SCOPE OF SERVICE WORKSHEET



Scope of Service

Internal Medicine Department

|Department/Service: Internal Medicine |

|Form Completed by: |

|Dr.Abdulrahman Al shaikh (Director Of Internal Medicine Department) |

|1.Unit Description |

|1.1 Mission |

|To provide safe and effective preventive and therapeutic health care services covering all subspecialties of Internal Medicine including, |

|endocrinology, nephrology, pulmonology, heamatology, gastroenterology, rheumatology, medical oncology, dermatology. This service is provided for |

|adult and geriatric patients of both sexes attending Dr. Soliman Fakeeh Hospital through organized experienced teamwork. |

|1.2 Vision |

|To be the leading internal medicine department in the Middle East by providing the best medical care practices to our patients, continuously |

|improving quality of care techniques and continuous education of our staff with an outreach of care to our community. |

|1.3 Goals: |

|1.3.1 Achieve better quality of patient care as guided by quality indicators. |

|1.3.2 More emphasis on staff and patient education. |

|1.3.3 Introduction of new therapeutic and diagnostic techniques. |

|1.3.4 More respect to patient and family rights. |

|1.4 Days and Hours of Operation |

|The department of medicine is on duty 24 hours a day, seven days a week including national and religious holidays. |

|1.5 Staff availability |

|Consultants cover sixteen hours per day from 9 am - 1am and 8 hours on call 1am-9am.Specialists cover 24-hour service. |

|2. Patient Population |

|2.1 External customers |

|Internal Medicine services are available to all in-patient and outpatient adults and geriatrics patient of both sexes and all races regardless of |

|financial class on emergent, urgent and elective basis. Total number of patients attending outpatient clinics of Internal Medicine Department was |

|67847 patients during the previous 10 months. |

|2.2 Internal Customers |

|2.2.1 Service Type: |

|- In-patient |

|- Outpatient |

|- Emergency |

|2.2.2 Medical Services: |

|Endocrinology |

|Nephrology |

|Pulmonology |

|Respiratory care services |

|Gastro-enterology |

|Hematology |

|Medical Oncology |

|Rheumatology |

|Dermatology and Venereology |

|Staff health |

|Infectious diseases |

|2.2.3 Level Or Intensity Of Patient Care: |

|Acute |

|Chronic |

|Intensive |

|Check-up. |

|2.2.4 Patient Age: |

|Adolescent |

|Young adult |

|Middle age |

|Older adult including geriatrics |

|N.B.Some Specialties like Dermatology, Oncology, Hematology, Respiratory Care Services and Nephrology can check patients from younger age. |

|2.2.5 Patient Origin: |

|National |

|Non-national |

|2.2.6 Patient Physical Capacity |

|Movement impaired |

|Wheel chair bound |

|Bed bound |

|Vision impaired |

|Hearing impaired |

|Speech impaired |

|3. Assessment Process |

|3.1 Departmental procedures |

|3.1.1 Endocrine procedures: |

|Anterior pituitary function test, ITT (insulin tolerance test). |

|Glucose tolerance test. |

|Combine GlT and glucose tolerance tests. |

|Synactine test. |

|LHRH or GnRh test. |

|Colindine stress test. |

|Arginine stress test. |

|TRH stimulation test. |

|24 hrs. glucose monitoring (sensor). |

|Install s.c. insulin pump. |

|Thyroid FNA. |

|3.1.2 Nephrology Procedures: |

|Hemodialysis. |

|Peritoneal dialysis |

|Through cooperation with other departments: |

|Anesthesia: subclaviculian catheter, internal jugular catheter, permicatheter. |

|U/S: ultrasound guided renal biopsy. |

|3.1.3 Pulmonary procedures: |

|Pulmonary function testing. |

|Simple spirometry. |

|Spirometry before and after bronchodilators. |

|Diffusion lung capacity. |

|Procedures in cooperation with other departments e.g thoracic surgery and radiology |

|Bronchoscopic work-up. |

|Thoracocentesis. |

|CT Guided aspiration and biopsies. |

|Interpretation of sleep studies |

|Diagnostic and therapeutic CPAP and BIPAP |

|Respiratory Care Services other than the abovementioned: |

|Chest physiotherapy, Breathing exercises, incentive spirometry, oxygen therapy, care for ventilators and other respiratory care equipment, etc. |

|3.1.4 Hematology Procedures: |

|Bone marrow transplantation. |

|Bone marrow aspiration. |

|Bone marrow biopsy. |

|Transfusion of blood products |

|RBC exchange. |

|Plasma exchange. |

|3.1.5 Gastroenterology: |

|Upper gastrodeodenoscope. |

|Colonoscopy. |

|ERCP |

|Gastrostomy tube. |

|Through cooperation with other departments: |

|Ultrasound: ultrasound guided abdomenal paracentesis, ultrasound guided |

|liver biopsy |

|3.1.6 Rheumatology Procedures: |

|Joint aspiration for synovial fluid analysis. |

|Intra-articular injections |

|Ultrasound guided intra-articular injections of the hip joints. |

|Injection of musculoskeletal soft tissues. |

|C.T guided injection of the costo-vertebral joints. |

|3.1.7 Oncology Procedures: |

|Screening for cancer. |

|Chemotherapy treatment. |

|Radiation therapy service for: |

|External irradiation. |

|Brachytherapy for cancer cervix. |

|3.1.8 Dermatology unit Procedures: |

|Electrocautery. |

|Cryocautery. |

|Intralesional injection (Dermojet). |

|Phototherapy. |

|Photo chemotherapy. |

|Skin biopsy |

|Skin Bencard test. |

|Skin Desensitization Vaccination. |

|Botox injection. |

|Camedo and milia extraction. |

|Dermabrasion. |

|Chemical peeling |

|Facials |

|3.1.9 Staff Health Clinic Procedures: |

|Pre-employment assessment. |

|Immunization program implementation. |

|Primary care of employees. |

|Determination of limitations to work assignments. |

|Work restriction determination. |

| |

|4. Staffing Requirements |

|4.1 Position Tittles and licensure or specification requirements |

|The department of medicine is directed by MD (or its equivalent)-certified internist and is staffed by MD (or its equivalent), certified internits, |

|Master degree (or its equivalent) certified specialists in different, subspecialities and certified registered nurses/technicians/therapists in |

|specialty care units. |

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|4.2 Organizational Chart |

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|[pic] |

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|4.3 Continuing Education and Training policy and requirements |

|All department staff is required to attend the hospital orientation upon employment in the organization, in addition to departmental orientation by |

|director of medicine or his designee. |

|All internal medicine staff are required to attend weekly department meeting including various activities as mini lectures, journal clubs, case |

|presentations. |

|Attendance and participation of monthly CME program within the hospital |

|All medicine department staff should be BLS certified. |

|5. Modalities used |

|5.1 Diagnostic/detection Modalities needed: |

|5.1.1 Endocrinology: |

|Glucometer |

|Orchidometer |

|Tuning fork. |

|Ophthalmoscope |

|Proctoscope. |

|Rigid sigmoidoscope and biopsy forceps. |

|Needles for fine needle aspiration. |

|Continuous glucose monitor. |

|Subcutaneous insulin pump. |

|5.1.2 Nephrology: |

|Monitor- biopsy needle, glucometer |

| |

|5.1.3 Pulmonology: |

|spirometery and Diffusion Capacity Machine. |

|Peak flow meter, pulse oximeter, bronchoscopy set, CPAP, BIPAP. |

| |

|5.1.4 Hematology |

|Bone marrow biopsy needle. |

|5.1.5 Gastroenterology unit: |

|Upper endoscopies,sigmoidoscope,colonscope, ERCP,liver ,gastric and colonoscopic biopsy |

|5.1.6 Rheumatology unit |

|Equipment for synoval fluid aspiration |

|Goniometer |

|Nail fold capillaroscope |

|Magnifying lens |

|Meter |

|5.1.7 Oncology modalities: |

| |

|5.1.8Dermatology unit: |

|Punch biopsy |

|Bencard test |

|Needle aspiration |

|Skin scrapper |

|Probes and culture media |

|5.1.9 Staff health unit: |

|Glucometer |

|5.2 Therapeutic/corrective Modalities needed |

|5.2.1 Endocrinology therapeutic equipments: |

|Glucometer |

|Orchidometer |

|Tuning fork. |

|Ophthalmoscope |

|Proctoscope. |

|Rigid sigmoidoscope and biopsy forceps. |

|Needles for fine needle aspiration. |

|Continuous glucose monitor. |

|Subcutaneous insulin pump. |

|5.2.2 Nephrology: |

|HD machine |

|Defibrillator |

|PD set |

|Sublavian and internal jugular catheters. |

|5.2.3 Pulmonology: |

|Thoracentesis set |

|Bronchoscopy set |

|Nebulizer (jet and ultrasonic). |

|CPAP and BIPAP |

|Other respiratory care services modalities e.g. oxygen therapy equipment, incentive spirometers, suction systems, oxygen cylinders, etc. |

|5.2.4 Hematology |

|Cell separator, Hickman catheter. |

|WBCs filters |

|chemotherapy infusion pumps. |

|5.2.5 Gastroenterology unit: |

|ERCP, varicel injection and ligation,gastrostomy,polypectomy and paracentesis. |

|5.2.6 Rheumatology unit |

|Corticosteroid injections. |

|Lowerlock needles and injections. |

|Local anesthetic injections. |

|Local anesthetic spray. |

|5.2.7 Oncology modalities: |

|Urinary bladder catheterization for intravesical chemotherapy. |

|Chemotherapy infusion pump. |

|Simulator for planning Oncology patients. |

|Amersham brachytherapy applicator for caecium intracavitary. |

|5.2.8 Dermatology unit: |

|Phototherapy |

|Photochemotherapy |

|Electrocautery |

|Cryocautery |

|Intralesional injection (Dermojet) |

|Dermabrasion |

|Chemical peeling |

|Skin desensitization vaccination |

|Comedo and milia extraction |

|5.2.9 Staff health unit: |

|5.3 List the procedural Modalities needed |

|5.3.1 Endocrinology: |

|Consent for FNA thyroid. |

|Clinical protocols for dynamic endocrine testing. |

|5.3.2 Nephrology: |

|Consent for HD/PD/ renal biopsy/ subclavican/ permicatheter catheter |

|5.3.3 Pulmonology: |

|Consent form, checklists. |

|Respiratory Care services forms e.g. respiratory Care Services request form, respiratory therapy follow up form, ventilator flow chart, etc. |

| |

|5.3.4 Hematology |

|Consent form for blood transfusion. |

|Consent form for central line insertion. |

|Consent form for chemotherapy administration. |

|Consent form for stem cell donation. |

|Consent form for bone marrow transplantation. |

|Checklist for chemotherapy administration. |

|5.3.5Gastroenterology unit: |

|Consent form for endoscopy, biopsy and paracentesis. |

|5.3.6 Rheumatology unit |

|Consent forms for instituting cytotoxic and other immunosupprecive agents |

|5.3.7 Oncology modalities: |

|Consent form for chemotherapy and radiotherapy. |

|Checklists for chemotherapy preparation for every patient. |

|Checklists for chemotherapy administration for every patient. |

|Checklists for accuracy of radiation machines. |

|5.3.8 Dermatology unit: |

|Consent form before retinoid intake. |

|Consent and checklist before operation. |

|5.3.9 Staff health unit: |

|Software for specific services foe staff health, data analysis software, computer system |

|protocols for staff immunization. |

|OVR for sharp needle injury/on the job injury/communicable disease exposure. |

|Medical history questionnaire from |

|6. Support Service |

|6.1 Communication chart |

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|[pic] |

|6.2 Departmental Committees and Meetings |

|Weekly department meeting for medicine. |

|Pharmacy and therapeutic committee monthly. |

|Blood utilization committee every month. |

|General check-up task force committee every two month. |

|Renal dialysis committee every 2 month. |

|6.3 Communication methods with other Departments/Divisions/Services |

|Referrals |

|Meetings |

|Memos |

|Memorandums |

|Personal communication |

|6.4 Standard of Practice |

|Evidence based medical data. All policies are reviewd and approved by Director of Internal Medicine and subjected to chief medical officer approval |

|where applicable. |

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|Endocrinology: |

|American Diabetic Association ADA |

|American Endocrine Society. |

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|Nephrology |

|American society of nephrology. |

|EDTA |

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|Pulmonology: |

|American college of chest Physicians. |

|European Respiratory Society. |

|American Association of Respiratory Care (AARC) Clinical Guidelines. |

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|Hematology: |

|American Association of Hematology |

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|Gastroenetrology: |

|American society of Gastroenetrology |

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|Oncology |

|American society of clinical oncology. |

|European society of clinical oncology. |

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|Dermatology: |

|American Academy of Dermatology |

|European Society of Dermatology and Venereology |

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|Rheumatology: |

|American College of Rheumatology |

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|Staff Health |

|American college of Occupational and Environmental medicine. |

|MOH standards. |

|MRQP standards. |

|JCI standards. |

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|Hyperbaric oxygen therapy unit: |

|American society of aerospace medicine. |

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|7. Approval |

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|7.1 Prepared by: _____________________________ Date: 30/04/2006 |

|Internal Medicine Department Director |

|Dr. Samir Sally |

|7.3 Approved by: |

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|______________________________ Date: 30/04/2006 |

|Chief Medical Officer |

|Dr. Bravo Badee |

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|_____________________________ Date: 30/04/2006 |

|Owner & Director General |

|Hospital Executive Committee, Chairman |

|Dr. Soliman Fakeeh |

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Medical Records

Nursing Department

Biomedical Engineering

CSSD

Infection Control

Specialty Technician

Laboratories

Nuclear Medicine

Radiology

Physical Therapy

Administration

Dietetic Dept

Surgery

Departments

The Internal Medicine Department Communication Chart

Department of Internal Medicine

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