Situation Analysis of Patient Load at a District Hospital of eastern-northern Rajasthan
Abstract
Picture of public district hospitals is usually is as underused, inefficient and providing poor quality care. So this study was aimed to assess patient load at district level hospital. For the study purpose a district hospital of Eastern-northern Rajasthan was selected and this study was conducted in year 2014 at R.K. Joshi District hospital Dausa (Rajasthan) India. Information about general activities like outdoor, indoor, operations, investigations etc were collected. Other activities like reproductive and child health activities, family welfare activities, immunization activities, Zanani Suraksha Yozana activities etc were also collected. It was found in this study that total 454596 outdoor cases and 31706 indoor cases of various diseases were attended in this year. Bed occupancy rate was 334.64 with average hospital stay 3.2 days. Total 151127 laboratory tests were done in hospital. Total 3003 minor and 474 major operations were performed. In this year 251 Laparoscopic Sterilization, 5 Tubectomies and 4 Vasectomies were done along with other family welfare activities. Total 5312 institutional deliveries were performed and these women were benefited by ZSY.
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Introduction
Health systems are often organized in a "hub-and-spoke" arrangement, with a large district hospital (the hub) having more and better-trained personnel and better equipment than more peripheral clinics (the spokes). If public district hospitals remain underused, inefficient, and providing poor quality care may reflect deficiencies in the entire health system as well as at the hospital level.1
The World Health Organization2,3 envisages that a district hospital should be able to offer diagnostic, treatment, care, counseling, and rehabilitation services provided by predominantly generalist practitioners various disciplines like medicine, surgery (including trauma and orthopedics), obstetrics, mental health, ophthalmology, ENT, pediatrics, geriatrics, rehabilitation and primary health care. Such hospitals will usually provide 24-hour care and be integrated into the district health system at a wider level to provide or support a range of services like health of persons of district with its detailed information, implementation of peripheral primary health care policies, administrative and logistics support to primary health care efforts, communication with the community, curative and chronic care for patients referred from peripheral units, district laboratory services, training and continuing medical education of health workers and students, links between health and other development agenda, development of local solutions to local health problems. Additionally, although the focus has often been on district hospitals as recipients of referrals, a much more dynamic relationship has been proposed4 for many PHC activities such as immunization programs the district hospital is both a provider of services and a coordinating center for information and supplies.
Conclusion
It was found in this study that district hospitals are overburdened with specially the patient load for diagnosis and treatment. Even patients for operations were also averaging 9.93 operations per day. Many other activities like MLCs, Postmortem, disability certification etc. increases this load. But fortunately no maternal and infant death occurred which depicted the quality care in this district hospital.