According to an audit report on performance audit on delivery of OPD services, RAA found that there is no proper patients registration system to capture the patients’ information of earlier diagnosis, frequency of visits, addresses and drugs prescribed to monitor patients’ progresses.
The records are maintained manually and there are no proper systems to manage the patient registration system.
Despite requirements by the National Health Policy to have a proper patient registration system, it was observed that there is no proper registration and recording both at General and Medical OPD. It was learned that patient registration in the OPD were done away as it resulted in longer queues at the reception counter and at the doctors’ consultation chambers.
Similarly, it was observed that patient registration system is also not properly maintained for the diagnosis services of the echocardiogram unit. The hospital does not have any standardized format to register and maintain the records of patient availing the diagnosis services. For instance, the registers at the units does not record the details of patients. Appointment dates were mentioned but test dates were not recorded in the register. In some cases, the name column was not filled in by the unit.
In absence of proper registration system, the hospital lacked comprehensive information on patients availing the services such as details on the patients’ attendance, earlier diagnosis, frequency of visit, address and drugs prescribed. It resulted in lack of reliable information and data for future planning and monitoring purposes thus affecting efficient delivery of health services.
The JDWNRH responded that the registration system done manually was done away after introduction of the HIS in 2011. However, the system did not pick up and could not be revived in 2014 and 2015 after calling the vendor. Since then there has not been proper registration of patients.
Likewise, Registration of patients also increased the waiting time and was done away. It has also been found that the hospital has been collecting lots of information which was of no use but increased the waiting time only. There has been duplication of registration at one reception counter and another registration at the doctor’s chamber which was done away with. Many of the doctors were not proficient in the use of IT which increased the waiting time. Hence the management had to comply with the manual registration.
On the other hand, the JDWNRH has information and service desk, which only assisted in addressing enquires related to the location of the Chamber and health care facility. The desk was functioning without a clearly defined terms of reference (ToR).
The desk does not have information on the availability of the doctors and officials on duty. For example, enquires about doctors are referred to the reception counters. The information and service desk with adequate information would contribute to efficient delivery of health services.
The JDWNRH responded that the HRD and General notify the information desk on doctor’s official/planned movement and the Medical Superintend send’s a copy on doctor’s ad-hoc movement. It says a receptionist shall maintain doctor’s information board. More brochures shall be arranged from Public Health, MoH. It says a a clear ToR has been drafted.
The RAA observed that information desk were ineffective as the desk is not equipped with basic facilities required in the information and service desk such as; computers, internet connections, information on the availability of the doctors and officials on duty.
It was also observed that staff on duty was most of time idle or doing some personal work without any additional responsibility assigned to them. Therefore, information and service desk should also maintain information of doctors availability, route map of the hospital and aid the general public in providing basic information about the hospital facilities. Further, the JDWNRH should formulate ToR for information and service desk for its effective functioning.