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Report By: Praveena Department:

University: Andhra University College:

2 Duration of Internship: Course: MBA

I owe a great many thanks to a great many people who helped and supported me during the internship session. I extend my deepest thanks to the project coordinator at the hospital, Mr T. Balaji Manager-HR, for guiding me throughout the program. I express my gratitude to the Hospital Administrator Mrs. Madhavi Datla for extending her support and giving me an opportunity to learn how the hospital works through the eyes of management. I share my happiness as I have been given a chance to work for this renowned hospital during its strive for accreditation from NABH. Thanks and appreciation to the helpful people at CARE HOSPITAL, Vizag for their support. I would also thank my Institution and my faculty members without whom this project would have been a distant reality.


2.1 Project Topic 2.2 Scope of Project 2.3 Purpose of Report 2.4 Data Collection Procedure

4) CONCLUSION....Pg. 7


5.1 Discharge Process 5.2 Hospital in General

As the hospital is known for its quality in care and compassion the services it provides must be of great efficiency and should be performed effectively for better results and satisfaction of the patient. Under the quality division, discharge procedure was the most critical juncture in the in-patient management process which had some bottlenecks in its flow.

2.1 Project Topic: Improvising the Discharge Process in Care Hospital, Vizag 2.2 Scope of Project: To study the discharge procedure in the In-patient Management processes. 2.3 Purpose of Report: - To improve the discharge process for attaining higher patient satisfaction - To increase the quality aspect of the In-Patient Management process. - To increase the bed availability. - To ensure the high standards of Care Hospitals MISSION and VISION 2.4 Data Collection Procedure: 1) 20 days of observation 2) Data gathered from the three floors of In-Patient Admission from April 19th to May 9th. 3) Size of Sample being taken is 50


- The Discharge process mainly involves three factors namely, 1) Doctors Summary 2) Pharmacy Clearance 3) Billing Clearance Any delay in any one or more of the above sub processes cascades and results in delay of the discharge process. - Upon observations, it was found out that the doctors summary is the main reason for the delay in the discharge process. - The average discharge time has increased to 5-6 hrs from 4-5 hrs since the previous three months. - If there is any pharmacy clearance delay it is due to GOODS RECEIPT NOTE factor. - Billing delay, if any, is generally due to the delay by the patient in matters of payment. - Night Billing is effectively done which helps reduce the discharge time. - There are three types of patients depending upon the payment: 1) Cash 2) Credit 3) Insurance - Majority of the patients pay by cash. - Average number of discharges is 20 per day. - There are no delays reported from the laboratory clearance which shows the accuracy and efficiency of the lab technicians.

Present flow of the discharge process:

A5 Procedure for Discharge Making final entries by Nurse verification of details by Billing Executive & Pharmacy Returns Intimation of Patient Discharge by doctor to Resident before 24 hrs of Discharge

Preparation of draft Discharge summary by Resident

Pharmacy Clearance slip

Verification & approval of Discharge summary

Shall recommend for necessary changes


Yes / No

Yes Billing

Keying into the system according to the tariff structure Preparation of Bill

Verification of Bill by another billing Executive

Corporate Billing Dept


Corporate / Insurance / Direct Patient Direct Patient

Insurance Patient

Insurance Billing Dept

Conversion into Corporate tariff


Conversion into TPA tariff

Pre Authorization of Bill with Discharge Summary

Yes / No

Pre Authorization of Bill with Discharge Summary

Corporate acknowledgement

Credit / Cash / Cheque

Credit / Cheque

HA / MD/ Concerned Doctor

TPA acknowledgement

Complete Authorisation


Unauthorized Bills

Payment at Cash Counter

Unauthorized Bills


Complete Authorisation Yes


G eneration of Checkout slip

Inpatient W ard

Patient Discharge


According to the data gathered from the three floors, it was observed that Doctors Summary was the main reason for the delay in discharge. That indicates that the bottleneck was found out at the initial stage of the flow itself. A new flow of process has to be introduced at the initial stages to address the above issue as Doctors summary takes almost 2-2.5 hrs of time on average.

5.1 DISCHARGE PROCESS: - The doctors summary can be signed by the duty or junior doctors working under the consultants. They can be assigned the work for discharge summary which reduces the discharge delay time. - Junior doctors or doctors doing their HOUSE SURGEON can be reliable for this task. - Additional PREs each for floor would increase the patient satisfaction and would decrease the burden over the nurses. - Introduction of electronic discharge summaries. As according to a study:
A system of electronic discharge summaries was developed. It replaced conventional discharge prescriptions and dictated discharge summaries. We conducted a prospective case-control study of 102 consecutive patients admitted to our hospital under the care of one consultant physician. Patients discharged after 1 December 2004 were discharged using the new computerized system (50 patients) while patients admitted under the same medical team, but to another ward were discharged using the conventional paper discharge system (52 patients). Patients in the electronic group and the conventional group were similar in age (mean 67 years versus 58 years, P>0.05) and duration of hospital stay (6 days versus 1 day, P>0.05). The mean time taken to produce an electronic discharge summary was immediate (0 days) which was significantly (P<0.0001) less than the mean time taken to produce a conventional discharge summary (80 days). Combining electronic discharge prescriptions with electronic summaries appears promising and merits further study.

5.2 HOSPITAL IN GENERAL: - The hospital can go for the certification of GREEN-HOSPITAL as per Go Green concept as many people are growing concerned for green hospitals. This can be brought from Indian Green Building Council. - More work-force can be included in the HR department as it seems bit weak for complying with the whole employee details. Greater the HR greater would be the concern for all the employees which would increase the Employee Satisfaction Rate and decrease the attrition rate. - Training for nurses not only on clinical standards but also in usage of computers that will enhance the quality and efficiency of work. Introduction of computers and user training may be one time cost intensive but will prove to be cost effective for the company which gives long-term results.