devsofttech_hms_ci4/.agents/skills/hms-ipd/SKILL.md

name	description
hms-ipd	Use when building, modifying, or testing Inpatient Department (IPD) features, including bed management, admission lifecycle, daily doctor rounds (SOAP), nursing care charting, vital signs monitoring, medication administration, OT/surgery documentation, and discharge workflows.

HMS IPD (Inpatient Department) Management Skill

This skill guides the agent through the complete Inpatient care lifecycle from admission, ward/bed management, clinical care, nursing charts, to discharge processing in E-Atria HMS.

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1. IPD Lifecycle Overview

graph TD
    A[Patient Recommended for Admission in OPD/Emergency] --> B[IPD Registration: Bed Allocation & Category Selection]
    B --> C[Initial Medical Assessment within 24h & Nursing Assessment within 4h]
    C --> D[Daily Inpatient Care: Rounds, SOAP Notes, Nursing Vitals]
    D --> E[Procedures / OT Surgery / Diagnostic Orders]
    E --> F[Accumulation of Daily Inpatient Charges]
    F --> G[Doctor Approves Discharge & Prepares Discharge Summary]
    G --> H[Billing Settlement: Final Bill & Clearance]
    H --> I[Bed Vacated & Cleaned for Next Admission]

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2. IPD Database Architecture

Table Name	Purpose	Key Columns
ipd_master	Inpatient admission record	id, ipd_no, patient_id, admission_date, admission_time, r_doc_id (admitting consultant), bed_id, department_id, status (admitted, discharged, transferred, expired), discharge_date, discharge_time
bed_master	Hospital bed master	id, bed_name, bed_category_id, ward_id, is_occupied, daily_rate
ward_master	Wards / departments	id, ward_name, floor, total_beds
bed_assignment_history	Bed allocation and transfer history	id, ipd_id, patient_id, bed_id, assigned_at, released_at, transferred_reason
ipd_master_doc_list	Multiple attending / visiting doctors assigned to an IPD case	id, ipd_id, doc_id, doc_type (primary, surgeon, anesthetist, consultant)
ipd_nursing_entries	Bedside nursing charts, TPR (Temp, Pulse, Resp), BP, SpO2, I/O chart	id, ipd_id, nurse_id, entry_time, temp, pulse, resp_rate, bp_systolic, bp_diastolic, spo2, blood_sugar, intake_oral, intake_iv, output_urine, remarks
nursing_ipd_charges	Inpatient consumables, nursing procedures, injections, dressing charges	id, ipd_id, charge_name, qty, rate, amount, charged_at
ipd_discharge	Master discharge document and final condition	id, ipd_id, patient_id, discharge_type (normal, lama, referred, expired), discharge_status, follow_up_date
ipd_discharge_templates	7 NABH Specialty discharge summary narratives	id, template_name, specialty, content_structure

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3. Daily Clinical Rounds & Documentation (SOAP Notes)

• Every admitted patient requires at least one daily progress note by the attending doctor using the SOAP Format:
  • S (Subjective): Patient symptoms, pain score, oral intake tolerance, night sleep.
  • O (Objective): Vitals review, physical examination, wound inspection, drain output, lab results.
  • A (Assessment): Clinical progress (improving, stable, deteriorating), revised differential diagnosis.
  • P (Plan): Medication orders, IV fluids, lab investigation advice, discharge timeline.
• Stored in ipd_document_templates / ipd_discharge_course.

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4. Bed Allocation & Ward Transfers

• Atomic Status: When a bed is assigned in ipd_master, bed_master.is_occupied = 1 must be updated atomically within a database transaction.
• Transfers: When transferring a patient to another ward/bed (e.g. Ward -> ICU -> Post-Op):
  • Record release time in bed_assignment_history for the old bed (bed_master.is_occupied = 0).
  • Create a new row in bed_assignment_history for the new bed (bed_master.is_occupied = 1).
  • Update ipd_master.bed_id to the new bed.
  • Update room tariff in ipd_invoice_item starting from the transfer timestamp.

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5. Discharge Workflow & Clearance

1. Medical Discharge: Treating doctor drafts and approves the Discharge Summary in ipd_discharge.
2. Medication on Discharge: Prescribe discharge medications with duration and explicit timing.
3. Nursing Clearance: Removal of IV lines, catheter, surgical dressings, return of unused pharmacy items.
4. Billing Settlement: Final bill audit, advance adjustment, receipt issuance (invoice_master).
5. Gate Pass / Discharge Slip: Printed with follow-up instructions and emergency contact numbers.
6. Bed Release: Bed marked as is_occupied = 0 and flagged for housekeeping sanitization.