1 INTRODUCTION
The Family and Community Medicine department is one of the major
and important departments of King Khalid University Hospital, King
Saud University Riyadh, Kingdom of Saudi Arabia.
Ministry of higher education KSA is an administrative body of this
teaching/tertiary hospital.
Family Medicine is the specialty of breath that integrates the biological,
clinical and behavioral sciences.
Family medicine is the medical specialty concerned with the total health care of
the individual and families in their communities. It includes curative, preventive,
promotive and rehabilitative care and provides continuing care from the bio-
psycho-social perspective. Its scope is not limited by age, sex, and organ system
or disease entity.
2 GOALS
2.1 Provision of clinical services
Easy provision of cost effective, good quality, comprehensive, holistic and continuous
care to Saudis and KKUH & KSU employees and their families
Family physicians can themselves provide care for the majority of conditions encountered
in ambulatory setting and integrate all necessary health care services. They possess
unique attitude, skills and knowledge which qualify them to provide continuing and
comprehensive medical care, health maintenance along with preventive, promotive
and rehabilitative services.
2.2 Teaching / training
To train family physicians and upgrade their skills and knowledge continuously to
deliver high quality, comprehensive primary medical care relevant to the needs of
individuals and families in Kingdom of Saudi Arabia
2.3 Research
To develop skills and competencies programs that will help physicians to meet the
changing health care system
To identify strengths and weaknesses of the system and work for its improvement
and development for more effective service delivery
To understand and recognize the limitations and roadblocks encountered in the
actual settings
To develop constructive and practical recommendations for the improvement of
the system based on evidence medicine
3 ORGANISATIONAL SETUP
3.1 LEGISLATIVE REQUIREMENTS
The care and treatment process as a whole is consistent with legislative requirements,
standards of practice and the respective code of ethics of each team member.
The Saudi commission for medical specialties has legislative requirements for medical
and pharmacists & Saudi Nursing Board for nurses
All employees are under KSU and Saudi labor law. In addition to medical staff by laws,
job description covers qualification, licensure and responsibilities for each position.
There is a general code of ethics applied to all hospital staff. Nursing code of ethics
established and developed by GCC
3.2 ADMINISTRATIVE
The Chairman of the Family and community medicine looks after the whole department
Medical Director and associate director of primary care clinics are responsible for direct
supervision of all primary care physicians in their activities, scheduling, evaluation of
their performance and discharging their duties and responsibilities.
They also provide guidance regarding patient care and treatment services
Head of the family medicine unit take cares the under graduate and postgraduate
teaching and training in the subject of family medicine and deal all the issues related
to family medicine
Peer review and CME committees are responsible for internal quality control and
CME/CPD respectively
At least one administrative director is appointed in every clinical unit. Responsibilities
of administrative directors are well defined. Their basic responsibility is to supervise
the work flow in the unit and handle problems concerning appointment and replacement
of patients who were not able to attend their regular appointment and refill of
patient’s medication if their stock is finished before appointment.
3.2.1 TEAM COMPOSITION
The management and quality of the patient care process depends upon the
integrated, co-ordinated and complementary activities of the team.
The composition of the team serving the patient group is to be identified by
the organization.
The team includes physicians (interns, residents, registrar, senior registrar,
consultants, assistant professors, associate professors and professors),
qualified nursing staff and all levels of staff representing the appropriate
diagnostic and therapeutic services.
Bi/tri lingual Family physician and nursing staff are employed in primary care clinics
3.2.2 ACCESS TO SERVICE
There is a process to define population eligible to access primary care setup
At initial visit all the patients are evaluated by administrator director primary
care clinics or eligibility department for their eligibility to access the primary care services.
Minimum Eligibility Criteria are:
· Saudis having referral letter from governmental
health center
· KKUH and KSU Employees and their dependents
3.2.3 MEDICAL RECORD
A system containing full first patient/family registry information is established
in medical file. Written consent is obtained and documented in the first registry i
nformation form Each patient is provided a separate medical record number and
all care entries are made in that medical record number/file.
3.2.4 CONTENTS OF MEDICAL FILE AT FIRST VISIT
· Initial Patient’s profile and consent form
· Patient’s personal identification documents
· Family physician’s progress sheet
· Other specialty doctor’s progress sheets
(continuation sheet)
· Data base sheet
· Problem list sheet
· Drug list sheet
· Referral letter
· Hospital plastic card (addressograph card showing name
and Medical record number)
3.2.5 APPOINTMENT SYSTEM
For first time patients are seen by doctor having referral letter
(from A&E department or primary health care centre outside KKUH)
After opening the file and allocating the medical record number, patient
approaches family physician through appointment system
Patients are offered a scheduled appointment for follow up visits.
Routine appointment for non urgent patients is 3-4 months.
Patients needing early appointment are adjusted accordingly by
the physicians
Patients who misses their scheduled follow up appointment is given
a timely appointment for a return visit and till that they are followed
in a refill clinic for their repeat prescription (for chronic disease).
Maximum 2 visits are allowed with refill clinics before patients follow
their physician
Administrative Directors of the clinics are authorized to accept patients
(up to 10%) as a replacement in place of those who did not attend clinic.
Medical records of replacement patients are requested at the same time
(waiting time 30 minutes approximately). Replacement patients and distributed proportionally to the physicians on duty.
Computer system identifies appointment of the patient
Files of the patients with appointment are requested and are easily delivered
by the medical record personnel in the nursing station the day before their
appointment
Staff nurse is responsible to identify/verify the patient before consultation
After consultation, medical record files are retained to the nursing station
and at the end of day the medical record personnel collects it
3.3 LOGISTICS
3.3.1 WAITING AREA
According to the safety & security policies we have separate male
and female waiting areas for appropriate ages, disabilities and numbers
in a safe environment.
News papers, magazines, different health related handouts and
television are available in every waiting area.
Wheel chairs are freely available at main entrance of the hospital
Toilet facilities are available in or near the waiting areas
3.3.2 RECEPTION AND NURSING STATION
Counter works as a first contact and guidance for patient.
Minimum of biluinguistic qualified nursing staff assigned in counter by
rotation and well educated Saudis are employed at the registration desk.
Ø Registration Desk:
Administrative director of PCC supervise the staff at registration desk.
Staff control patient’s registration, appointment, opening of new file and
activate closed file
Ø Reception Desk:
Nursing staff controls reception desk under kind control of head nurse.
Scheduled and walk-in patients file are sorted, updated and prepared
in this area
Nursing staff at the counter also
· Provide guidance to patient/families
· Request medical file a day before the appointment,
· Identify/verify patient on the day of appointment
· Distribute patient to family physician according to the policy
already established,
· Accompany patient to family physician office,
· Assist family physician during patient consultation
3.3.3 CLINICS
There are different clinical units as under
a) Male Primary Care Clinics (PCC-II).
b) Female Primary care clinics (PCC-I)
c) Refill/walk-in clinic
d) Procedure/dressing clinic
e) Employees Health Clinic.
f) Academic Staff Clinic.
g) Darayah Family Clinic.
h) University Health Center.
Aims:
· To provide cost effective comprehensive medical service to all
eligible patients attending the hospital.
· To screen the patients thoroughly so that unnecessary referrals
to specialists’ clinics are avoided thus reducing the waiting lists.
· To screen all the new employees of the hospital and students
of the university so that infectious conditions if any can be identified
and treated.
· To provide good training to under graduate & postgraduate
students of family medicine and interns.
3.3.3.1 SCOPE OF SERVICES OFFERED
a) Primary care clinics for male patients (PCC-II):
ü Eleven clinics
ü These clinics are an integral part of KKUH offering hospital based
general practice (primary care) service to a large number of referred
Saudi and other eligible patients. On an average 175 patients are seen daily.
ü Usually Beneficiaries of these clinics are
· Referred saudi patients working outside KKUH,
· Non faculty male employees of KSU& there adult male
dependents (above the age of 12)
· Adult male dependants of KKUH employee
ü Consultation with appointment
ü We evaluate and manage acute and/or chronic medical problems.
b) Primary care clinics for female patients (PCC-I):
ü Twenty one clinics
ü These clinics are an integral part of KKUH offering hospital based general
practice (primary care) service to a large number of referred Saudi and other
eligible patients. On an average 175 patients are seen daily.
ü Usually Beneficiaries of these clinics are
· Referred saudi patients working outside KKUH,
· Non faculty female employees of KSU& there adult female dependents
(above the age of 12)
· Adult female dependants of KKUH employee
ü Usually consultation with appointment
ü We evaluate and manage acute and/or chronic medical problems.
ü Mostly female family physicians are working in this area
c) Refill/walk-in clinic:
ü One clinic
ü Situated in PCC-II clinical unit
ü Run by a family physician
ü All patients or their relatives for refill of medications must go to
the administrative director to get approval for refill
ü The family physician only prescribe medications required until the
next appointment and control prescription for one month only
ü The family physician will not write any medication that is not documented
on the file of the patient
ü The family physician will document the medication that they refill
ü Average 25-30 patients are entertained in this clinic per day
ü Walk in clinic is also being established soon
d) Minor procedure / Dressing clinic
ü One clinic in each clinical area i.e ASC, USC, DHC
ü Two clinics in PCC-I & two in PCC-II
ü Main clinic is situated in PCC-II clinical unit
ü These clinics are run by a qualified staff nurse under
supervision of a family physician
ü Dressing, removal of sutures and administering parental
injections are the basic treatment modalities of these
clinics
ü These clinics are well established and equipped according to the
international rules and regulations. Crash cot and all other emergency
means of equipment are updated on daily basis
ü Each clinic can accommodate 24 patients per day and is divided into
two cubicles to avoid any contamination and infection. Clean and infected
wounds are managed and treated separately.
e) Employee health clinics (EHC):
ü Two male and two female employee health clinics are established to
entertain all the employees of KKUH and medical students.
ü These clinics are walk-in as well as with appointment.
ü We evaluate and manage acute and/or chronic medical problems.
ü Average 80 patients are being evaluated in these clinics per day
ü Aims of These clinics are
· To screen all the new employees and to look after his/her
continued health care. Clinic is meant for employees only and not
for their family members.
· To screen the new housemaids of the hospital and university
staff for medical fitness. Once they are certified fit they are not
eligible to be treated at EHC and should attend primary care
clinics for their medical problems.
· Routine medical screening for sporting activities, driving
license and for studies abroad is not done routinely except
for cases approved by the Director of primary care clinics.
· Medical consultation is by appointment only and however
urgent cases are seen without prior appointment especially
night staffs are seen at the beginning of the clinic in the morning.
· Employees are expected to bring a letter of approval by
their supervisors before attending the clinic.
· Academic staffs working in various colleges other
than the college of medicine are not seen at EHC and
should attend PCC or ASC.
ü These clinics also provide screening for
· Renewal of iqama
· Premarriage
· Students selected to study in our medical college,
· Approval to swim in swimming pole
f) Academic staff clinics (ASC):
ü One male and one female academic staff clinics are established
to entertain all the faculty staff of KSU, their dependents and their
children of less than 18. Dependents above 18 are seen in PCC
ü These clinics are walk-in as well as with appointment.
ü We evaluate and manage acute and/or chronic medical problems.
ü These clinics provide pre employement check up for faculty
employees of KSU
ü Certify the health fitness certificate requested by the personnel
department for the extension of contract of faculty staff when he/she
crosses the age of retirement
ü These clinics also provide screening for
· Renewal of iqama
· Premarriage
· Employees selected to study/work outside KSA,
· Approval to swim in swimming pole
ü Average 40-50 patients are entertained in these clinics per day
g) Darayah Housing (campus) clinics (DHC):
ü Male and female clinics are established inside the campus
(housing/residence) of KKUH and KSU employees.
ü It is staffed by 2 physician, 2 nurses, and a pharmacist.
On an average sixty patients are seen each day. Initially this
clinic was established to offer treatment for minor aliments.
At present there is growing expectation and demand from
the patients for better and more advanced medical care.
ü These are walk in clinics and entertain all the employees
and their dependents living inside the residential compound
ü Mechanism to provide care to a minor not accompanied
by a parent or guardian is already established
ü We also entertain drivers and housemaid of faculty members
ü Health check up for approval to swim in swimming pole
ü Average 50-60 patients are entertained in this clinic per day
h) University health center (UHC):
ü Two walk in clinics situated on the 5th floor of Building 17 of the University,
ü UHC is staffed by two doctors, 2 nurses, one pharmacist, one phlebotomist,
two registration clerks and administrative supervisor.
ü On an average of 80 patients attend the health center daily.
ü UHC offers health care to:
· All male students of the King Saud University
· Screen all the new students.
3.3.3.2 WORKING HOURS & TIME PER CONSULTATION
All clinics are open from 7:30 am to 4:30 pm daily from Saturday - Wednesday.
Lunch and prayer break from 12:30 pm to 1:30 pm.
Waiting time in PCC (from report at nursing counter to consulting room)
for appointment patient is usually not more then one hour and is variable
for walk in clinics
Consultation time in PCC is 15 minutes in average and that for walk in
clinics is variable
3.3.3.3 COMPUTERS
Computers are available in all consulting rooms as well as at reception
and nursing counters.
All the computers are connected with internal hospital network system.
Laboratory results through “HIS’ and radiological results and
films / Ultrasound through “PACS” system can be attained and
one can review on-line results of diagnostic services.
Internet access is available for continuous professional development (CPD)
3.3.3.4 OTHER EQUIPMENTS
Each clinic is equipped with
· Table and chairs for doctor and nursing staff
· Chairs for patient and his/her attendant
· Examination couch and step
· Sheets, blanket and a pillow for each couch
· Hand washing facilities with disinfectant & tissue papers
· Shelves for storage of forms, information handouts and
reference books
· Full range of forms
· Telephone
· Illuminator
· Eye chart (snellen chart)