Literature study

on
Out Patience
Department
(OPD)
 01

Introduction
 What is OPD
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.
 01

Roles and functions of OPD

Outpatient Department
The facility shall be planned keeping in mind the maximum peak hour load and shall have scope for future expansion.
Name of Department and doctor, timings and user fees/ charges shall be displayed. Layout of the Out Patient Department
shall follow the functional flow of the patients:

e.g. Enquiry→ Registration→ Waiting→ Sub-Wafting→ Clinic→ Dressing room/Injection Room→ Billing→
Diagnostics (lab/X-ray) → Pharmacy→ Exit

●
● Clinics for Various Medical Disciplines These clinics include general medicine, general surgery, dental,
obstetrics and gynaecology, paediatrics and family welfare.
● Separate cubicles for general medicine and surgery with separate area for internal examination
(privacy) can be provided if there are no separate rooms for each.
● The cubicles for consultation and examination in all clinics should provide for doctor’s table, chair, and
patient’s stool, and follower’s seat, wash basin with hand washing facilities, examination couch and
equipment for examination.
● •Room shall have, for the admission of light and air, one or more apertures, such as windows and fan
lights, opening directly to the external air or into an open verandah.
● •The windows should be in two opposite walls.
Family Welfare Clinic
•The clinic should provide educative, preventive, diagnostic and curative facilities for maternal,
child health, school health and health education.
• Importance of health education is being increasingly recognized as an effective tool of preventive
treatment.
People visiting hospital should be informed of personal and environmental hygiene, clean habits,
need for taking preventive measures against epidemics, family planning, non-communicable
diseases etc. Treatment room in this clinic should act as operating room for IUCD insertion and
investigation, etc. It should be in close proximity to Obstetrics & Gynaecology. Family Welfare
counselling room should be provided
. •Waiting room for patients. •
The Pharmacy should be located in an area conveniently accessible from all clinics.
• The dispensary and compounding room should have two dispensing windows, compounding counters
and shelves.
The pattern of arranging the counters and shelves shall depend on the size of the room. The medicines which
require cold storage and blood required for operations and emergencies may be kept in refrigerators.

Emergency Room/Casualty
• At the moment, the emergency cases are being attended in OPD during OPD hours and in inpatient units
afterwards. It is recommended to have a separate earmarked emergency area to be located near the entrance of
hospital preferably having 4 rooms (one for doctor, one for minor OT, one for plaster/dressing) and one for
patient observation (At least 4 beds).
 USER FLOW

● From such a concept, patient flow in outpatient

departments (OPDs) is developed in this study as an
outpatient flow value chain by classifying the OPD
facilities into two types: primary and support
facilities. how OPD facilities can be allocated based
on the value chain concept.

● separating the primary and support facilities can

reduce congestion in the floor area of the OPD’s
clinics. More importantly, the results also claim that
at the new building, the only processes which
happen after clinical processes are worth for the
capacity optimization.
 03

SERVICES PROVIDED BY OPD

 Services Provided by the OPD
OPDs provide all general services and
facilities which are necessary for any
hospital. OPDs act as the first step for
consulting the doctor and getting the tests
done to proceed with treatment. Through the
services provided in OPD, the hospital
works for the smooth functioning of the
healthcare system. These services are
classified as -
•Prevention and wellness
OPDs provide guidance to the patients for
overall wellness and prevention of health
issues. Doctors guide patients to maintain a
healthy weight, improve sleep, balance sugar
levels, etc.
•Diagnosis
OPD is the first place where the patient and doctor meet and discuss the
•patient's health condition. After discussing the issue, the doctor suggests
the necessary tests for the patient. The lab tests and MRI scans are
conducted in the OPD.

•Treatment
Treatment and minor surgeries can be done in the outpatient department.
Modern OPD has all the necessary equipment to treat a patient. Surgeries
such as cuts, wounds, etc., can be easily handled in the modern OPD.
 04

TYPES OF OPD
Types of Outpatient Department
There are different types of OPD like ENT (ear, nose, and throat), paediatric,
skin, and eyes. These types are based on the function and facility they offer.
Several other OPDs are also there, which contribute to the easy working of
the healthcare system. Such types are OPDs are -

1. Primary Care Clinic -

Primary care clinics are facilities where patients consult the
physicians. These physicians conduct tests and direct the patient to
specialists when the need arises. Examples of primary care
physicians include nutritionists, family doctors, gynaecologists, etc.
These are regular doctors that conduct the check-up.
1. Community Clinic
The community health clinic is for the people who cannot access healthcare.
These allow people with low incomes, no health insurance, workers, or migrants.
2. Urgent Care Centre
The urgent care centre is a clinic that serves the purpose of an emergency ward. It
is for those treatments which require urgent attention but are not life-threatening.
The patients are treated for illness and injuries without the emergency rooms.
Hence the urgent care centre reduces the workload of the emergency rooms by
providing timely and convenient treatment to the patients
1. Specialized Outpatient Clinic
Specialized Outpatient Clinic is for the patients suffering from a specific illness under
the specialization like cardiology, nephrology, wound care, pain management,
chemotherapy treatment, and radiation treatment at specific centres.
2. Pharmacy
Nowadays, a pharmacy functions much beyond what it used to do years ago. Today,
the pharmacy provides preventive measures for health conditions, possible side effects
and other information associated with the drug, and the readings such as heart rate and
blood pressure. These facilities are provided rather than simply providing medicines to
the patients.
1. Emergency Department
The emergency department is popularly known as emergency rooms,
abbreviated as ER. The emergency department is in every hospital and
provides service to the patients who require immediate treatment and
attention. The staff of the ER department is highlyskilled and includes
doctors, nurses, and radiologists who treat emergency illnesses or
injuries. All these professionals identify the problem and immediately
work on recovering the patient.
 05

IMPORTANCE OF OPD
 Importance of OPD in Healthcare Systems
•An Outpatient Department is at the entrance of any hospital. It acts as the first place where the patients
and doctors communicate.
•It is a crucial link between the patients and the healthcare system and is hence inseparable.
•It is vital in preventing diseases and ensures fast recovery of the patient.
It controls the number of patients in the inpatient ward by providing small surgeries and treatments.
It evaluates the patients, and only those who require a bed or special care are shifted to the inpatient
ward. Thus, saving the number of occupied beds.
Generally, people that visit for the first time and have minor health are treated in OPD. Doctors conduct
tests, provide consultancy, and give prescriptions to the patient in the OPD.
OUTPATIENT ACTIVITY
● Because physical medicine in the Outpatient Activity is used by both inpatients and
outpatients, it is situated for the convenience and accessibility of both types of patients.
Patients arriving at the Emergency Activity are evaluated (triage), and appropriate disposition
is made of each case .
● The surgical suite is located close to the Emergency Activity to ensure the most rapid
conveyance of a patient in a life-threatening situation .
● Cardiac arrest patients will receive immediate treatment by the code blue alert team within the
Emergency Activity, After the crisis, the patient will be transferred to an adjoining intensive
coronary care unit .
● Since patients entering the Emergency Activity are frequently assigned elsewhere, close
working relationships should exist with other areas of the hospital such as the surgical suite,
intensive care units, and the main X-ray department .
 Intradepartmental Relationships

● elements of the Outpatient Activity are arranged along the main circulation route .
● Since considerable traffic is expected, this corridor is 10 ft wide and forms the spine of the scheme
● . Branch corridors, each 8 ft wide, which separate other elements from each other, originate from the spine
and provide access for people and goods to respective elements .
● Since new patients do not know locations of the various clinics, some method must be devised to assist them
. The architect can help by incorporating into the physical design a simple, easily understood system of
signs . They might be either wall-mounted or incorporated into the floor surface, adding what can be an
exciting physical design element to relieve the monotony of a long hospital corridor .
 06

FEATURES OF OPD
 Features of OPD
The main features of OPD which significantly contribute to the healthcare system operation are listed below:
•It acts as the first point where the patient and the healthcare system interact with each other.
•It is the most important step in health promotion and vital in the prevention of diseases.
•The screening is done to find the illness and see whether the patient needs admission to the hospital.
•All patients can easily access the medical practitioners and get the treatment done.
•It facilitates vaccination, common illness, or minor surgeries.
TYPES OF OPD Basically can be classified in
two types;

● Centralized: In centralized type of system all

the OPDs of clinical departments of the hospital
are grouped together in the form of OPD
Complex.
● It will include all the diagnostic, therapeutic
and utility areas concerning OPD.
● The consultants from different departments
come to this area for OPD work. In some
hospitals, there is organizational structure of the
OPD.
In decentralized system the outpatient care is provided in respective departments of the hospital. Similarly the diagnostic
and therapeutic services are also provided department wise. The specialty Clinics are more suitable for this type of OPD
like department of Opthalmology, ENT, etc.
 06

PLANNING CONSIDERATION
 PLANNING CONSIDERATIONS

● After the expected demand has been determined, the following considerations should be taken into account. Range of
outpatient services to be provided and defining the functions of the outpatient department.
● Daily and hourly capacity required. Number of the staff required by category and the tasks required of staff.
● Possible service time per patient, both average and its distribution over various aspects of outpatient care.
● Flow of patients and work Requirement of furniture and equipment Layout of the department considering all the above.
● To make it convenient for patients, the hospital staff and the community, an OPD should be a separate complex within a
hospital.
● he location should be such that an OPD shares diagnostic services, such as medical imaging, laboratory, pharmacy, blood
bank with other departments of a hospital.
 KEY PARAMETERS AND DESIGN CONSIDERATION

● To make it convenient for patients, the hospital staff and the community, an OPD should be a separate complex within a
hospital.
● The location should be such that an OPD shares diagnostic services, such as medical imaging, laboratory, pharmacy,
blood bank with other departments of a hospital.
● An OPD should be readily accessible from the hospital’s main entrance and people should not have to pass through the
wards.
● OPD should be designed either as a centralized polyclinic or decentralized specialty clinic. May be planned as general
OPD or specialty
Patients have different degrees of physical and mental abilities. Patient accessibility should accordingly be designed.
● Effective, comprehensible, and standard signage should be planned. Peak hours should be estimated to cater effectively
to peak load.
 KEY PARAMETERS AND DESIGN CONSIDERATION

● Entrance should be near the reception to efficiently answer patient queries. Dignity and privacy of patients must be
maintained. Design should cater for future expansion.
● Educational resource areas for patients education should be integrated in the lobby and waiting areas.
● Design of individual functional areas should not allow extraneous traffic to penetrate any work area. Preferably, design
should be such that the flow of patients and visitors is unilateral.
● Waiting areas and public spaces should be large enough to accommodate patients and accompanying friends and family
without causing congestion.
● Sub-waiting areas should be provided adjacent to various clinics. Space recommended is 0. 8 msq per patient for one
third of the average daily number of the patients attending OPD in one session.
● Day care facilities may be planned as support services. Design should allow natural light and good ventilation. It is
desirable to provide a good view of the outside.
 PHYSICAL FACILITIES

The main physical facilities to be planned are the following:

● Public Areas
● Clinical Areas
● Consultation Rooms
● Special Examination Rooms
● Administrative Areas
● Circulation Areas
● Ancillary and Auxiliary Facilities
● the subsidiary/ ancillary facilities include: Injection Rooms Treatment and Dressing
Rooms
● Pharmacy Medical Records Room, exclusive for OPD or combined with the IPD records
section
ADMINISTRATIVE AREAS
The administrative area should include offices and counters for the hospital
administrator, nursing superintendent and medico-social workers. This area may also
include storage facilities.

FUNCTIONAL ZONES These include public zones, joint use zones and staff zones.
Public Zone: This includes: Main Entrance Foyer, which further includes: Reception
Sign Boards Layout Plans and

Some Recommendations A/c to BIS(Bureau of Indian Standards):

For Entrance Zone - 2 sq. meter/bed.
Ambulatory Zone – 10 sq. meter/bed.
Diagnostic Zone – 6 sq. meter/bed.
Total hospital area – 60 sq. meter/bed.
FUNCTIONAL ZONES

● Bays for trolleys and wheelchairs

● Public telephone booths Public conveniences Value added services
such as vending machines for snacks and beverages and book store
● Registration Area which includes: Centralized counter for new,
repeat patients Control desk for monitoring sub-registration at the
respective service areas.
● Cash counter
● Health Education Facilities that include: Posters Pamphlets
Audio-Visuals Aids Waiting areas in the foyer as well as each tier of
consultation and treatment rooms.
FUNCTIONAL ZONES.
● Joint Use Zone: These include areas jointly utilized by staff and the patients
such as the consultation and examination rooms.
● It can be made as; Two consultation rooms with one examination cubicle.
● Combined consultation, examination cubicle. Rooms should be designed to
accommodate multiple medical specialties.
● A room of about 12. 5 msq is adequate for a consultation as well as examination.
● This also includes the space for examination tables, a washbasin, instrument
trolley, an X-ray viewing screen, desk and chair for consultant/ doctor as well as
two chairs for patients/ visitors.
● If examination room is catered for separately, a space of 8 m sq is sufficient.
● Specialized examination rooms may be planned depending on facilities
provided, such as: Refraction, perimetry, tonography and slit lamp. Audiometry
CLINICAL LABORATORY
● This should include a centralized sample collection area for urine, stool
and blood.
● A washroom and toilets (separately for male and female) and a blood
collection room should also be provided. In a large OPD, it would be
advantageous to have a side room adjacent to the collection station for
routine examination of blood, stool and urine.

PHARMACY
● It should be so located so as to serve both inpatients and OPD patients.
● They should have multiple dispensing windows, drug storage cabinets and
shelves.
Ancillary facilities
Injection room : It should be with waiting area for 10 -20 patients with 0. 6 -0. 8
sq. meter/patient.
Area may vary from 12 to 40 sq. meter depend on work load.
Treatment & dressing room: About 12 -16 sq. meter.
Pharmacy : It should accommodate 5% of total clinical visits to OPD in one
session
Health Education Facilities –
Min. area required is 15 sq. meter. Medical Social Service Facilities
should be located in.
OPD with suitable cubicle for each social worker/Counselor.

Screening Clinic required in teaching or tertiary hospital & should

be located near reception area having one or more cubicle with 12
sq. meter area for each cubicle
SPECIALIZED OPD
Specialized OPD services may include the following;
Gastrointestinal endoscopy lab,
sigmoidoscopy and colonoscopy
Pulmonary Function Lab including spirometery Cardiac OPD with ECG,
Echocardiography, TMT and Holter Monitoring Lab.
PARKING AND ENTRANCE
The following are recommended for the entrance and parking areas of an OPD:
● Main entrance to the OPD should have gentle sloping ramps to facilitate
movement of patients on wheelchairs and those carried on stretchers. The
surface should be slip/skid free.
● Entrance should have a double door with a width of 1500 mm to facilitate
passage of stretchers and wheelchairs. Wheelchairs should be readily available
at the entrance.
● Storage area for wheelchairs and stretchers should be allocated, conveniently
located and not obstruct the flow of traffic.
● Staff and patient entrance should be separate, with each entrance providing
access to the respective zone.
● For convenience of patients especially those with disabilities parking should
be as close to the entrance as possible.
● Barrier free movement for the disabled should be provided.
ENQUIRY DESK, RECEPTION STATION
● The following are recommended:
● The height of the counter should be adapted to the needs of wheelchair
patients.
● To ensure privacy of discussion between and reception staff, the
reception should have counters.
● Sufficient numbers of drawers and shelving space should also be
provided.
WAITING AREA
● The following parameters should be considered; Waiting Area should be planned
to accommodate more than the number of people expected during peak hours.
● Sub waiting area may be shared between the various consultation rooms.
● To facilitate movement of patients, a call system should be provided, which
directs the patient to the appropriate consultation room.
● The distance from the waiting area to the consultation room should be short and
clearly marked.
● Patients on wheelchairs require extra space for movement.
TOILETS

Toilets should be close to the waiting area. Male and female toilets should
be separate.
A scale of 1 -2 WCs for every 100 patients attending OPD and at least one
urinal for every 50 patients are recommended.
Toilets for the staff should also be separate from those for the patients.
Circulation Area should be no less than 30%.
COMMON PROBLEMS IN OUTPATIENT SERVICES Operations
–
● Long Queues,
● Queue jumping,
● inadequate service time,
● patients queries not answered by medical staff, punctuality.
● Resources – Adequacy and competence of medical and other staff,
● availability of drugs and supplies. Efficiency Physical Facilities and layout Quality
of Care Patient and Staff Satisfaction
 07

MATERIALS USED IN OPD

● Effective flooring materials
● The perfect flooring would have these characteristics:
● Pleasing visual impact.
● Durable.
● Easily cleaned.
● Resilient.
● Slip-resistant.
● Nonabsorbant to liquids and odors.
● Resistant to microbial growth.
● No single flooring material is appropriate for use in all areas of an animal hospital, and no flooring material is a top
performer in all of these categories, so choosing the "best" floor is a matter of balancing the requirements of specific areas
with the cost and performance of available flooring materials
● 1. Floor tile
● Good material for front of clinic.
● Durable and "dressy."
● Can also be used in working portions of clinic, but is tiring to stand on all day.
● Preferred floor material because it requires minimum upkeep, such as damp mopping.
● 4'' x 8'', 8'' x 8'', and 12'' x 12''. Glazed and unglazed tile, brick plate, and paver tile
● Vinyl composition tile
● Good all-around, inexpensive material for the front and working portions of clinic.
● Frequently used in human health care facilities.
● 9'' x 9'' and 12'' x 12''. Probably the most inexpensive and durable flooring material. Can be prone to breakage and curling at edges of tile, but can be
replaced easily. Cannot flash cove base. Joints are not chemically bonded or heat welded. Frequent waxing is required to keep the joints sealed.
● Liquid applied epoxy
● Can be used in procedure and run areas.
● Easily cleaned; no sealers or wax needed.
● Two- or three-step trowel-applied epoxy resin flooring is seamless and can be formed up the wall as a base or
wainscot. Obtaining an even slip-resistant finish that is easy to keep clean can be difficult. It is worth noting
that the off gassing of the epoxy during the curing/drying process can be potentially dangerous if you or your
patients are exposed to it for any length of time.
● MMA flooring (liquid applied acrylic resin flooring)
● Can be used in procedure and run areas.
● Easily cleaned; no sealers or wax needed.
● Cures quickly; solvent free.
● Chemically bonds to concrete. More expensive than liquid applied epoxy flooring, but because it is acrylic based, it has no noxious off
gassing problems. Also, unlike the epoxy flooring, the acrylic forms a monolythic, chemical bond between layers. Fresh resin dissolves
the surface of the cured material and cures with the fresh material. Even after years, new or additional coatings can be installed, with
integrated surfaces added in the future. The grit or slip resistance is obtained through the use of acrylic color chips versus the sand that is
used in the epoxy flooring.
● Stained and sealed concrete
● Can be used in the waiting area and throughout the facility.
● Can be a relatively low-cost alternative to a tiled floor.
● Can create an "antica roma" type of mottled or aged-looking floor often seen in commercial and retail establishments.
● Requires resealing every few years, depending on traffic.
● In this process, once the concrete has set, it is stained with a penetrating chemical stain. It is then sealed with a glossy
sealer that is compatible with the stain. This glossy sealer is the wear layer and needs to be reapplied periodically.
CONCLUSION
The outpatient department has functional and administrative links with the hospital of which it is a part. During planning a
measure of adaptability has to be incorporated in the internal arrangements and a substantial capacity for expansion must
be considered. It is the first point of contact between the hospital and the community hence, substantial deliberation for the
planning and designing of an OPD is a must.
THANK YOU

PRESENTATION BY-
NEHA LACHHWANI
KIRTI KHERA
ADITI SHARMA
NIDHI DAUD