BPMNBusiness Process Model and Notation

model the current (as-is) scenario for an admitted patient's stay(the section, "In-House Treatment" starts on page 213) from the doctor's determination that admission is necessary through the patient's discharge.

Note the following:

a)The process has many actors involved, be sure to document all of them.

b)You may use the (+) symbol where appropriate.

In-house treatment

The hospital has four separate wards-one each for (i) males,

(ii) females, (iii) children and expectant women, and (iv) the

clergy. Twentyfifive patients can be accommodated in each

ward except the one for the clergy, which can accommodate

only up to 10 patients at a time. On any given occasion, all the

wards except for the ward for clergy are full and in total

accommodate an average of 75 patients a day.

Despite being recommended by a doctor at the OPD or a

clinic, not all patients are accommodated for in-house treat[1]

ment because of lack of capacity. However, in case of capacity

problems, special preference is given to patients who arefifirst[1]

time patients waiting to be admitted. Patients who have been

admitted at the different wards on prior occasions will only be

admitted if 3 months have elapsed after the last date of them

being discharged from the ward. This is recognised as a

general rule applied by the hospital to provide its services to

the majority of the masses who seek in-house medication at

the hospital.

To admit a patient to a ward, a referring doctor mustfifirst

informally check the available ward capacity by consulting

with the ward staff. The Chief Medical Offificer (CMO) at the

OPD is also kept informed about the ward occupancy details

by the duty nurse on a daily basis.

The patient takes the prescribed admission document

offered by the doctor to the Resident Medical Offificer's

(RMO) offifice. The RMO at this stage approves the patient

admission. The RMO considers both patient details and the

availability of space at the wards before approving admittance

to the ward. Upon approval, the patient's details are provided

by the patient or the patient's guardian to the staff (most

probably a clerk) at the RMO's offifice who completes an in[1]

house registration application for the patient. The application

form includes details such as the name, age, gender, marital status and residential address of the patient and/or guardian.

The patient and the guardian then leave for the ward with the

in-house registration application and hands it over to the

nurse in-charge of the ward at the particular point in time.

The nurse will then record details of the patient in the log

book maintained at the ward. As a general hospital rule, in[1]

house patient admissions are only allowed from 8.00 am to

11.30 am and 2.00 pm to 3.30 pm.

Upon admission, the patient is given a special ward-patient

ID number. This number is different from the number that the

patient was initially registered with. A separate patient register

is maintained in each ward by a nurse that includes details

such as (1) the number of cases from the commencement of

the year, (2) number of cases from the commencement of the

month, (3) the name of the patient, (4) age of the patient, (5)

gender of the patient, (6) marital status of the patient, (7) the

religion and ethnicity of the patient, (8) date and time of

admission to the hospital, (9) number of days the patient was

ill before admission or the date on which he/she fell ill and

(10) place at which he/she fell ill or was wounded. Upon

discharge, the date and time at which the patient was

discharged will also be noted in the register. Once a patient is

admitted to a ward for in-house treatment, they will be subject

to care and medication from the staff at the ward. As soon as

the patient is admitted to a ward, the doctor-in-charge is

informed who then examines the patient. If the doctor-in[1]

charge is not available, another available doctor or the RMO

will be informed to examine the patient.

The doctors, who are in-charge of the wards, will examine

the patient and prescribe medicine and diets, and conduct

various medical examinations (e.g., urine, blood pressure,

heart, etc.) of the in-house patients on a daily basis. These will

be recorded separately for each patient in the prescription

forms (containing patient's name, details of prescribed medi[1]

cines and dietary requirements) used for in-house patients.

Apart from this, the patient's condition is also recorded on a

daily basis by the doctor.

The average cost incurred by the hospital for an in-house

patient's medicine amounts to Sri Lankan Rupees (LKR)

1500.00 (see Appendix for some further details related to costs

described here and currency conversions).The treatments

specifified by the doctors will be provided by the nurses and

the attendants at the wards. The wards also have very basic

facilities of toilets, bathrooms and eating spaces for the

patients. Certain equipment within the wards was donated by

the patients and their caretakers. However, because of limited

infrastructure, some of the equipment has not been used. The

archaic design of the ward does not provide adequate privacy

for patients. Female patients have to take additional steps on

their own to ensure their privacy. The admission capacity can

be increased by utilising the ample space available at the

hospital (the hospital sits in an area of 18 acres of land with

suffificient buildings already established and in good condition,

which are not used in a very'space-wise'manner). The

inadequate furniture for visitors makes it diffificult for them to

manage their visits to the ward patients.

In-house patients are examined daily by the doctor-in[1]

charge. They will decide on the patient's condition and make

the decision whether the patient needs further in-house

treatment or is ready to leave for home. If a patient is notfifit

to leave for home, they will continue to remain at the hospital

on medication and under daily monitoring. The ward staff

although few in number to attend to all the work relating to

the in-house patients, try their utmost best to serve the

patients well. If it is decided that the patient no longer needs

treatment in-house, the patient will be set for discharge and

will be informed of it. In most cases, patients are advised by

the ward-in-charge doctor to continue with the prescribed

medication at home. The patient will have to purchase the

prescribed medicine externally if it is not available at the

indoor dispensary (IDD).

On certain occasions, because of the unavailability of

adequate space and inadequacy to handle a large number of

patients, certain patients cannot be accommodated in the

wards, and, therefore, they are required to visit the wards for

treatment either on a daily basis or on specifific days.

The records of the patients'medication history are kept at

the ward in a separate summary patient register. This is

maintained by the ward staff during a patient's stay.