Opening your own Level 3 hospital in India is an exciting and important venture, especially in a country with a growing need for quality healthcare services. As a doctor planning to start your own hospital, it’s crucial to understand the necessary standards and regulations to ensure your facility provides exceptional care while staying compliant with health authorities.
A Level 3 hospital typically offers a wide range of services, including multispecialty care, diagnostics, and emergency treatment, all of which must meet high standards to build trust and reliability in the community.
For your Level 3 hospital to succeed, it’s essential to follow the guidelines set by the Clinical Establishment Act and other relevant regulations. From staffing qualified medical professionals to maintaining safety, hygiene, and proper infrastructure, each aspect of your hospital needs careful planning.
This guide will help you understand the key requirements for staffing, services, patient care, and support services needed to run a successful hospital. Let’s start by addressing the question, ‘What is a level 3 hospital’?
What is a Level 3 Hospital?
A Level 3 hospital in India is a clinical establishment that provides tertiary healthcare services, offering advanced specialized care for complex and critical medical conditions.
These hospitals are equipped with state-of-the-art facilities, including sophisticated laboratory and radiology services, along with departments for general surgery, pediatrics, general medicine, obstetrics and gynecology, emergency care, and intensive care units. Tertiary healthcare is typically provided by both public and private healthcare organizations.
Level 3 hospitals offer a wide range of specialized services such as cardiology, cardiothoracic surgery, neurology, neurosurgery, nephrology, joint replacement, plastic and reconstructive surgery, rheumatology, endocrinology, respiratory medicine, oncology, nuclear medicine, pediatric surgery, gastroenterology, GI surgery, transplantation services, and blood storage centers or blood banks.
These hospitals are often affiliated with universities for medical research and the training of healthcare professionals, including physicians, surgeons, and nurses. They may also be teaching hospitals, providing education and training alongside patient care.
Level 3 hospitals can be located in both rural and urban settings and can be operated by the public sector (such as central, state, or local government, public sector undertakings, or registered societies) or the private sector (including individual proprietorship, registered partnerships, companies, co-operative societies, trusts, or charitable organizations).
It is important to note that these hospitals are required to adhere to the guidelines set forth by regulatory bodies such as the Medical Council of India (MCI) or other relevant legal authorities to ensure compliance with medical standards and patient safety.
Scope of Services Offered under Level 3 Hospital
To open your own Level 3 hospital in India, it’s important to understand the scope of services you will be expected to provide in order to meet the healthcare needs of your community. A Level 3 hospital practicing allopathy or modern systems of medicine will typically offer a comprehensive range of clinical services across various specialties. These services may include, but are not limited to, the following:
Clinical Services:
- General Medicine, General Surgery, Obstetrics and Gynaecology
- Fertility and Assisted Reproduction
- Paediatrics, Paediatric Intensive Care, Paediatric Surgery, Neonatology
- Orthopaedics, Orthopaedics with Joint Replacement
- Anaesthesiology, Emergency Medicine & Trauma
- Critical Care Medicine (e.g., HDU, ICU)
- ENT, Ophthalmology, Neurology, Neurosurgery
- Cardiology, Cardiothoracic Surgery
- Urology, Nephrology & Dialysis
- Gastroenterology, GI Surgery (Surgical Gastroenterology)
- Minimally Invasive Surgery or Minimal Access Surgery
- Respiratory Medicine, Endocrinology, Rheumatology
- Clinical Immunology, Psychiatry & Mental Health
- Medical Oncology, Surgical Oncology, Radiation Oncology, Nuclear Medicine
- Plastic & Reconstructive Surgery, Dermatology, Community Health
- Palliative Medicine, Geriatric Care, Family Medicine
- Clinical Haematology, Organ Transplantation, Genetics
- Dentistry (including subspecialties), Physical Medicine & Rehabilitation
- Transfusion Medicine/Blood Storage Centre/Blood Bank
- Emerging sub-specialties in any of the above fields or emerging independent specialties
In addition to these clinical services, a Level 3 hospital will require several support services to ensure smooth and efficient operations. These may include:
Support Services
- Registration/Help Desk and Billing
- Diagnostic Services, including Laboratory, Imaging, and Non-imaging services (e.g., Audiology Lab, TMT, Echocardiography, Neurophysiology, Urodynamics, PFT, Sleep Studies, etc.)
- Pharmacy and Stores
- CSSD/Sterilization Area
- Linen and Laundry Services
- Kitchen & Dietary Services
- Waste Management Services (General and Biomedical)
- Medical Gas Supply, Storage & Distribution
- Ambulance Services
Infrastructure Requirements for Level 3 Hospital
To open your own Level 3 hospital in India, it’s also important to understand the infrastructure standards required to ensure a safe, functional, and compliant healthcare facility. These infrastructure requirements are designed to provide a comfortable and efficient environment for both patients and staff while adhering to the Clinical Establishment Act standards.
Signage
To guide patients and visitors, your hospital must display clear and informative signage. The following signage requirements must be met:
- The hospital must have signage in at least two languages, with the hospital’s name displayed prominently at a visible location.
- Directional signage should be placed throughout the facility to guide patients to various areas, such as wards, the emergency department, and diagnostic areas.
- Informative signage should include:
- The name of the care provider along with their registration number.
- Registration details of the hospital.
- Availability of the fee structure for services provided.
- Hospital timings and details of services available.
- Mandatory information, such as details under the PNDT Act, where applicable.
- Emergency contact numbers for services such as blood banks, fire departments, police, and ambulances.
- Patients’ rights and responsibilities.
- Safety signage must include:
- Hazard and caution signs (e.g., electrical hazards, inflammable materials, radiation, etc.).
- Fire exit signs.
- No-smoking signs placed in prominent areas.
Other Requirements
Your hospital must be designed to provide a safe, comfortable, and hygienic environment for patients, staff, and visitors. The following requirements should be met:
- Accessibility: Ensure easy access to the hospital for patients, visitors, and attendants, including those with disabilities, in compliance with the “Persons with Disabilities Act.”
- Water and Electricity Supply: Provide 24-hour access to potable water for drinking and hand hygiene, and ensure an uninterrupted supply of electricity.
- Noise Control: Sensitive areas such as wards, treatment rooms, and operation theatres should be located away from sources of outdoor noise. The hospital should be well illuminated and ventilated.
- Toilet Facilities: Provide separate, clean public toilets for males and females.
- Maintenance: Implement a mechanism for the timely maintenance of the building and hospital equipment.
- Communication Facilities: Ensure appropriate internal and external communication systems for the efficient functioning of the hospital.
- Furniture and Fixtures: Equip the hospital with functional furniture and fixtures as per the scope of services and hospital workload. Ensure that they are well-maintained.
Space Requirements for Level 3 Hospital
The total area and space allocated to various departments should meet the following minimum standards:
- Total Area: For a hospital with Level 3 services, the minimum area required is 50 sq. meters per bed, including 30% circulation space for corridors, reception areas, and lobbies.
- Wards:
- The minimum space per bed in wards is 6 sq. meters, with additional circulation space (30%) for nursing stations, ward stores, and other utilities.
- For general wards, provide a minimum of two WCs and one hand wash basin for a 12-bed ward.
- Ensure that the distance between beds is at least 1 meter, with 0.25 meters of space at the head end of each bed.
- Door width should be at least 1.2 meters, and the corridor should be 2.5 meters wide.
- Intensive Care Unit (ICU):
- The ICU should provide at least 10.5 sq. meters of space per bed, with additional circulation space (30%) for nursing stations, doctors’ duty rooms, and other essential areas.
- Ensure that the ICU is equipped with suction, oxygen supply, and compressed air for each bed.
- Minor Operation Theatre/Procedure Room: The minimum area for a minor operation theatre should be 10.5 sq. meters, with 30% additional space for circulation and utilities.
- Emergency & Casualty: Provide at least 10.5 sq. meters of space per emergency bed, with designated areas for nurse stations, doctor duty rooms, stores, and utilities.
- Pharmacy: The pharmacy should have enough space to accommodate 5% of the total clinical visits to the OPD in one session at a rate of 0.8 m² per patient.
- Bio-medical Waste (BMW) Area: The BMW area should be a minimum of 5 sq. meters for hospitals with fewer than 50 beds, 10 sq. meters for hospitals with 50-100 beds, and 20 sq. meters for hospitals with more than 100 beds.
Furniture and Fixtures
For smooth and efficient operations, your hospital will need various furniture and fixtures. Here’s an indicative list to guide you:
- Examination Table
- Writing Tables
- Chairs
- Almirah
- Waiting Benches
- Medical/Surgical Beds
- Labour Table (if applicable)
- Wheelchair/Stretcher
- Medicine Trolley, Instrument Trolley
- Screens/Curtains
- Foot Step
- Bedside Table
- Baby Cot (if applicable)
- Stool
- Medicine Chest
- Examination Lamp
- View Box
- Fans
- Tube Light/Lighting Fixtures
- Wash Basin
- IV Stand
- Colour-coded Bins for BMW
This list provides an overview of the essential furniture and fixtures required for a Level 3 hospital. You can adjust this list based on your hospital’s size, services, and patient load. Ensure that all items are functional and well-maintained to support the delivery of high-quality healthcare services.
Medical Equipment and Instruments for Level 3 Hospital
To set up your hospital, it is crucial to ensure that the medical equipment and instruments you procure are suitable for the scope of services you intend to provide and the number of beds your facility will accommodate.
Alongside this, it is important to implement a robust system for the regular maintenance of critical equipment. This system should ensure that all equipment is inspected, cleaned, and maintained periodically to ensure its functionality and safety.
A detailed equipment logbook must be maintained for all major equipment, documenting inspections and maintenance activities. To assist with your procurement process, a list of essential medical equipment and instruments, categorized by department and usage, can serve as a guide.
This list is specifically tailored for hospitals offering comprehensive services at the Level 3 level, ensuring that your facility meets all operational needs efficiently.
Emergency Equipment
Here is a list of emergency equipment required for your hospital:
- Resuscitation Equipment: Laryngoscope, endotracheal tubes, suction equipment, xylocaine spray, oropharyngeal and nasopharyngeal airways, Ambu bag (adult & paediatric, including neonatal if indicated).
- Oxygen Cylinders with flow meter, tubing, catheter, face mask, and nasal prongs.
- Suction Apparatus.
- Defibrillator with accessories.
- Dressing/Bandaging/Suturing Equipment.
- Basic diagnostic equipment: This includes blood pressure apparatus, stethoscope, weighing machine, thermometer.
- ECG Machine.
- Pulse Oximeter.
- Nebulizer with accessories.
Department-Specific Equipment
Below is an overview of equipment needed by the department, categorized by hospital level (1, 2, or 3) to ensure that your hospital is fully prepared and compliant with required standards.
Non-Medical Equipment
- Administration: Office equipment and furniture.
- Electricity: Emergency lights.
- Water Supply: Hand-washing sinks, taps, bowls, and water storage.
- Waste Disposal: Buckets for contaminated waste, drainage system, incinerator or burial pit, sharps containers, and bio-medical waste disposal.
- Safety: Fire extinguisher and 4-wheel drive vehicles (vehicle availability differs for levels 1 and 2).
Clinical Equipment
- Outpatient Rooms: Blood pressure machine, stethoscope, examination gloves, examination table, minor surgical instruments (level 3), ophthalmoscope (level 3), otoscope (level 3), and weighing scale.
- Women and Child Health Examination Room: BP machine, stethoscope, contraceptive supplies, child register, IUD insertion set, speculum and vaginal examination kit, syringes and needles, etc.
- Labour Room: Delivery bed, clean delivery kits, fetal stethoscope, oxygen tank, suction machine, suturing sets, partograph charts, self-inflating bags, etc.
Inpatient Wards
- Basic Examination Equipment: Stethoscope, BP machine.
- Patient Beds and Linens: Washable mattresses, curtains, dressing sets, IV stands, oxygen tanks, and concentrator.
Operation Theatre
- Basic Equipment: Ambu resuscitation set, defibrillator, electro-cautery, fixed operating lights, suction machines, and various surgical instruments.
- Anesthesia Equipment: Anesthetic trolley/machine, CO2 monitor, O2 monitor.
- Endoscopic Equipment: Bronchoscope, colonoscope, laparotomy set, and surgical supplies like sutures and dressings.
Specialized Equipment for Services
If your hospital provides specialized services, additional equipment will be required to meet those needs. This includes specific sets for procedures such as hernia repair, vascular repairs, tracheostomy, and thoracotomy, as well as equipment for laparoscopic surgeries and endoscopic procedures.
Summary of Essential Equipment by Department
- Emergency Department: Resuscitation equipment, defibrillators, suction apparatus, and ECG machines.
- Outpatient Department: Basic diagnostic equipment (BP machines, stethoscopes), examination tables, and minor surgical instruments.
- Laboratory: Blood test analyzers, microscopes, and other diagnostic tools.
- Operation Theatre: Full range of surgical and anesthesia equipment, including endoscopic tools, resuscitation sets, and specialized surgical kits.
- Inpatient Wards: Functional beds, IV stands, oxygen concentrators, and basic examination equipment.
This list should be customized based on the services your hospital will offer and the expected patient load.
See Also: What Clinical Equipment Do You Need To Open A Clinic In India? A Complete List
Drugs, Medical Devices, and Consumables Required for Level 3 Hospital
As part of your Level 3 hospital setup, it is essential to ensure a sufficient and appropriate supply of drugs, medical devices, and consumables. These supplies must align with both the scope of services provided and the number of beds available.
Furthermore, the hospital must adhere to specific standards for the storage, inventory management, and dispensing of these items while also maintaining a safe environment for patients. To begin with, your hospital should have an adequate supply of drugs, medical devices, and consumables that can meet the demands of patient care.
This inventory should be available in the required quantity and be easily accessible when needed. Additionally, emergency drugs and consumables must be readily available at all times to facilitate prompt treatment in critical situations.
These items should be stored properly, ensuring they can be quickly accessed during emergencies. In terms of drug storage, it is important that medications are kept in a clean, well-lit, and safe environment, complying with all applicable laws and regulations.
This will help maintain the integrity of the drugs and prevent contamination. Lastly, the hospital must implement well-defined procedures for the storage, inventory management, and dispensing of drugs, covering both the pharmacy and patient care areas. By doing so, the hospital ensures that drugs are handled safely and in compliance with safety guidelines.
List of Drugs, Medical Devices, and Consumables
Emergency Drugs and Consumables (Essential in All Hospitals)
Injections
- INJ. Diazepam 10 MG
- INJ. Furosemide 20 MG
- INJ. Ondansetron 8 MG/4ML
- INJ. Ranitidine
- INJ. Nor Adrenaline 4 MG
- INJ. Phenytoin 50 MG
- INJ. Diclofenac 75 MG
- INJ. Deriphyllin
- INJ. Chlorpheniramine Maleate
- INJ. Hydrocortisone 100 MG
- INJ. Atropine 0.6 MG
- INJ. Adrenaline 1 MG
- INJ. KCL (Potassium Chloride)
- Sterile Water
- INJ. Soda Bicarbonate
- INJ. Dopamine
- INJ. Naloxone 400 MCG
- INJ. Lignocaine 50 ML
- Tab. Sorbitrate
- Tab. Aspirin
- INJ. Tetanus
- INJ. Adenosine
Other
- Nebulizer Salbutamol 2.5 ML
- Nebulizer Budesonide
- Lignocaine Jelly 2%
- Activated Charcoal
- Calcium (Injection or Tablet)
Fluids
- RL (Ringer’s Lactate) 500 ML
- NS (Normal Saline) 500 ML
- NS (Normal Saline) 250 ML
- NS (Normal Saline) 100 ML
- DNS (Dextrose Normal Saline) 500 ML
- Dextrose 5% 500 ML
- Dextrose 10% 500 ML
- Pediatric IV Infusion Solution 500 ML
Additional Drugs and Consumables
Further drugs and consumables will be required based on the scope of services, bed strength, and patient turnover. These should be procured according to your hospital’s specific needs and capabilities.
Medical Devices
Medical devices must be available in accordance with the scope of services, bed strength, and patient turnover. Devices such as diagnostic equipment, surgical instruments, patient monitoring devices, and therapeutic tools are necessary for providing quality care.
By ensuring that you maintain an adequate supply of essential drugs, medical devices, and consumables, and adhere to the prescribed storage, management, and dispensing protocols, your hospital can operate efficiently and provide effective care to patients.
Human Resource Requirements for Level 3 Hospital
The hospital must employ qualified and/or trained medical, nursing, paramedical, and support staff based on the scope of services provided. All medical care should align with the requirements set by professional and regulatory bodies to ensure high-quality patient care.
Similarly, the nursing staff must meet the standards prescribed by these bodies, ensuring safe and effective nursing care. Paramedical and support staff should also be appropriately qualified or trained according to the services offered, adhering to the standards set by the relevant professional or regulatory bodies.
In addition to these qualifications, it is essential to maintain personal records for every staff member, including contractual staff. These records should include the appointment orders, documentary evidence of qualifications or training, and, where applicable, professional registration details.
Furthermore, the hospital must implement periodic training programs for all staff members. These training sessions should focus on skill enhancement, refresher courses, and updates relevant to each staff member’s role.
Importantly, training should follow the guidelines set by professional bodies and comply with local laws and regulations to ensure continuous improvement and competence across all categories of staff.
Below is the minimum staffing requirement for a multispecialty hospital with fewer than 50 beds. These numbers can be prorated based on specific needs.
Staffing Requirements for Hospital Level 3
- Doctors:
- At least 1 MBBS doctor shall be available round the clock on-site per unit.
- 1 doctor with specialization in the subject concerned as per the scope of services (full-time, part-time, or visiting).
- In the ICU, 1 MBBS doctor shall be available for every 6 beds, on-site 24/7.
- Nurses:
- Qualified nurses per unit per shift as required by “The Indian Nursing Council, 1985.”
- Nurses shall be available based on the occupancy rate and bed distribution in the hospital.
- A qualified nurse is a staff member approved as per state government rules and regulations.
- Pharmacist: At least 2 pharmacists in the hospital should be available.
- Lab Technicians: At least 2 lab technicians in the hospital (minimum DMLT qualification).
- X-ray Technicians: At least 2 X-ray technicians in the hospital (minimum Diploma in X-ray Technician course).
- Other Technicians: As per the requirements of the hospital.
- Nutritionist: As per the requirements of the hospital.
- Social Worker: As per the requirements of the hospital.
- Administrative Assistant: As per the requirements of the hospital.
- Medical Record Technician: As per the requirements of the hospital.
- Driver: As per the requirements of the hospital.
- Security Guard: As per the requirements of the hospital.
- Multi-purpose Worker: A minimum of 2 multi-purpose workers (minimum 12th pass).
Additional Staff: The requirement for other support and administrative staff will depend on the scope of services provided by the hospital.
Support Services offered by Level 3 Hospital
- Registration/Help Desk and Billing: The hospital shall have a Registration/Help-desk & Billing counter, which shall also provide patient guidance on services available, cost estimation, healthcare insurance, etc.
- Diagnostic Services:
- Diagnostic services may be in-house or outsourced.
- The diagnostic services must meet the minimum standards for imaging and laboratory services as per Clinical Establishment Act Standards for Hospital (LEVEL 3).
- Whether in-house or outsourced, the services shall ensure safe and timely patient care.
- The scope of diagnostic services shall align with the hospital’s scope of services.
- Pharmacy Services:
- Pharmacy services can be in-house or outsourced.
- All applicable legal requirements must be complied with.
- Medicine storage shall be in a clean, well-lit, and safe environment, in accordance with the manufacturer’s requirements.
- The quality of drugs, medical devices, and consumables shall be ensured.
- CSSD/Sterilization Area:
- Provision for instrument and linen sterilization, along with storage of sterile items, shall be available as per the scope of services.
- Validation of sterilization shall be done to ensure the effectiveness of the sterilization process.
- Linen Management:
- Soiled linen shall be collected, transported, and washed separately in a clean and hygienic environment.
- Appropriate decontamination procedures shall be carried out where linen is contaminated before dispatch for washing.
- Waste Management Services:
- Segregation, collection, transportation, storage, and disposal of biomedical waste shall comply with the Bio-Medical Waste Handling Rules.
- Waste management guidelines for Mercury and other toxic materials shall be followed as per applicable local laws.
- Segregation, collection, transportation, storage, and disposal of general waste shall comply with applicable local laws.
- Medical Gas:
- Oxygen for medical use shall be available. Additionally, other gases like Nitrous oxide, Carbon dioxide, etc., may be available depending on the scope of services and bed strength.
- Medical gases shall be stored and handled in a safe manner.
- All applicable legal requirements must be complied with.
- Appropriate backup and safety measures must be in place to ensure patient safety at all times.
- Ambulance Services:
- The hospital shall have provisions for transporting patients for transfer, referral, investigations, etc., in a safe manner.
- The ambulance service shall be in-house and comply with applicable local laws.
- Critical patients shall be transported under the supervision of trained and qualified staff.
List of Legal Requirements for Level 3 Hospital in India
Below is the list of legal requirements to be complied with by a hospital as applicable by the local/state health authority (not all may be applicable):
- Registration under Nursing Home Act/Medical Establishment Act
- Bio-medical Waste Management Licenses
- Authorization of HCO by PCB
- MOU with Vendor
- AERB Licenses
- Type approval
- Layout approval
- License for CT-interventional/ Registration for other machines
- NOC from Fire Department
- Ambulance
- Commercial Vehicle Permit
- Commercial Driver License
- Pollution Control Licenses
- Building Completion Licenses
- Lift Licenses for Each Lift
- DG Set Approval for Commissioning
- Diesel Storage Licenses
- Retail and Bulk Drug License (Pharmacy)
- Food Safety Licenses
- Narcotic Drug Licenses
- Medical Gases Licenses/ Explosives Act
- Clinical Establishments and Registration (if applicable)
- Blood Bank Licenses
- Boilers Licenses
- MoU/ Agreement with Outsourced Human Resource Agencies as per Labor Laws
- Spirit Licence
- Electricity Rules
- Provident Fund/ESI Act
- MTP Act
- PNDT Act
- Transplantation of Human Organs Act
- Sales Tax Registration
- PAN
- No Objection Certificate under Pollution Control Act (Air/Water)
- Wireless Operation Certificate from Indian P&T
- Arms Act, 1950 (if guards have weapons)
Record Maintenance and Reporting
- Medical Records Requirements: The minimum medical records to be maintained and the nature of information to be provided by the hospital shall be as prescribed in CG 2 Annexure, in accordance with Section 12 (1)(iii) of the Act.
- Format of Medical Records: Medical records may be maintained in physical or digital format.
- Confidentiality and Security: Confidentiality, security, and integrity of medical records shall be ensured at all times.
- IPD Patient Records: The medical records of inpatient (IPD) patients shall be maintained in accordance with national or local law, MCI guidelines, and court orders.
- Health Information and Statistics: Every hospital shall maintain health information and statistics related to national programs, notifiable diseases, emergencies, disasters, and epidemics and report the same to district authorities as per prescribed formats and frequency.
Content of Medical Record
Medical records shall include, at a minimum, the following information:
- Name & Registration number of treating doctor
- Name, demographic details & contact number of patient
- Relevant clinical history, assessment and reassessment findings, nursing notes, and diagnosis
- Investigation reports
- Details of medical treatment, invasive procedures, surgery, and other care provided
- Applicable consents
- Discharge summary
- Cause-of-death certificate & death summary (where applicable)
See Also: 10 Benefits Of EMR: Why Are Doctors Switching To EMR?
Basic Process for Level 3 Hospital in India
Registration/Help Desk and Billing Services
- Patient Registration: All patients visiting the hospital shall be registered, except when the required services are unavailable. In such cases, the patient will be directed to the nearest appropriate facility.
- Patient Guidance:
- Once registered, patients will be guided to the appropriate service area, such as OPD or ER, based on their clinical needs.
- Patients will be informed about their rights and responsibilities, cost estimates, third-party services (e.g., insurance), etc.
- Billing: The hospital’s billing shall follow the hospital’s tariff list, which will be made available to patients in an accessible format.
Assessment and Plan of Care
- Initial Assessment: Each patient shall undergo an initial assessment by qualified and/or trained personnel.
- Further Management: Based on the initial assessment, a registered medical practitioner will manage the patient’s care, such as OPD treatment, admission, transfer/referral, investigations, etc.
- General Consent: At the time of admission, general consent for admission shall be obtained.
- Patient Referral: If beds are unavailable or clinical need warrants, patients will be referred to another facility with the necessary clinical information or notes. Appropriate arrangements for safe transport will be ensured.
- Reassessments: Reassessments will be performed for admitted patients at least once daily or based on clinical needs, and the findings will be documented.
- Examination of Female Patients: Any examination, treatment, or management of female patients shall be conducted in the presence of a female attendant/nurse if done by male personnel, and vice versa.
Informed Consent Procedure
Informed consent shall be obtained from the patient, next of kin, or legal guardian as required for procedures such as invasive treatments, anaesthesia, blood transfusion, HIV testing, research, etc., in a language the patient can understand.
Care of Patient
- Clinical Practices: Care provided shall adhere to best clinical practices, referring to Standard Treatment Guidelines set by government and professional bodies.
- Patient Education: Patients and/or their families will be educated about preventive, curative, promotive, and rehabilitative aspects of care, either verbally or through printed materials.
- Documentation of Procedures: All relevant documents pertaining to invasive procedures, including the procedure safety checklist, shall be maintained in the patient record.
- Monitoring: Patients will be monitored during and after procedures (e.g., anaesthesia, surgical procedures, blood transfusion) and the observations will be documented.
- CPR Training: Staff involved in direct patient care shall receive basic CPR training.
Emergency Services
- Emergency Care: Emergency patients shall receive priority. The Emergency Department shall be equipped with trained staff.
- Referral and Transfer: If emergency services are unavailable, the hospital will provide first aid and arrange an appropriate transfer or referral.
Medication Prescription, Administration, and Monitoring
- Prescription Requirements: Prescriptions will include the patient’s name, date, medication name, dosage, route, frequency, duration, and the medical practitioner’s name, signature, and registration number.
- Drug Allergies: Drug allergies shall be checked before prescribing and administering medications. Any discovered allergies will be communicated to the patient and documented.
- Medication Verification: Patient identity, medication, dose, route, timing, and expiry date shall be verified before medication administration.
- Injection Practices: Safe injection practices shall be followed as per WHO guidelines.
- High-Risk Medications: High-risk medications shall be verified by two trained healthcare personnel before administration.
- Post-Medication Monitoring: Patients will be monitored after medication administration, and any adverse drug reactions/events will be recorded and reported.
Infection Control
- Standard Precautions: The hospital will follow standard infection control precautions, including hand hygiene and use of personal protective equipment, to reduce the risk of healthcare-associated infections.
- Space and Hygiene: Proper spacing in patient care areas will be maintained to prevent infection transmission, and regular cleaning with disinfectants will be carried out as per prescribed procedures.
- Infection Control in High-Risk Areas: Infection control practices will be strictly followed in high-risk areas like the operation theatre, ICU, and HDU, as per good clinical practice guidelines.
- Housekeeping and Sanitation: Housekeeping and sanitary services will ensure appropriate hygiene and sanitation throughout the hospital.
Safety of Patients, Staff, Visitors, and Relatives
- Safety Measures: The hospital shall ensure the safety of patients, staff, visitors, and relatives through appropriate safety installations and measures, such as mother-baby identification in obstetrics facilities.
- Fire and Emergency Preparedness: The hospital will take all necessary measures for fire and non-fire emergencies, ensuring patient, staff, and visitor safety. This includes periodic staff training and mock drills.
- Fire Safety Compliance: All fire safety measures as per local law shall be followed, including fire prevention, detection, mitigation, evacuation, and containment. Staff training and mock drills shall be conducted regularly and documented.
- Cooperation During Emergencies: In case of an epidemic, natural calamity, or disaster, the hospital shall cooperate and provide reasonable assistance, including medical aid, as requested by the designated supervising authority.
Patient Information and Education
- Information Sharing: Patients and/or their families will be informed about the disease condition, proposed care, risks, alternatives, and benefits. They will also be informed about the expected cost of treatment and any changes in condition.
- Medication and Disease Prevention Education: Patients and/or families will be educated about the safe and effective use of medication, food-drug interactions, diet, and disease prevention strategies.
Discharge
A discharge summary shall be provided to all patients being discharged. The discharge summary shall include:
- Name & registration number of the treating doctor.
- Name, demographic details, and contact number of the patient.
- Date of admission and discharge.
- Relevant clinical history, assessment findings, and diagnosis.
- Investigation results.
- Details of medical treatment, invasive procedures, surgery, and other care provided.
- Discharge advice, including medications and other instructions.
- Instructions on when and how to obtain urgent care.
- A discharge summary will also be provided in cases of patient transfer, Leave Against Medical Advice (LAMA), Discharge Against Medical Advice (DAMA), or death.
Conclusion
In conclusion, opening a hospital in India requires careful consideration of numerous factors to ensure a high standard of care while complying with the legal and regulatory framework. From recruiting qualified medical, nursing, and support staff to ensuring the provision of essential services like diagnostics, pharmacy, and emergency care, a successful hospital is built on a foundation of quality and safety.
As a doctor planning to establish your own hospital, your commitment to following these guidelines will not only help you meet regulatory requirements but also provide the best possible care to your patients.
By focusing on well-trained staff, proper patient management, informed consent protocols, infection control, and safety measures, you will create a trusted and reputable healthcare institution.
The standards outlined in this guide for level 3 hospitals provide a comprehensive blueprint for the development of your hospital, enabling you to deliver exceptional medical services while maintaining a safe and compliant environment for both patients and staff.
