The Department of Orthopedics, Eastern Visayas Regional Medical Center performs three basic roles that are congruent with the general purpose of a teaching training regional medical center. These are the delivery of orthopedic services, the training of competent and safe surgeons and involvement in relevant research activities. The main focus, however, is on the delivery of the best orthopedic care to any patient it serves. The following policies are designed to ensure that such carried out properly and efficiently. These policies, however, will need periodic re-evaluation to assess its relevance to the role that the department plays.
An organization of empowered, competent and compassionate health service professionals recognized globally for innovative and quality orthopedic service, training, relevant research and orthopedic health policy development.
To advance the art and science of orthopedics in providing an excellent and resilient service delivery, training and promotion of relevant research by an empowered, compassionate and highly skilled health professionals in Eastern Visayas Region.
POLICIES ON PATIENT CARE
The Department maintains the following services:
- Orthopedic Emergency service
- Orthopedic In-patient service
- Orthopedic Out-patient service
A. ORTHOPEDIC EMERGENCY SERVICES
- All orthopedic case will be entertained and services offered 24 hours daily.
- Orthopedic cases at the emergency room that will not require admission will be discharged after evaluation and management by DEMS staff and/or orthopedic staff.
- All patients with orthopedic emergencies that need emergency orthopedic procedures and all medico-legal orthopedic cases will be transferred to EVRMC, Magsaysay Boulevard after evaluation and stabilization.
- Elective, non-complicated orthopedic cases will be admitted for elective surgery.
- All patients for referral must have a corresponding properly filled up referral slip.
- A logbook for all cases attended to, will be maintained and all entries must be signed by the surgeon on duty.
- Procedures to be done at ER must have informed consent by the patient or representative unless it is a life-threatening injury.
- All procedures done by students and trainees must be supervised by a member of the staff. Prescription and orders by them must be countersigned by a staff member.
- Patients for co-management must be referred, examined and managed by the concerned department before transport to Ortho ward
- All trauma cases must be cleared of life-threatening injuries at the ER prior to admission to orthopedic ward.
- Problematic/Difficult cases must be referred to the orthopedic consultant.
- Amputated parts of the human body should be endorsed to ER nurse for proper identification and disposal.
- Recovered offending instruments (knives, slugs, etc.) must be properly labeled and endorsed to record section for safekeeping and retrieval later on.
B. ORTHOPEDIC IN-PATIENT SERVICES
- Only the following patients will be admitted to the surgical wards:
- Those with admitting orders from the emergency room.
- Those with admitting orders from the outpatient services.
- Those from other departments with orders for transfer to orthopedics ward made by a member of the orthopedic staff.
- Only bona fide members of the orthopedic staff will be allowed to admit, manage and follow up patients admitted in the orthopedic ward.
- Only bona fide members of the orthopedic nursing staff will be allowed to attend patients. The clinical instructor and regular ward nurse will be responsible for the activities of nursing students.
- All orders are made by trainees and students must be countersigned by a member of the staff.
- All patients must give consent for management. In cases of minors ( below 21 yrs. old ) without guardians, unconscious patients and those unable to give consent and no relative is around, the administrative officer or senior house officer must be notified about the situation. For emergency procedures to be done on these patients, two (2) members of the staff will sign as witnesses to the emergency nature of the case.
- No patient will be allowed to go out of the hospital premises without written consent by the attending surgeon. Patient missing for 8 hours as noted by the ward nurse will be considered as having absconded.
- “Out on pass” patients are expected to be back in 12 hours from time departure as noted by the nurse on duty.
- Indigence classification of patients is a function of the Social Services Section and as such will be made only by them.
- No patient will be held in the surgical wards only because of inability to pay hospital bills.
- Only patients are allowed to occupy hospital beds. Rules on visiting hour’s need watchers will be strictly adhered to.
- Upon discharge of the patient, all entries on the chart must be completed before sending them to records sections.
C. ORTHOPEDIC OUT-PATIENT SERVICES
- The Orthopedic OPD service will offer consultation during Mondays and Thursdays.
- A resident will be assigned to man the OPD for such consultations.
- Only OPD patients with consultation forms issued by the OPD records clerk shall qualify for consultation.
- No consultation fee will be solicited by any member of the surgical staff
- Referrals from other outpatient services must carry a history and P. E by the resident in charge. For problematic cases the consultant of the team must be informed.
- Dates for follow –up consultations or dates for follow up after discharge from the ward must be specified by the resident in charge or the service concerned.
- All elective minor surgeries must be scheduled. An informed consent must always be given by the patient or the parent/relative.
- A female nurse must assist a male physician during examination of a female patient.
- Patients who develop reactions and/or complications from treatment must be admitted for observation or further management.
- All laboratory and X-ray request must be duly accomplished by the resident in-charge before such are sent to the laboratory or radiology departments.
POLICIES ON CONSTITUTION OF THE SURGICAL STAFF
Appointment to the consultant staff will be made only upon recommendation by the chair and consultant staff of a prospective applicant to the PSB and hence to the MCC for evaluation and approval.
The following are the qualities for consideration:
- The applicant must be known to the staff as one who is proficient in his field of practice.
- A Diplomate of by the Philippine Board of Orthopedics and preferably a Fellow of the Philippine Orthopedic Association.
Voluntary “Visiting Consultant” status may be given to one who possess any of the above qualifications and who applies for such.
Appointments to the resident staff of the department will be made only after screening of prospective applicants thru written/oral evaluation. Existing policies on residency training admission process in government hospital by the Department of Health shall also apply. There shall be no discrimination as regard to sex, civil status and religion of applicants. Applicants 40 years old and above will however be discouraged.
The process of accepting in-service trainees from other hospitals is based upon existing policies by the Department of Health and only after recommendation by the Training Officer of the hospital or the department of origin. The Department however, reserves the right to refuse a trainee or to defer training to another period. Training period begins January 1 and July 1 of the calendar year.
SURGICAL CLERKS, POST GRADUATE INTERNS AND OBSERVERS
Clerks, PGIs and observers are in the category of students. All their activities will be under supervision.
OPERATING ROOM POLICIES
- Only bona fide members of the orthopedic staff will be allowed to perform surgery on patients in the department.
- The senior consultant of the surgical team takes full responsibility for the conduct of operation.
- Visiting surgeons from the Department of Health, POA, and visiting foreign surgeons on medical missions will be allowed to do the surgery after presenting their credentials and mission orders to the Chairman of Department.
- For the duration of their stay, visiting surgical teams are considered members of the surgical department of the hospital with all privileges and responsibilities thereat.
- Only bona fide members of the anesthesia department will be allowed to administer anesthesia to surgical patients except those done under local infiltration anesthesia.
- Informed consent must be given by patient or guardian before any surgical procedure is done.
- In emergency cases where consent from the patient, the parents or the guardian is not possible, two (2) members of the orthopedic staff must sign as a witness to the emergency nature of the case. Likewise, the administrative officer must be notified as soon as possible.
- A regular member of the OR nursing staff must scrub in all major operations. Nurse trainees will be under direct supervision.
- Rules of conduct inside the OR areas will be strictly enforced and followed.
- All tissue specimens removed inside the OR must be submitted for histopathological examination. As such they become the property of the hospital.
- All offending instruments ( eg. Knives, slugs, etc.) removed in the OR must be properly labeled and endorsed to the records section for safekeeping.
- A completed written record of the operation (including operative findings, surgical technique/ procedure done and intra-operative complications) must be made immediately after the operation by the surgeon or his assistant.
PROCEDURES FOR SCHEDULING OF OPERATIONS
- Only Elective procedure will be scheduled for surgery (at the new site).
- The Chief/senior resident prepares the schedule of operations, approved by the Chairman of the Department and submitted to the OR, the orthopedic ward and Anesthesia department before 12 noon the day before the operation.
- Operating days for elective surgeries will be from Monday to Friday 24 hours daily.
- The operating surgeon must be at the OR at least 30 minutes before the scheduled cutting time. If at cutting time the surgeon is not yet around, the next case may be wheeled in as first case.
- Earliest incision time will be 7 AM with exceptions during:
- Surgical missions
- Operating load for emergency cases is heavy thus adjustment for elective cases have to be made
- No elective surgeries will be scheduled on Saturdays, Sundays and Holiday
POLICIES ON REFERRALS
- All referrals to the surgical department must be officially made on referral form duly signed by the resident in charge.
- Resident in charge of the case must be around when referral is seen.
- Referrals from the department of surgery to another department must be allowed up by resident charge.
POLICIES ON ISSUANCE OF CERTIFICATES
- The attending orthopedic surgeon who saw/ managed the case will be responsible for filling up and signing the requested certificate. If he or she is already separated from service, out of the country and or cannot be contacted, the senior resident can sign the certificate to attest the veracity of entries recorded in the logbook and/or in the chart.
- Only members of the records section may bring such certificate to attending physician for signature.
- Certificates of treatment, physical examination and confinement may be issued upon the request by patient or guardian only if said patient has an OPD record, appears in logbook as treated or seen and/or an admitting chart was made.
- A “Death Certificate” will be issued to all deaths occurring within the responsibility of the department only.
- Where case is to be autopsied, issuance of the final death certificate will have to be deferred until after the autopsy results is in.
- No “Death Certificate” will be issued by the department for DOA cases. A case is considered as DOA if on arrival at the surgical emergency room the patient has:
- Absence of vital signs i.e. blood pressure, heart rate and respiratory rate
- Signs of brain death i.e. absent pupillary reflexes.
- This holds true also even if resuscitation efforts were made and failed
Such cases of DOA’s will be referred to NBI or to the MHO from whence the incident occurred or the patient came from.
- Certificates of Training will be issued by the Training Officer of the Hospital. The department will issue a communication certifying satisfactory completion of training of Resident or in-service to the training office.
|NAME||POSITION / DESIGNATION||ADDRESS||CONTACT||EMAIL ADDRESS|
|BALANO, ALLAN||MS III ( PART TIME )||Cristina heights, Tacloban Cityemail@example.com|
|CAALIM, ALDEN FLORENCIO||MS III ( PART TIME )||Jiboren ville subdivision, Marasbaras Tacloban Cityfirstname.lastname@example.org|
|CABOBOY, FRANCISCO||MS III ( PART TIME )||Brgy.79, Marasbaras Tacloban Cityemail@example.com|
|LABINE, ARVIN||MS III ( PART TIME )||B20 L12 P4Ext V&G Subd, Tacloban Cityfirstname.lastname@example.org|
|EXALTACION, JESSE JAMES||MS II ( PART TIME, J.O )||218-C Tres De Abril St. Labangon Cebu Cityemail@example.com|
|CALACAL, DEXTRE||MS II ( PART TIME, J.O )||Borongan, city|
|VILCHES, NESTOR||MO IV||P4B4L14 V&G Subd, Tacloban Cityfirstname.lastname@example.org|
|TAN, WICHELLE||MO IV||110 B8L20 Flexi Homes, V&G Tacloban Cityemail@example.com|
|INDENCIA, NELMARC||MO III||Romualdez Street Poblacion Tolosa Leytefirstname.lastname@example.org|
|CLAVECILLAS, JOHNWILL||MO IIIemail@example.com|
|FAMI, VLADEMIR ERICK||MO III||Brgy. 77 sapphire street Sundylane Marasbaras Tacloban Cityfirstname.lastname@example.org|
|MAGLONZO, ARCHIE||Clerk – JO||55 EL Reposo St. Tacloban Cityemail@example.com|
DEPARTMENT OF ORTHOPEDICS ORGANOGRAM
DEPARTMENT OF ORTHOPEDICS ORGANOGRAM