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LVPEI SECONDARY LEVEL EYE CENTRE |
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OBJECTIVE :
The major objective of the secondary eye care is to provide high quality comprehensive eye care available to all with excellence and equity DESIGN :
1. INFRASTRUCTRE a) Building The floor space of rural eye-care centre is 13,000 square feet this is divided into:
As a policy the candidates are recruited from local areas of each rural centre to facilitate greater commitment as well as to provide employment for the local population candidates for various positions are selected through interviews. All the candidates selected are imparted training at International Centre for Advancement of Rural Eye Care L.V.Prasad Eye Institute, Hyderabad. Staff at the rural eye-centre includes: a. Professional :
Service Delivery is broadly described as below: A. Medical
A. Medical i. Out-patient care Patients are schedule with an appointment by the reception staff for out-patient evaluation. While the initial work up is done by an Optometrist, final evaluation & treatment recommendations are given by the Opthalmologists. Every single patient is seen on a slit-lamp biomicroscope, tonometry is done and comprehensive evaluation is done with state-of-the-art equipment to identify blinding diseases. The medical records of all patients advised surgical intervention are sent to patient counseling service. Patient counseling is the art and science of disseminating information to a patient to make/her understands the financial and administrative implications of the surgical advice. This functions as a liaison between the patient and the doctor by giving such information which would help the doctor to devote more time on medical management of patients. Patient counseling, with trained staff, is essentially directed to remove the fears and apprehensions about the surgery advised. This becomes more important for cases with guarded prognosis & our attempts to restore or at least stablilise the patients vision explained. Patient counselors also take care of personalized admissions & discharges of the patient on the Opthalmologists advice. ii. Surgical care Patients are scheduled with an appointment for surgical procedures. While out-patient surgery in actively encouraged, those who opt for surgery as in-patients are admitted one day prior and discharged on the first post-operative day after surgical dressing removal. Surgeries are performed in absolute sterile Operating rooms with state-of-the-art equipment like operating microscope, steam, sterilizers. The concept of one patient operated at a time in the Operating room, is adopted at a time in the Operating room, is adopted with sterile drapes, high quality instruments, sutures, viscoelastic fluids and their intra-operative supplies. All cataract surgeries are performed with an intraocular lens implantation. iii. Nursing care Round-the-clock nursing care is provided with trained Ophthalmic nurses. The patients on admission, are received from patient counseling, prepared for the surgery and managed post-operatively as per the Ophthalmologists advice. The Operating room nurses are specially trained to assist in all latest techniques of Ophthalmic surgery performed in such centers, including sterilization methods and giving anesthetic blocks. The nursing staff works in close co-ordination with the Patient counselors during admission and discharge of the patient. B. Non-Medical i. Patient care service This includes the Reception and patient Counseling. The staff working in these areas is trained in scheduling appointments, to identify patients qualifying for paying and non-paying services, to take a systematic biographical detail of the patient, cash collection and related aspects. They provide comfort and hospitality to every single patient irrespective of whether they belong to paying or non-paying category. ii. Medical Records documentation Every patient is registered with a unique medical record number and his/her case record is documented in a separate folder. All medical records are stored in and retrieved from a medical record library. No medical record is destroyed at any point of time as they are invaluable in terms of patient management, research and training. This department generates patient care statistics periodically, which helps in providing an insight into the performance of the hospital and helps in improved patient care planning with a scientific data base. While patients are not allowed to handle these medical records, they are given comprehensive medical reports on request. iii. Finance and Accounts The concept is to meet the operating (recurring) expenditure, with income generated by the paying service, without depending on outside funding support to run the center. As these rural centers operate with a 50% non-paying service commitment, efficient financial planning and controls are adopted to make the service delivery financially viable. Operating revenues and expenditure are monitored on a daily, weekly and monthly basis to identify areas requiring control or additional financial inputs. iv. Stores and Purchase This works in co-ordination with finance and accounts department. This procedure of material indents, requisitions, issues is systematized to monitor consumption patterns. Stores inventory, order and reorder levels and related controls are maintained to eliminate any pilferage or wastage of material. Planning is done for optimal stocking. v. Personnel All the staff from ophthalmologist to housekeeping assistants is adequately trained before they are allowed to perform their respective functions. Staffing is done to ensure efficient service delivery in all areas. While the ophthalmologist is available around the clock, others staff work on a three-shift systems. Outstanding employees are recognized with monthly and yearly best employee awards, promotions and other such motivational approaches. vi. Community Eye Care & Rehabilitation Program Since traditional methods of eye care delivery in these areas through the concept of eye camps has not been successful in providing an extensive, intensive and ongoing community screening. Therefore, door-to-door surveys, school screening and patient referral to the base hospital for surgery or further management is adopted in these rural eye centers. The irreversibly blind are also identified in this approach and Community Based Rehabilitation (CBR) is done to make them self-reliant and lead independent lifes. C. Ancillary Services i. Optical & Pharmacy Every rural eye center is provided with an optical shop and a pharmacy. These two apart from serving as an ancillary service for the patients, generates revenue for the eye center. ii. Maintenance All aspects of the eye center have to be evaluated periodically and preventive and regular maintenance has to be done. This should be a round clock service. This is essential to keep the downtime of any equipment/service as low as possible. iii. Food & Beverages Food and beverage service (F&B) in a hospital is primarily engaged balanced, nutritious and variety diet who are under medical treatment. The service should meet the specific dietary requirements of the patients, pre-operatively and post-operatively. The food habits of patients should be kept in mind while preparing the menu, as it has to cater to a cross section of the society. F&B service also contributes to patients satisfaction with the eye center. iv. Security Security of the eye center is essential and inevitable for obvious reasons. Insurance of the Center against burglary, fire and other aspects should also be taken care. This is again a round-the-clock service, with proper security protocols, duties and responsibilities. v. Water Adequate availability of water through both municipal supply and a borewell has to be ensured. A concrete/synthetic overhead tank with a pump set should be provided to ensure 24 hours water supply. vi. Electricity Electrical power supply should be obtained from the State Electricity Board. To ensure 24 hours availability of electricity, a 30 KV generator run by diesel is indispensable. vii. Drainage & Waste Disposal A good closed drainage system should be planned, along with septic tanks, to keep the environment clean and hygienic. Wastes from the Operating room, food and beverages etc., could be disposed in a medium sized incinerator. viii. Landscaping Landscaping is important to give the place the required relief form the conventional hospital atmosphere. Natural trees and plants should be grown amidst lush green lawns and a moderate kitchen garden could also be planned to generate revenue for the maintenance of the landscaping. ix. Parking Parking area should be planned to blend with the landscaping, to avoid a dry and barren sight. Parking area for the physically handicapped, general public and staff should be clearly demarcated with relevant sign boards. Direction boards and ground signs for proper traffic regulation should also be provided. 3. FINANCIAL SELF SUSTAINABILITY Lvpei Rural Eye Care model is expected to be financial self sustainable within three-five years by generating revenue from those patients who can afford to pay (40 50%), and those who are economically underprivileged are provided the same service free of cost. Our model has multi-tier paying system in which the service will be the same and the comforts will be different according to the needs and income levels of the patient as following.
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