FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA

MINISTRY OF HEALTH 1
 Learning objectives
 Introduction
 Operational Standards
 Implementation Guidance
 Assessment checklist
 Indicators

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 At the end of this presentation the participant will able to
◦ Explain Concepts and principles of outpatient service
organization and management
◦ Describe resources and infrastructure needed for outpatient
service management
◦ Identify tools and methods used to measure outpatient service
◦ Explain the function of patient reception, central triage and
outpatient clinics

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 Outpatient services management refers to the processes and
procedures needed to ensure the efficient flow of patients
 Efficient flow of patients requires various inputs.
 Properly designed and implemented patient flow will reduce
patient waiting times, increase provider efficiency and
staff/client satisfaction

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 The Hospital has established management structures and job
descriptions that detail the roles and responsibilities of each
discipline within services/departments/units, including
reporting relationships.
 The hospital has well-equipped service specific OPD rooms
with necessary equipment and supplies as per hospital tier
level of care.

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 The hospital has established outpatient specific diagnostic
laboratory, radiology, and pharmacy service units.
 The hospital has an OPD staffed with adequate and
appropriately trained personnel and OPD service rooms are
managed by at least a GP and specialty clinics by a service
specific specialist/ sub- specialty clinic by sub specialist as per
hospital tier level of care.

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 Outpatient department (OPD) specific central triage procedure
is established to ensure efficient patient flow; and seek to
reduce patient crowding.
 The hospital has established OPD patient appointment and
queuing management systems.
 The hospital has an outpatient department waiting area with
adequate lightening, ventilation and multimedia facilities .

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 Outpatient service organizational structure
◦ The outpatient department will be led by full time outpatient
director / outpatient case team manager with nurse coordinator
and will be accountable to the hospital’s CCO/MD.

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 Outpatient Service Layout
◦ Outpatient services should be organized in a manner that
reduces the length of time that it might takes a patient to travel
from one service area to another.
◦ Each facility has a different layout and plan, clinical services
should be organized as close to one another as possible.

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 Outpatient services includes
◦ Central triage and patient waiting area
◦ Medical Record Room
◦ Examination room, sample collection and treatment rooms
◦ Pharmacy dispensing unit and cashier
◦ Laboratory team, with cashier
◦ imaging diagnostic team, with cashier

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 Central Triage Pathway
 The central triage is the first point of patient contact in outpatient
services.
 The central triage infrastructure should include a waiting area with
adequate seats, registration and clinical assessment areas.
 Patients will be directed to Central Triage from the reception
service or Emergency Department.
 All relevant administrative processes will be conducted

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 Central Triage Activity
◦ The central triage should be open one hour before regular working
hours.
◦ Triage officers should register and report patients not seen on the
same day regularly
◦ Taking V/S, directing patients to the specific case team/examination
room, sorting base on the triage guideline and Securing IV line for ER
patient
◦ All patients should undergo Central Triage using guideline except
selected patients

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 Central Triage Human Resource Requirements
◦ The Central Triage Case Team consists of both clinical and non-
clinical staff.
◦ Ideally, triage should be carried out by a General Practitioner.
However, depending on the availability of human resources, it can be
conducted by a Health Officer or BSc Nurse.
◦ Non-clinical members of the Central Triage case team include runners,
cashiers, registrars/ clerks and cleaners.
◦ The Central Triage Case Team should have ready access to the Liaison
and Referrals Service.

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 Central Triage Equipment and Supply Requirements
◦ The following is a list of the minimum items that should be available for
Central Triage:
◦ 2Examination bed, 2Thermometer, Adult stethoscope , Adult
sphygmomanometer (automatic or manual)
◦ Adult weight scale, Resuscitation tools, Electrocardiogram (ECG) (for
general and tertiary hospitals), Pulseoxymetry
◦ Wheelchair, Stretcher, Screens, partitions or separate rooms
◦ Gloves, face masks and other personal protective equipment, Wall clock(s)
and Microphone/PA system

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 Outpatient Clinics Activity
◦ The outpatient team will take a history, examine the patient and record
the findings if laboratory or imaging tests are needed, the patient has to
be sent to the respective departments guided by a runner.
◦ A note entered to the patient card should include at least pertinent
history, physical examination and laboratory/imaging findings
◦ If any procedures required it has to be performed within the outpatient
department.
◦ The results of any investigations and treatment options should be
explained and discussed with the patient.

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 Procedure room at outpatient clinic
◦ The outpatient clinic should encompass a procedure room where
diagnostic and therapeutic minor procedures and tests can be performed
and where simple bedside tests can be carried out.
◦ The procedure room should be staffed and equipped with: Physician,
nurse, cleaner, minor OR different procedure sets, hand washing
facilities, coach, IV stand, IPPS materials.
◦ The infrastructure at the outpatient clinic should facilitate easy access
way to treatment services for differentlyabled people and other people in

need of special help.

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 Waiting Area at outpatient clinic
◦ Waiting area of the hospitals should be located closest to the
reception and should incorporate the followings:
 Designated, spacious with washable sits and floor
 Natural or mechanical ventilator
 Natural or artificial light sources
 Usher/guide
 Audiovisual corner with TV for educating patients and their
families.

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 Outpatient Human resource and their role
◦ Outpatient Director / outpatient case team manager
 Organize and lead the outpatient service as per the national
standards and treatment guidelines
 Ensure the availability of adequate human power and
equipment’s for outpatient services.
 Plan, budget and report the outpatient activities

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 Outpatient Human resource and their role
◦ Nurse coordinator
 Coordinate the outpatient nursing service
 Plan the necessary supplies, drugs and equipment’s for patient
care
 Coordinate and monitor daily recording of all patient diagnosis in
to the HMIS register
 Monitor and evaluate the implementation of outpatient specific
nursing standards
 Assign nurses to each clinic
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 Outpatient Human resource and their role
◦ Specialists/general medical practitioner per discipline to run
the regular outpatient service for full working hour
 Examine and treat a patient
 Plan, document and report daily activities
 Actively participate on the implementation of the
transformation guideline

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 Outpatient Human resource and their role
◦ Laboratory professionals
 Collect samples and transport to outpatient laboratory
 Collect results and distribute to respective outpatient clinics
 Plan, document and report daily activities
 Actively participate on the implementation of the
transformation guideline

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 Outpatient Human resource and their role
◦ Pharmacy professionals
 Dispense drugs and supplies to outpatient clinics
 Provide information/ counseling service
 Plan, document and report daily activities
 Actively participate on the implementation of the
transformation guideline

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 Outpatient Human resource and their role
◦ Cashier, cleaners , runners and gourds
 Collect daily cash from outpatient service users
 Clean and protect the outpatient facilities as per standards
 Will safe guard the patients and staff and visitors
 Transport patients, patient cards, results and other from place
to place
 Plan, document and report daily activities

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 Equipment and Furniture Needed for Outpatient
Services
◦ Examination bed,
◦ Chairs and tables ,
◦ Stretcher, Wheel chair, Stethoscope, Sphygmomanometer (automated or
manual),
◦ Otoscope, Ophthalmoscope, Thermometer,
◦ Weight and height scale, Measuring tape, Screen for patient ,
◦ examination Steam sterilizer,
◦ Minor procedure kits,
◦ Computer and Communication materials (TV....)

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 Supply Needed for Outpatient Services
◦ Patient forms:
 History and examination sheets
 Consultation request form
 Referral form
 Laboratory, X ray request form
◦ Prescription pads
◦ Sample collection supplies
◦ Dressing supplies
◦ Personal protective equipment

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no Criteria Yes No
1 There is a central triage.

2 There are personnel trained in triage processes working in both the central
triage.
3 Central triage is equipped with necessary supplies and equipment.

4 Outpatient appointment system is in place.

5 Outpatient department is managed by at least a GP and specialty clinics by a

7 There is a written protocol for the referral of patients (receiving into the
hospital and referring outside of the hospital).
8 There is a referral directory listing which facilities that hospitals can receive
patients from or refer patients to.
9 An outpatient director with office, secretary, plan and report

10 Accesses to laboratory, pharmacy and radiology service

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no I ndicator Formula Frequency omments
C

1 OPD attendance

2 Outpatients not
seen on same day

3 Number of OPD
visits per
practitioner per
day

4 OP wait time to
triage

5 OP consultation
transit time

6 Outpatient
satisfaction score

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END

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