HOSPITAL ORGANIZATION, OPERATIONS AND

PLANNING
Q1a. Define Medical records?
Solution-
A medical record, health record, or medical chart is a systematic documentation of a
patient's individual medical history and care. The term 'Medical record' is used both for
the physical folder for each individual patient and for the body of information which
comprises the total of each patient's health history. Medical records are intensely
personal documents and there are many ethical and legal issues surrounding them such
as the degree of third-party access and appropriate storage and disposal. Although
medical records are traditionally compiled and stored by health care providers, personal
health records maintained by individual patients have become more popular in recent
years.
Structure of a Medical Record
* Name, birth date, residence and emergency contact
* Sex, Blood type
* Date of last physical examination
* Dates and results of tests and screenings
* Major illnesses and surgeries, with dates
* List of medication, dosages and duration of prescription
* Any allergies
* Any chronic diseases
* Any history of illnesses in the family
b. Enumerate the functions of the medical records
department?
Solution-
In brief the major and important ones are:
1. Computerised new and revisit registration of ambulatory care (OPD) patient
(between 8.00 AM –11.00 AM) & collection of annual fee/ duplicate card fee
under token and display system.
2. Computerised new and revisit registration of emergency care patient (round the
clock service) & collection of annual fee/duplicate card fee.
3. Issue of health care clinical notes to various ambulatory care (OPD) clinics.
4. Pasting of various types of reports in the respective ambulatory care-health
record charts (OPD file)
5. Providing case summary of Medico-Legal cases to police authorities & patients
on written request.

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6. Providing medical information to insurance agency on prescribed form of
insurance company on written request by deceased nominee/insurance
authorities.
7. Collection of various investigations/tests charges etc. and issue of receipt at both
the counters, emergency (round the clock) and at fee section of OPD from
8.00AM to 12.30 PM.
8. Round the clock admission registration, documentation, security collection at the
emergency and issue gate passes.
9. Round the clock discharge of patients at the emergency counter, security
adjustment/ refund services.
10. Providing information and guidance to patients, attendants and visitors.
11. Compiling statistics of various data & services.
12. Issue of health record charts to faculty members, administrative authorities for
various purposes.
13. Medical records department and management is the CUSTODIAN of
ambulatory, emergency and in–patient care health record charts, including
Medico-Legal and death cases etc.

c. Draw the Organizational Structure of a medical records

department?
Solution-
a. The First Axis: Specifications of a Health Information
Management Division

The Health Information Management Division is responsible for integrating all hospital
information resources and providing comprehensive, integrated health information
management services in line with the goals of the hospital.
This division consists of three organizational departments:
1. a medical library department, mainly responsible for preserving, maintaining,
and providing information services related to library information resources
2. an information technology department, mainly responsible for carrying out
information and communication technology (ICT) affairs for hospitals
3. a healthcare information management department, mainly responsible for
providing medical records and healthcare information management services

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All these departments are to be organized under the direction of a new top manager
known as the health information manager. The health information manager's activities
include those related to information resource integration, information strategic planning,
development and coordination of policies and procedures for information technology,
and information management.
In order to coordinate the work of the Health Information Management Division with
the appropriate establishments related to clinical and nonclinical hospital affairs, the
health information manager will be under direct supervision of the hospital president
with an indirect relationship with the hospital manager.
The organizational structure of the Health Information Management Division suggested
for

b. The Second Axis: Specifications of a Healthcare Information

Management Department
Since many inappropriate names are used to designate MRDs in Iran, and considering
the goals and functions of this department as well as the philosophy of organizational
restructuring, the name of this department in hospitals in Iran should be changed to
Healthcare Information Management Department. In addition, according to the first
axis, as described above, this department should be in the Health Information
Management Division, under the direction of the health information manager.

c. The Third Axis: Functions of the Healthcare Information

Management Department

According to the House of Delegates of AHIMA, HIM is a profession that focuses on

healthcare data and the management of healthcare information resources. HIM
professionals collect, integrate, and analyze primary and secondary healthcare data, and
disseminate information and manage information resources related to research,
planning, provision, and evaluation of healthcare services. The functions of the
Healthcare Information Management Department therefore include those related to
healthcare data/information gathering, processing, and distribution, as follows:
1. Healthcare data/information gathering
• Cooperation with form designing committee for designing information
form
• Data/information quality analysis
2. Healthcare data/information processing
• Data/information organizing
• Data/information classifying (coding)

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• Extraction and classifying of information other than disease and
operation data
• Compiling administrative and health statistics
3. Healthcare data/information storage and distribution
• Storage and retrieval of medical records
• Maintenance of a variety of indices and registries (paper-based or
electronic)
• Release of information
• Research coordination
• Support for quality assurance, risk management, and utilization
management

d. The Fourth Axis: Units of the Healthcare Information

Management Department
The Healthcare Information Management Department should consist of three
organizational units based on service line departmentalization as follows:
1. A data gathering and maintenance services unit, responsible for medical
record storage, cooperation with form designing committee in form
design/redesign, and analysis of data quality
2. A data processing services unit, responsible for organizing data, classifying
(coding) data, and compiling administrative and health statistics
3. An information distribution services unit, responsible for release of
information, research coordination, and cooperation in utilization review, risk
management, and quality assurance.

Q.2 a. Draw a flowchart of discharge procedure for

inpatients?
Solution-
FLOW CHART FOR PATIENT DISCHARGE.
Patient requests self discharge

Health care professional

discusses request and
implications with patient,
identifies problems, and
implements any appropriate
action
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Patient agrees to stay

YES NO

Rectify Pt concerns,
Ensure Pt understands implications of request, and is
inform NOK, Dr, &
able to make informed decisions? **
MM of events, record
NO YES
in Pts notes, complete
complaints form if
appropriate Request visit from Inform Pts Dr and NOK. Explain to pt
Dr, inform NOK, MM. contents of self discharge form, and
Record in patient’s implications on PCT responsibilities.
notes. Patient signs form if continues to
request discharge. Record events,
Patient agrees Dr to advice on including reasons for self discharge in
To stay appropriate action pts notes. Complete complaints form
YES NO if applicable

Ensure Pt has medication & transport,

and that any relevant services, and
social worker have been informed of
pts self discharge prior to pt leaving

b. Outline the functions of the following

Solution-
1. Bin card- Bin card is a record of receipt and issue of materials Quantity of store
received is entered with receipt column and the quantity of store issued is
recorded in the issue column of Bin Card. Balance of quantity of stores is
ascertained after every receipt or issue
2. Stores ledger- This ledger is kept in the costing department and is identical with
the bin card except that receipt, issues and balances are shown along with their
money values. This contains an account for every item of stores and makes a
record of the receipts, issues and the balances, both in quantity and value. Thus,
this ledger provides the information for the pricing of materials issued and the
money value at any time of each item of stores.

3. Stock identification card- An identity document (also called a piece of

identification or ID) is any document which may be used to verify aspects of a
person's personal identity. If issued in the form of a small, mostly standard-sized
card, it is usually called an identity card (IC). In some countries the possession
of a government-produced identity card is compulsory while in others it may be
voluntary. In countries which do not have formal identity documents, informal
ones may in some circumstances be required.

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4. Materials requisition slip- A source document that indicates the types and
quantities of material to be placed into production or used in performing a
service; it causes materials and its cost to be released from the Raw material
Inventory warehouse and sent to Work in Process Inventory.

5. Materials transfer note- A form that records the transfer of material from one
accounting code to another.

Q.3 Distinguish between autoclaving and ethylene oxide

sterilization
Solution-

a. Autoclaving
An autoclave is a device to sterilize equipment and supplies by subjecting them
to high pressure steam at 121 °C or more, typically for 15 to 20 minutes
depending on the size of the load and the contents. It was invented by Charles
Chamberland in 1879 although a precursor known as the steam digester was
created by Denis Papin in 1679. The name comes from Greek auto, ultimately
meaning self and Latin clavis meaning key — a self-locking device.

A notable growing application of autoclaves is in the treatment and sterilization

of waste, such as pathogenic hospital waste. Machines in this category largely
operate under the same principles as the original autoclave in that they are able
to neutralize potentially infectious agents by utilizing pressurized steam and
superheated water. A new generation of waste converters is capable of
achieving the same effect without any pressure vessels to sterilize culture
media, rubber material, gowns, dressing, gloves etc. It is particularly useful for
materials which cannot withstand the higher temperature of hot air oven. For all
glass syringes, hot air oven is a better sterilizing method.

b. Ethylene Oxide Sterilization

Ethylene oxide (ETO) gas uses relatively low temperatures for sterilization.
Using a heated unit, sterilization can be achieved in 2-3 hours at 120°F.
However, a lengthy aeration time must follow each cycle. Materials such as
suction tubing, hand pieces, radiographic film holders, and prosthetic appliances
may be sterilized without adverse effects. Follow the manufacturer’s instructions
for safety precautions, operation, and maintenance. Because of the serious
Occupation Safety Health Agency (OSHA) problems with ETO gas, COs of

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Naval Dental Clinics (NDCs) should not purchase new ETO equipment. Large
naval hospitals with ETO capabilities in their CSR may use them to sterilize non
heat stable dental instruments and equipment

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** Does Pt have cognitive problems,

confusion, dementia or any other
condition that may affect judgement?