At the OPD records and registration, common problems are delay in locating and retrieval of records due to faulty filing, numbering and storage. Although at present many small hospitals do not have the services of medical record librarians, OPD records systems without medical records librarian are difficult to visualise.
At least one record librarian in even the smallest hospital should be a must, who can train the other paramedical staff in the OPD to maintain OPD records under his overall supervision.
Adequate space and filing racks for storage of records should be ensured, with identification numbers on each rack and shelf. Numbering of cards by a hand-operated machine should be introduced to obviate misinterpreting of numbers which is one of the most common causes of confusion in a busy OPD.
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Arrangement to position the records of patients by appointment on the desks of concerned doctors in advance must be organised. Use of cards of different colours could also be considered for different specialty clinics.
During busy hours at the enquiry and registration there may be a need to augment the services with additional staff. Some voluntary groups offer their services in large towns and cities.
Otherwise the hospital should have the services of at least one medical social worker in the OPD who can help in many ways such as help to arrange for indigent patients drugs not stocked by the hospital, arrange help for the physically handicapped and otherwise incapacitated patients in going about the OPD.
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The working of the OPD supportive services, central injection room, specimen collection centre, pharmacy and radio diagnosis also need to be continuously monitored. In the injection room, sufficient availability of syringes and needles should be ensured.
At the specimen collection centre, facilities and staff to draw blood samples and for collecting urine and stool samples should be adequate to the requirements. Laboratory investigation reports should be made promptly available with an in-built system of prompt distribution of reports to specialists.
Insufficient number of counters and short supply of drugs are the two chief problems in Pharmacy. Sufficient number of pharmacists should be available to man all counters during the busiest hours.
It is certainly in the interest of the hospital to develop a reasonable standard of efficiency in the utilisation of staff and facilities in the outpatient department.
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Laying down policies and procedures for various aspects of OPD operation should help in many cases where an atmosphere of laissez faire now exists.
The policies and procedures should be made known to staff, and those which pertain to patients should be made known to them in brief terms, by notices displayed at appropriate places. The policies should cover operational, administrative and technical aspects of OPD functioning.
In conclusions, it can be said that although many problems may be beyond solution by the OPD administrator and would require decision and support from the hospital’s governing body or other higher authority, there is always scope for improving OPD operations in most hospitals.
Efforts should be made to improve things by:
i. Simplification,
ii. Combination,
iii. Improved organisation,
iv. Delegation,
v. Task allocations and job descriptions,
vi. Communication,
vii. Improved motivation, and
viii. Discipline.
Due to an imbalance between demand and available resources, the long-term solution to the problems caused by sheer numbers can only be the provisioning of more OPD services.
But in the existing situation we should ask ourselves—can we do better with what we have? Can we make better use of available resources? Can we improve efficiency? Can we improve motivation and discipline? Even knowing that there is a limit to the possible increase in efficiency, the only short-term solution to the present situation is to strive for increased efficiency.
This in turn requires reconsideration of the established operational policies and administrative procedures. Nevertheless, consideration of the long-term solution must also be taken up simultaneously.