SCOPE OF SERVICE
INTERNAL MEDICINE DEPARTMENT
Department/Service: Internal Medicine
Form Completed by:
Dr.Abdulrahman Al shaikh (Director Of Internal Medicine Department)
1.Unit Description
1.1 Mission
To provide safe and effective preventive and therapeutic health care services covering all
subspecialties of Internal Medicine including, endocrinology, nephrology, pulmonology,
heamatology, gastroenterology, rheumatology, medical oncology, dermatology. This service is
provided for adult and geriatric patients of both sexes attending Dr. Soliman Fakeeh Hospital through
organized experienced teamwork.
1.2 Vision
To be the leading internal medicine department in the Middle East by providing the best medical care
practices to our patients, continuously improving quality of care techniques and continuous education
of our staff with an outreach of care to our community.
1.3 Goals:
1.3.1 Achieve better quality of patient care as guided by quality indicators.
1.3.2 More emphasis on staff and patient education.
1.3.3 Introduction of new therapeutic and diagnostic techniques.
1.3.4 More respect to patient and family rights.
1.4 Days and Hours of Operation
The department of medicine is on duty 24 hours a day, seven days a week including national
and religious holidays.
1.5 Staff availability
Consultants cover sixteen hours per day from 9 am - 1am and 8 hours on call 1am9am.Specialists cover 24-hour service.
2. Patient Population
2.1 External customers
Internal Medicine services are available to all in-patient and outpatient adults and geriatrics patient of
both sexes and all races regardless of financial class on emergent, urgent and elective basis. Total
number of patients attending outpatient clinics of Internal Medicine Department was 67847 patients
during the previous 10 months.
2.2 Internal Customers
2.2.1 Service Type:
- In-patient
- Outpatient
- Emergency
2.2.2 Medical Services:
Endocrinology
Nephrology
Pulmonology
Respiratory care services
Gastro-enterology
Hematology
Medical Oncology
Rheumatology
Dermatology and Venereology
Staff health
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Infectious diseases
2.2.3 Level Or Intensity Of Patient Care:
Acute
Chronic
Intensive
Check-up.
2.2.4 Patient Age:
Adolescent
Young adult
Middle age
Older adult including geriatrics
N.B.Some Specialties like Dermatology, Oncology, Hematology, Respiratory Care Services and
Nephrology can check patients from younger age.
2.2.5 Patient Origin:
National
Non-national
2.2.6 Patient Physical Capacity
Movement impaired
Wheel chair bound
Bed bound
Vision impaired
Hearing impaired
Speech impaired
3. Assessment Process
3.1 Departmental procedures
3.1.1 Endocrine procedures:
Anterior pituitary function test, ITT (insulin tolerance test).
Glucose tolerance test.
Combine GlT and glucose tolerance tests.
Synactine test.
LHRH or GnRh test.
Colindine stress test.
Arginine stress test.
TRH stimulation test.
24 hrs. glucose monitoring (sensor).
Install s.c. insulin pump.
Thyroid FNA.
3.1.2 Nephrology Procedures:
Hemodialysis.
Peritoneal dialysis
Through cooperation with other departments:
Anesthesia: subclaviculian catheter, internal jugular catheter, permicatheter.
U/S: ultrasound guided renal biopsy.
3.1.3 Pulmonary procedures:
Pulmonary function testing.
Simple spirometry.
Spirometry before and after bronchodilators.
Diffusion lung capacity.
Procedures in cooperation with other departments e.g thoracic surgery and radiology
Bronchoscopic work-up.
Thoracocentesis.
CT Guided aspiration and biopsies.
Interpretation of sleep studies
Diagnostic and therapeutic CPAP and BIPAP
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Respiratory Care Services other than the abovementioned:
Chest physiotherapy, Breathing exercises, incentive spirometry, oxygen
therapy, care for ventilators and other respiratory care equipment, etc.
3.1.4 Hematology Procedures:
Bone marrow transplantation.
Bone marrow aspiration.
Bone marrow biopsy.
Transfusion of blood products
RBC exchange.
Plasma exchange.
3.1.5 Gastroenterology:
Upper gastrodeodenoscope.
Colonoscopy.
ERCP
Gastrostomy tube.
Through cooperation with other departments:
Ultrasound: ultrasound guided abdomenal paracentesis, ultrasound guided
liver biopsy
3.1.6 Rheumatology Procedures:
Joint aspiration for synovial fluid analysis.
Intra-articular injections
Ultrasound guided intra-articular injections of the hip joints.
Injection of musculoskeletal soft tissues.
C.T guided injection of the costo-vertebral joints.
3.1.7 Oncology Procedures:
Screening for cancer.
Chemotherapy treatment.
Radiation therapy service for:
External irradiation.
Brachytherapy for cancer cervix.
3.1.8 Dermatology unit Procedures:
Electrocautery.
Cryocautery.
Intralesional injection (Dermojet).
Phototherapy.
Photo chemotherapy.
Skin biopsy
Skin Bencard test.
Skin Desensitization Vaccination.
Botox injection.
Camedo and milia extraction.
Dermabrasion.
Chemical peeling
Facials
3.1.9 Staff Health Clinic Procedures:
Pre-employment assessment.
Immunization program implementation.
Primary care of employees.
Determination of limitations to work assignments.
Work restriction determination.
4. Staffing Requirements
4.1 Position Tittles and licensure or specification requirements
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The department of medicine is directed by MD (or its equivalent)-certified internist and is staffed by
MD (or its equivalent), certified internits, Master degree (or its equivalent) certified specialists in
different, subspecialities and certified registered nurses/technicians/therapists in specialty care units.
4.2 Organizational Chart
Internal Medicine Department Organization Chart
Chief Medical Officer
Director of Medicine
Staff Health
Pulmonary
Internal Medicine
Specialist
Nephrology
Pulmonary
Consultant
Hematology
Nephrology
Consultant
Hematology
Consultant
Specialist
Specialist
Respiratory
Care providers
Endocrinology
Dermatology/
Venereology
Endocrinology
Consultant
Specialty
Nurses
Specialty
Nurse
Medical Oncology
Dermatology
Consultant
Specialty Nurse
Specialty
Technician
Diabetic
Educators
Gastroenterology
Oncology
Consultant
Rheumatology
Gastro.
Consultant
Specialist
Rheum.
Consultant
Endoscopy
Technician
Medical
Physicist
4.3 Continuing Education and Training policy and requirements
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All department staff is required to attend the hospital orientation upon employment in the
organization, in addition to departmental orientation by director of medicine or his designee.
All internal medicine staff are required to attend weekly department meeting including various
activities as mini lectures, journal clubs, case presentations.
Attendance and participation of monthly CME program within the hospital
All medicine department staff should be BLS certified.
5. Modalities used
5.1 Diagnostic/detection Modalities needed:
5.1.1 Endocrinology:
Glucometer
Orchidometer
Tuning fork.
Ophthalmoscope
Proctoscope.
Rigid sigmoidoscope and biopsy forceps.
Needles for fine needle aspiration.
Continuous glucose monitor.
Subcutaneous insulin pump.
5.1.2 Nephrology:
Monitor- biopsy needle, glucometer
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5.1.3 Pulmonology:
spirometery and Diffusion Capacity Machine.
Peak flow meter, pulse oximeter, bronchoscopy set, CPAP, BIPAP.
5.1.4 Hematology
Bone marrow biopsy needle.
5.1.5 Gastroenterology unit:
Upper endoscopies,sigmoidoscope,colonscope, ERCP,liver ,gastric and colonoscopic
biopsy
5.1.6 Rheumatology unit
Equipment for synoval fluid aspiration
Goniometer
Nail fold capillaroscope
Magnifying lens
Meter
5.1.7 Oncology modalities:
5.1.8Dermatology unit:
Punch biopsy
Bencard test
Needle aspiration
Skin scrapper
Probes and culture media
5.1.9 Staff health unit:
Glucometer
5.2 Therapeutic/corrective Modalities needed
5.2.1 Endocrinology therapeutic equipments:
Glucometer
Orchidometer
Tuning fork.
Ophthalmoscope
Proctoscope.
Rigid sigmoidoscope and biopsy forceps.
Needles for fine needle aspiration.
Continuous glucose monitor.
Subcutaneous insulin pump.
5.2.2 Nephrology:
HD machine
Defibrillator
PD set
Sublavian and internal jugular catheters.
5.2.3 Pulmonology:
Thoracentesis set
Bronchoscopy set
Nebulizer (jet and ultrasonic).
CPAP and BIPAP
Other respiratory care services modalities e.g. oxygen therapy equipment, incentive
spirometers, suction systems, oxygen cylinders, etc.
5.2.4 Hematology
Cell separator, Hickman catheter.
WBCs filters
chemotherapy infusion pumps.
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5.2.5 Gastroenterology unit:
ERCP, varicel injection and ligation,gastrostomy,polypectomy and paracentesis.
5.2.6 Rheumatology unit
Corticosteroid injections.
Lowerlock needles and injections.
Local anesthetic injections.
Local anesthetic spray.
5.2.7 Oncology modalities:
Urinary bladder catheterization for intravesical chemotherapy.
Chemotherapy infusion pump.
Simulator for planning Oncology patients.
Amersham brachytherapy applicator for caecium intracavitary.
5.2.8 Dermatology unit:
Phototherapy
Photochemotherapy
Electrocautery
Cryocautery
Intralesional injection (Dermojet)
Dermabrasion
Chemical peeling
Skin desensitization vaccination
Comedo and milia extraction
5.2.9 Staff health unit:
5.3 List the procedural Modalities needed
5.3.1 Endocrinology:
Consent for FNA thyroid.
Clinical protocols for dynamic endocrine testing.
5.3.2 Nephrology:
Consent for HD/PD/ renal biopsy/ subclavican/ permicatheter catheter
5.3.3 Pulmonology:
Consent form, checklists.
Respiratory Care services forms e.g. respiratory Care Services request form, respiratory
therapy follow up form, ventilator flow chart, etc.
5.3.4 Hematology
Consent form for blood transfusion.
Consent form for central line insertion.
Consent form for chemotherapy administration.
Consent form for stem cell donation.
Consent form for bone marrow transplantation.
Checklist for chemotherapy administration.
5.3.5Gastroenterology unit:
Consent form for endoscopy, biopsy and paracentesis.
5.3.6 Rheumatology unit
Consent forms for instituting cytotoxic and other immunosupprecive agents
5.3.7 Oncology modalities:
Consent form for chemotherapy and radiotherapy.
Checklists for chemotherapy preparation for every patient.
Checklists for chemotherapy administration for every patient.
Checklists for accuracy of radiation machines.
5.3.8 Dermatology unit:
Consent form before retinoid intake.
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Consent and checklist before operation.
5.3.9 Staff health unit:
Software for specific services foe staff health, data analysis software, computer system
protocols for staff immunization.
OVR for sharp needle injury/on the job injury/communicable disease exposure.
Medical history questionnaire from
6. Support Service
6.1 Communication chart
The Internal Medicine Department Communication Chart
Nursing Department
Surgery
Departments
Biomedical
Engineering
Physical Therapy
Department of
Internal Medicine
CSSD
Medical Records
Infection Control
Dietetic Dept
Administration
Radiology
Laboratories
Nuclear Medicine
6.2 Departmental Committees and Meetings
Weekly department meeting for medicine.
Pharmacy and therapeutic committee monthly.
Blood utilization committee every month.
General check-up task force committee every two month.
Renal dialysis committee every 2 month.
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6.3 Communication methods with other Departments/Divisions/Services
Referrals
Meetings
Memos
Memorandums
Personal communication
6.4 Standard of Practice
Evidence based medical data. All policies are reviewd and approved by Director of Internal Medicine
and subjected to chief medical officer approval where applicable.
Endocrinology:
 American Diabetic Association ADA
 American Endocrine Society.
Nephrology
 American society of nephrology.
 EDTA
Pulmonology:
 American college of chest Physicians.
 European Respiratory Society.
 American Association of Respiratory Care (AARC) Clinical Guidelines.
Hematology:
 American Association of Hematology
Gastroenetrology:
 American society of Gastroenetrology
Oncology
 American society of clinical oncology.
 European society of clinical oncology.
Dermatology:
 American Academy of Dermatology
 European Society of Dermatology and Venereology
Rheumatology:
 American College of Rheumatology
Staff Health
 American college of Occupational and Environmental medicine.
 MOH standards.
 MRQP standards.
 JCI standards.
Hyperbaric oxygen therapy unit:
 American society of aerospace medicine.
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7. Approval
7.1 Prepared by: _____________________________
Date:
Internal Medicine Department Director
Dr. Samir Sally
7.3 Approved by:
______________________________
Chief Medical Officer
Dr. Bravo Badee
30/04/2006
Date: 30/04/2006
_____________________________
Date: 30/04/2006
Owner & Director General
Hospital Executive Committee, Chairman
Dr. Soliman Fakeeh
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