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Rao Tula Ram Memorial Hospital
Annual Report 2012-13

Annual Report

2012-13

_______________________________

Rao Tula Ram Memorial Hospital

Govt. of NCT of Delhi

Jaffarpur, New Delhi-110073

Tel: 25318444; email: msrtrmh@gmail.com

1. Introduction:

Rao Tula Ram Memorial Hospital, located at Village Jaffarpur in South-west District of Delhi is one of the five peripheral hospitals envisaged in early eighties to reduce overcrowding in larger central hospitals and to provide secondary health care to the citizen nearer to their place of residence.

The Hospital Cell of Directorate of Health Services GNCTD oversaw its plan and construction. It prepared the manpower and equipment plans and got approval of the EFC of Delhi Govt. RTRM Hospital. The hospital was constructed through PWD and started functioning as a Polyclinic in 1989. The Indoor services with 25 beds came up in 1995 and four years, in 1999, all 100 beds were commissioned. Being a rural hospital and due to scarcity of water in the area, hospital faced lots of operational difficulties, shortage of manpower and its services functioned only during day time. Since 2006, this hospital is functioning directly under the Health & FW Dept. and the financial powers of MS enhanced to that of HOD.

2. Some Statistical data about South-West District:

Geographical area 420 sq. Km.
No. of Assembly constituencies 7
Number of villages 88
Number of slums 58
No of resettlement colonies 10
No of unauthorized colonies 80
Total population 22.9 Lakhs (Census 2011)
Population: Sex ratio 836 (Census 2011)
Decadal growth rate 30.62% (Census 2011)
Density per square km 5445 (Census report 2011)
Literacy rate 88.81 % (Census 2011)

3. Organizational Structure:

4. Details of Existing Services at RTRM Hospital:

a. Specialties: Medicine, Surgery, Anesthesia, Radiology, Pediatrics, Orthopedics, Pathology, Obstetrics & Gynecology, Microbiology, Bio-Chemistry, Forensic Medicine & Dermatology, Dental Services.

b. Hospital Services:

  1. OPD with Physiotherapy, Occupational Therapy and a new separate MCH wing for RCH and other family welfare services
  2. Indoor (100 beds)
  3. Operation Theatres (Main, Gynae and Emergency)
  4. Delivery room
  5. Casualty and Emergency
  6. Support Services like MRD, Pharmacy, Laboratory, Radiology, Blood storage, Mortuary, Ambulance, Stores
  7. Outsources Ancillary services: CSSD, Laundry, HKS, Security, Kitchen and Computerized OPD/Emergency Registration

C. Note on Services:

  1. All services except OPD and USG are running round the clock.
  2. Sunday Clinics are held for senior citizen.
  3. Diabetes and HT clinics are held twice a week on Mon and Wed.
  4. AYUSH dispensaries are functioning in RTRMH.
  5. HRD and Training: A state of Art Seminar Room through NRHM Funds is being used for holding training workshops for hospital as well as for IDHS (SWD). Hospital provides technical and infrastructural support.
  6. ATM and public conveniences are available.
  7. Hospital has been selected as Study Centre for IGNOU for its courses run through its School of Health Sciences.
  8. HICC (Hospital Infection Control Committee), Bio Medical Waste Management system is functioning and Hospital is managing its waste as per rules. STP is installed and functioning.
  9. Water: R.O. plant with installed capacity of 1000 KL per day is functioning in the hospital.
  10. Other Services: Help desk for senior citizen.

5. Hospital Performance data for the year 2011-12 & 2012-13:

Areas of the Hospital No. of cases in Year 2011-12 No of cases in Year 2012-13
OPD 373413 386237
IPD 10486 10369
Laboratory Tests 269403 283471
Operations 4060 4127
Casualty Registrations 63792 73014
Medico Legal Cases 5701 6037
Deliveries 2598 2697
Postmortems (5 PS) 229 272
X-RAYs 37038 34630
ULTRASOUND 9490 8858
ECG 11032 12063
Tubal Ligation 165 127
Non-Scalpel Vasectomies 92 59

6. Staff Strength: As on March 2013

Category Sanctioned filled
Doctors 101 82
Nursing staff 88 87
Pharmacist 06 05
Other paramedical staff 42 35
Ministerial staff including officers 37 30
Class-IV staff 122 107
Total 396 346

7. Plan Outlay:

Annual Plan 2013-14

A: - Plan: Revenue – Rs.14 Crores

Capital -- Rs.25 Crores

Total -- Rs.39 Crores

B: - Non Plan:-Rs.23.09 Crores

This Outlay covers expenditure on Medicine/Consumables, Machinery and Equipment, Office expenditure and Salary of the staff

8. Facilities available:

  1. A) Multi-specialty OPD: Timings 9AM to 1 PM:
Medicine Daily Room No. 4,5
Pediatrics Daily 18,19
Gynecology & Obstetrics Daily New Porta Cabin Block
Eye Daily 01
ENT Daily 16,17
Dental Daily 02,03
Surgery Daily 08,10
Physiotherapy/Occ. Therapy Daily 40,41
Orthopedics Daily 20,21

B) Special Clinics:

Clinic Day Room No.
Cancer Clinic Tue, Fri 16
Antenatal Clinic Tue, Thurs, Sat. New Porta Cabin Block
Leprosy Clinic Fri 11
STD Clinic Daily 11
Chest Clinic Daily 59,60
Diabetic Clinic Mon, Wed 4,5
Senior Citizen Clinic Sunday 4,5
Immunization clinic Daily 23

C) Diagnostic Services and User Charges:

Services Charges Room No.
Laboratory Free* 102
X-ray Free 100
Ultrasound Rs.50/-** 100
ECG Free 100
Audiometry Free 15
Colour Doppler Rs.100/- 100

** Free for indoor patients

Sample collection time: Weekdays-9AM to 12 Noon; Saturday- 9AM to 11AM

D) Laboratory: Laboratory is divided into three sub-divisions viz. Pathology, Microbiology and Biochemistry. It is headed by a SAG level officer (Pathologist). Besides routine investigations it also carries out FNAC, PAP Smears and Histopathology. Physiotherapy & Occupational therapy services are also available in the hospital by qualified physiotherapist.

E) Indoor Services: There are four wards on two floors of Indoor block with 25 beds in each. The following facilities are available in IPD:-

  1. Drinking water facility at each floor.
  2. Patient info display system has been installed to give the proper information required.
  3. Public redressal system to improve the patient care.
  4. Air conditioner facility has been installed in all wards.
  5. Laying of tiles of all wards for better patient care.
  6. Dietary services have improved for indoor patients.

The department wise bed strength is as follows:-

Department Bed Strength*
Medicine 15
Pediatrics 20
Surgery 15
Obst. & Gynecology 25
Orthopedics 15
Otorhinoharyngology (ENT) 05
Ophthalmology 05
Total 100

Note: The bed division is not rigid and some flexibility is permitted in need. There is a make shift nursery with 8 cribs/incubators under Pediatrics but is not included in the bed complement.

(F) Casualty Services: - 24-hours casualty services are available in the hospital with specialist backup, X-ray, Lab investigations, ECG. Total of 10 beds are available in Casualty block. There is an Emergency Operation Theater working round the clock in casualty block. Medico-legal services are also available under five police stations of south-west Distt. of Delhi Police.

(G) Ambulance Services: 24 hours ambulance service is available to shift serious patients to higher centers.

(H) Family welfare:-Separate space provided for family welfare services in the port cabin. Contraceptive counseling, distribution of condoms, oral contraceptive pills, emergency pills and copper T insertions are done on all working days. Tubal ligations by Laparoscope & Mini Lap are done in Gynae OT on Monday, Wednesday & Friday. NSV is carried out in a separate OT on all days. The department is participating in all the initiatives under NRHM e.g. JSY, JSSK & IYCF etc.

(I) Operation Theatre Service: There are 3 Operation Theatres available in the hospital. Operation theatre is well equipped for advance surgeries.

i). Main OT: It is equipped to handle all types of cases in the disciplines of General Surgery, Orthopedics, Eye and ENT.

ii) Gynae OT: It is equipped to handle all types of cases of Routine and Emergency Surgeries in Gynae and Obstetrics including abdominal and vaginal hysterectomies, Ovarian cystectomy. Facilities like Tubal ligations, MTP, D&C, and LSCS are being performed routinely.

(iii) Emergency OT Room: It is equipped to handle emergency surgeries in various disciplines.

(J) Labor Room (Delivery Facilities): The delivery room services are operational round the clock in Ward No. 1.

(K) Nursery: A small make-shift Nursery is operational round the clock also in ward no. 1 in the ward block with 8 cribs/incubators providing Level 1 & Level 2 neonatal care.

(L) Mortuary: Hospital provides mortuary services round the clock and post-mortem services between 9 AM to 4PM as and when requested by the police.

9. Computerization and HIMS:

The hospital has been depending traditionally on a paper-based information system but in past one year some initiatives have been taken by the hospital administration an attempt has been made department is backbone of any institution. The RTRM hospital is well equipped with computers and its peripherals. Hospital already has a LAN with 24 nodes and trained staff is also available. In the annual plan an SRS will be undertaken to expand the LAN system, provide computers with internet facility to all departments/units. This activity will be the base for commissioning of full H.I.M.S on lines already implemented for another 100 bedded Delhi Govt. Hospital in West Delhi.

The HIMS project letter has been sent to CDAC for early implementation LAN survey will be completed in 1 month time and after approval from IT Dept and FD the 200 nodes LAN will be functional by 3 months time after survey. Simultaneous after approval from IT Dept and FD procurement of Hardware and Software will be started and Training and Capacity Building of all staff will start from October 2012.

Delay in Hardware and software procurement may delay the Implementation of the Project.

The Main Objectives of the computerized HIMS in RTRM Hospital are aimed in three phases as below:

PHASE I: In this Phase we will establish the total LAN of the Hospital with about 200 nodes and procurement of Hardware, Software and Networking will be done. The Server Room will be established and planned training of all the staff in basic computer knowledge and HIMS will be done.

PHASE II : In this phase all the remaining areas will be equipped with systems and peripherals and HIMS software will be implemented totally.

PHASE III : In this Phase the total LAN of the new building will be established and as soon as the new building is operational all software and hardware requirement will be met and it will be connected to the existing Server Room and integrated with the whole system.

The Expected Outcomes are seamlessly integrated modules, improved Business Processes with reduced paper-work, improved efficiency and convenience to patients to get reports and records. Ultimate goal is to have a ‘Paperless Hospital’ with a complete Electronic Health Record (HER) with unique ID for each patient that can be shared by any hospital of Delhi Govt. through its network of HIMS. The HIMS will provide the right knowledge, at the right time, at the right place, to the right person, in the right form and at the right cost and will assist to conform to NABH Standards.

10. Hospital Infection Control Committee:

The Hospital Infection Control Committee was in the year 2011 for the first time in RTRMH Hospital under the chairmanship of MS and HOO as Co-Chairman. Specialist Microbiology as Member Secretary along with in-charges of various Department, ANS and HICC Nurse.

The Committee looks after issues regarding infection control, BMW, patient safety and other related issues. Daily rounds are carried out to ensure sanitation & hygiene to prevent infections. Regular training and teaching programs of Medical, Paramedical and other staff e.g. waste handlers and Nursing Orderlies are carried out on regular basis. S.O.P.'s have been prepared regarding post exposure prophylaxis for needle & stick injury and have been circulated to various workstations. Hospital is in process of making antibiotic policy.

11.Bio- Medical Waste Management at RTRMH:

Hospital waste is extremely hazardous and if it is not managed properly, it can lead to serious health and environment problem. Hospital waste is different from our domestic waste and must be segregated, collected stored, transported and disposed-off properly. In RTRM Hospital BM waste is being managed as per Bio-Medical (Handling & Management Rule 1998) and DPCC norms. The environment Management group has been constituted and is looking after matters pertaining to Bio-Medical Waste Management and other issues related to environment, in addition to the HICC.

Hospital has an autoclave and shredder for treatment of Cat.7 (red bags). Yellow bags have been lifted by M/s SMS Water Grace Pvt. Ltd as per the agreement with DHS. The liquid waste is chemically treated before drainage. Hospitals also have a Sewerage Treatment Plant (STP) for treating the organic waste.

As per annual report of BMW items for the year 2011, the category-wise data regarding BMW is as under:-

1. Cat 1,3,5,6 (by incineration) - 8530 kg.

2. Cat 7 (by autoclaving & shredding) - 6753 Kg.

3. Cat.4 waste Sharp-790 Kg

Data pertaining to BMW is well maintained and monthly, quarterly and annual report is sent to DPCC and DHS. Regular rounds are taken to ensure proper segregation/ management of bio-medical wastes by its handlers.

Hospital has applied for authorization for consent to Operate/Establish under Air and Water Act to DPCC. Standard operating procedures (SOPs) have been laid down for BMW Management

12. Disaster Management:

The Rao Tula Ram Memorial Hospital has prepared its own Disaster Management Plan which includes a team of officers and staff and every officer has been entrusted with a special task in the light of preparedness of Disaster Plan.

This hospital is situated in the outskirts of Delhi in South West District is a 100 bedded multi-specialty district hospital. It receives about 1500-2000 patients in its OPD daily half coming from across the border from neighboring district of Haryana. South West District is identified as disaster prone district due to its location in seismic zone 4 and presence of huge quantities of fuel stored by Indian Oil and other Oil companies. It’s also caters Indra Gandhi Domestic and International airport. Its nearest hospital are DDU Hospital about 25 KM and Safdarjung Hospital, AIIMS Trauma centre about 35 KM Delhi is very much vulnerable for both natural as well as manmade disaster. Delhi is prone to all type of Disaster

A. Natural Disaster Earth quack, flood, etc.

B. Man-made Disaster: Terrorism, fire, explosion, accident and civil disturbance etc.

Types of disasters/hazards expected in south west district of Delhi are as under:

1. Vehicular accidents and aircraft emergencies

2 Bullet and Blast Injuries

3. Collapse of building

4. Fire in adjoining area and in Indian Oil Depot

5. Food poisoning---Gastroenteritis

6. Drowning

7. Natural Disaster.

Peculiarities/Problems of Disaster Plan Coordination.

  1. Sudden occurrence
  2. Mass casualties
  3. Problems of rescue/evacuation
  4. Heavy requirements of blood/blood products and medicines.

Mock Drill for disaster preparedness: In the recent past a mock drill was conducted on 15-02-2012 in the hospital premises and the targets were achieved successfully that had been planned to check preparedness according to disaster situation.

Handling of disaster occurred in nearby village: After mock drill a major incident was reported here on 16-02-2012 it was as equal as disaster in which people at least 200- to 250 of a village were in a great trouble due to food poisoning. The Hospital’s officers and staff successfully managed the situation independently. The Disaster Management Team is, therefore, fully prepared to combat any disaster at any time.

13. Coordination and Control:

The Medical Superintendent is the overall in-charge and head of the Department of this hospital. He exercises complete control over the staff posted here. He is ably assisted by DMS, CMO, Specialists, SMO, MO, SR, JR, ANS, OS, SO, AAO.

Medical officers are assigned various administrative duties beside the clinical work.

The Medical Superintendent personally evaluates and supervises the work of each unit in regular meetings with the DMS, CMO, Specialists and respective medical officer in-charge of the units; he discusses the problems and tries to find the solutions for each one of them thereby improving the quality of hospital services and patient care constantly.

DUAC and fire clearance for setting up of a separate ward of 100 beds has already been obtained and Environmental clearance is awaited. Ms is taking up the matter with consultants and EE for speedy approval etc.


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