Student Dissertation

Agency : Conversion of OPD to IPD; Out-Patient Department; In-Patient Department; Hospital Admission process

Objective : • To calculate the conversion of out-patients to the in-patient department • To determine the reasons for non-conversions • To describe the profile of the admissions

Background : The OPD is considered as the landing place in a hospital. Patients from various areas, locations, as well as seeking different services come to the hospital. There are various touchpoints or service touch points as we call them, where patients seek services offered by the hospital. The conversion data from the out-patient department to the in-patient department will provide us with the idea of a number of patients (out of the total advised for admissions) that are converted to in-patient department (admission towards) giving the number actually getting converted. The next step would be to calculate the number of non-conversions, i.e. the patients not getting admitted even after advice for admissions, their reasons for the same.

Methodology : Study Design- The study design is a Cross-sectional study with a descriptive design. The data of converted patients was recorded daily and at the end of study duration, it was analyzed based on the reasons for non-conversion and the details of the ones getting converted. Duration of Study - The study duration was from 1-Mar-18 to 30-Apr-18. Sample Size - The sample size is 280, including all patients advised for admission. Sampling Technique - Purposive Sampling, including patients advised for admission into the in-patient department. Inclusion Criteria - Patients coming to the out-patients department and further advised for admission by consultants. Exclusion Criteria - Emergency cases converted to in-patient department. Data Collection Procedure - Primary data would be gathered, analyzing the consultant’s prescription copies to collect the data of the ones advised for admission. Data Analysis - The data would be analyzed using MS-Excel. Firstly, the total number of patients visiting OPD and those that are advised for admission would be calculated. Out of the total advised, the ones getting converted would be recorded and the reasons for non-conversion analyzed.

Findings : The following were the results of the total sample data-analysis: -> Conversion of OP patients to IP Admissions- a) Admitted- 81% b) Not-Admitted – 19% -> Doctor’s Category-wise admissions- a) Physician’s- Admitted- 78%; Not-Admitted- 22% b) Surgeon’s- Admitted-86%; Not-Admitted- 14% -> Reasons for non-admissions: a) Follow-up after children’s exams b) Awaiting approval from respective credit authorities c) Not willing d) Financial reasons e) Location constraints (outskirts of Nagpur) -> Analysis of Admitted Patients a) First-consultations/Follow-up based admissions- C- 63%; F- 37% b) Medical/Surgical based admissions- M- 74%; S- 26% c) Cash/ Credit based admissions- Cash- 69%; Credit- 37% d) Length of stay- (1-5) days-64%; (6-10) days-27%; (11-16) days- 8%; (17-22) days- 1%

Recommendations : In my study, the conversion of OP patients to IP admissions was 81%. The major reason for non-conversions- patients were not-willing for admissions; other reasons cited were financial reasons, location constraints (outside of Nagpur), following later after children's exams and awaiting approval from respective credit authorities. Of the total admitted, 63% were first-consultations; rest was follow up. 74% were medical, and the rest were surgical admissions. Cash-based admissions were 69% and credit-based was 31%. Majority of the admitted patients had a length of stay for (1-5) days-64%; (6-10) days-27% and the rest 9% had a length of stay greater than 10 days.

Research Question: • What is the percentage of conversions of patients (from those advised) from out-patient department to the in-patient department? • What are the reasons for non-conversions? • What is the profile of admissions in the hospital?