4. Introduction
• Internal medicine department is one of the four
major departments at HFSUH
• The department was established in 2007 G.C
• Residency program started in 2017 G.C
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5. Cont…
Internal medicine department incorporates
• Regular OPD
• MRC
• TB clinic
• ART clinic
• Internal medicine Ward and
• Medical ICU/high dependence unit
5
6. • Internists
• Neurologist
• Residents
• General practitioners
• Interns
• Nurses
• Runners
• Cleaners
• Guards
Current human power
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7. OBJECTIVES
General objective
• To present the activities of HFUSH Internal
medicine department during month of Sene
2015 E.C. and to identify the strengths and
problems during the month
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8. Cont…
Specific objectives
• To assess the activities of internal medicine ward,
OPD, and medical ICU during the month of sene 2015
E.C.
• To point out the strengths and gaps of the sub
departments.
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9. Methods and Materials
• Study area: HUHFSH Internal Medicine
department
• Study period: month of Sene 2015E.C.
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10. Cont…
• Data source
– HMIS log books
– Patient appointment registry(neurology OPD)
– EMR of ART clinic
– Interviews and direct observations
• Data processing and analysis
– Manual tally sheet 10
12. OUTPATIENT DEPARTMENT STRUCTURE
Cold OPD
– 3 separated rooms having two examination beds
– 1 physicians assigned to each room but 2 nurse for
all
• Chronic Follow Up
– 1- Room and 1 exam bed
– 2 Physicians and 1 nurse are assigned
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13. Cont…
• TB Clinic
– 2 rooms
–1 physician and 3 nurses
• ART clinic
– 2 rooms
– 1 physician and 1 consulting internist
– 4 nurses
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14. As per the 2016 Ethiopian hospital
services transformation guidelines
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16. MediCal Regular OPD
• Total Number of case
seen at OPD= 457
Male =215
Female=242
F/M ratio=1.1:1
• Title
16
Title
female male
17. Cold OPD activities
17
TOP 10 COLD OPD
Cases
Diagnosis Frequency
No Diagnosis Frequency
1 CAP 75
2 UTI 68
3 Dyspepsia/GERD 39
4 AFI 35
5 Anemia 17
5 AGE 9
6 PN 8
7 M.check up 21
8 TB 25
9 Others 63
18. Chronic case seen at COld OPD
18
Month of
sene
Previous
month
No Diagnosis Frequency Propertion Propertion
1 CLD 13 2.8 2.3
2 HF 6 1.3 2.5
3 HTN 33 7.2 0.8
4 Asthma/COP
D
17 3.7 2.5
5 Epilepsy 3 0.65 0.8
6 DM 11 2.4 0.4
Total chronic
case seen
=83
New
case=72
Repeated
case=11
19. Summary
19
No Patient
outcome
Frequency Propertion(%) Previous
month (%)
1 Admitted 18 3.9 4.21
2 Linked to MRC 27 5.9 2.95
3 Linked EOPD 8 1.7 0.1
4 Linked to other
sites
23 5 3.37
5 Neurology
clinic
5 1.09
6 Link not
documented
2 0.5
20. STRENGTHS AND GAPS
STRENGTH
• Relatively good physician numbers and
activities as compared to other team
members
• Separate rooms and examination couches
• Improved MRC linkage as compared to
previous Audit.
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21. Cont ...
• GAPS
• PITC not being done for eligible patients
• No PITC KIT, pulse oximetry, glucometer
,adequate sphygmomanometer and other basic
materials
• incomplete documentation
• Only 2 nurses are assigned, no regularly
available porter and security guards
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22. • Title
MRC activity
Total Number of visit-
532
• M:277
• F:255
• M:FRatio=1.08:1
22
title
Male female
26. STRENGTHS AND GAPS OF MRC AND
NEUROLOGY CLINIC
STRENGTH
• Relatively better documentation of MRC
cases.
• Improved chronic case linkage from ward and
OPD as compared to previous Audit.
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27. CONT…
GAPS
• Inadequate nurses ,no regularly available
porter and security guards
• Shortage of basic equipment including pulse
oximetry, wheel chair, stretcher, patient screen
and so on
• Majority cards are being brought to follow up
OPDs by patient themselves
• Single clerking room for MRC OPD
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28. • Total case seen=575
• Female= 392
• Male -183
• F/M ratio= 2.14:1
• Title
ART clinic
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titles
female male
29. SUMMARY
TOTAL NUMBER OF ADULT PATIENTS ON ART=1892
NEW PATIENT 4
LOST PATIENT 15
TRANNSFERRED out 4
TRACED BACK 24
On 2 nd line 118
ON 3RD LINE ART 3
DEATH 0
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30. STRENGTH AND GAPS
STRENGTH
• Good documentation
• Well equipped and well staffed with nurses
and non clinical workers
• Good patient linkage from Ward
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31. CONT…
GAPS
• Poor communication with physicians(almost
none)
• The patient at ART are evalaulated for their
new compliant at MRC OPD
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32. TB CLINIC
Total Number of visists-
78
• M:45
• F:33
• M:F Ratio=1.36:1
titles
Male
Female
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33. Tb clinic activity
• Total Number of case seen =78
33
EPTB Smear positive Smear negative
25 28 25
34. Overall outpatient activity
OPD PREVIOUS
MONTH
Sene
COLD OPD 474 457
MRC 491 532
NEUROLOGY
FOLLOW UP
133 105
TB CLINIC 87 78
ART CLINIC
562 575
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44. Outcome at neurology ward
44
No Outcomes Frequency Propertion(
%)
Previous
months
1 Discharged
improved
3 25 60
Discharged
the same
15
Transfered
to ICU or
deteriorated
2 16.6 5
LAMA 4 33.3 5
Disappeared 2 25 --
Died 1 8.33 --
45. Equipment at ICU
Equipment Numbers Functional
Standing ICU
monitors
3 2
Portable vital sign
monitor
1 1
Iv infusion pump 0 0
Defibrillator 0 0
ECG machine 1 With no ECG paper
Fridge 0 0
Suction machine 1 1
Bedside U/S 0 0
Emergency trolley with
emergency drugs
0
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46. MEDICAL ICU
Total Number of
admissions -31
• M:16
• F:17
• M:F Ratio=1:1.06
TITLE
MALE
FEMALE
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48. OUTCOME SUMMARY
NO OUTCOME IN THE MONTH OF
sene
IN THE PREVIOUS
MONTH
FREQ PROPOR
TION(%)
FREQ PROPOR
TION(%)
1 TRANSFERRED TO WARDS 16 51.6 14 45.16
2 Transfered to CICU 2 6.4 - -
3 REFFERED 3 9.7 3 9.6
4 DEATH 5 16.12 4 16.12
5 OTHER 5 16.12 5 16.12
6 TRANSFERRED TO NEXT MONTH 2 6.4 3 _
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49. Total Number of
admissions -41
• M:24
• F:17
• M:F Ratio=1.4:1
• Title
Harme Intermidiate ward activity
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title
female male
50. Reason for admission at harme
50
No Diagnosis Frequency
1 HF 7
2 CLD 3
3 Anemia 3
4 DVT 5
5 SCAP 8
6 COPD 3
7 Malaria 2
8 Others(DM,AKI ,
pylonephritis)
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51. OUTCOME SUMMARY
N
O
OUTCOME MONTH OF sene PREVIOUS
MONTHS
FREQ PROPOR
TION(%)
FREQ PROPOR
TION
1 TRANSFFERED TO HIWOT FANA
MEDICAL WARD
13 30.9 14 22.5
2 DISCHARGED 24 57 39 62.3
3 REFFERED 1 1.6
4 LAMA 2
3
3.2
4.8
5 DISAPPEARED 2 4.76
6 DEATH _ 0
7 TRANSFFERED TO NEXT MONTH 6 14.2 3 4.8
8 Not documented 2 7.1 0
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52. LENGTH OF HOSPITAL STAY
INPATIENT SITES
MAX MIN
MALE AND FEMALE 25 DAYS 8 HRS
INTERMIDIATE 19 days 1DAYs
NEUROLOGY 28 DAYS 2 DAY
MEDICAL ICU 20DAYS 4 hrs
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53. SUMMARY OF DEATHS AT ICU AND MEDICAL WARDS
N
O
MRN AGE/S
EX
DX AT
ADMISSION
LOS POSSIBLE
CAUSE OF
DEATH
LOCA
TION
REMAR
K
1 677034 35/F impending
respiratory
failure ?ARDS ?
SCAP+septic
shock+known
pulmonary TB
1
DAY
Hypoxia ?ARDS MICU Poor
prognosis
2 678212 80/M Decompensated
CLD
+ARDS+septic
shock of chest
focus
2
DAY
MOF MICU poor
prognosis
3 677936 18/M Hemhorhagic
stroke
1
DAY
Brain hernation MICU
4 695712 30F Sepsis of GI focus 4 hrs Respiratory failure MICU
5 624675 27m Decompensated
CLD +G4 HE
1
DAY
MICU poor
prognosis
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54. • Strength
• Relatively decreased
number of of LAMA
• Increasec no of referal
• GAPS
• The same HMIS for
male and female
• documentation
• more patients
transferred to MICU
than preveous
Strength and Gaps at medical
ward
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55. Strength and Gaps at Medical ICU
• Strength
• Quick patient transfer to wards
• relatively good documentation
• Decreased number of LAMA as compared to
previous Audit
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56. CONT…
GAPS
• Physician admision & death registory book
• Underequipment of MICU and wards
• No procedure room
• No porter on duty time
• Inadequate bed sheets and no blanket for the
patients
• The issue of tetanus room and TB room is still
unresolved
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57. Strength and GAP at Radiology and
Laboratory Unit
• Gaps
• Only few IX modalities
available
• Serum electrolyte not
arrived fast and not
being done after mid
night
• Incomplete and non
clear documentation
• Pathology
department
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58. Priority problems
• Lost cards at MRC
• Group/mass education
• Pathology
• Duty time porter Vs Radiology
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59. Priority..equipments
• Perfuser, at MICU
• sphygmanometer, pulse oxymetry at cold OPD
• Pulse oxymetry at MRC
• Bone marrow set at wards
• wheelcher ,stretcher at wards
• Lab reagents
• Medications
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