Hospitals -- the place where most people do not like to visit - or wish they don't have to visit - until it is absolutely necessary, that is. And hospitals are absolutely necessary institutions in a civilized society. Within each hospital, health professionals including specialists, experts, consultants, medical officers, medical interns, technicians, pharmacist, pathologists, therapists, nurses, para-medics, admin staff, housekeeping are all working around the clock, with a well-defined operating guidelines and procedures. Different experts from their Departments and Units work in precise manner, shifts and schedules, so that all-round service is delivered to patients - with an objective of delivering health services for a better, healthy prolonged life. The activities inside a hospital function like a clock-work, so that it can give the desired services, without causing undue inconveniences to the patient and patient party. One small glitch in this clock-work, results in amble inconvenience, resulting in having to "wait in long ques" to - as grave as - loss of life. So no small error is small enough, or insignificant, in a hospital setting. The importance of management of hospital functioning, thus need not be over emphasized and Hospital Management degree is also conducted and is popular in colleges.
A visitor who either as a patient or a patient party can instantly experience and observe how well the hospital management is functioning, as soon as they start to receive their intended services. The hospital's Emergency Department, is a mirror that reflects how well the hospital is managed. ERs are led by MDGPs doctors and are equipped with life saving medicines, equipment, technicians, interns, medical officers and nurses, with pathological labs. The ER's doctors seek specialized consultation from area specialists within the hospital, as and when required. The patient party generally will not know how the line of treatment is decided upon them. The entire ER Team and the hospital's physician's team's consolidated effort and swift action not only plays vital role during life and death situation, but also paints an ever lasting positive (or not too positive) image of the hospital's services onto a person who had undergone this situation. Every hospital has a fixed number of patient beds that can be served at a time. All equipment and personnel are arranged to cater an average expected flow of patients. However, there will be times when a sudden and instantaneous increase in patients will occur and managing such times require special skills and backup arrangements.
The in-patients that are required to be admitted to hospitals for further treatment are admitted in several departments within the hospital - where the department's doctors, when required, conduct consultations within doctors outside their departments to narrow down the diagnosis and provide suitable treatment. Within the hospital departments, the treating doctors hold a weekly "grand-rounds" where they discuss and present typical cases. The doctors treating in-patients require support from pathology, radiology, pharmacy and a constant team of nurses to treat and make patient's stay in hospital as short as possible.
The patients visiting the Out-Patient Department, take consultations with doctors in different departments. Generally in a hospital, there are no limitations to the numbers of patients to be seen by the treating doctor, if the patients get their registration ticket taken, within a certain time. Patients may require to wait considerably to see a doctor and the doctor needs to spend their major portion of their time with the OPD patients, limiting their time for seeing the in-patients. The hospital management thus is required to come up with arrangements for the convenience to patients as well as not to overburden the treating doctor.
Recently the author was admitted to an Intensive Care Unit, as advised by the ER doctor, to monitor my cardiac activity. The ER doctor had consulted the Cardiologist who ordered the resident doctor for my admission to the ICU, after immediately required drugs were administered in the ER. The resident doctor, who is in their training phase for their MD, took care of requesting for an ICU bed, and getting consent from the Medicine Department's Consultant doctor. The ICU's Consultant doctor decides which patients are to remain in the ICU, and who can be transferred to Wards, or discharged, according to the patient's conditions. While awaiting for the ICU bed to be ready, the resident doctor arranges to send all the lab investigations, radiography etc. ordered by senior doctors. The resident doctor push-wheel, and carry the drug-infusion pump set, along with the patients, if there helpers are not available - which is also very common sight in hospitals.
My admission to the ICU bed was not for the first time and I knew what was to expect therein. The ICU I was admitted to had 7 beds, and each bed was preoccupied prior to my admitting - probably for a few days. Two of the patients were in motionless conditions with a life-supporting ventilator equipment with many hoses, wire and pipes attached to them. All the patients were attached to the cardiac function monitors with its lead wires attached to the patient's chest, a blood-pressure monitoring arm cuff, and oxygen level monitoring finger clamp devices. The intermittent beeping sound from all the seven cardiac monitors filled the ICU room, and nurses were quickly attending to the patients. All together there were six nurses, and had day shifts or night shifts. The treating consultant doctor is accompanied by resident doctors, house officers, interns and nurses and make medical rounds twice daily, or upon need, and get update on the patient's progress and future line of treatment. The resident doctor fills in the cardex with the medicines ordered by the consultant, and any other significant issues. Unlike in foreign hospitals, where the medical records are filled electronically, the doctors here do all work by manually writing it down. The medicines dose, inter-reactions with other drugs etc. are frequently checked by doctors in their handheld electronic devices in standard drug formulatory manuals. The nurses frequently communicate with doctors to verify what is ordered in the cardex.
The nurses have the responsibility that right amounts of drugs are administered exactly as ordered by the doctor; send lab investigation; request USG, ECG, X-rays to be do at bed site; clean patients; measure urine outputs; take measurements of temperature, BP, heart rate, oxygen level, fluid intake and release, and food taken. The nurses also need to take care of individual needs. While I was in the ICU, I witnessed patients who were asking for water - but the nurses had to restrict fluid intake due to her body asites. The doctors round takes place after
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