Project on “Admission and Discharge Process in IPD” at

NH MMI Narayana Superspeciality Hospital, Raipur

A Project Report (BBA(HM) 594 (A) Minor Project Submitted in Partial Fulfilment of
the Requirements for the Award of the Degree of

Bachelor of Business Administration in

Hospital Management
Submitted by
Ms. Neha Chakraborty
(Reg No: 22149030297)
(Roll No: 14903322097)

Under the Guidance of

Mr. Rahul Raj & Ayan Chakraborty
(Managers of IPD & Service Excellence)
And
Under the Guidance of
Prof. Prateek Singh
(Assistant Professor)

Submitted to :
Department of Hospital Management
NSHM Business School
NSHM Knowledge Campus Durgapur, West Bengal

Affiliated to
Maulana Abul Kalam Azad University of Technology, West Bengal
 September 2024

APPROVAL OF REPORT

The project report entitled “Admission and Discharge Process in IPD at NH MMI

Narayana Superspeciality Hospital, Raipur ” conducted from 3rd July 2024 to 5th

September 2024 by Neha Chakraborty, Reg. No 22149030297, Roll No 14903322097,

is approved for partial fulfilment of the degree of Bachelor of Business Administration in

Hospital Management

Examiners:

1. ___________________ ___________________

2. ___________________ ___________________

3. ___________________ ___________________

Supervisor:

___________________________

Director:
___________________ ___________________

Date:

Place: Durgapur, West Bengal

II
 DECLARATION

I’m Neha Chakraborty, hereby declare that the project report, entitled “Admission and
Discharge Process in IPD at NH MMI Narayana Superspeciality Hospital, Raipur”
is a record of original work undertaken by me for the award of the degree of Bachelor of
Business Administration in Hospital Management. I have completed this study under the
supervision of Prateek Singh(Assistant Professor ) during the period from 3rd July to 5th
September

I also declare that this project work has not been submitted for the award of any degree,
diploma, associateship, fellowship or other title. It has not been sent for any publication
or presentation purpose. I hereby confirm the originality of the work and that there is no
plagiarism in any part of the dissertation.

Place: Durgapur, West Bengal

Date: .................

Student Signature:
Student Name: Neha Chakraborty
Reg No.: 22149030297
Roll No.: 14903322097
Department of Hospital Management
NSHM Business School

III
 CERTIFICATE

This is to certify that the project report submitted by Neha Chakraborty, Reg. No
22149030297, Roll No 14903322097 entitled “Admission and Discharge Process in
IPD at NH MMI Narayana Superspeciality Hospital, Raipur” is a record of project
work done by him/her during the academic year 2022-2025 under our supervision in
partial fulfilment for the award of the degree of Bachelor of Business Administration in
Hospital Management. This project work has not been submitted for the award of any
degree, diploma, associateship, fellowship or any other title. It has not been sent for any
publication or presentation purpose. I hereby confirm the originality of the work and that
there is no plagiarism in any part of the dissertation

Place: Durgapur
Date: .................

Prof. Prateek Singh

Assistant Professor
Department of Hospital Management
NSHM Business School
NSHM Knowledge Campus, Durgapur

Prof. (Dr) Alok Satsangi

Director
NSHM Knowledge Campus, Durgapur

IV
(provided in the NSHM Letter Head the Student should collect from the Faculty Guide
on successful completion and approval of the report. The original will be with students
and the Colour copy will be attached here.)

V
 CERTIFICATE

ACKNOWLEDGEMENT

This Project work is the part of my journey in obtaining my Bachelor of Business

Administration in Hospital Management. This project report has been kept on track
and been seen through to completion with the support and encouragement of numerous
people including my well-wishers, my friends, colleagues and various institutions. At the
end of my project work I would like to thank all those people who made this thesis
possible and an unforgettable experience for me. Ultimately, it is a pleasant task to
express my thanks to all those who contributed in many ways to the success of this study
and made it an unforgettable experience for me.
I am also extremely indebted to the Management of NSHM Knowledge Campus, Chief
Mentor Mr. Cecil Antony, Trustee Mr. Francis Antony and Director Prof. (Dr.) Alok
Satsangi for providing us with the academic infrastructure and India’s top rated hospitals
to accomplish my Internship. I would like to express the deepest appreciation to
Prof. Justin Babu, Head, Department of Hospital Management, NSHM Business School.
At this moment of accomplishment, first of all I pay homage to my supervisor and mentor
Prof. Prateek Singh . This work would not have been possible without his guidance,
support and encouragement. I would also like to extend huge, warm thanks to all my
faculties namely Prateek Singh who willingly devoted so much time in giving guidance
to me.
In addition, I thank the CRTT Team of NSHM Knowledge Campus, Durgapur including,
Mr. Jaydeep Banerjee, Ms. Sanjukta Palit Biswas and Ms. Sriparna Banerjee for
their advice and directions in a systematic and timely manner.
I have to appreciate the guidance given by the Management of MMI Narayana
Multispecialty Hospital and my industry guide Mr. Rahul Raj &Ayan Chakraborty
Supervisor as well as the Department of IPD & Service Excellence and its team members
especially during the internship days that has improved my skills, thanks to their comment
and advices.
My special thanks to my friends and classmates Kunjan Pal, Joyashri Chowdhury, Jaya
Dewasi whose support cannot be expressed through words. Last but not least, my special
acknowledgements go to all my family members peculiarly my Father Mr. Krishnendu
Chakraborty My Mother Mou Chakraborty My brother Krishanu Chakraborty for
their sincere encouragement and inspiration throughout my internship and lifting me
uphill this phase of life. I owe everything to them. Besides this, several people have
knowingly and unknowingly helped me in the successful completion of this project.

VI
 Neha Chakraborty
Student Full Name
Roll No: 14903322097
Reg. No: 22149030297
TABLE OF CONTENTS
Chapter Title Page
No No
Approval of Report ii
Declaration iii
Certificate iv
Certificate v
Acknowledgement vi
Table of Contents viii
List of Tables x
List of Figures xi
Abbreviations xii
Executive Summary xiii
1 Chapter 1 – Profile of the Hospital 1
1.1 Introduction
1.2
1.3
1.n Summary
2 Chapter 2 – Introduction to the Study
2.1 Introduction
2.2
2.3
2.n Summary
3 Chapter 3 - Review of Literature
3.1 Introduction
3.2
3.2
3.n Summary
4 Chapter 4 – Objective of the study
4.1 Introduction
4.2 Study Objective
4.3 Need of the study
4.4 Research gap of the study
4.5 Statement of the Problem
4.6 Summary
5 Chapter 5 – Methodology
5.1 Study Design
5.2 Materials and Methods
5.3

VII
 5.4
5.n Summary
6 Chapter 6 - Results and Observations
6.1 Introduction
6.2
6.3
6.n Summary
7 Chapter 7 - Discussion and Recommendations
7.1 Introduction
7.2 Discussion
7.3 Novelty of the Study
7.4 Limitations of the study
7.5 Recommendation
7.6 Summary
8 Chapter 8 – Conclusion
9 References
10 Appendix

LIST OF TABLES
Table No. Table Description Page No
1. Cost Estimation 25
2. Patient Admittance Flowchart 33
3. Flowchart of Discharge Process 42
4. Patient Data chart about “The Ticking Clock: A Study of 57
Initial Medication Delays”

LIST OF FIGURES
Figures No. Figure Description Page No

VIII
 ABBREVIATION

ABC -

NABH –
JCI

IX
 EXECUTIVE SUMMARY

This report is about my internship program with Inpatient Department(IPD) in reference

to NH MMI Narayana Superspeciality Hospital. The principal purpose of this report is to
demonstrate my internship experience which would enable to understand the operations,
functionality and overall efficiency of the department.

In this internship program, I worked in OPD, IPD and Service Excellence Department in
the hospital but here I explained only about Inpatient Department (IPD). I described
thoroughly about the Inpatient Department on day to day basis.

In this report a brief description has been given about the profile of hospital, inpatient
department and the tasks of my department. All the information presented in these section
has been gathered based on my internal and external analysis.

These sections are personal development, lessons learnt from internship, difficulties faced
during my internship and how I have overcome them, difference between expectations
and reality, influence of internship on my career plan.

X
 CHAPTER 1
PROFILE OF THE HOSPITAL

XI
XII
 Chapter 1 Profile of the Hospital
Founder of Narayana Health
Dr. Devi Shetty
Devi Prasad Shetty (born 8 May 1953) is an Indian cardiac surgeon who is the chairman
and founder of Narayana Health, a chain of 21 medical centers in India. He has performed
more than 100,000 heart operations. In 2004 he was awarded the Padma Shri, the fourth
highest civilian award, followed by the
Padma Bhushan in 2012, the third highest
civilian award by the Government of India
for his contribution to the field of
affordable healthcare. Dr. Devi Shetty
founded Narayana Health in 2000.
A cardiac surgeon of repute and a
successful entrepreneur, Dr. Shetty is a
highly respected luminary for his ingenious
ideas for reforms in healthcare sector. His
visionary leadership to make quality
healthcare affordable for all has drawn global recognition.
Treading the path of economies of scale to bring down the cost of healthcare delivery,
Narayana Hrudayalaya has been an interesting case study for the likes of Harvard
University and The Wall Street Journal.
In association with Government of Karnataka, Dr. Shetty pioneered Yeshaswini, a very
inexpensive micro health insurance scheme benefitting more than 3.4 million rural poor.
Dr. Shetty is the current Chairman, Board of Governors, Indian Institute of Management,
Bangalore. He has also served as member Board of Governors of Medical Council of

XIII
India and Representative of President of India in the Board of Governors of Indira Gandhi
National Open University.

Geographical Presence of Narayana Health

XIV
(Fig. no. 2 Geographical Presence of Narayana Health)

XV
Profile of NH MMI Narayana Superspeciality Hospital
Narayana Hospital is a Multi Speciality Hospital in Malleswaram, Bangalore. The group
of hospitals was founded by Dr. Devi Shetty in 2000. It has 23 hospitals, 7 heart centres
and 24 primary care facilities across India along with one hospital in Cayman Islands,
North America.

Narayana Health took over the management of MMI Hospitals in August 2011 to provide
affordable, high quality healthcare to the people of Raipur and Chattisgarh. Add extra
care and nurture. The MMI Narayana Superspeciality Hospital, Raipur came into
existence when the earlier hospital was transformed by incorporating state-of-the-art
equipment and facilities with modernized operation theatres as well as the best of clinical
talent. Set amidst one of the most tranquil locations in Raipur, the hospital makes it an
ideal place to recover and rejuvenate faster.

We have also introduced various preventive health check-up packages to emphasize the
importance of getting a regular health check-up done and detecting diseases at an early
stage thereby helping ineffective treatment.MMI Narayana Superspeciality Hospital,
Raipur offers treatment and procedures in diverse medical specialities covering Adult &
Paediatric Cardiology, Minimally Invasive Cardiac Surgery, Thoracic & Vascular
Surgery, Nephrology & Kidney Transplant, Neurology, neuro-surgery, Orthopaedics &
Joint Replacement, General & Laparoscopic Surgery.

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Two of Narayana Health’s hospitals are accredited by the Joint Commission International
(JCI), and 19 are accredited by the National Accreditation Board for Hospitals (NABH).

Narayana Health aims to provide high-quality healthcare at affordable prices while

maintaining a focus on patient-centric care. The mission emphasizes compassion,
innovation, and accessibility in healthcare delivery.

MMI Narayana Super Specialty Hospital is a premier healthcare institution known for its
advanced medical services and comprehensive patient care. It operates under the
Narayana Health Group, which is renowned for its commitment to quality healthcare at
affordable prices.

Narayana Health’s core values are represented by the acronym “iCare”, which stands for
innovation, compassionate care, accountability, respect, and excellence. Narayana Health
partners with insurance companies to offer cashless treatment services. Narayana Health
uses telemedicine to expand its outreach and awareness efforts, and to provide triage
services.

Mission:
• To provide high-quality healthcare at affordable prices.
• To innovate and improve healthcare delivery through technology and efficient practices.
• To ensure accessibility to healthcare for all segments of society.

Vision:
• To be a global leader in healthcare, known for excellence in clinical outcomes and
patient care.
• To create a sustainable healthcare model that can be replicated worldwide.
• To promote health awareness and preventive care within communities.
For the most accurate and updated information, it’s best to check Narayana Health’s
official website or their latest publications.

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Narayan Health’s Story Grew From Seeds of Compassion
2000
Narayana Health’s journey begins as Narayana Hrudayalaya started by Dr. Devi Prasad
Shetty, 1st hospital launched in Kolkata – Rabindranath Tagore International Institute of
Cardiac Sciences and 2nd in Bengaluru – Narayana Health City.
2008
Launch of new hospitals in Jamshedpur & Jaipur & our First Heart Centre in Dharwad.
2009
Launch of the Multi-speciality hospital – Mazumdar Shaw Medical Centre (MSMC) in
Narayana Health City, Bangalore.
2012
Dr. Devi Prasad Shetty receives Padma Bhushan the third highest civilian award.
2013
Dr. Devi Prasad Shetty is awarded Padma Shri, the fourth highest civilian award by the
Govt. of India.
2014
Narayana Health City & Narayana Hospital, Jaipur receives the most prestigious JCI
accreditations. Our 2nd Hospitals started in Bengaluru and new hospitals launched in
Raipur, Ahmedabad, Mysore, Shimoga, Durgapur & Guwahati.
2016
Narayana Health gets listed in Bombay Stock Exchange.
2017
Launched our first Paediatric hospital in Mumbai with SRCC Children Trust.
2018
Partnership with Dharamshila Cancer Foundation and Research to provide healthcare
services in Delhi initiated.
2019
Started operations in Gurugram with our world-class medical Facility in DLF.
2020
Launched NH Care – Narayana Health App & introduced virtual consultation platform.
2022
Acquired Sparsha Hospital, Bommasandra and launched world class orthopaedic centre
in Narayana Health City, Bengaluru.
2023

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Narayana Health gets International JCI Enterprise Accreditation becoming first hospital
group in the country to achieve this milestone.

Chapter 2

Inpatient Department (IPD)

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 (Fig. no. 4 IPD means In-patient department)

Introduction
The Inpatient Department (IPD) is a critical component of healthcare facilities,
responsible for the care and management of patients who require hospitalization. This
department plays a vital role in providing comprehensive medical services to
individuals who need continuous monitoring and treatment for various health
conditions.

Key Functions of the Inpatient Department

1. Patient Admission: The IPD manages the admission process, ensuring that
patients receive timely care based on their medical needs. This includes
assessment, documentation, and allocation of appropriate resources.
2. Clinical Care: Healthcare professionals in the IPD provide round-the-clock
medical care, including diagnosis, treatment, and ongoing monitoring of patients’
conditions.
3. Multidisciplinary Team Collaboration: The IPD involves collaboration among
various healthcare providers, including doctors, nurses, specialists, and allied
health professionals, to ensure comprehensive patient care.
4. Patient Monitoring: Continuous monitoring of vital signs and health status is
essential in the IPD to detect any changes that may require immediate attention.

XX
 5. Discharge Planning: The IPD coordinates discharge planning to ensure that
patients transition smoothly from inpatient care to outpatient follow-up or home
care.

Importance of the Inpatient Department (IPD)

• Quality of Care: The IPD is dedicated to providing high-quality, patient-centered
care, ensuring that patients receive the necessary treatments and support during
their hospital stay.
• Resource Management: Effective management of beds, staff, and medical
supplies is crucial for optimizing hospital resources and minimizing wait times
for admission.
• Patient Safety: The IPD implements protocols and standards to ensure patient
safety and reduce the risk of complications during hospitalization.
• Data Collection and Research: The IPD often contributes to clinical research
and data collection, helping to improve treatment protocols and patient outcomes
over time.

Some key aspects of Inpatient Department

1. Admission Process

• Assessment: Patients are evaluated by healthcare professionals to determine the

need for inpatient care.
• Documentation: Medical history, consent forms, and insurance information are
collected.

2. Patient Care

• Monitoring: Patients receive continuous monitoring by nurses and doctors to track

their vital signs and overall condition.
• Treatment: Various treatments, including medications, therapies, and surgeries,
are administered as needed.

3. Facilities

XXI
 • Rooms: Patients may be placed in private or shared rooms, depending on the
hospital’s resources and patient needs.
• Support Services: Access to nutritionists, physical therapists, social workers, and
other specialists as part of holistic care.

4. Duration of Stay

• Varies based on the patient’s condition, treatment plan, and recovery progress.
Some may stay for a few days, while others may require weeks or longer.

5. Discharge Planning

• Begins at admission and involves preparing the patient for a safe transition back
home or to another care facility.
• Includes follow-up appointments, medication instructions, and home care
recommendations.

6. Types of Inpatient Services

• Surgery: Post-operative care for patients recovering from surgical procedures.

• Medical Management: Treatment for chronic illnesses, acute conditions, or
complications requiring close monitoring.
• Maternity: Care for women during labour, delivery, and postpartum recovery.

7. Multidisciplinary Approach

• Involves a team of healthcare professionals, including doctors, nurses, therapists,

and support staff, working together to provide comprehensive care.

8. Quality and Safety Measures

• Hospitals implement protocols to ensure patient safety, reduce infections, and

enhance the quality of care.

9. Insurance and Billing

XXII
 • Inpatient care typically involves different billing processes compared to outpatient
services. Insurance coverage can vary widely.

The Inpatient Department plays a critical role in the healthcare system by providing
necessary care for patients who require more intensive medical attention than what can
be offered on an outpatient basis. Some potential area I could focus on:

Admission Process
Introduction

▪ Admission is defined as allowing a patient to stay in hospital for observation,

treatment and care Plan.
▪ Admission is the entry of a patient into the hospital /ward for
therapeutic/diagnostic purposes.
▪ The admission process is a critical component of healthcare management,
ensuring that patients Receive timely and appropriate care.

Source of Admission
I. Emergency Admission
II. Routine Admission
• Emergency Admission: Emergency admission means the patient are admitted
in acute condition requiring immediate treatment come to casualty with emergency
critical condition .
Examples- MI, brain stroke, RTA, burning, poisoning etc.
• Routine Admission: Routine Admission means the patient are admitted for
investigation, diagnosis, medical or surgical treatment. Treatment is given according to
initial condition of patients .

XXIII
Examples – Patient with hypertension, diabetes, mellitus etc.

(Fig. no. 5 Types of Admission)

Pre-Admission Procedures

• Referral: Patients may be referred by a primary care physician or specialist.

• Pre-Assessment: Some hospitals conduct pre-admission assessments, which may
include medical history and preliminary tests.

Patient Registration

• Documentation: Patients must provide personal information, insurance details,

and identification.
• Form Filling: Completion of necessary forms, including consent for treatment and
privacy policies.

Initial Assessment

• Triage: A nurse or healthcare professional evaluates the patient’s condition to

prioritize care based on urgency.
• Vital Signs Monitoring: Initial checks of vital signs (blood pressure, heart rate,
temperature) are performed.

Room Assignment

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 • Bed Allocation: Based on the patient’s medical needs and available facilities, a
suitable room or bed is assigned.
• Orientation: Patients are informed about the hospital layout, facilities, and rules.

Medical Evaluation

• Consultation: The admitting physician conducts a thorough medical evaluation,

including physical examinations and necessary diagnostic tests.
• Care Plan Development: A preliminary care plan is created based on the
assessment findings.

Communication with Family

• Information Sharing: Healthcare staff communicate with family members

regarding the patient’s condition and treatment plan.
• Support Services: Information about support services (social work, chaplaincy)
may be provided to the family.

Insurance Verification

• Coverage Confirmation: The hospital verifies insurance coverage and discusses

payment options with the patient or family.
• Financial Counselling: If necessary, financial advisors may meet with the patient
to discuss costs and payment plans.

Admission Orders

• Physician Orders: The attending physician writes orders for medications, tests,
and treatments that will be initiated upon admission.
• Nursing Care Plan: Nurses develop a care plan based on physician orders and
patient needs.

Patient Education

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 • Informing the Patient: Patients receive information about their rights,
responsibilities, and what to expect during their stay.
• Preoperative Instructions: If applicable, patients are given specific instructions
regarding surgery or procedures.

Final Steps Before Admission

• Transport to Room: Once all procedures are complete, patients are transported to
their assigned room.
• Introduction to Nursing Staff: Upon arrival in the room, nursing staff introduce
themselves and explain their roles in patient care.

This structured approach not only ensures that patients receive timely and appropriate
care but also enhances the overall efficiency of hospital operations.

Cost Estimation

The MMI Narayana Hospital, Raipur is a multi-specialty hospital in Raipur, Chhattisgarh,

India. It is part of the Narayana Health chain of hospitals. The hospital offers a wide range
of services, including emergency care, surgery, and diagnostic services.

An estimate in a hospital is a preliminary calculation of the potential cost of a medical

procedure or treatment. It helps patients understand the financial implications of their
healthcare decisions.

Consider Additional Factors:

1. Patient Admission:

• Patient arrives at the hospital.

XXVI
 • Basic demographic and insurance information is collected.

2. Initial Medical Assessment:

• Doctor assesses the patient’s condition

• Preliminary diagnosis is made.
• Potential procedures and tests are identified.

3. Initial Medical Assessment:

• Doctor assesses the patient’s condition.

• Preliminary diagnosis is made.
• Potential procedures and tests are identified.

4. Insurance Verification:

• Insurance information is verified with the insurance provider.

• Coverage limits, co-pays, and deductibles are determined.

Cost Estimation

Firstly open in system OPD Paper/Consultant Paper

The MRN number of the patient is given in the

system (OPD Paper) to know the details of the
patient( ex. Name, Mobile Number etc.)

Scheduling payment options according to patient's needs

(Cash, TPA, Corporate, Scheme)

XXVII
 Then Medical Management /Surgery Cost are added

Explain Patient and patient’s attendent about bed charges

Also add Test and Supporting Cost

Thereafter the approximate cost are generate, and then the

final bill/cost explain to the patient and their attendance.
5. Cost Estimation:

• Room and Board:

• Estimated length of stay is determined based on diagnosis and treatment plan.
• Room type (general ward, semi-private, or private) is selected.
• Daily room rates are calculated.

6. Medical Procedures and Tests:

• Costs of necessary procedures and tests are estimated based on hospital’s fee
structure.

7. Medications:

• Estimated cost of medications is calculated based on prescription and pharmacy

rates.

XXVIII
8. Other Services:

• Costs of additional services like therapy, dietary, or lab services are included.

9. Financial Counselling:

• A financial counsellor reviews the estimated costs with the patient or their
representative.
• Payment options and financial assistance programs are discussed.

10. Admission and Treatment:

• Patient is admitted to the hospital.

• Treatment plan is implemented.
• Costs are tracked throughout the hospital stay.

11. Discharge Planning:

• Final costs are calculated, including any additional charges incurred during the
stay.
• Billing and payment arrangements are finalized.
• Patient is discharged with necessary instructions and follow-up care.

Inpatient Care
Inpatient care refers to medical treatment that requires a patient to be admitted to a
hospital or healthcare facility for at least one overnight stay. This type of care is essential
for individuals who need continuous monitoring, specialized treatment, or surgical
procedures.

Types of Inpatient Care

▪ Medical Care: Treatment for acute illnesses or chronic conditions that require
close monitoring (e.g., pneumonia, heart failure).

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 ▪ Surgical Care: Procedures that necessitate hospitalization, such as orthopaedic
surgeries, appendectomies, or cardiac surgeries.
▪ Maternity Care: Care for women during labour, delivery, and postpartum
recovery.
▪ Paediatric Care: Specialized care for children with various health issues.
▪ Psychiatric Care: Treatment for mental health disorders requiring hospitalization.

Components of Inpatient Care

▪ Admission Process: As previously described, this includes registration,

assessment, and room assignment.
▪ Nursing Care: Continuous monitoring of vital signs and overall health status.
Administration of medications and treatments as per physician orders. Patient
education on managing their condition and recovery.
▪ Medical Team Involvement: A multidisciplinary team often includes physicians,
nurses, pharmacists, dietitians, and therapists. Regular rounds by the healthcare
team to assess progress and adjust treatment plans.
▪ Diagnostic Tests: Access to laboratory tests, imaging studies (like X-rays or
MRIs), and other diagnostic procedures as needed.

Patient Experience

▪ Comfort and Amenities: Many hospitals focus on creating a comfortable

environment with amenities such as private rooms, meal options, and recreational
activities.
▪ Communication: Open lines of communication between patients, families, and
healthcare providers are crucial for understanding treatment plans and
expectations.
▪ Discharge Planning: Begins upon admission and includes preparing the patient
for transition back home or to another level of care. This involves: Education on
medications and follow-up appointments. Coordination with home health
services if needed.

Challenges in Inpatient Care

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 ▪ Infection Control: Hospitals must implement strict protocols to prevent hospital-
acquired infections (HAIs).
▪ Resource Management: Efficient use of hospital resources, staff, and beds is
essential to avoid overcrowding and ensure quality care.
▪ Patient Safety: Continuous efforts are made to minimize errors in medication
administration and ensure patient safety throughout their stay.

Quality of Care Metrics

▪ Patient Satisfaction: Surveys are often conducted to gauge patient experiences and
satisfaction levels.
▪ Clinical Outcomes: Monitoring recovery rates, readmission rates, and overall
health outcomes is essential for evaluating the effectiveness of inpatient care.

Technological Integration

▪ Electronic Health Records (HER): Streamlines documentation, enhances

communication among providers, and improves patient safety.
▪ Telemedicine: Increasingly used for consultations and follow-ups, even in
inpatient settings.

Inpatient care plays a vital role in the healthcare system by providing intensive medical
attention to patients who require it. The focus is not only on treating the immediate health
issue but also on ensuring a safe and supportive environment that promotes healing and
recovery

Challenges, Solutions and Impacts

Patient Flow and Bed Management

• Challenge: Overcrowding and inefficient bed utilization can lead to delays in

patient admissions and discharges.
• Solution: Implement real-time bed management systems to track occupancy and
streamline the admission/discharge process.

XXXI
 • Impact: Delays in admission and discharge can lead to prolonged hospital stays,
increased risk of hospital-acquired infections, and higher healthcare costs.
Efficient bed management is crucial for timely interventions.

Communication Breakdowns

• Challenge: Poor communication among healthcare teams can lead to errors and
delays in patient care.
• Solution: Use standardized communication protocols (like SBAR) and invest
in integrated communication platforms to enhance collaboration.
• Impact: Poor communication can result in medication errors, missed
treatments, and misunderstandings about care plans. This can lead to adverse
events and negatively affect recovery.

Staffing Shortages

• Challenge: Insufficient staffing can lead to burnout and decreased quality of

care.
• Solution: Utilize flexible staffing models, offer incentives for overtime, and
invest in recruitment and retention strategies.
• Impact: Insufficient staffing can lead to increased workload for existing staff,
resulting in burnout and decreased attention to patient needs. This can
compromise the quality of care and patient safety.

Infection Control

• Challenge: Infections acquired during hospitalization can lead to complications

and increased healthcare costs.
• Solution: Strengthen infection control protocols, conduct regular training, and
promote hand hygiene practices among staff and visitors.
• Impact: Ineffective infection control measures can lead to hospital-acquired
infections (HAIs), which can prolong hospitalization, increase morbidity, and
even result in mortality.

Patient Safety

XXXII
 • Challenge: Adverse events, such as falls or medication errors, can compromise
patient safety.
• Solution: Implement safety checklists, conduct regular training on safety
protocols, and encourage a culture of reporting near misses.
• Impact: Adverse events such as falls, pressure ulcers, and medication errors
can lead to serious complications, extended recovery times, and increased
healthcare costs.

Data Management and Documentation

• Challenge: Inefficient data entry and management can lead to errors and time
wastage.
• Solution: Adopt electronic health record (HER) systems that streamline
documentation and ensure interoperability between departments.
• Impact: Inefficient documentation can lead to incomplete patient histories,
miscommunication about treatment plans, and ultimately affect clinical decisions,
resulting in poorer patient outcomes.

Patient Satisfaction

• Challenge: Low patient satisfaction scores can affect hospital reputation and
funding.
• Solution: Regularly gather patient feedback, address concerns promptly, and
implement patient-centered care practices.
• Impact: Low patient satisfaction can indicate underlying issues in care quality.
Unsatisfied patients may be less likely to follow discharge instructions or attend
follow-up appointments, negatively impacting their health outcomes.

Coordination of Care

• Challenge: Fragmented care transitions can lead to miscommunication and

poor outcomes.

XXXIII
 • Solution: Establish multidisciplinary teams for care coordination and use care
transition protocols to ensure continuity of care post-discharge.
• Impact: Fragmented care can lead to miscommunication during transitions,
increasing the likelihood of readmissions and complications. Effective
coordination is essential for maintaining continuity of care.

Financial Constraints

• Challenge: Rising operational costs can strain budgets and limit resource
availability.
• Solution: Conduct regular financial assessments, optimize resource allocation,
and explore alternative funding sources.
• Impact: Budget limitations may restrict access to necessary resources,
technology, and staffing, which can compromise the quality of care provided to
patients.

Technology Integration

• Challenge: Difficulty in integrating new technologies into existing workflows

can hinder efficiency.
• Solution: Provide comprehensive training for staff on new technologies and
involve them in the selection process to ensure usability.
• Impact: Failure to effectively integrate technology can hinder the ability to
monitor patient progress, share critical information, and utilize data for
informed decision-making, leading to suboptimal outcomes.

The interplay between these challenges and patient outcomes underscores the importance
of addressing operational inefficiencies within inpatient departments.

Ward or Room Allocation

The admission receptionist enquires from the patient about their preferred Ward or room
is allotted according to the patient’s medical condition which is:

XXXIV
 • ICU (Intensive Care Unit)/CCU (Coronary Care Unit)/ITU (Intensive Therapy
Unit)
• MICU (Medical Intensive Care Unit)/CICU (Cardiac Intensive Care Unit)
• Cardiac HDU (High Dependency Unit)
• Neuro HDU

The admission receptionist enquires from the patient about their Preferred ward or room
is allotted according to the patient’s Attendant required which is:

• General Rooms
• Semi Private Rooms
• Private Rooms
• Deluxe Room

(Fig. no. 6 Ward and Room Allocation)

Patient Admittance Flowchart

Patient Arrives

XXXV
 Verify if the patient has gone
through a pre- admission
screening

Verify Patient Details

If the patient has insurance then verify it,

and if not then check patient credit card
to make sure he can pay upon discharge

Schedule a
Follow-up
Assist patient/patient’s
attendent in filling up the Check if the
Examination
admission form discharge has
been authorised

Patient leaves
Clarify the patient Doubts

Overview of Payment Options

XXXVI
Narayana Superspeciality Hospital typically offers various payment modes for patients.
These may include:

▪ Cash
▪ TPA
▪ Corporate
▪ Scheme

Cash: This is processing of payments Made by patient and patient’s attendant via
Cash/check/ credit cards. A daily lump sum amount The insured can get in case of
hospitalization.

TPA: TPA stands for Third Party Administrator. It is an entity that helps insurance
Companies manage insurance policies and claims on Behalf of policyholders. The
primary function of TPA Is to assist insurance companies in providing health Insurance
policies to individuals and managing their Claims.
Example- HDFC, TATA AIG, ICICI Lombard, Star Health etc.

Corporate: Corporate payments, usually refer to the financial transactions made by a

Company or corporation to pay for various expenses related to its business operation.
Example- NTPC, NMDC, SECL, Airport Authority etc.

Scheme: A scheme is a plan or arrangement involving many people which. Are made by
a government or other organization.
Example- Ayushman Scheme.

Cashless Treatment Facilities

XXXVII
Cashless treatment refers to the process where patients do not need to make upfront
payments for their medical expenses. Instead, the hospital directly bills the insurance
company or third-party payer.

• NH MMI Narayana Superspeciality Hospital collaborates with numerous health

insurance providers. This network enables patients to avail of cashless treatment
by presenting their insurance card and necessary documentation at the time of
admission.
• To facilitate cashless treatment, patients may need to provide certain documents,
including:
i. Insurance policy details
ii. A government-issued ID
iii. Referral letters (if applicable)
iv. Any previous medical records relevant to the treatment
• Once treatment is rendered, the hospital generates a bill that is submitted to the
insurance provider. The hospital’s billing department typically handles this
process, ensuring timely submission and follow-up on claims.
• While cashless facilities are beneficial, there may be challenges such as:
▪ Limited coverage for certain treatments or procedures.
▪ Delays in claim approvals from insurance companies.
▪ Variability in out-of-pocket expenses depending on individual policy
terms.
• Including feedback from patients who have utilized cashless treatment can
provide insight into the effectiveness and efficiency of this facility at NH MMI
Narayana Superspeciality Hospital.

Cashless treatment facilities at Narayana Superspeciality Hospital represent a significant

advancement in making healthcare accessible and affordable for patients.

XXXVIII
Challenges and Solutions Of payment method
Here are some specific challenges related to payment modes at NH MMI Narayana
Superspeciality Hospital, Raipur, along with potential solutions:

Here are some specific challenges related to payment modes at NH MMI Narayana
Superspeciality Hospital, Raipur, along with potential solutions:

1. Limited Acceptance of Payment Methods

• Challenge: Patients may face issues if the hospital does not accept their preferred
payment method (e.g., digital wallets, credit/debit cards).
• Solution: Expand the range of accepted payment methods, including mobile
wallets, UPI, and international credit cards. Regularly update the payment systems
to incorporate new technologies.

2. Insurance Claim Processing Delays

• Challenge: Delays in processing insurance claims can lead to financial stress for
patients and operational challenges for the hospital.
• Solution: Establish a dedicated insurance liaison team to handle claims efficiently.
Implement a tracking system that allows patients to monitor the status of their
claims.

3. Lack of Transparency in Billing

• Challenge: Patients may encounter unexpected charges or unclear billing

statements, leading to confusion and dissatisfaction.
• Solution: Provide clear and detailed billing statements that outline all charges.
Offer pre-treatment cost estimates to help patients understand their financial
responsibilities upfront.

XXXIX
4. Complex Payment Processes

• Challenge: Complicated payment procedures can deter patients from seeking

care or cause delays in treatment.
• Solution: Simplify the payment process by offering user-friendly online
payment options and clear instructions at the point of service. Train staff to
assist patients with any payment-related queries.

5. Inadequate Financial Counselling

• Challenge: Patients may not be aware of financial assistance programs or

payment plans available to them.
• Solution: Establish a financial counselling department that provides guidance
on payment options, insurance coverage, and available financial assistance
programs. Promote these services through hospital communication channels.

6. Technical Issues with Payment Systems

• Challenge: Technical glitches or downtime in payment systems can frustrate

patients and staff alike.
• Solution: Invest in reliable and secure payment technology. Ensure regular
maintenance and updates of the systems, and have a backup plan in place for
any technical failures.

By addressing these challenges with targeted solutions, NH MMI Narayana

Superspeciality Hospital can enhance the patient experience related to payment processes,
ultimately leading to higher satisfaction and better healthcare outcomes.

XL
 Discharge Process

A hospital’s discharge process is the process of leaving the hospital after treatment. The
hospital discharge process is a series of steps taken to ensure a smooth transition for
patients from the hospital setting to their homes or other care facilities. The process May
take a few hours to complete. Here’s a breakdown of the typical discharge process in a
hospital:

▪ Medical Clearance

Physician’s assessment: Your doctor will determine if you’re stable enough to be

discharged. They’ll consider your condition, vital signs, and any ongoing treatments.

Discharge summary: Your doctor will create a summary of your diagnosis, treatment,
and instructions for home care. This document is crucial for your follow-up care.

▪ Administrative Procedures:

Billing: The hospital will finalize your bill, including any outstanding charges. You’ll
need to settle the bill before discharge, either through insurance or personal payment.

Medication: You’ll receive a list of medications to take at home, along with instructions
on dosage, frequency, and potential side effects. Any unused medications will be returned
to the pharmacy.

Medical equipment: If you need any medical equipment at home (like oxygen tanks or
walkers), it will be arranged and provided to you.

▪ Patient Education:

Discharge instructions: You’ll receive detailed instructions on how to care for yourself
at home, including wound care, diet, and exercise.

XLI
Follow-up appointments: You’ll be scheduled for any necessary follow-up
appointments with your doctor or specialists.

▪ Transportation:

Ambulance or personal vehicle: You’ll arrange for transportation home, either by

ambulance if required or by personal vehicle.

▪ Additional Considerations:

Discharge planning: A social worker or case manager may be involved in discharge

planning, especially if you have complex needs or require additional support at home.

Home health services: If needed, home health services like nursing, physical therapy, or
occupational therapy can be arranged to assist you at home.

Types of Discharge
In a hospital setting, discharge refers to the process of releasing a patient from the facility
after treatment. There are several types of discharge, including:

XLII
 (Fig. no. 6 Ward and Room Allocation)

Planned Discharge

Definition: This is a structured and intentional discharge from a healthcare facility, often
involving a discharge plan that includes follow-up care, medications, and instructions for
the patient.

Characteristics:

• Involves coordination among healthcare providers.

• Patients are typically stable and ready to continue recovery at home or in another
facility.
• Follow-up appointments are usually scheduled.

DAMA (Discharge Against Medical Advice)

XLIII
Definition: This occurs when a patient chooses to leave the hospital or healthcare facility
before the medical team recommends discharge.

Characteristics:

• Patients may feel they are well enough to leave or have personal reasons for
wanting to go.
• Healthcare providers typically document the risks involved and may ask the
patient to sign a waiver.

LAMA (Leave Against Medical Advice)

Definition: Similar to DAMA, this refers to patients who leave the facility without the
consent of their healthcare providers.

Characteristics:

• Often associated with patients who may not fully understand the implications of
leaving early.
• Documentation of the patient’s decision and the potential risks is crucial.

Death

Definition: This refers to the end of life for a patient while in a healthcare facility.

Characteristics:

• May involve specific protocols for notifying family, conducting autopsies, and
managing the deceased’s belongings.
• Emotional support for family members is often provided.

Abscond

Definition: This term refers to a patient who leaves the healthcare facility without
permission and cannot be located.

XLIV
 Characteristics:

• Often involves patients who may be at risk for harm or are non-compliant with
treatment.
• Healthcare facilities may implement protocols to search for the patient and ensure
their safety.

Transfer

Definition: This involves moving a patient from one healthcare facility to another or from
one department to another within the same facility.

Characteristics:

• Usually occurs when specialized care is needed that the current facility cannot
provide.
• Coordination between facilities is crucial for continuity of care.

Each type of discharge is tailored to the patient’s needs and circumstances, ensuring they
receive appropriate care after leaving the hospital.

Flowchart of Discharge Process

Doctor Advice for Discharge

Extra Medicine will be returned to the Pharmacy

Mark As Discharge through the system

BILLING TYPE
Discharge summary Mandatory 1.Cash
2.TPA
For TPA and Corporate Patient.
3. Corporate

XLV
 Pharmacy Approval

Floor Coordinator will inform to patient’s attendant for the payment clearance

Payment by patient attendant for discharge procedure

Discharge Card provide by billing team for further discharge Procedure

Discharge Card submit to allocated sister by patient attendant

Discharge Summary explain by Doctor to the Patient Attendant

Physical Discharge of the patient from the Hospital.

XLVI
 Chapter 3

Review of Literature

Review of Literature
This review of literature focuses on the admission and discharge processes within the
Inpatient Department (IPD) at NH MMI Narayana Superspeciality Hospital, Raipur.
The goal is to understand the current practices, identify potential areas for improvement,
and inform future research or interventions.

Key Areas of Focus:

1. Admission Process

Patient Registration :

XLVII
 ▪ Time taken for registration
▪ Efficiency of the registration process
▪ Accuracy of data entry

Medical Records :

▪ Completeness of medical history documentation

▪ Availability of relevant medical records

Bed Allocation :

▪ Time taken for bed allocation

▪ Efficiency of bed allocation process
▪ Bed availability and management

2. Discharge Process
Discharge planning :

▪ Timeliness of discharge planning initiation

▪ Involvement of multidisciplinary team
▪ Patient and family education regarding post-discharge care

Billing and Payment :

▪ Accuracy of billing
▪ Efficiency of payment process
▪ Time taken for final billing and payment

Discharge Summary :

▪ Timeliness of discharge summary generation

▪ Completeness and accuracy of discharge summary

Patient Handoff :

▪ Effective communication between healthcare providers

XLVIII
 ▪ Smooth transition of care to outpatient or home care settings

Literature Review Findings

Limited Specific Literature :

• There is a scarcity of specific research or publications focusing on the admission

and discharge processes at NH MMI Narayana Superspeciality Hospital, Raipur.
• Most of the available literature pertains to general hospital management
practices and patient experience studies.

General Hospital Management Practices :

• Several studies have examined hospital management practices, including

admission and discharge processes.
• These studies highlight the importance of efficient processes, clear
communication, and patient-centered care in ensuring smooth patient transitions.

Patient Experience Studies :

• Research on patient experience has emphasized the significance of timely and

efficient admission and discharge processes.
• Patient satisfaction is often linked to the overall experience, including the ease
of admission and discharge procedures

Conduct a Detailed Process Analysis :

• A comprehensive analysis of the current admission and discharge processes at

NH MMI Narayana Superspeciality Hospital, Raipur is necessary.
• This analysis should include a mapping of the steps involved, identification of
bottlenecks, and measurement of key performance indicators (KPIs).

Patient and Staff Surveys :

XLIX
 • Collecting feedback from patients and staff members can provide valuable
insights into their perceptions of the admission and discharge processes.
• Surveys can help identify areas of satisfaction and dissatisfaction, as well as
potential areas for improvement.

Benchmarking with Other Hospitals :

• Comparing the admission and discharge processes at NH MMI Narayana

Superspeciality Hospital, Raipur with other similar hospitals can help identify
best practices and potential areas for improvement.

Implementation of Quality Improvement Initiatives:

• Based on the findings of the research, specific quality improvement initiatives

can be implemented to optimize the admission and discharge processes.
• These initiatives may include streamlining paperwork, improving
communication, and utilizing technology to enhance efficiency.

While there is limited specific literature on the admission and discharge processes at
NH MMI Narayana Superspeciality Hospital, Raipur, a comprehensive review of
general hospital management practices and patient experience studies provides valuable
insights.

L
 Chapter 4
Objective of the Study

Objective of the Study

The primary objective of this study is to comprehensively analyse the admission and
discharge processes within the Inpatient Department (IPD) of NH MMI Narayana

LI
Superspeciality Hospital . Here are some potential objectives for a study on the admission
and discharge process in an IPD setting:

Overall Objective :

To evaluate the efficiency, effectiveness, and patient experience of the current admission
and discharge processes within the IPD department of the hospital.

Specific Objectives :

Process Analysis
▪ To map the current admission and discharge processes, identifying key steps,
decision points, and potential bottlenecks.
▪ To assess the time taken for each step of the process, from initial patient contact
to final discharge.
▪ To identify any redundant or unnecessary steps in the process.

Patient Experience :

▪ To assess patient satisfaction with the admission and discharge processes,

including factors such as communication, information provision, and overall
experience.
▪ To identify any areas where patient experience could be improved.

Staff Satisfaction :

▪ To evaluate staff satisfaction with the current processes, including workload,

clarity of roles, and availability of resources.
▪ To identify any factors that may contribute to staff stress or burnout.

Compliance with Standards :

▪ To assess compliance with relevant regulatory standards and guidelines for

admission and discharge processes.
▪ To identify any areas where compliance could be improved.

Identification of Improvement Opportunities :

LII
 ▪ To identify areas where the admission and discharge processes could be
streamlined, expedited, or enhanced to improve efficiency and patient satisfaction.
▪ To develop recommendations for specific improvements, such as implementing
new technologies, revising policies and procedures, or improving staff training.

Develop Recommendations :

▪ Propose actionable recommendations to optimize the admission and discharge

processes, including potential technological solutions, workflow modifications,
and staff training initiatives.

Measure Key Performance Indicators (KPIs) :

▪ Establish relevant KPIs to monitor the performance of the admission and

discharge processes, such as average wait times, patient satisfaction scores, and
adherence to discharge protocols.

Identify Areas for Improvement :

▪ Determine specific opportunities to streamline processes, reduce wait times, and

enhance overall patient experience.

By addressing these objectives, the study can provide valuable insights into the strengths
and weaknesses of the current processes, leading to targeted improvements and a more
efficient and patient-centered healthcare delivery system.

LIII
CHAPTER - 5
Methodology

LIV
 Methodology

This report aims to provide a comprehensive understanding of the admission and

discharge processes for Inpatient (IPD) patients at NH MMI Narayana Superspeciality
Hospital, Raipur. The study will analyse the current procedures, identify potential areas
of improvement, and recommend strategies to enhance the overall efficiency and patient
experience.
1. Literature Review
• Review existing literature and industry best practices related to hospital admission
and discharge processes.
• Analyse relevant policies and procedures of NH MMI Narayana Super Speciality
Hospital.
2. Data Collection:
• Observation: Direct observation of the admission and discharge processes,
including patient interactions with staff, paperwork, and technology usage.
• Interviews: Conduct semi-structured interviews with key stakeholders such as:
▪ Admission desk staff
▪ Nursing staff
▪ Discharge planning team
▪ Patients and their caregivers
• Document Analysis: Review relevant documents like patient records, discharge
summaries, and insurance claim forms.
3. Data Analysis:
• Qualitative Analysis: Analyse interview transcripts to identify themes and
patterns related to patient experiences, staff perceptions, and process bottlenecks.
• Quantitative Analysis: Analyse numerical data (e.g., wait times, discharge delays)
to identify trends and potential areas for improvement.

LV
4. Current Admission Process:
• Patient arrival and registration
• Medical assessment and triage
• Room allocation
• Insurance verification and billing
5. Current Discharge Process:
• Physician’s discharge order
• Final billing and settlement
• Patient handover to caregivers
• Post-discharge follow-up
6. Analysis of the Current Process:
• Strengths and weaknesses of the current system
• Identification of bottlenecks and delays
• Patient satisfaction and experience
7. Recommendations for Improvement:
• Streamlining processes
• Improving communication
• Enhancing technology utilization
• Implementing patient-centric practices
• Training and staff development

By following this methodology and addressing the identified areas of improvement, NH

MMI Narayana Super Speciality Hospital can enhance its patient experience, optimize
resource utilization, and achieve greater operational efficiency.

LVI
 CHAPTER - 6
The Ticking Clock: A Study of Initial Medication Delays

LVII
 The Ticking Clock: A Study of Initial Medication Delays

Timely medication administration is a critical component of patient care. Delays in

initiating treatment can have significant implications for patient outcomes. This study
aims to investigate the time interval between patient admission and the administration of
the first medication dose. By analysing this data, we hope to identify potential areas for
improvement in the medication delivery process and ultimately enhance patient care.

Research Methodology

1) Literature Review:
▪ A comprehensive review of existing literature on medication administration
delays, including studies on root causes, impact on patient outcomes, and
interventions to improve medication delivery.
2) Data Collection:

Retrospective Chart Review:

▪ Review a sample of patient charts to identify delays in medication administration,

including time from order entry to medication administration.
▪ Analyse factors associated with delays, such as nursing workload, physician order
entry time, and pharmacy dispensing time.

Direct Observation:

▪ Observe medication administration processes on various units to identify

bottlenecks and inefficiencies.
▪ Document time taken for each step, including order entry, pharmacy dispensing,
and nurse administration.

Interviews:

LVIII
 ▪ Conduct semi-structured interviews with healthcare providers, nurses,
pharmacists, and hospital administrators to gather qualitative data on their
perceptions of medication delays and potential solutions.

3) Data Analysis:

Quantitative Analysis:

▪ Calculate average medication administration times and identify trends.

▪ Use statistical analysis to determine the significance of factors influencing delays.

Qualitative Analysis:

▪ Thematic analysis of interview transcripts to identify common themes and

underlying causes of delays.

Potential Factors Contributing to Initial Medication Delays

Physician Order Entry:

▪ Delayed or incomplete orders

▪ Lack of clarity in medication orders

Pharmacy Dispensing:

▪ Understaffing
▪ Drug shortages
▪ Complex medication orders
▪ Inefficient workflow

Nursing Administration:

▪ High workload
▪ Interruptions
▪ Lack of adequate staffing
▪ Complex medication regimens
▪ Patient factors (e.g., difficulty accessing veins)

LIX
Strategies to Optimize Medication Administration

Implement Electronic Health Records (EHRs):

▪ Automate medication order entry and reduce transcription errors.

▪ Utilize clinical decision support systems to improve medication appropriateness
and reduce errors.

Optimize Pharmacy Workflow:

▪ Implement automated dispensing systems to streamline medication distribution.

▪ Use barcode scanning technology to improve accuracy and reduce errors.
▪ Optimize staffing levels to ensure timely medication dispensing.

Enhance Nursing Practices:

▪ Implement standardized medication administration protocols.

▪ Use medication administration technologies, such as smart pumps and barcode
scanning.
▪ Provide adequate staffing to reduce nurse workload.
▪ Prioritize urgent medications.

Improve Communication:

▪ Establish effective communication channels between physicians, pharmacists,

and nurses.
▪ Use real-time communication tools to facilitate timely information exchange.

Continuous Quality Improvement:

▪ Regularly monitor medication administration times and identify areas for

improvement.
▪ Implement quality improvement initiatives, such as root cause analysis and Plan-
Do-Study-Act (PDSA) cycles. Patient’s data chart/ Observation:

I have collected data of some patients from private and semi-private wards of NH MMI
Narayana Superspeciality Hospital, Raipur. I have collected data about patient’s

LX
admission time and then when the first Medicine is given to the patient. This is what I
have observed:

I have observed that there is a difference of about one hour between the time of Arrival
in the patient room or the time of giving the first medicine. Here is my observation chart-

MRN No. Patient reaching time First medicine given time

17540000xxxxxx 08/07/2024; 10:29 A:M First medicine given at 12:30 P:M

17540000xxxxxx 08/07/2024; 12:13 P:M First medicine given at 2:00 P:M

17540000xxxxxx 08/07/2024; 12:39 P:M First medicine given at 1:40 P:M

17540000xxxxxx 08/07/2024; 2:30 P:M First medicine given at 3:30 P:M

17540000xxxxxx 09/07/2024; 3:20 P:M First medicine given at 4:20 P:M

17540000xxxxxx 09/07/2024; 1:15 P:M First medicine given at 2:30 P:M

17540000xxxxxx 09/07/2024; 1:30 P:M First medicine given at 2:45 P:M

17540000xxxxxx 09/07/2024; 11:00 A:M First medicine given at 12:10 P:M

17540000xxxxxx 10/07/2024; 2:00 P:M First medicine given at 3:00 P:M

17540000xxxxxx 10/07/2024; 1:50 P:M First medicine given at 2:45 P:M

17540000xxxxxx 10/07/2024.;10:15 A:M First medicine given at 11:20A:M

17540000xxxxxx 10/07/2024; 1:50 P:M First medicine given at 2:45 P:M

17540000xxxxxx 11/07/2024; 12:27 P:M First medicine given at 2:15 PM

LXI
17540000xxxxxx 12/07/2024:2:00 P:M First medicine given at 3:10 P:M

17540000xxxxxx 12/07/2024; 1:10 P:M First medicine given at 2:00 P:M

17540000xxxxxx 12/07/2024; 3:30 P:M First medicine given at 11:30 P:M

17540000xxxxxx 15/07/2024; 10:00 A:M First medicine given at 11:30 P:M

17540000xxxxxx 15/07/2024; 1:46 P:M First medicine given at 2:50 P:M

17540000xxxxxx 15/07/2024; 2:00 P:M First medicine given at 3:10 P:M

CHAPTER - 7

Discussion and Recommendation

LXII
 Discussion and Recommendation
Narayana Health is considered one of the top hospitals in India for cardiology. To
conduct a thorough analysis and provide actionable recommendations, it's essential to
have a deep understanding of the current processes.

The admission and discharge processes in an Inpatient Department (IPD) are crucial
for patient experience, operational efficiency, and overall hospital management. This
may involve:

1. Document Review: Examining existing policies, procedures, and forms related to admission
and discharge.

2. Staff Interviews: Conducting interviews with staff members involved in the process to gain
insights into their experiences and challenges.

3. Patient Surveys: Collecting feedback from patients and their families regarding their
experiences with admission and discharge.

4. Process Mapping: Creating a visual representation of the current processes to identify

bottlenecks and areas for improvement.

Key Areas for Analysis and Recommendation

I. Admission Process:
Pre-Admission:

LXIII
 • Efficiency of pre-authorization and insurance verification processes.
• Clarity and comprehensiveness of pre-admission information provided to
patients.
• Smoothness of appointment scheduling and coordination with the concerned
department.
Admission:

• Welcoming and efficient registration process.

• Timely room allocation and patient orientation.
• Effective communication with patients and families about the admission
process, treatment plan, and expected costs.

Post-Admission:

• Prompt initiation of treatment and diagnostic procedures.

• Timely and accurate documentation of patient information.

II. Discharge Process:

Pre-Discharge:

• Timely and accurate generation of discharge summary and medical records.

• Effective communication with patients and families regarding the discharge
plan, including post-discharge care instructions, medication regimen, and
follow-up appointments.
• Coordination with insurance companies for final billing and claim settlement.

Discharge:

• Smooth and efficient discharge procedures, including final billing and

payment processing.
• Assistance with transportation arrangements, if needed.

LXIV
 • Provision of necessary medications and medical supplies for post-discharge
care.

Potential Areas for Improvement:

1) Digitalization and Automation:

• Implement electronic health records (EHRs) to streamline documentation and

reduce paperwork.
• Utilize digital tools for pre-admission registration and insurance verification.
• Automate routine tasks, such as appointment scheduling and billing.

2) Patient-Centric Approach:

• Prioritize patient comfort and experience throughout the admission and discharge process.
• Provide clear and concise information to patients and families.
• Offer personalized care and attention to individual needs.

3) Interdepartmental Coordination:

• Enhance communication and collaboration between different departments involved in the

admission and discharge process.
• Establish clear roles and responsibilities to avoid delays and errors.

4) Performance Monitoring and Improvement:

• Regularly monitor key performance indicators (KPIs) related to admission and discharge,
such as average length of stay, patient satisfaction, and time to discharge.
• Conduct regular audits and reviews to identify areas for improvement and implement
corrective actions.

Recommendations:

LXV
 ▪ Conduct a Comprehensive Review: Conduct a thorough review of the current admission
and discharge processes, involving staff, patients, and relevant stakeholders.
▪ Implement Digital Solutions: Invest in digital technologies to streamline processes and
enhance efficiency.
▪ Prioritize Patient Experience: Focus on creating a positive and seamless experience for
patients and their families.
▪ Strengthen Interdepartmental Collaboration: Foster strong communication and
coordination between departments.
▪ Continuous Improvement: Implement a culture of continuous improvement, regularly
monitoring performance and making necessary adjustments.

By addressing these areas and implementing the recommended strategies, NH MMI Narayana
Superspeciality Hospital, Raipur can significantly improve its admission and discharge processes,
leading to enhanced patient satisfaction, operational efficiency, and overall quality of care.

CHAPTER - 8

LXVI
 Conclusion

Conclusion

Narayana Health is considered one of the top hospitals in India for cardiology. The
admission and discharge process in an inpatient department (IPD) is a critical aspect of
healthcare delivery. It involves a seamless transition of patients from the community to
the hospital and back again.

The admission process typically begins with the patient’s arrival at the hospital, where
they are registered and assigned a bed. Upon admission, a thorough medical history is
taken, and a physical examination is conducted. Diagnostic tests may also be ordered to
assess the patient’s condition. Once the initial evaluation is complete, a treatment plan is
developed and implemented.

LXVII
The discharge process involves several steps, including the preparation of a discharge
summary, which outlines the patient’s diagnosis, treatment, and prognosis. Medications
are prescribed, and instructions for follow-up care are provided. The patient or their
caregiver is also educated on any necessary self-care measures. Finally, the patient is
discharged from the hospital and returns home or to a rehabilitation facility.

The efficiency and effectiveness of the admission and discharge process can significantly
impact patient satisfaction, clinical outcomes, and resource utilization. Streamlining the
process can reduce wait times, improve communication between healthcare providers,
and minimize errors. Additionally, a well-coordinated discharge process can prevent
readmissions and ensure that patients receive the necessary care and support upon leaving
the hospital.

LXVIII
 CHAPTER -9
List of References

List of References

▪ Nirupam Gardia [Assistant Manager(L&D)], Dept. of HR NH MMI Narayana

Superspeciality Hospital, Raipur.
▪ Jayant Kumar Yadav (Head of Department), Dept. of Operation NH MMI
Narayana Superspeciality Hospital, Raipur.
▪ Rahul Raj (Manager), Dept. of IPD NH MMI Narayana Superspeciality Hospital,
Raipur.

LXIX
▪ Ayan Chakraborty (Manager), Dept. of Service Excellence NH MMI Narayana
Superspeciality Hospital, Raipur.
▪ Sushant Pal (Assistant Manager of Billing), NH MMI Narayana Superspeciality
Hospital, Raipur.
▪ Ritesh Raj (Assistant Manager of Billing), NH MMI Narayana Superspeciality
Hospital, Raipur.
▪ Divya Pandey (Floor Coordinator), NH MMI Narayana Superspeciality Hospital,
Raipur.
▪ Neha Chouhan (Floor Coordinator),NH MMI Narayana Superspeciality Hospital,
Raipur.
▪ Shubham Saha (Care Coordinator), NH MMI Narayana Superspeciality Hospital,
Raipur.
▪ Sabina Khatun (Care Coordinator),NH MMI Narayana Superspeciality Hospital,
Raipur.

LXX