Entry Level COP2

COP 2: Emergency services including ambulance are guided by documented procedures and applicable laws and regulations.

a)     Whenever a patient is arrived in emergency the receptionist informs the available resident doctor about the same and the instructions of doctor are obeyed. For initial assessment of such patients the following steps are observed.

SOP for Initial Assessment of Emergency Patients
Sr. No.	Process Flow
1	All patients who come to the OPD as emergency shall be assessed and entered in Register.
2	The following parameters shall be assessed in detail: ·         Chief complaints ·         History of illness ·         Allergies or any associated disease ·         Physical examination of the patient
3	In case of mass casualties, triage shall be completed first, and then followed by assessment.

In case of patient arriving as medico-legal case a MLC form as displayed below is filled in and sent to the police and acknowledgement obtained. The case paper is stamped with MLC in bold.

Format for MLC Intimation

To The Police Inspector, MLC NOTIFICATION We have received the following patient and request you to intervene as we suspect this case as MLC (This form should be filled by the Doctor while admitting/discharging the patient) Patient                                                 Patient identification mark/L.H.T.I        Name:…………………………………           …………………………………….. Address:……………………………………………………………………………………… Age: …………Sex:………M/F:……………UHID( Registration No) :……………….. REMARK:- 1. Treatment on OPD basis:…………………………………………………. 2. Admitted on:…………….at……………….IP No.:………….MLC No.:………… 3. Otherwise:…………………...                   Date:                           Time: Patient Brought:……………………………………………………………………………… Treating Doctors:……………………………………………………………………………. Admitted by.:………………………………………………………………………….. Observation of injuries/history while admitted: Date/Time of admission/Discharge/Death: …………………………………………….. Doctor

In case of medico-legal cases the following steps are observed

SOP for MLC
Sr. No.	Process Flow
1	All complaints and events shall be recorded.
2	Each event shall be recorded in detail including the date, time and place of the event and involvement of person and/or objects during the event.
3	Each case should be intimated to the relevant police station by phone after counseling the patient and relatives about the hospital policy and procedures. The name and buckle number with designation of the police personnel who has taken down the information along with date and time shall be noted. A written intimation shall be prepared and given to the police.
4	All MLCs after registration are to be issued for OPD / IPD cases and should be marked “MLC”, MLC number shall be stamped on all paper and patient records.
5	Clinical notes shall be entered in IPD/OPD case paper. a.    Examine the patient for all types of disease or injuries. Take a detailed history of the event. Start the medical management as required. Inform the concerned Consultant accordingly; proceed further with the necessary investigations. b.    For all MLCs, the patient record must be filled up and all columns completed. c.     While filling the record, place special emphasis on identification marks, who the patient was brought by, the site of accident, name, age, sex, date, time of arrival and detailed examination of the injury. d.    In assault or trauma cases, the left thumb impression of the patient along with two marks of identification is mandatory to identify the patient – whether conscious or unconscious. e.     Obtain the consent of the patient and a declaration that “I have shown all my injuries to the Doctor on Duty”. This is mandatory in assault cases. f.      No information about any document or investigation shall be released in any MLCs unless an authority letter from the patient himself or court order, and/or a police requisition note is received.  Police requisition should pertain to queries.
6	A separate entry in the register shall be maintained for each MLC with the required information.
7	A counter-signature from the police station shall be taken from the representative in a patient’s MLC form/book.
8	The time of informing the police and time of arrival of the police shall be entered in the MLC form.
9	In case the police do not arrive within two to four hours of MLC report, a reminder shall be sent asking for an acknowledgement.
10	If any patient registered under MLC dies during hospitalization, post mortem is a mandatory procedure and the patient’s body shall not be handed over to the patient’s relative but to the respective police station in order for the post mortem to be conducted at the district hospital.
11	A case summary shall be provided to the police at the time of handing over the dead body for submission to the district hospital.
12	When MLCs are discharged, the relevant police station shall be notified.
13	A copy of all reports of investigations shall be kept in the MRD file before discharging the patient.
14	After handing over the documents and reports to the patient, the patient or relatives signature shall be obtained for the MRD file.
15	After discharge, MRD files of all MLCs shall be stored separately and be under the control of designated person.
16	Admin shall preserve the copy of the signed certificate in the patient’s record.
17	At the time of handing over the certificate to the police, the designation and the buckle number of the police shall be noted in the second copy and the signature of the police taken.
18	The original injury certificate shall only be issued to the police and not to the patient or relative.

b)   Staff is trained to give due priority for patients arriving in emergency. Since _______Hospital is a multi speciality hospital the staff was trained for all type of emergency patients. In case if such patient arrives when the medical team is in OT or not present then the staff is trained to transfer such patients as per policy.

c)      Emergency patients are seen by the Duty Doctor & concern Consultant and a suitable treatment plan is prepared and executed in consultation with the patient or accompanying person. In case the patient doesn’t need any further investigation or treatment he/ she is sent home. In case the patient cannot be handled in ________Hospital the transfer is made as per requirement. All the activities are documented.

SOP for referral out or transfer out of patient when Medical professional  is not present in the premises
Sr. No.	Process Flow
1	Transfer out or referral out shall be done through OPD consultation, Emergency or IPD Services.
2	The Duty Doctor will talk to concern consultant and find out if he/she can come immediately or the patient should be transferred to the nearest Hospital. The Patient or the accompanying person is briefed about this situation and guided to the nearest health care facility as advised by Concern Consultant. In case if the Consultant is inaccessible, then the patient is referred to the nearest Hospital. Travelling arrangement is discussed with patient or their attendant and if required suitable ambulance is called for transportation.
3	Verbal consent for transfer out/referral out is obtained from the patient or relative or accompanying person.
4	The order for transfer out/referral out shall be mentioned in the Emergency register with patient’s name, date, time.
SOP for Inpatient admission
Sr. No.		Process Flow
1		Inpatient admission shall be done through OPD consultation, Emergency & by appointments.
2		Patients case paper is checked with patient details & admission checklist is filled ,consent for admission and treatment is obtained from the patient and/ or the patient’s relatives.
3		At the admission counter the availability of investigation reports, fitness certificate if required & case file  is checked
4		The patient is received room facility as per facility or patient condition at the time of admission. The treatment is initiated as per the order.