RABINDRANATH TAGORE INTERNATIONAL INSTITUTE

OF CARDIAC SCIENCES

PROJECT ON MANAGEMENT OF INPATIENT DEPARTMENT

NAME: DEBLINA DUTTA, BBM ( H )

ROLL NUMBER: 15403315010

SESSION: 2017-18

DINABANDHU ANDREWS INSTITUTE OF TECHNOLOGY & MANAGEMENT

LOCATION:124, EASTERN METROPOLITAN BYPASS, PREMISES

NO.1489, MUKUNDAPUR, KOLKATA, WEST BENGAL, 700099.

HOURS: 24 HOURS

PHONE: 1860 208 0208

EMERGENCY DEPARTMENT: 24x7

CARE SYSTEM: PRIVATE

DECLARATION FORM

I declare and inform you that this project entitled “A STUDY

ON MANAGEMENT OF INPATIENT DEPARTMENT” has

been submitted by me for the partial fulfillment for the requirement of

the degree of Bachelor in Hospital Management from Dinabandhu

Andrews Institute of Technology and Management under WBUT

under the guidance of Mrs. Nivedita Roy of RTIICS Hospital during

the academic year of 2017-2018.

1. NAME- Deblina Dutta

2. ROLL NO.- 07

3. REG NO.- 151541310010

4. DURATION OF TRAINING- 3 Months

5. (Signature of the Student)

6. For office use only-

7. The project has been approve/not

ACKNOWLEDGEMENT

I am using this opportunity to express my gratitude to

everyone who supported me throughout the course of this training. I

am thankful for their aspiring guidance, invaluably constructive

criticism and friendly advice during my training and the project work.

I am sincerely grateful to them for sharing their truthful and

illuminating views on a number of issues related to the project.

I express my warm thanks to Mr. Surajit Das, HOD of

our stream, Mrs. Anuriya Roy, Mrs. Nivedita Roy, Mrs. Debasree

Mitra, Mrs. Krishna Poddar and Ms. Sumana Ghosh of RTIICS

Hospital for their support and guidance and all the people who

provided me with the facilities being required and conductive

conditions for my project.

Thank you,

DEBLINA DUTTA

EXECUTIVE SUMMARY

I have done my internship in RTIICS, in which I got training

from its INPATIENT DEPARTMENT as a WARD COORDINATOR (ACTC

BUILDING 4TH Floor, Ward-2412 and 7 TH Floor, Ward- 2701 – 2705). The

internship basically revolved around the product knowledge training. The

system, the commitment of employees in RTIICS is really exemplary.

The difference between the success and failure is doing things

right and doing things nearly right; RTIICS has always tried for success &; that

is why it is known to be one of the leading organizations in India. In this report I

have given a brief review of what I have seen during my internship. I have

mentioned all these as I have made an internship as according to the schedule. I

also mentioned about the job responsibilities of a Ward Coordinator of RTIICS.

I have discussed about my learning in the whole internship. I

have made it possible to write each and every thing that I have learnt there. I

gave all my practical efforts in the form of this project that’s the asset for my

future career.

CONTENTS

1. INTRODUCTION

2. REVIEW OF LITERATURE

3. OBJECTIVE

4. HISTORY OF THE HOSPITAL

5. HOSPITAL PROFILE

6. VISION, MISSION, VALUES & SCOPE OF SERVICES

7. FACILITY LAYOUT OF ACTC BUILDING

8. MANAGEMENT OF INPATIENT DEPARTMENT

9. JOB DESCRIPTION OF A EARD COORDINATOR

10. SAFETY AND SECURITY

11. INPATIENT IDENTIFICATION

12. PATIENT VALUABLE POLICY

13. DISASTER PREPARDNESS

14. METHODOLOGY

15. DATA COLLECTION

16. SUMMARY OF FINDINGS

17. CONCLUSION

18. BIBLIOGRAPHY

19. ANNEXURE

INTRODUCTION

For most of the people hospital means ward. For hospitalization we

necessarily need an inpatient Department (IPD). Inpatient care is the care of

patients whose condition requires admission to a hospital. Patient enters

inpatient care mainly from previous ambulatory care. The patient formally

becomes an inpatient at the writing of an admission note and is formally ended

by writing a discharge note.

The IPD consists of following components:

Nursing Station

The beds

Necessary services, storage work

Public areas, needed to carry out the nursing care

The functions of Inpatient Department are:

To provide highest possible quality of medical and nursing care.

To provide essential equipment, drugs and other materials required for

patient care.

To provide comfortable environment, substituting temporary home for

patients designed to accommodate all their basic needs.

To provide facilities for visitors.

To provide highest possible degree of job satisfaction.

Meticulously maintaining of the medical records from the point of view

of patient, faculty and hospital administration and for maintaining

continuity of medical care.

REVIEW OF LITERATURE

Sitzia, J. and Wood, N. (1997). Patient Satisfaction: A Review of Issues and Concepts.

Social Science and Medicine, 45: 1829-1843. Sitzia and Wood review the literature

and suggest that patient satisfaction could be assessed by measuring 1) the degree to

which patients believe that care possesses certain attributes and 2) the patient’s

evaluation of those attributes. They suggest that satisfaction is no single concept made

up of multiple determinants, but that there exist three independent models of

satisfaction, each associated with one determinant.

Inui, T. and Carter, W. (1985). Problems and Prospects for Health Services Research

on Provider-Patient Communication. Medical Care; 23(5): 521-538. In this review of

studies of provider-patient communication, the authors assert that even with the vast

knowledge available on biological processes and disease mechanisms, communication

between health care provider and patient is an extremely important aspect of health

care. Attempting to measure this, however, requires interdisciplinary activities, since

merely measuring satisfaction at the conclusion of an interaction cannot measure all

the nuances of communication (both verbal and non-verbal).

Andaleeb, Siddiqui & Khandakar (2007) said that the ability to satisfy customers is

vital for a number of reasons. For one, today’s buyers of health care services in

developed countries are better informed, a condition that is being driven by greater

levels of information available to them. These buyers are therefore more discerning,

knowing exactly what they need.

Feldman, Novack & Gracely (1998) looked at specific aspects of managed care, such

as gate keeping and capitation, to assess physicians’ views. To gain more information

about the impact of managed care, they developed a survey to assess the attitudes of

primary care physicians on how managed care affects (1) physician patient

relationships, (2) their abilities to carry out their ethical obligations to patients and

quality of care. There is widespread agreement that trust between patient and

physician is important for high-quality health care.

Sultana, Riaz, Rehman & Sabir, (2009) suggested that quality of health care showed

that efficient delivery of Primary Health Care through the existing health system will

lead to improved health conditions by reducing morbidity, maternal and infant

mortality and population growth rate. Nurses need to know the factors influencing the

patient satisfaction in order to improve the quality of health care.

OBJECTIVE

The basic objective of doing this project is to study and

observe the INPATIENT DEPARTMENT of RTIICS Hospital

for better knowledge and to understand the workflow of the

Department.

Secondly, the objective of doing the project is to know

how the services are to be controlled, the quality is maintained

thus gaining maximum attention in the provision of the quality

services and getting feedback from the patients and relatives of

the patients.

HISTORY OF THE HOSPITAL

Rabindranath Tagore International Institute of Cardiac Sciences

(RTIICS) Kolkata is a multi-specialty hospital spread over 4 acres on Eastern

Metropolitan Bypass at Mukundapur. RTIICS, a unit of Narayana Health has 14

fully equipped operation theatres and 3 state-of-the-art Catheterization

Laboratories with 24 hours’ facility.

In the last 14 years, RTIICS has performed over 24500 life-saving

adult and paediatric cardiac operations, 93000 cardiac Cath Lab procedures,

1500 Kidney Transplants, 258000 dialysis and over 35600 multispecialty

surgeries, including joint replacements, minimally invasive surgeries,

neurosurgeries and other general surgeries. Over 80000 senior citizen club

members and over 20000 patients received financial assistance through Guest

Support Cell. A dedicated team of renowned surgeons, specialist doctors,

nurses, technicians and paramedical staff with the most modern equipment and

laboratory has made RTIICS one of the leading hospitals of the Narayana

Health group.

RTIICS comprises of 34 major clinical departments that cater to the

people of West Bengal and neighbouring districts in Eastern India as well as the

North Eastern states. The hospital also has many international patients coming -

in from Bangladesh, Nepal, Bhutan, Africa and Myanmar for various treatments

and returning home with successful remedies.

HOSPITAL PROFILE

Rabindranath Tagore International Institute of

Cardiac Sciences (RTIICS) in Mukundapur, Kolkata, West Bengal,

India, is multispecialty, tertiary care unit of Narayana Health group. It

received accreditation from the NABH in 2014. RTIICS is the group's

main hospital in Eastern India, with a primary catchment area of

Kolkata. The hospital also treats patients from neighbouring districts,

North-Eastern states as well as from neighbouring countries and

continents such as Bangladesh, Nepal, Bhutan, Africa and Myanmar.

It specialises in cardiology, neurology, neurosurgery,

nephrology and urology.

RTIICS, a unit of Asia Heart Foundation, was established

in April 2000 by Dr. Devi Prasad Shetty, founder and chairman of

Narayana Health. Early in 2016, RTIICS announced the establishment

of ‘Stride’, a clinical centre offering multidisciplinary care

for vascular diseases and traumas. Apart from vascular surgery, Stride

is supported by an endocrinologist, radiologist, physiotherapist,

counsellor and other specialists.

VISION

We desire to emerge as a healthcare destination and training hub to everyone all

over the world and reach to the masses in the remotest corner of the country and

out.

MISSION

We dream to make sophisticated health care facilities available to the masses

irrespective of status, class, creed or community with the sole aim of care and

service to the sick and unhealthy.

VALUES

Values are represented by the acronym “I care” where

I stand for Innovation and Efficiency

C stands for Compassionate care

A stands for Accountability

R stands for Respect for all

E stands for Excellence

SCOPE OF SERVICES

Services available are-

Anesthesiology and Critical care medicine

Cardiology-Diagnostics & Interventional

Cardiac Surgery- Adult, Pediatric& Neonates

Diabetology & Endocrinology

Dentistry

Dermatology

Emergency medicine

ENT

Gastroenterology & Hepatobiliary

General medicine

General surgery & Minimally Invasive Surgery

Hemato-oncology

Laboratory Medicine

Medical Oncology

Nephrology

Neurology

Neuro-surgery

Nuclear medicine

Obstetrics &Gynecology

Ophthalmology

Orthopedics& Joint Replacement

Pediatric Cardiology

Pediatric Surgery

Physiotherapy & Rehabilitation

Plastic Surgery

Psychiatry

Pulmonary/Chest Medicine

Radiology-Diagnostics & Interventional

Renal Transplant

Surgical Oncology

Thoracic Surgery

Transfusion Medicine

Urology & Lithotripsy

FACILITY LAYOUT OF ACTC BUILDING

1. GROUND FLOOR-Main OPD, May I Help You Desk, Discharge

counter, Billing Counter, Gynecology& Obstetrics Department,

Orthopedic Department, Urology Department, Nephrology Department,

Neurology Department, ENT, Gastro Department, Psychiatry,

Interventional Medicine,

2. FIRST FLOOR- Endoscopy Room, HDU 2103, OBS & Gynae Ward

2102, Conference Room, Biomedical, Operation Theatre.

3. SECOND FLOOR- Neuro HDU 2202, Neuro General Ward 2203,

dialysis, General ward 2201, and CCU 1.

4. THIRD FLOOR- General Ward, Renal TX Unit 2306-2311, General

Ward 2312, House Keeping Desk.

5. FOURTH FLOOR- Twin Sharing/Semi Private, Department of

Academics, General Ward 2412, Server Room, CSSD.

6. FIFTH FLOOR- Cath Lab, CCU 2, 3 &4.

7. SIXTH FLOOR- Operation Theatre, ITU 7, 8 & 9.

8. SEVENTH FOOR- Ward 2701-2705, ITU 1 & 2, NICU, HDU 2706,

Department of Clinical Research.

9. EIGHT FLOOR- Private and Deluxe.

MANAGEMENT OF INPATIENT SERVICES

DEFINITION- Medical treatment, assessment and the services that are

provided to the patient by the HCO (Health Care Organization) after admission

can be termed as Inpatient Services.

AIM- The aim of inpatient services is to provide best possible patient care

through medical skill combined with compassionate care and continuous

improvement and services.

RECEPTION OF PATIENT IN WARD:

Floor coordinator will receive the patient on arrival on admission to the ward

after admission formalities.

She will wish the patient and introduce herself as the Ward-Coordinator.

She will inform the patient that for any assistance he/she should call for her.

Brief the patient about her availability.

Educate the patient and relatives about their rights and responsibilities.

Enter the details of the patient in the Master Register & Allocation board.

Instruct the sister to take the patient to the allocated bed after checking the

bed is ready.

Inform the consultant about the patient arrival.

Inform the ward RMO about the new admission.

Provide the patient with a new pair of slippers & take a receiving signature

in slipper register.

Inform the patient relative to bring required toilet articles.

If the patient comes from Emergency, then provide the patient with tooth

paste & brush.

From ward stock.

DAILY ROUTINE OF WARD COORDINATOR:

Take rounds of the ward.

Meet all patients in ward at least twice during the tenure of her duty.

Obtain the feedback on the services that are provided to them and enquire of

any administrative problems if they have.

Ask the following questions to each patient on arrival at the ward:

Was the dinner served on time?

Was it hot and palatable?

Was the medicine administered to them on time?

Was the nursing staff available when needed?

If case of any complains immediately attend to it.

If need arise refer to the floor manager.

All clinical related problems should be immediately intimated to the

concerned nursing staff or the ward RMO as the case maybe.

UPDATING SYSTEMS:

Update the system after completing the daily round

Generate the current in patient list of the ward

Input the transfer in and transfer out of patients from the ward in the system.

Input the discharge request for the planned discharges.

Update the system after every discharge.

Make necessary changes in Consultant names as & when required.

BED RESERVATION:

Communicate to sisters regarding the requirement of beds for the day.

Reconfirm with the other wards with regards to bed reservations.

Inform the patient relative of CCU & ITU regarding different tariffs of beds

& facilities provided & make them choose their bed category, keep in mind

about the category of bed and the gender while booking the bed for every

patient.

Maintain correct documentation of bed reservations of the day.

Surrender the reserved beds if not required to the Admission. Department for

new admission well on time.

SHIFTING OF PATIENTS FROM ONE WARD TO ANOTHER:

Inform the concerned ward before shifting the patient.

Reconfirm the availability of the bed.

Check the clearance card before shifting the patient.

After every transfer informs the concerned consultant about the new ward

and the bed number to which the patient has been shifted to.

Inform the patient’s relatives about the patient exact location by giving them

the bed and the ward number.

Inform the relatives about the visiting time and the formalities of changing

the visitors pass from the “May I Help You” counter.

Provide the relatives with the extension number of the ward.

Update the allocation board and the system simultaneously.

PACKAGE AND NON PACKAGE UPDATION:

Yellow sticker denotes Package Patient and red denotes Regular

Paying/Non-package patient.

Change sticker on the patient’s file appropriately for the purpose of correct

billing.

For any clarification regarding billing call up the billing department.

Convey all communication about patient billing if suggested by the

consultant, to the billing department.

DAY TO DAY MAINTAINANCE:

Take note of all maintenance requirements including repair/replacement in

the ward on daily basis during the rounds.

Maintain record of requirement of maintenance in PEARL register.

Keep in touch with the said department till the work is completed.

In case if the required maintenance is not carried out within 48hrs of

reporting, bring it to the notice of the SR.IPD MANAGER directly.

COLLECTING REPORTS FOR THE PATIENTS:

Send the X-Ray requisitions (I-1)to the radiology department for reporting

on daily basis.

After 48hrs contact the department for the reports.

Keep the reports in the patient file.

Send the reports of the discharged patients to the MRD department.

Taking a list from Ward in charge containing all the due reports, contacting

with the concerned department & collecting the reports.

In case of any delay of report following up regarding the same.

ADMINISTRATIVE WORK FOR THE WARD:

Prepare planned discharge list of the ward by 5pm everyday & keep the

same in server hence any person can go through the discharge list of a

particular ward.

Inform the relatives about the discharge procedure for planned discharge

during the visiting time.

Furnish following information to the relatives:

Time of discharge.

To report first at Discharge desk in Admission room & take the

Provisional discharge pass if both discharge summary& bill is

ready.

Take final bill from cash counter & clear all the billing formalities.

Relatives should get the dress.

Prepare the Patient list in the ward.

Handover one Patient list to the security once in the morning & during the

visiting time.

Take rounds during the visiting hours and attend to the queries of patient’s

relatives.

Refer to the Senior IPD Manager for any problems.

Check the patient tasting food before the food is served & give a round

during lunch & dinner.

Checking the food being served for the patients attendants.

OPERATIONAL DOCUMENTS TO BE MAINTAINED IN THE WARD:

Photocopy of charge sheet in MRD file

Pearl register

Charge sheet sending register

File sending register

Slipper register

Corporate report sending register

MRD register

Stock Register of ward items less clinical.

Receipt of patient’s medical file handed over the various departments.

PROTOCOLS TO SEND PATIENTS OUTSIDE THE HOSPITAL

FOR TEST:

Call up the required hospital and take the booking for the patient.

Note the details about the time, the cost of the test, required preparation

of the patient and the documents that the patient need to carry.

Inform the consultant and the sister in charge of the ward.

Check with the consultant whether the patient requires any escort or not.

In case the patient requires a paramedic for escort, and then inform the

doctor of the Emergency ward for the needful.

Organize vehicle conveyance of patient with the support services.

Handover details of the patient to the escort accompanying the patient.

Ensure the form for sending a patient outside the hospital for test is

completed in all respect before sending the patient.

The form should be duly signed by the Medical Super, Nursing Super,

Security Supervisor and the Sister in charge of the ward.

Inform the MOD and the Floor Manager.

The Floor Manager will write an interdepartmental note to the GM

Finance for the cash required for the test.

The patient name, ward number, the required cash, the destination and the

time of arrival should be given to the hospital escort who will accompany

the patient.

All the details should be provided to the patient relatives.

Patient relatives may or may not accompany the patient, however in case

the patient is below 14 years of age then relatives will accompany.

Patient to wear the hospital uniform only.

Patient file may be given for reference if the patient is going to R N

Tagore Surgical Centre.

If the patient is going to any other hospital, then photocopy of the reports

and prescription should be given.

Keep in touch with the hospital driver as or when required.

PROTOCOL-DISCHARGE OF PATIENTS:

Handover the patient medical file to the ward RMO to write the draft

discharge.

Send the file along with the draft discharge to the Discharge Typing

Section.

Instruct nursing staff to return back the unconsumed medicines to the

store and obtain the return voucher

Received the Return Voucher and keep it in the patient file.

On receipt the return voucher sends the Charge Sheet to the billing

department & does MARK FOR DISCHARGE in system to generate the

final bill.

Enter the patient’s name, the ID number and the name of the HK in the

“Charge Sheet Sending Copy” and send to the billing department.

After receiving the Charge Sheet Sending Copy please check the

receiver’s signature.

Inform the patient party about the discharge time and the formalities.

In case the patient is of Corporate/TPA category then only the

photocopy is to be given and original sent to the corporate billing desk

In case the patient is an MLC (Medico Legal Case) only photocopy is

given and originals are sending to the medical record department.

In case DORB (Discharge on Risk Bond) the relatives have to sign the

DORB form declaring reason for taking their patient& intimate the same

to the Consultant, IPD manager, Medical Superintendent & the same is

kept in the MRD file before the discharge procedure commences.

The RMO has to take the signature of the patient NOK (Next of Kin as

recorded in the Admission Form) on the DORB form.

In case of DORB all original documents are given to patient.

Rest of the Discharge Procedure remains the same as enunciated before.

At the time of discharge coordinator must check the discharge I.P. card

to confirm the bill clearance, put signature & time in Discharge time

tracking card, provide the patient with Feedback form.

After the patient is dressed up & the explanation of discharge sum &

medication is done by nursing staff co-coordinator must counter check

the patient file & take patient relative signature confirming that they get

all the correct reports of their patient.

If the patient relative faces any language problem in understanding the

discharge sum she will help them to clarify queries.

Provide the patient a wheel chair & HK girl to escort the patient till the

hospital premises.

CORPORATE DISCHARGE:

In case of both planned & unplanned corporate discharge coordinator has

to check with corporate desk regarding the discharge time.

Act proactively to make fast the discharge procedure as after the final bill

& discharge summary are prepared the Corporate desk send the bill for

sanction.

Check minutely the discharge file & hold all the original documents for

corporate billing.

SENDING MRD(MEDICAL RECORDS) FILE:

After every discharge MRD file is prepared.

Enter the details in the MRD record register

Send the files to the MRD department within 48hrs of the discharge.

Check list maintained for MRD file:

C-14

C-15

Discharge card

Sign in admission paper

P.F.E.

Dr. sign in discharge summary

Final bill

Discharge order

Photo copy charge sheet

Consent paper

D.C. & death sum

DORB form

All lab reports signed by Doctor.

Consultants sign in 24 hours

If a file is returned back from MRD department due to some reasons she

has to make the file ready at the earliest & send the file back to MRD.

MANAGEMENT OF STORE:

Ward coordinators are responsible for intending the general store of

wards.

Weekly once the general intends are made in store after thoroughly the

stocks are checked.

Intends are made keeping in mind the cost factor .

ROLES AND RESPONSIBILITIES OF A DIETICIAN:

Nutritional assessment of in patients and fixation of their diet plan.

Formulation and regular modification of various hospital diets.

Planning and monitoring of special liquid homogeneous diet plan.

Diet counseling and distribution of diet chart to out-door patients.

Planning diet for each patient through diet sheets and provides

information to kitchen staffs well in advance to ensure timely supply.

ROLES AND RESPONSIBILITIES OF F& B INCHARGE:

Monitoring the overall operation of canteen and kitchen from where food

is served to the in-patients.

Planning of menu and kitchen operation.

Looking after the standard of services, cooking method, overall cleaning.

Checking all the billing, accounting and food costing of catering services.

Handling and sorting out in-patient’s complaints regarding quality of

food and food services to minimize their inconvenience.

Checking the quality of food and services.

Handling and organizing all outdoor and indoor catering of our hospital.

ROLES AND RESPONSIBILITIES OF CANTEEN INCHARGE AND

SUPERVISOR:

Supervising overall activities of all kitchen staffs.

Follow instruction given by the dietitians and F&B In charge.

To maintain hygiene and cleanliness of the kitchen.

To ensure that the kitchen premises, cooking and serving vessels are

maintained in clean and hygienic manner.

Supervising overall activities of all Pantry area and service staffs.

Follow instruction given by the Canteen In charge.

To maintain hygiene and cleanliness of the pantry.

NPM Orders and emergency snacks and beverages order served in

priority basis.

To check the food or meal of the patients as per prescribed by the

dieticians and doctors.

DIET PLANNING FOR PATIENTS:

1. RESPONSIBILITY-The dietitians are responsible for planning of the

patient’s diet and their consolidation for preparation by the kitchen staffs. 2. ASSESSMENT OF PATIENT DIET REQUIREMENT-Dietitians fill up

nursing assessment diet record sheet with patients bed number, respective

diet advice, clinical conditions and specific requirement during morning

ward visit, keeping in mind new admission, change of diet, bed transfer

and discharge intimation.

QUALITY ASSURANCE IN DIETARY SERVICES:

1.PURPOSE- To ensure good quality of patient food and achieve a high level

of satisfaction of patients and guest regarding the food and beverage services of

the hospital.

2.RESPONSIBILITY- The F & B In charge are responsible for ensuring the

quality of food provided and ensuring its monitoring through established

methods.

3.PROCEDURE- The F & B In charge / Floor coordinators/Sister in charge

taste the food prepared for the patients for lunch and dinner to ensure quality in

the food being served to the patients. The supply of food to the patient does not

commence without approval of them.

4.FEED BACK ABOUT F&B SERVICES- A feedback form is provided to

each and every patient before their discharge to get a feedback about the food

services and any suggestions. Any complaints / grievances / inputs regarding F

& B services are registered through the complaint management system of

PEARLS.

PEARLS:

Patients and Employee Ailment and Resolution and Learning System, shortly

called as PEARLS.

All Kinds of complaints can be raised to a single forum.

Complaints are tracked and resolved which triggers corrective & preventive

actions.

Continual improvement- It provides a basis for continual review and

analysis of complaints-handling process, the resolution of complaints and

where improvements can be made.

Operational efficiency- It ensures a consistent approach to handling

complaints, enabling to identify trends and eliminate the causes of

complaints, as well as improve organization’s operations.

Management Information-An effective complaints and feedback

management system should provide management information that is

essential in identifying problem areas. It can tell which areas need

improvement and how you can efficiently plan your resources.

Customer Care- By adopting the complaint management system, ability to

retain the loyalty of patients will be enhanced. The organization is

committed in managing customer care issues and has processes in place to

handle, analyse and review complaints.

Continual Process Improvement- Co-coordinators prepares different

trackers in the process of day to day Improvement. They are-

1. PAEDIATRIC LIST:

This list is maintained to track all admitted pediatric patient in

hospital

Details of every pts like admission date, consultant, status,

diagnosis are maintained in this list

The waiting surgical &post-surgical list is maintained here

Occupancy of pediatric pts is tracked & consultants are informed

regarding stopping admission when occupancy is high.

2. EDOD TRACKER:

This tracker contains the details of a patients expected date of

discharge.

With the help of this tracker we come to know the discharge

date of a patient & start prepare the necessary arrangements

Can inform the patient relative regarding coming discharge thus

helps them to prepare themselves to take their patient home.

Ask them to attend classes provided by nursing staff regarding

home care of their patient.

3. ITU TRACKER:

This tracker contains the post-surgical stay of a patient in ITU.

With the help of this list we track the average Length of Stay of

a patient in ITU.

4. TR IN AND TR OUT TRACKER:

This tracker is maintained in critical care areas.

Purpose of this tracker is to see the average Length of stay for

any critical care patient both surgical & observation pts.

This tracker contains turnaround time of a patient in critical

care units.

The tracker also gives the data of different specialties turn over

in different critical care units & diagnosis.

5. MASTER TRACKER:

Master tracker is based on details of the discharge of all pts in

a day.

All area of our hospital is covered in one tracker.

The declared time of discharges for both planned &

unplanned pts & the exact time of discharge are reflected in

this tracker.

The list helps to track the on time discharge& delayed

discharge at one glance.

6. BED VACANT TRACKER:

Ward coordinators keep a note of daily distribution of beds

for NA.

With the help of this list we track the time of a bed is asked

for admission, the time we allocate the bed, when the bed is

vacant & finally when the patient is received in ward.

7. INVESTIGATION TRACKER:

Purpose of this list is to track the time taken of a patient s

diagnostic investigation.

We track the loopholes of the delay behind & give extra

effort to minimize the time for any investigation.

8. PATIENT ROUND TRACKER:

Ward coordinators keep a note in patient list regarding

communication made with pts in morning & evening

round.

If any problem a patient faces during hospital stay that is

notified thus try not to repeat the same.

All the trackers are maintained on daily basis to improvise the day to day

activities of support services enhancing towards continuous quality

improvement.

JOB DESCRIPTION OF A WARD COORDINATOR

ROLE- To act as a facilitator to ensure highest standard of all round care of the

patients of their ward at all times and coordinate all clinical, nursing and

operational activities related to care of the patients.

RESPONSIBILITY AS A COORDINATOR-

Coordinator should be present on time at their respective wards.

Coordinate their respective wards with a smiling gesture, appropriate

body language and polite behavior with all.

Coordinate and book beds as per requirement.

Expedite smooth discharge of patients and coordinate with printing,

billing, return store & corporate department for it.

Coordinate cleanliness and smooth functioning of the ward in

coordination with the HK supervisor and nursing staffs

Coordinate smooth and timely transfer of patient to other wards as per

clearance card and inform the patient parties accordingly.

Coordinate with admission room for bed allocation.

Coordinating with different departments for sending a patient outside for

any tests.

Coordinate repair of all items (electrical, biomedical, sanitary and civil)

with concerned departments through pearls and keep a documentation of

the same.

Update the Master register of the ward.

Update the allocation board.

Update the software during the tenure of their duty.

Make the inpatient list and discharge list and circulate as per

requirements.

Keep the concerned consultant informed with regards to arrival of their

patient to the ward and confirm their discharges.

Answer to administrative queries of patient relatives.

Circulate and collect feedback forms and send them to the respective

departments.

Maintain the following documents in the ward related to operation-

a) Patient grievance register

b) Patient slipper register

c) File sending register

d) Charge sheet register

e) General stock registers of ward

f) Basic health education forms

g) Medical records register

h) Pearls register

i) X-ray reporting register

j) Corporate report sending register

k) Capital items register

Interact with patients during their tenure of duty and ensure availability

for any problem they face.

After admission interact with patients and relatives and give some basic

information about the hospital protocol.

To speak with every patient while giving ward round and document the

problems and keep a softcopy of the same in respective wards and try to

solve the problems with the help of HOD s.

Act as a bridge between patients, doctors, nursing staffs and

administrations.

Indent all requirements of the ward through HOD from general store

Change the stickers (package/non-package) on the patient file.

Take rounds of the ward during lunch and dinner and solve problems

arising there.

To maintain a count of lunch & dinner plates served for the patient and

make an entry in tally of the same daily.

To check the smooth serving of food till the end whether extra food is

properly given or not. To check if the crockery s is removed on time.

To make it ensure that the in pediatric wards the attendants have food on

proper time.

Co-ordinate for ASSAM and ORISSA GOVT pts to make them easy in

wards. Have the proper food arrangements, look after their lodging

arrangements when patient is in ITUs and make proper arrangements of

their discharge.

Solve any issues regarding the medicine indent & return or clinical items

placed by nursing staffs.

Give rounds for corporate patients and send their x-ray plates for

reporting as per requirements.

After the discharge of patients collect all the pending reports and send to

respective departments.

In case of discharge or expiry of MLC patients, send a Xerox of MLC

paper, admission paper and discharge or death certificate to the MOD and

also collect a received copy from them and keep in the MRD file.

Taste patient’s food before serving to patients.

Maintain inventory of their ward and account for every item.

Send all relevant medical documents after rechecking to MRD within 48

hours of the discharge of the patients. All the files should have the Final

Bill for that particular admission.

MRD files are checked in different criteria as follows-

C-15

C-14

Consultant signature within 24 hours

Proper discharge order

Signature of doctor present in all blood reports

PFE paper present in file

All consent paper is properly signed

Photocopy of charge sheet present

For expiry patient to check D.C. & death summary

If the MRD files are not having the Xerox copies of charge sheet, then try

to arrange it from the billing department.

If files are returned from MRD for any kind of incompletion to co-

ordinate with nursing staff to make the file ready and send back to MRD

within 48 hours.

Take classes of the nursing staffs to help them in administrative works

To manage all kinds of problems arising in emergency situations in the

ward through the help of their HOD.

Report all lapses and ward incidents in their ward to the Floor Manager.

Response to all emergency codes and acts accordingly.

While giving discharges check all the reports present in patient’s file and

final bill of the patient and discharge card.

As doctor confirms the discharges co-ordinate with medicine return store

to return the residue medicines and co-ordinate with billing department

for Final Bill and inform patient parties also the same. Arranging the

discharge summary to be written by concerned doctor & send the pink

sheet with file to printing department for preparing discharge summary.

Co-ordinate with discharge printing department time to time for making

ready the discharge sum in 3 hours of time to make the discharge happen

in between 4 hours and try to make the vacant as early as possible.

Maintain a proper discharge list where the timings are maintained for

sending medicine for return in store, after return the time of sending

charge sheet, the declared time for patient to come for discharge, time of

sending the file for making sum. The discharge list is kept in server for

every respective ward & this list is updated till the co-coordinator leaves

ward at the end of day.

Co-ordinate with all the investigation rooms to get all the tests done and

get the respective reports on time.

Prepare all the corporate files with all the reports as per the final bill and

send it to corporate department within 48 hrs.

Co- ordinate with nursing staffs and give support to them to run the ward

smoothly.

Co-ordinate with House Keeping department for patient’s linen and send

a written document for required linen.

Maintain all the lists of the ward and send it to HOD.

Co-ordinate with doctors for patient’s proper treatment, patient’s transfer,

inform referrals.

Inform patient parties about their OT/ CATH timings while taking the

patient to OT or CATH lab or any unplanned tests need to be done.

Get the print out of all the blood reports of ITU1/2 and ITU7/8/9 and get

it signed by the doctors and keep it in patients file.

Give updated information to MAY I HELP YOU DESK and

DISCHARGE desk

Check the green files of patients having printed pre op Echo report,

Family Education paper, proper admission paper containing surgeon’s

name.

Send day to day X- ray reporting for corporate patients.

In GWs for surgical pts maintain a daily tracker for Expected Date of

Discharge and work accordingly.

In ITU s for surgical pts maintain a daily tracker for shifting the pts from

ITU to ward in proper time.

In Pediatric GW maintain a daily list of all pediatric pts in hospital for

regular updating of pediatric pts.

In CCU & ITU maintain a Transfer in & Transfer out tracker of pts

arrival & departure time and send the same to Quality department in

every fortnight.

Co-ordinate for minimum usage of resources to maintain the cost.

MAINTAINING DISCHARGE MASTER TRACKER: This tracker is

maintained daily to evaluate the causes behind the discharge time taken for

every patient in different specialty.

Signing on admission slip mentioning the exact time of the arrival of

patient in wards thus cooperating with Admission department to track

the PT REPORTING TRACKER & track the time taken from a pts

arrival for admission to receiving in the ward.

Signing on provisional discharge card mentioning the time thus

cooperating with the Discharge department to track the pts total time of

discharge from giving the discharge pass to vacating the ward.

Maintaining BED VACANT TRACKER in patient list where the time

is tracked from a bed is allocating to NA & EMG & when the bed is

vacated & when the patient is being received.

Taking special care for International patient. There are some particular

procedures for Bhutan or Assam or Nigerian patients. Coordinator is

supposed to take care of different criteria s of these pts & to look after

the comfortable stay of these patients. Co-ordinate with International

cell to provide post discharge medicines for Bhutan patient.

To coordinate with the Bed manager to cater maximum beds in every

ward& to keep a record in charge sheet if a patient can’t be shifted to

require ward or upgraded & take HOD s sign for smooth billing. The

same has to be mailed to HOD & nursing manager.

Giving a round during visiting hour & communicate with patient

relatives to share their problems & try to help them in every possible

way.

Documenting & filing the paper of daily rounds of morning & evening.

Checking the admission criteria of pediatric patient & change the

admission paper accordingly if necessary.

To change admission paper whenever necessary in case of surgical

reference (joint admission)

To co-ordinate DORB (Discharge on risk bond) with special care. In

case of DORB try to make discharge ready by 2 hours. Informing

Medical Super, nursing super, HOD regarding DORB. Making the

patient relative state the reason of taking their patient on risk bond in a

DORB form. Keeping the form in MRD file.

Preparing isolation room when required for isolation patients. The AC

duct needs to be covered before making the rooms isolate.

Coordinating with nursing staff to maintain cleanliness of wards thus

coordinating with HK department for high level cleaning & fumigation.

Collecting the procedure boxes of corporate patient (like PTCA, PPI) &

sending them to corporate office.

Attending all the training classes.

Maintaining PLAY STATION in pediatric ward. Doing all the

necessities to maintain the play area.

Coordinating different criteria of different specialties to prepare

discharge summary.

In addition to the above, the manager may assign responsibilities as

necessary from time to time.

SAFETY AND SECURITY

Coordinators give maintenance rounds daily. Checking of toilets,

electrical are done on regular basis. Whenever a fault is found we make

Pearls complain is made & the stakeholders are informed verbally to

repair the fault at the earliest.

Rounds of calling bell, side rails, safety belts of wheel chairs & trolleys

are made regularly. Whenever a fault is found we make Pearls complain

is made & the stakeholders are informed verbally to repair the fault at the

earliest.

The time of admission we give patient& relative teaching every time. We

educate the patient regarding their safety methods, rights

&responsibilities. Education of calling us with a bell, lifting up the side

rails at the time of rest is important, how to keep babies while sleep, how

to walk in wards when a cleaning is going on, in a demand to speak with

us, what to do in case of spillage, not to go to toilet without assistance, all

these are communicated to the patients.

Everyday rounds are given to patients. We take a feedback from every

patient & educate same in our daily rounds.

Dieticians give rounds & keep track of every single patient diet. We

supervise the lunch & dinner served. We test the food before serving to

secure the patients safety.

We send MRD files of a patient within 48 hours to make sure the file is

not lost.

We collect all the reports ready & collect the pending reports too & make

sure the reports are sent to MRD to make the patient reports secured.

At the time of discharge, we check the bill & bill no to make sure the

final payment is made. We are having papers where patient attendant

signs & take the patient. After the patient relative is explained the

discharge summary signature is taken in discharge summary to secure his

consent in understanding the discharge summary. We take signature when

the patient file is handed over after the relative counter check the file that

he is receiving all the reports of his own patient to secure his consent in

getting all the correct reports.

We countercheck if a patient is wearing ID band as this is the patient’s

identification marker after the patient is admitted.

INPATIENT IDENTIFICATION

• Identification band shall be provided to all the patients at the time of

admission with the help of which he/she shall be identified during his or her

stay irrespective of the condition (conscious / unconscious).

A tamper-proof, non-transferable identification band shall be affixed to the

patient’s wrist.

ID band shall consist of:

Patient’s name, age, sex and blood group in block letters.

Patient’s ID number and date of admission from the admission report.

Diagnosis by seeing the OPD sheet form.

Signature of the nurse who is tying the band

Patients are educated not to remove the ID band.

ID band shall be checked daily before any investigation, procedure and

administration of medication. The patient name will also be asked to confirm

the patient identification.

The following colors codes shall be used for the patient:

Cardiac patient - Blue

Non cardiac patient – Yellow

Patients falling under the vulnerable group are provided with the same

color coded ID bands but with a “V” marked on it.

PATIENT VALUABLE POLICY

POLICY:

To safeguard the valuables of its patients.

To inform the patient that the hospital cannot assume responsibility

for valuables or personal property retained by them.

SCOPE: All inpatient areas.

DEFINITION:

Valuables – Items identified by RTIICS staff or the patient as having

significant monetary or personal importance. Examples include but are not

limited to: Old medical records, Cash, Credit and debit card, Jewelry, document,

passport, spectacles, denture, mobile phone.

PROCEDURE:

The Hospital is not responsible for lost, theft, or breakage of

personal items that the patient maintains in their possession while

hospitalized.

During admission, the admission room staff and the floor

coordinators/ nurse in-charges explains the patient /relatives - the

necessary items to be brought by the patient on admission.

On admission the nurse shall handover the jewelry, old medical

records, clothes, and any other belongings to the relatives and shall

get their signature confirming the handing over.

All old records shall be photocopied before handing over and

photocopy shall be kept in the case file.

All the old medication brought by the patient/ relatives shall be

returned to them.

Patient shall be informed to take care of the other belongings that

they bring along such as mobile phones, spectacles, dentures, etc on

admission.

On transferring the patient for Surgery/ any other procedure/ to

critical care areas, the nurse shall make sure that the relatives have

taken all the patient valuables.

METHODOLOGY

TRAINING DURATION: 04/01/2018 to 03/04/2018

TIMING: Monday to Saturday from 09:00 A.M to 05:00 P.M.

DATA COLLECTION METHOD:

PRIMARY DATA- A questionnaire had been formulated in order to

collect the primary data consisting of close ended questions and open

ended questions. Questionnaire was mainly objective types based on

Inpatient department services, waiting time, facilities, behavior of the

staff, and support services.

SECONDARY DATA- The secondary data had been collected

directly from the hospital, with the help of hospital yearly records and

other reports.

Number of samples- I have collected data from 50 samples.

The data were mainly collected through

observation during the training period and regular interactions with

the doctors, employees, and nurses of the hospital.

DATA COLLECTION

DOCTOR’S ENTRY TIME EVALUATION:

TIME DOCTOR’S ENTRY

>30MIN 8.2

30MIN-1HR 3.2

1HR-2HR 1.4

2HR-3HR 1.2

>30 MIN

30MIN-1HR

1HR-2HR

2HR-3HR

STAFF WORK EFFICIENCY:

WORK EFFICIENCY

PERCENTAGE EXCELLENT 50%

VERY GOOD 35%

GOOD 30%

FAIR 10%

INTERPRETATION: From the above data it can be seen that the

staff work efficiency is 50% excellent, 35% very good, 30% good

and 10% fair.

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

EXCELLENT VERY GOOD GOOD FAIR

Work Efficiency

PERCENTAGE

NO OF ADMISSIONS:

MONTH NO. OF ADMISSIONS

JAN’18 652

FEB’18 762

MAR’18 795

INTERPRETATION: From the above data it can be seen that there

was 652 admissions in the month of January, 762 admissions in the

month of February and 795 admissions in the month of March in

general wards.

0

100

200

300

400

500

600

700

800

900

JAN'18 FEB'18 MAR'18

NO. OF ADMISSIONS

NO. OF ADMISSIONS

NO OF DISCHARGES:

MONTH NO. OF DISCHARGES

JAN’18 734

FEB’18 750

MAR’18 783

INTERPRETATION: From the above data it can be seen that there

was 734 discharges in the month of January, 750 discharges in the

month of February and 783 discharges in the month of March in

general wards.

700

710

720

730

740

750

760

770

780

790

JAN'18 FEB'18 MAR'18

NO. OF DISCHARGES

NO. OF DISCHARGES

QUALITY OF FOOD MAINTAINED:

QUALITY OF FOOD MAINTAINED PERCENTAGE

GOOD 75%

FAIR 25%

POOR 10%

INTERPRETATION: From the above data it can be seen that

quality of food maintained was 75% good, 25% fair and 10% poor.

0%

10%

20%

30%

40%

50%

60%

70%

80%

GOOD FAIR Poor

QUALITY OF FOOD MAINTAINED

QUALITY OF FOOD MAINTAINED

NO. OF SURGERIES PERFORMED IN GENERAL WARDS:

MONTH NO. OF SURGERIES PERFORMED

JAN’18 390

FEB’18 420

MAR’18 450

INTERPRETATION: From the above data it can be seen that there

were 390 surgeries performed in the month of January, 420 surgeries

in the month of February and 450 surgeries in the month of March in

general wards.

360

370

380

390

400

410

420

430

440

450

No. of surgeries performed

JAN'18

FEB'18

MAR'18

PERCENTAGE OF SURGICAL SITE INFECTION IN GENERAL

WARDS:

MONTH % OF SSI

JAN’18 0

FEB’18 0.27

MAR’18 0.3

INTERPRETATION: From the above data it can be seen that there

was 0% of SSI in the month of January, 0.27% of SSI in the month of

February and 0.3% of SSI in the month of March in general wards.

0

0.05

0.1

0.15

0.2

0.25

0.3

% of SSI

JAN'18

FEB'18

MAR'18

ALOS IN GENERAL WARDS:

MONTH ALOS

JAN’18 4.64

FEB’18 4.62

MAR’18 4.85

INTERPRETATION: From the above data it can be seen that the

Average length of stay in January was 4.64, in February was 4.62 and

in March was 4.85 in general wards.

ALOS

JAN'18

FEB'18

MAR'18

BED OCCUPANCY IN GENERAL WARDS:

MONTH BED OCCUPANCY

JAN’18 76.42%

FEB’18 83.47%

MAR’18 88.91%

INTERPRETATION: From the above data it can be seen that the

bed occupancy rate in January was 76.42%, in February was 83.47%

and in March was 88.91% in general wards.

70.00% 75.00% 80.00% 85.00% 90.00%

JAN'18

FEB'18

MAR'18

BED OCCUPANCY

BED OCCUPANCY

TOTAL DEATH IN ITU 1 & 2, NICU:

MONTH TOTAL DEATHS

JAN’18 2

FEB’18 3

MAR’18 1

INTERPRETATION: From the above data it can be seen that the

number of total deaths in January was 2, in February was 3 and in

March was 1 in ITU 1 & 2.

0

0.5

1

1.5

2

2.5

3

JAN'18 FEB'18 MAR'18

TOTAL DEATHS

TOTAL DEATHS

REASONS FOR DEATH:

REASONS FOR DEATH NUMBERS

HEART FAILURE 2

PNEUMONIA 1

ARRHYTHMIA 2

UTI 1

INTERPRETATION: From the above data it can be seen that the

reasons for death was heart failure, pneumonia, arrhythmia and UTI

in ITU 1 & 2.

NUMBERS

0

0.5

1

1.5

2

HEARTFAILURE PNEUMONIA

ARRHYTHMIAUTI

NUMBERS

NUMBERS

MORTALITY PERCENTAGE IN GENERAL WARDS:

MONTH MORTALITY %

JAN’18 2.75%

FEB’18 2.54%

MAR’18 2.62%

INTERPRETATION: From the above data it can be seen that the

mortality percentage in January was 2.75%, in February was 2.54%

and in March was 2.62% in ITU 1 & 2.

2.40%

2.45%

2.50%

2.55%

2.60%

2.65%

2.70%

2.75%

2.80%

JAN'18 FEB'18 MAR'18

MORTALITY %

MORTALITY %

SUMMARY OF FINDINGS

PROBLEM AREAS IN THEINPATIENT DEPARTMENT:

Planned Discharge: -

1. Availability of RMOs to write the pink sheet-

RMOs are looking after more than 1 unit. One RMO is responsible for

7th floor GW & 7th floor HDU as well 8th floor.

If a cardiac surgery patient is being told to be discharged the very next

day when the ECHO is not done the summary gets delayed as the adult

ECHOs are done after 2PM till evening. The reports get ready next day

(no time limit can be after 2 PM).

2. Some of the CATH reports are delayed due to consultant’s unavailability.

3. Last minute correction in the discharge summary by consultants or referrals

takes too much time to change the summary.

4. Sometimes Printing Department makes mistakes in summary like

medication time error or wrong ID. Changing the summary takes time.

5. Summary are not written properly in the pink sheet. Discharge printing as

to clarify many things with the nursing staffs & RMOs.

Unplanned Discharge: -All above points remain unchanged in case of

unplanned discharges.

Clinical Problems: - 1. Patient relatives have many clinical queries (RMOs are not available to

speak to them).

2. Intimation of Discharge- Consultants does not inform the discharge at

proper time in wards.

3. We come know from relatives that one particular patient is being asked to

discharge.

Nursing: - 1. When a bulk of discharge comes at the same time the nursing staffs are

unable to make the entire patients ready at the same time due to less

nursing staffs.

2. Collection of reports by nursing staff is a big problem. At the last moment

they ask for X-ray plates or other diagnostic reports which they don’t

collect at the proper time. In last hour we have to arrange a HK girl and

collect the reports.

3. Discharge files are not kept ready all the times.

4. Sometimes discharge summary is not signed by the nursing staff and the

patient relatives as nursing students release the discharges and they didn’t

know about the procedures.

5. If a coordinator is not available for any reason they don’t send the file for

printing or charge sheet for billing quickly.

6. Medicine returns by nursing staffs are not done properly. Many times

medicines are left unreturned in the cupboard.

7. Explaining discharge summary by junior staffs takes a long time as they

are unable to explain properly.

Arranging wheels: -Wheel chairs along with HK girls are a time taking

factor for every patient.

Billing problems: -

1. Patient relatives come to the ward with many billing related problems.

Final bill settlement takes a long time.

Housekeeping problems: -

1. Behavior of some of the housekeeping staffs is very bad.

2. There are always less number of housekeeping staffs which make it

difficult for the patients to go for certain tests and discharges.

RECOMMENDATIONS:

1. At least two RMOs should be present during the morning & afternoon

shift to cope up with the huge discharges.

2. RMOs should be requested to write the summary properly in the pink

sheet so that discharge printing is not delayed.

3. Nursing staffs should be appointed more.

4. Discharge files should be made ready prior to the discharge time.

5. Nursing students must be well trained before giving them duties in the

ward.

6. Before returning medicines all cupboards should be checked so that no

medicines are left.

7. Senior staffs must explain the discharge summary as junior staffs cannot

do it properly.

8. Final bill settlement time must be reduced.

9. Housekeeping staffs should be educated to behave properly with

coordinators and the nursing staffs.

10. More HK staffs should be appointed in the GW as it remains busy for the

whole day.

11. Need to focus on time management.

12. The staff discipline should be more improved.

13. No of chairs, outside the wards should be increased.

14. Public holidays should be clearly displayed on the notice board for the

convenience of the patient.

15. Better communication should have made between the staffs.

16. Lack of coordination between the staffs, there should be more clarity.

CONCLUSION

The inpatient department is becoming more and more

important. Ambulatory care reduces dislocation of work, is cheaper

and at the same time gives access to the various investigative and

diagnostic facilities of the hospital.

The hospital should have a policy for its inpatient

services regarding admission process, discharge process, surgeries,

food and cleanliness, VIP patient protocol, and activation of disaster

program on the event of disaster, drug distribution system, billing

system, contracting system. These are broad guidelines for the IPD

administration by the governing board for day to day decisions.

Analyses of quality information on patient experiences of inpatient

hospital care should not only take the hospital level, but also at the

more specific department level into account.

Patients attending the hospital are responsible for

spreading the good image of the hospital and therefore satisfaction

of patients attending the hospital is equally important for hospital

management. Therefore it can be concluded that IPD services form

an important component of hospital services and feedback of

patients are vital in quality improvement.

BIBLIOGRAPHY

1. HOSPITAL ADMINISTRATION by DC JOSHI and MAMTA

JOSHI.

2. https://www.narayanahealth.org

3. https://en.wikipedia.org/wiki/Rabindranath_Tagore_International_Institu

te_of_Cardiac_Sciences

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958929/

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