electricity supply
• Provided with instantaneous power to control switching served from the
vital electricity supply

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 Electrical Services

• Earthing
– There shall be an earthing diagram mounted in the main
switch room
– This shall identify the earthing arrangement of the system
and
– Earth resistance parameters to be achieved

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 Electrical Services
• Cabling
– Cabling should have a 25% spare capacity above the
calculated maximum demand
– Cabling shall be located so as not interfere with medical
equipment sensitive to magnetic fields
– Cabling carrying heavy loads should not be located adjacent to
ICU, OT, and similar areas where electro-cardiograph-
monitoring equipment is to be operated
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 Electrical Services

• Emergency / Vital (30 second) Electricity Supply

– Generators should have fuel supply arrangements that will
keep them in operation for the longest credible normal
supply outage
– Be installed in an environment where they can be serviced
and maintained in the most unfavourable conditions

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 Electrical Services
• Instantaneous and Uninterruptible Electricity Supplies
– The following lighting to be connected:
• Fixed SurgicalLuminairs
• Procedure Room Examination Light
• Birth Room Examination Lights
• Emergency Evacuation and Exit Lights
• PABX, Paging, Alarm and Call System Supplies

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 Engineering Services, Fire
• Fire services shall be provided to comply with
requirements of National Building Code, 2005
• These shall include (but not limited to):
– Provision of materials and methods of construction to
comply with codes and regulations
– Compartmentation of the buildings into fire and smoke
compartments

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 Engineering Services, Fire
– Provision of complying fire egress arrangements
– Provision of fire and smoke alarms
– Storage arrangements for fire fighting water
– Fire fighting water pressure boosting arrangements
– Provision of smoke clearing ventilation
– Provision of escape route air pressurisation
– Provision of hose reel and hydrant fire extinguishing equipment
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 Engineering Services, Fire
– Provision of automatic fire extinguishing systems
– Provision of portable fire extinguishers
– Provision of equipment to aid transportation of disabled
persons
– Provision of escape diagrams

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 Engineering Services, Hydraulic
• Extent of Services
– Cold potable water service
– Hot potable water service
– Warm potable water service
– Water filtering and conditioning equipment
– Water storage tanks
– Gardens and ground irrigation
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 Engineering Services, Hydraulic
– Bore water supplies
– Sanitary drainage service
– Process waste water discharge conditioning facilities
– Sanitary fittings and fixtures
– Roof plumbing
– Storm Water Drainage
– Sub soil drainage
– Sewage treatment facilities

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 Engineering Services, Hydraulic

• Drinking Water Specification (Indian Standard)

– IS 10500: 2012
• Water requirement
– 450 Lit per bed per day

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 Engineering Services - Mechanical

• Mechanical services may include but not be limited to:

– Air cooling and heating services
– Building automation control system
– Energy Management System
– Ventilation services
– Plants and Machinery

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 Engineering Services - Mechanical
• Ventilation Service
– Good ventilation is fundamental to proper hospital function
– It shall provide breathing air free from contamination
harmful to building occupants
– Capture as close as practicable to source, any air
contaminated by persons or processes within the buildings
and remove it to discharge at a safe place
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 Engineering Services - Mechanical
– Provide special air environments for:
• Isolation and infectious disease
• Protection of immuno-deficient patients
• Surgery
• Handling sterile instruments and goods
• Safe handling and storage of hazardous materials
• Body holding, viewing in mortuary areas
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 Engineering Services - Mechanical
– Provide air pressure to control outside air infiltration and
provide an internal airflow gradient from clean to dirty areas
and processes
– Provide air flow or pressure, in the event of fire, to prevent
smoke entering escape routes

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 Engineering Services – Medical Gases

• Medical gas services may include but not limited to:

– Oxygen storage and distribution
– Nitrous oxide storage and distribution
– Compressed air storage and distribution
– Medical suction pumping storage and distribution

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 Which System to select?
• For smaller hospitals, where the demand is typically
below 3000 m3 per annum, the most cost-effective
method of supplying medical oxygen is from a
compressed gas cylinder manifold.
• As the demand increases, it becomes less practicable
to use compressed gas cylinders and more cost
effective to use medical liquid oxygen

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 Which System to select?
• Liquid cylinders are ideal for an annual consumption of between
3000 m3 and 40,000 m3
– They can be connected together by a manifold to provide adequate
storage capacity and flow rate.
• For hospitals with larger demands, a bulk medical oxygen VIE
will generally be used
• There is a nominal overlap of annual consumption between
27,500 m3 and 40,000 m3,
– Here, either a bulk VIE or a liquid cylinder installation could be
considered
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 Services - security

• Extent of services
– Access control systems
– Asset tracking systems
– Video surveillance systems
– Door intercommunication system
– Security lighting

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 Lifts
• Any building of more than one storey shall haveadequate lifts
to provide safe and reliable vertical transport for persons and
goods
• The number of lifts and their size, speed and loadcarrying capacity
shall be determined by a professional analysis

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 Lifts

• Healthcare buildings are dependent on lifts

– They provide an efficient, fast, comfortable, safe and
reliable vertical transportation for movement of staff,
patients, visitors, medical equipment and ancillary services
items
– Required also for fire fighting and evacuation facilities
– Lifts are subject to strict statutory regulations
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 Lifts
• Location
– Should be based on medical function and service function such as
goods, fire fighting, etc
– Lifts should be located away from sensitive areas
– Wherever possible lifts should be provided, at least in pairs, to
provide service in the event of breakdown or unavailability for
maintenance or inspection
• Types
– Passenger, goods/passenger and goods only
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 Lifts
– They fall into one of the following categories
• General passenger lifts,
• trolley /stretcher lifts,
• bed lifts,
• goods lift, and
• service lifts

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