Causes of Obstruction in the Outpatient Department of National Hospital, Sri Lanka: A Qualitative Study

Sri Lanka is a country with a well-established healthcare system in South Asia. The National Hospital, Sri Lanka (NHSL), located in Colombo, is the country's largest hospital and final referral center, with a bed occupancy rate of 75% and an average length of stay of 3.7 days. The OPD of the National Hospital of Sri Lanka (NHSL) has been overburdened with the problem of congestion. The goal of this study is to figure out what's causing the congestion at NHSL's OPD and what can be done about it. The approaches employed were key informant interviews with important stakeholders, focus group discussions, desk evaluation of secondary data, and direct observation of OPD operations. The deputy director, OPD, medical officer-in-charge, and nursing sister in charge of the unit were all interviewed by the primary investigator. Twelve randomly selected medical officers and ten nursing officers with a minimum of one year of work experience at the OPD participated in two focus group talks. Secondary data was obtained through a desk review of the admission book and OPD monthly statistics. The data was triangulated using direct observation. The NHSL OPD treats around 690,000 patients each year. On a daily basis, the average number of OPD patients is around 1900. A doctor at NHSL's OPD examines 36 persons every hour on average. As a result, the consultation time is restricted to 1.6 minutes, which is insufficient. The Ishikawa diagram was used to investigate the root causes of congestion. The fundamental causes were identified as poor layout arrangements, doctor delays, and a quota system of examinations, non-availability of the patient information management system, lack of a good referral mechanism, and a higher amount of staff patients. The major recommendations of this study to reduce congestion at OPD, NHSL, included improving the layout of OPD in a unidirectional manner, advising doctors to start duties on time, abolishing the quota system of examination, establishing a computer-based patients' registration system, establishing a laboratory within OPD, and establishing two more counters at OPD pharmacy. Keywords: Outpatient Department, Congestion, Waiting Time, Patient Care Process