Department: Col Zulfiquer Ahmed Amin Armed Forces Medical Institute (AFMI)

DEPARTMENT
Col Zulfiquer Ahmed Amin

M Phil, MPH, PGD (Health Economics), MBBS
Armed Forces Medical Institute (AFMI)
Definition
OPD is defined as a part of the hospital with
allotted physical facilities and medical and other
staffs, with regularly scheduled hours, to provide
care for patients who are not registered as
inpatients.
A hospital department where patients receive
diagnosis and/ or treatment but do not stay
overnight.
Objective of OPD
History of OPD
Types of OPD
Ambulatory care is medical care provided on an outpatient basis,
including diagnosis, observation, consultation, treatment, intervention,
and rehabilitation services. This care can include advanced medical
technology and procedures.
A polyclinic is a clinic that provides both general and specialist
examinations and treatments to outpatients and is usually independent
of a hospital.
A health center is one of a clinics staffed by a group of general
practitioners and nurses providing healthcare services to people in a
certain area. Typical services covered are family practice and dental care.
A walk-in clinic accept patients on a walk-in basis and with no
appointment required.
A day hospital is an outpatient hospital facility where patients attend for
assessment, treatment or rehabilitation during the day and then return
home or spend the night at a different facility.
A dispensary is an office in a school, hospital, industrial plant, or other
organization that dispenses medications, medical supplies, and in some
cases even medical and dental treatment. In a traditional dispensary set-
up, a pharmacist dispenses medication as per prescription or order form.
Facilities of OPD
OPD Process Arrival at OPD
Reception
Registration
Issue of Token Number
Waiting Room
Investigations Consultation with Doctor
Issuance of med Chit

Referral to Spl
Arrival at Pharmacy
Token Number
Waiting
Collection of Med
Departure
OPD Planning
• OPD has functional and administrative links with

the hospital of which it is a part.
• It may also be linked with Health Centers,
Satellite Clinics and Dispensaries dependent on it.
• Expected demand should be determined basing
on catchment area and population to be served.
• Should include curative, preventive and
promotive health services
Design Consideration
Requirements for OPD
• 60% of area should be for waiting and corridors.
• Seats for 1/3 of daily attendance @ 8 sq ft/pt.
• Consultation room – 150 sq ft
• Attached examination room – 80 sq ft
Projection of Out-Patient Load
• For every hospital bed, 1.5 to 3 patients attend OPD
• 1-10 visits per capita per year of the dependent population
basis
Organogram of OPD
/CO
Organizational Components of OPD
Physical Facilities
Administrative Areas: Circulation Areas (30% of all
Admin Office area):
Business Office Corridors, Stairs, Lifts
House Keeping Easy Accessibility of elevator
Storage Facility Corridor- 1.8 m wide
Security Point
ATM Card Booth
(Post Acute Care)
Functional Zones
(Treadmill Test)
Problems at OPD
General Problems:
1. Insufficient number of doctors: It is found that there are a
significant large number of patients wait in front of the doctor
rooms. I it can be concluded that this is the bottleneck of the
process. This is mainly due to insufficient number of doctors to
serve as compared to the number of patients arrive the clinic.
2. Inappropriate appointment system: Appointment-patient has

no priority over non-appointment patient. Two types of patients
follow the same process. Therefore, appointment-patients are
likely to ignore their appointment time and tend to arrive the
clinic very early. This causes congestion in the clinic during the
beginning of the day. Moreover, there is no formal appointment
system in place. There is no time slot information to guarantee
the availability of doctors on the appointment day.
3. Long waiting time at Medicine room: After patients receive the
prescription from the clinic counter, patients are directed to
medicine room to pay for the fee and receive the medicines.
According to our observation, patients currently spend significant
amount of time at the medicine room counter. Most of which is
waiting for medicine.
4. Shortage of facilities.
5. Insufficient training of medical personnel concerning
ambulatory care.
6. Fragmentation of care, poor communication and inadequate
understanding of their demands.
7. An organizational structure geared to traditional preferences
and needs of the providers.
8. Resistance to change.
Specific Problems:
9. Duties undertaken by the auxiliaries are carried out hurriedly in
order to keep pace with consultation of doctors. This creates
inappropriate documentation.
10. Auxiliary staffs sometimes misbehave with the patients.
11. In absence of appointment system, patients start accumulating
even before office time starts; creating a long queue of patients
even before arrival of doctors.
12. Absence of visible serial number of appointment.
13. Interruption of consultation or investigation.
14. Lack of privacy.
15. Advices are not clearly spelled out.
16. Illegible hand-writing of the doctors.
17. Poly-pharmacy.
18. Prescription of too much antibiotics.
19. Queues are not properly maintained.
20. Prescribed medicines are not always available at pharmacy.
21. Use of trade-name of medicines by the doctors, create
confusion to patients, when different-named medicines of same
genera is supplied to the patients.
22. No clear advice about when, how and how long to take the
medicines.
23. Sometimes, wrong medicines are given by the pharmacists.
24. Insufficient and un-cleaned toilets.
25. Undue influence of local political leaders.
HOW TO DEAL WITH LONG WAITING TIME
Normal Queue System
• Make queue attractive.

• Make waiting-lines bent, so that they don’t see a
long line of queue always ahead of them. Give
them hope.
• Keep provision of visible token-number; so that
one can predict his turn of appointment.
• People always remember the last part of service.
So provide a satisfying consultation.
Single queue, and multiple servers model
Multiple queues, and multiple servers model

Suggestions for managing queues
• Determine an acceptable waiting time for customer.

• Try divert customer’s attention when waiting.
• Inform customers of what to expect.
• Keep employees not serving the customers out-of-sight.
• Train servers to be friendly.
• Encourage customers to come during slack period.
• Identify the bottle-neck in the service delivery and take
remedial measures.
Records at OPD

Department: Col Zulfiquer Ahmed Amin Armed Forces Medical Institute (AFMI)

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Department: Col Zulfiquer Ahmed Amin Armed Forces Medical Institute (AFMI)

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DEPARTMENT

Col Zulfiquer Ahmed Amin

Issue of Token Number

Investigations Consultation with Doctor

Issuance of med Chit

• OPD has functional and administrative links with

2. Inappropriate appointment system: Appointment-patient has

• Make queue attractive.

Multiple queues, and multiple servers model

• Determine an acceptable waiting time for customer.

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