Quyết định 1313/QD-BYT

DECISION

GUIDANCE ON PROCEDURES FOR MEDICAL EXAMINATION AT OUTPATIENT DEPARTMENTS OF HOSPITALS

MINISTER OF HEALTH

Pursuant to the Decree No. 63/2012/ND-CP on functions, tasks, entitlement and the organizational structure of the Ministry of Health dated August 31, 2012 by the Government;

At the requests of Directors of the Agencies of Medical Services Administration and Directors of the Departments of Health Insurance.

DECISION

Article 1. This Decision is issued together with the guidance on procedures for medical examination at Outpatient Departments of hospitals.

This guidance is promulgated with the purposes of simplifying cumbersome procedures, saving time and improving quality of medical examination and treatment.

Article 2. This guidance applies to public and private hospitals and clinics having sickbeds

Article 3. This Decision comes into effect from the date of signature and issue.

Article 4. The Chief of the Ministry Office , Directors of Agencies of Medical Services Administration, Directors of Departments of Health Insurance, the Chief Inspector of the Ministry of Health, Director of Departments and Agencies affiliated to the Ministry of Health, Directors of hospitals or clinics having sickbeds affiliated to the Ministry of Health, Director of Departments of Health of provinces and centrally-affiliated cities (hereinafter referred to as provinces), Heads of medical specialties and relevant agencies shall be responsible for the implementation of this Decision.

GUIDANCE

PROCEDURES FOR MEDICAL EXAMINATION AT OUTPATIENT DEPARTMENTS OF HOSPITALS
(Promulgated together with the Decision No.1313/QD-BYT dated April 22, 2013 by the Minister of Health)

I. PURPOSES

1. Ensure the consistency of procedures for medical examination across all hospitals.

2. Provide hospitals with instructions on simplification of cumbersome procedures for medical examination, especially for patients having health insurance cards (hereinafter referred to as insured patients).

3. Clarify procedures for medical examination to patients.

II. GENERAL RULES

1. Provide patients with clinical and subclinical examinations and techniques for medical examinations according to specialties.

2. Ensure the reasonability and equality between insured patients and uninsured patients.

3. Simplify procedures regarding to payment and co-payment for hospital charges.

III. OBJECTIVES

1. Duration of medical examinations:

a) Physical examination: average duration of under 02 hours

b) Physical examination with 01 techniques of medical testing/ diagnostic imaging or functional diagnosing (common testing, X-raying using conventional radiology and ultrasound scanning): average duration of under 03 hours.

b) Physical examination with 02 techniques of medical testing and imaging or testing and functional diagnosing (common testing, X-raying using conventional radiology, ultrasound scaning): average duration of under 3.5 hours.

b) Physical examination with 03 techniques of testing and medical imaging and functional diagnosing (common testing, X-raying using conventional radiology, ultrasound scanning, endoscopying): average duration of under 4 hours.

2. Capacity of medical examination:

- By 2015: the maximum capacity of an examination room is expected to be 50 patients/08 hours
By 2020: the maximum capacity of an examination room is expected to be reduced to 35 patients/08 hours. In case the number of patients rockets for any reasons, the number is expected to increase by no more than 30%.

IV. PROCEDURES FOR MEDICAL EXAMINATION

1. Step 1: Patient reception

1.1. Responsibilities of patients

- Take a check-in slip.

- Present the health insurance card, ID card or identity documents having photos, referral letter or appointment slip.

- Take a medical examination form and check-in slip at the examination rooms.

- Request patients bypassing the referral system or patients requiring on-demand services to make payment in advance.

1.2. Responsibilities of hospitals

- Arrange patient reception counters to receive patients, check health insurance cards and relevant documents.

- Input patients’ information into computers, designate respective examination rooms print medical examination forms and provide patients with check-in slip.

- Retain health insurance cards, referral letters and appointment slips (and transfer them to hospital’s billing departments).

- Collect payments of patients bypassing referral facilities or on-demand services in advance (specified in regulations of each hospital).

2. Step 2: Physical examination and diagnosis

According to the severity of illness, doctors may request the patient to take medical tests, medical imaging or functional tests, or may give diagnosis of the illness and make up prescriptions without any subclinical test.

2.1: Physical examination, diagnosis and indications for treatment

2.1.1. Responsibilities of patients

- Wait for their turn according to the number on the check-in slip.

- Enter the examination room as informed.

2.1.2. Responsibilities of hospitals

- Call patients, in numerical order.

- Designate clinical examination rooms and specialty rooms

- Examine, record patients’ illness, make diagnosis and prescribe treatment.

- Make up and print prescriptions (03 copies, each patient, accountant and the hospital pharmacy shall keep one), print and sign payment slips (form 01/BV) and direct patients to the hospital’s billing department.

- Make medical records for inpatients and residential patients, instruct such patients or their guardians to go through procedures for hospitalization and payment for hospital and medical fees in advance.

Annex 1: Diagram of procedures for physical examination and prescription

2.2: Physical examination, medical testing, diagnosing and indications for treatment

2.2.1. Responsibilities of patients

- Wait for their turn according to the number on the check-in slip.

- Enter the examination room as informed.

- Receive medical test order forms, if required.

- Submit medical test order forms to the specimen collection room and wait for their turn.

- Follow the instructions of medical laboratories technicians .

- Return to the medical room, and wait for their turn.

- Receive prescriptions, treatment indications and go through the formalities of payment or co-payment.

2.2.2. Responsibilities of hospitals

a) At examination rooms

- Call patient, in numerical order.

- Administer clinical examinations, record information on the illness, request patient to take medical tests and print medical test order forms .

- Direct patients to the specimen collection room.

b) At specimen collection rooms

- Provide adequate sampling rooms for patients. Sampling rooms shall be located at outpatient departments.

- Receive medical test order forms from patients.

- Provide patients with instruction on preparation for sampling and take specimens for medical tests

- Transfer specimens to the medical laboratories

c) At medical laboratories

- Execute specimen testing

- Transfer subclinical test results to the examination rooms where the medical test is required

Annex 2: Diagram of procedures for subclinical examination required medical tests

2.3: Physical examination, medical imaging, diagnosis and indications for treatment

2.3.1. Responsibilities of patients

- Wait for their turn according to the number on the check-in slip.

- Enter the examination room as informed.

- Receive imaging order forms if required.

- Present at medical imaging rooms, submit imaging order forms and wait for their turn.

- Follow instructions of imaging physicians.

- Receive imaging results, submit the imaging results to the examination room and receive medical imaging results and indications for treatment.

- Receive prescriptions, treatment indications and go through the formalities of payment or co-payment.

2.3.2. Responsibilities of hospitals

a) At examination rooms

- Call patients according to their numbers on the check-in slips.

- Provide physical examinations, record information on the illness, indicate imaging techniques, and print imaging order forms.

- Direct patients to the designated imaging room.

- Receive medical imaging results, make diagnosis and give indications for treatment and prescriptions.

b) At imaging rooms

- Imaging rooms should be located at the outpatient departments. Where imaging rooms are not located in the outpatient rooms, the hospital shall put up the route map.

- Imaging physicians shall:

Receive imaging order forms from patients.

- Provide patients with instruction on preparation for imaging and carry out the imaging.

- Give patients their imaging results enclosed with films or images (if any).

Hospitals are encouraged to directly transfer imaging results and films or images to the examination rooms.

Annex 3: Diagram of procedures for physical examination required medical imaging.

2.4. Physical examination, functional diagnosis, medical diagnosis and indications for treatment

2.4.1. Responsibilities of patients

- Wait for their turn according to the number on the check-in slip.

- Enter the examination room, as informed.

- Receive functional diagnostic order forms if required.

- Present at functional diagnostic rooms, submit the forms and wait for their turns.

- Follow instructions of fuctional diagnosis specialists.

- Receive the functional results and return to the medical room.

- Submit the functional results to the examination room and receive medical diagnosis and indications for treatment.

- Receive prescriptions, treatment indications and go through the formalities of payment or co-payment.

2.4.2. Responsibilities of hospitals

a) At examination rooms

- Call patients according to their numbers on the check-in slips.

- Provide physical examinations, record the information on the illnesses, designate functional diagnostic techniques and print functional diagnostic order forms.

- Direct patients to the designated diagnostic room.

- Receive functional diagnosis results, diagnose, give indications for treatment and make up prescriptions.

b) At diagnostic rooms

- Diagnostic rooms should be located at the outpatient departments. Where diagnostic rooms are not located in the outpatient departments, the hospital shall put up a route map.

- Functional diagnostic physicians and doctors shall receive functional diagnostic order forms from patients.

- Provide patients with instruction on preparation for diagnosis and carry out the functional diagnosis.

- Give patients their functional results enclosed with films or images (if any).

Annex 4: Diagram of procedures for physical examination required medical tests, diagnostic imaging and functional diagnosis

2.5. Patients undergoing physical examination and combined subclinical examination (medical tests, diagnostic imaging, and functional diagnosis) , medical techniques or referral to specialties

All patients and hospitals shall follow the aforesaid procedures. Doctors or workers at examination rooms shall provide patients with procedures for taking subclinical examinations. After obtaining the subclinical results, the patient shall submit such results to his/her treating doctor. The treating doctor shall make medical diagnosis, make up prescriptions give indications for treatment. If patients require to take other specialty examinations or techniques, such patient shall be provided with on-demand services or specialty examinations.

The patient shall receive prescriptions, treatment indications and go through the formalities of payment or co-payment.

3. Step 3: Payment for hospital charges

3.1. Responsibilities of patients

Insured patients

- Submit the payment slip (form 01/BV).

- Wait for their turns.

- Co-pay the hospital and medical fee and get their health insurance cards back.

* Uninsured patients shall pay the hospital and medical fees in accordance regulations of the hospital.

3.2. Responsibilities of hospitals

- Verify contents of the form 01/BV and countersign the form.

- Collect medical and hospital fees.

4. Step 4: Dispensing drugs

4.1. Responsibilities of patients

- Submit the prescription to pharmacies

- Check and compare received drugs with that in the prescription.

- Receive drugs, the prescription and sign the receipt

4.2. Responsibilities of hospitals

- Check prescriptions and provide patients with drugs .

- Give indications of the provided drugs and prescription.

IV. REFORMS IN PROCEDURES FOR MEDICAL EXAMINATION AT HOSPITALS

According to the reality, the hospital shall apply one of the following reforms:

1. Comprehensive reforms:

1.1. Reforms in facilities of outpatient departments

Provide adequate areas, place more patient reception counters, lounges and registration areas, medical tables and specimen collection rooms, design interconnected outpatient departments, and accommodate imaging rooms, functional diagnostic rooms and hospital’s billing departments. Provide patients with instructions on procedures for medical examination and exercise medical examination in accordance with provisions hereof.

1.2. Enhancement of application of information technology

- Create network amongst outpatient departments, medical laboratories, pharmacies, billing departments, Directorate of the hospital and relevant departments.

- Apply software that is designed for physicians in order to improve the accuracy of diagnosis results, prescriptions and treatment .

- Utilize barcodes, magnetic strip cards for patient identity.

1.3. Employment of high-qualified and adequate personnel

- Allocate adequate personnel in reception counters, outpatient departments, specimen collection rooms or personnel specialized in techniques, collection of payments, health insurance cards and provision of drugs.

- Provide personnel with training courses in profession and communication manners.

1.4. Addition of necessary equipment to outpatient departments

Equip necessary equipment including equipment for diagnostic imaging, medical tests and functional diagnosis for outpatient departments.

1.5. Development of flexible procedures for medical examination responsive to increases in number of patients

2. Reforms in procedures for medical examination introduced to relevant departments

In addition to the aforesaid comprehensive reforms, the hospital shall consider applying the following measures:

2.1: Patient reception

- Apply automatic numbering machines.

- Do not allow patients to photocopy their personal identity cards or equivalent documents, health insurance cards and referral letters etc.themselves. The hospital shall photocopy the aforesaid documents , if necessary (for hospitals that apply the new schedule of medical and hospital fees).

- Provide adequate reception counters and reception personnel, collect medical and hospital fees and provide insured patients with instructions on procedures for medical examination .

- Provide adequate medical tables and instructors at outpatient departments.

- Allow to book medical appointments via telephone, online or the telephone exchange 1080.

- Publish working hours, procedures for medical examination, schedules of medical and hospital fees and prioritized entities.

- Have diagrams of outpatient departments available.

2.2: Clinical and subclinical examinations, medical diagnosis and treatment indications

- Use electronic spreadsheets and electronic bulletin boards.

- Make appointments for giving medical test results or imaging results.

- Transfer medical test results to the examination rooms of the outpatient departments.

2.3. Collection of medical and hospital fees and return of health insurance cards

- Arrange adequate billing departments.

- Allow to pay by electronic payment cards.

2.4: Dispensing drugs

- Create networks between drug dispensaries with pharmacies and examination rooms to facilitate the clinical pharmacology and drug dispensing.

- Keep drug cabinets in order and according to types of specialty drugs

V. IMPLEMENTATION ORGANIZATION

1. Directors of hospitals

a) According to this guidance, directors of hospitals shall specify their procedures for medical examination and make such procedures publicly available to patients.

b) Continuously reform the procedures for medical examination as follows:

- Set up a broad of innovation including representatives of outpatient departments and relevant departments.

- Review the procedure for medical examination and propose reforms in such procedures.

- Determine prioritized issues necessary for being reformed.

- Consider approving and implementing reforms, evaluate the effectiveness and keep executing such reforms.

2. Agency of Medical Services Administration shall take charge of and cooperate with Departments of Health Insurance and relevant agencies to direct, inspect and evaluate the implementation of this guidance of hospitals affiliated to the Ministry of Health.

3. Heads of specialties shall direct, inspect and evaluate the implementation of this guidance of hospitals affiliated to the Ministry of Health.

4. Director of Departments of Health of provinces shall direct, inspect and evaluate the implementation of this guidance of hospitals affiliated to the Department of Health and private clinics within their province.