Projection of outpatient demand in a given area depends on:
i. Unmet needs of population for general medical and surgical care,
ii. Potential of cases being referred by GPs (this will have a bearing on the demand on speciality clinics rather than on general medical and surgical clinics),
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iii. Alternative services available in the area, and
iv. Reputation of the hospital.
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Present statistics indicate that per hospital bed, 1.5 to 3 patients attend the outpatient department of a large Govt hospital per day. A 300 beds hospital should expect to cater for 450 to 900 outpatients a day.
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The attendance tends to rise towards the higher side of the scale as the bed strength of the hospital increases, although the converse is not always the case.
Out of the cases seeking attention in a hospital, up to 65 per cent are for minor ailments and only 35 per cent are for major conditions. Of these 35, 10 per cent may be acute and 25 per cent non acute. However, this figure can vary widely.
Planning considerations:
After the expected demand has been determined, the following considerations should be taken into account.
1. Range of outpatient services to be provided and defining the functions of the outpatient department
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2. Daily and hourly capacity required
3. Number of the staff needed by category and the tasks required of staff
4. Possible service time per patient, both average time and its distribution over various aspects of outpatient care
5. Flow of patients and work
6. “Holding capacity” and “lifting capacity”
7. Requirement of furniture and equipment
8. Layout of the department considering all the above.
Defining the range of outpatient services and scope of the service:
The range of outpatient services provided by a hospital should depend on the characteristics of patients, namely sex, age profile and socioeconomic characteristics and ability to easily reach the hospital.
The level of staff, viz. junior or senior staff physicians, specialist or superspecialist would also influence the range of services.
To be decided at the outset would, therefore, be the proposed scope and range of the services, viz., preventive, diagnostic, therapeutic, follow-up, rehabilitative, scheduled and unscheduled.
Currently, the one factor that appears to gain importance in OPD services is the continued demand for sophisticated and expensive medical instrumentation and equipment.
Daily and hourly capacity envisaged:
Clinics must be scheduled for regular hours, for a specific time and duration. A simple method to determine outpatient scheduling is the calculation of room hours needed to deal with the expected number of visits, or assume the expected number of visits to determine number of rooms and rooms hours, based on the “possible service time”.
Room hours mean the number of doctor’s examination and consulting rooms available multiplied by the number of scheduled clinic hours. Average service time in minutes can also be calculated (60 divided by average visits per room hour).
Staff organisation and the tasks required of staff:
To the clinicians, outpatient work is just as important and interesting as inpatient work.
Many observers feel that the senior members of the medical staff should play a leading role in the OPD clinics which should not be left entirely to the junior clinicians.
The medical staff working in a hospital should be the same in both the inpatient and outpatient departments, i.e. the permanent staff of the outpatient clinics should be drawn from hospital staff and not separately employed to man outpatient services alone.
The nursing staff has to be headed by a senior sister in charge who will exercise supervision over the work of nurses and paramedical workers employed in OPD.
Continuity of care could be maintained by rotation of such staff between the inpatient department and outpatient clinics. In speciality clinics like ENT, eye, paediatrics and psychiatry, it is definitely advantageous for the ward nursing staff to work in respective clinics in the OPD.
Possible service time per patient and its distribution:
It is hard to determine the amount of time a physician should spend for an outpatient. Differing from clinic-to-clinic, service time is also likely to differ from physician-to- physician.
Physician and clinic staff may be able to make their own assessment for new and return visits. The sequence of physician activity during the visit can have a considerable impact on the turnover of patients.
Flow of patients and work scheduling:
On outpatient visits, patients flow is in a predictable manner usually from Enquiry to Registration to Waiting to Examination room to Investigation facilities, although there are many exceptions to this.
Nevertheless, it is beneficial to draw a flowchart of activities and movements in the outpatient department to guide the planning process for location of various facilities and their relationship with one another.
Holding capacity and lifting capacity:
All patients passing through the outpatient department do not do so at one and the same time. At any one time, the OPD will have certain number of people some of whom will be patients and the others their friends and relatives.
The physical capacity of the OPD to hold the maximum expected number of people at any one time in the main waiting area, subsidiary waiting areas and the clinics constitutes the holding capacity of the OPD.
Lifting capacity refers to the capacity for vertical transportation in high rise, multistoreyed OPD blocks. It has to take into consideration the traffic of patients and those accompanying them, the staff, and stores and supplies transportation during scheduled OPD hours.
Out of the probable number of lifts required, at least one should be large enough to take a stretcher trolley.
Also, planning a bank of two lifts together has been found to be structurally and functionally more efficient than locating each of them at two different points.