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Patient Care Facilities

About 100 out-patients referred from the various regional hospitals in the interior and from health care facilities in the capital area attend the various specialist clinics each day. Additionally, about 200 ambulatory emergency walk-ins report at the adult and pediatric Emergency departments. The Hospital provides facilities for 630 in-patients admitted through the divisions of Child Health, Medicine, Surgery, Obstetrics and Gynecology, and Oncology. Besides the 17 large general wards, each of which can accommodate 34 patients, there are the following critical care wards with 8 beds each: Neonatal ICU, Pediatric ICU, Adult ICU, Coronary Care Unit, Post Cardiac Surgery Unit. The other specialized areas include a 30-bed Special Care Baby Unit, 18-room Delivery Suite, VIP Ward and Special Nursing Ward. The National Oncology Centre has been built as an extension block and comprises of an outpatient department, daycare Chemotherapy areas for adults and children, Radiotherapy section, cytotoxics preparation area, Nuclear Medicine, adult and pediatric Oncology wards, a general purpose Daycare Ward, and an ICU/HD ward. A 139-bed Cardiac Center is being built adjacent to the Oncology Center. This will be a state-of-the-art facility for pediatric and adult Cardiology and Cardiothoracic Surgery. It will have an extensive outpatient department with separate sections for adult cardiology, pediatric cardiology and cardiothoracic surgery; adult and pediatric sections for non-invasive cardiac studies; 12 bed coronary care unit; 4 cardiac cath laboratories; cardiac-angio CT scan unit; 4 operation theatres; 24 bed adult and pediatric post-cardiac surgical units; and 4 inpatient wards.

Quality Assurance

The Royal Hospital places much emphasis on delivery of quality health care. The Medical Committee meets once a month to review risk management statistics, performance indicators and quality improvement initiatives. There is a Clinical Audit Committee to audit quality of care and monitor mortality and morbidity audits conducted by the various divisions and departments. Other activities undertaken by the QA office include: monitoring of adverse events, accidental inoculation injuries, quality improvement teams, and patient satisfaction surveys.

Ambulatory Care

Adult and Pediatric Emergency Departments There are separate Emergency Departments for children and for adults who present with medical, surgical and gynecological emergencies. Trauma cases that are brought are stabilized and transferred to Khoula Hospital, which is the designated Trauma Center. The Resuscitation Rooms in these emergency departments are well equipped to simultaneously manage multiple patients. There are also 14 plus 4 cubicles respectively in the major treatment halls in the Adult and Pediatric emergency departments. Each of these departments also has observation beds for patients who require reassessment for a maximum period of 6 hours before deciding on admission to the hospital or discharge home. Specialty Clinics The Royal Hospital outpatient specialty clinics cater to non-emergency referrals from regional referral hospitals in the interior and from hospitals and health centers in the capital area. These referral requests are vetted, for appropriateness and urgency, by the clinician of the respective specialty at Royal Hospital, and an appointment is scheduled. Per day, about 500 such referred patients attend the OPD, either for a first visit related to a new clinical episode, or for a re-visit for diagnostic work-up or review. Much emphasis is placed on the back-referral of these patients to their primary catchment area for follow-up. The waiting period is monitored to ensure that patients do not have to wait too long for a consultation appointment. Keeping in mind that the referrals are for higher technical expertise and for tertiary care, the patients are seen by senior clinicians, who are available on specified days of the week in the 40 consultations rooms in Adult and Pediatric OPDs and in the Obstetrics and Gynecology specialty clinic. Delivery Suite Emergency Room Patients in labor have ready access to the Delivery Suite through a separate maternity entrance at Level O of the Hospital. The Delivery Suite is well designed, with a 4-bed assessment room, 13 delivery rooms and a 4-bed high dependency unit. The Delivery Suite also has immediate access to the Emergency Obstetrics Operation Theatre.

Day Care

Several clinical procedures (chemotherapy, lithotripsy, haemodialysis, upper and lower GI endoscopy, bronchoscopy, coronary and peripheral angiography, bone marrow biopsy, apheresis, therapeutic phlebotomy, transfusion, chelation, etc.) are carried out on a day-care basis. A separate Day-care Ward is in the process of being constructed.

Critical Care

Intensive Care The Hospital has the following critical care beds: 8 coronary cares, 7 adult ICU, 6 pediatric ICU, 8 post cardiac surgical units. Another ICU of 8 beds is being established in the Oncology Block. The special care baby unit includes the following incubator basinets: 10 levels 4 intensive care, 16 levels 3 high dependencies, and 4 level 2 intermediate dependencies. To ensure proper use of these beds, there are strict admission criteria for each of these critical care areas. For example, only patients requiring ventilator support, cardiac and invasive blood pressure monitoring and intensive medical and nursing care are admitted to the ICU. Further, because of the high demand for these beds, every attempt is made to expedite transfer of these patients to the general wards. High Dependency As a step-down facility to the intensive care areas, and also to manage seriously ill patients who do not require artificial ventilation, there are the following high dependency units: 4 male and 4 female surgical beds; 8 medical beds managed by intesivists; 4 pediatric surgery beds; 4 cardio-thoracic beds; 4 obstetric/gynecological beds; 8 pediatric beds. Cpr And Trauma Resuscitation The Hospital has an emergency alert system whereby adult or pediatric cardiac resuscitation teams can be summoned immediately for life saving measures on a patient who sustains cardio-respiratory arrest. All medical and nursing staff is certified in basic life support, while doctors functioning as team leaders on the resuscitation team are certified in advanced life support. The trauma resuscitation team is paged to assist with patients brought to the Accident and Emergency Department in a critical state consequent to poly-trauma. There is also a Disaster Management plan which can be activated when more than 5 seriously wounded surgical patients, who require resuscitation, or 10 critically ill medical cases are simultaneously brought to the Accident and Emergency Department and more are expected. Operation Theatre The Hospital has 9 operation theatres, which are well equipped for the most complex of surgeries such as: open heart surgery for coronary artery bypass graft and transposition of great vessels in newborns, pediatric surgery, separation of conjoined twins, vascular surgery, kidney transplantation, Wertheim’s hysterectomy, laparoscopic gastric bypass surgery for morbid obesity, etc. The Theatre Users’ Committee oversees the functioning of the operating rooms, provision of common equipment and instruments, theatre policies, and allocation of theatre time to the different clinical units.

Teaching

The Royal Hospital is a major teaching hospital for the MD course conducted by the Sultan Qaboos University. It also serves as the main training facility for the post-graduate Residency Program of the Oman Medical Specialty Board in Medicine, Surgery, Obstetrics & Gynecology, Child Health and Laboratory Medicine. Further, the Royal Hospital is recognized by the Royal Colleges of UK and Ireland as an official center for the membership examinations in Medicine, Pediatrics and Surgery. Nursing and paramedical students of the Nursing Institutes in the capital area, the Institute of Health Sciences, and the Sultan Qaboos University are also provided clinical training at the Royal Hospital. Royal College confers Fellowship on Omani Consultants On the occasion of the inaugural meeting of the Gulf Chapter of the Royal College of Physicians of Ireland, an honorary fellowship was awarded to His Excellency Dr. Ali bin Mohammed bin Moosa, Minister of Health, and fellowships under by-law 5(c) were bestowed on 8 leaders of the medical profession in Oman including Dr. Abdulla Mohammed Al Riyami, Dr. Saleh Mohammed Al Khusaiby, Dr. Saadia Amer Al Riyami, Dr. Sayed Mohammed Laiq and Dr. Riaz Ahmed Syed from the Royal Hospital. The honorary fellowship awarded to His Excellency the Minister is the highest honour that the College can award and was in recognition of His Excellency's singular contribution to the Omani health services. The College has had a connection with doctors in the Gulf area over many years. Many medical graduates have taken the Membership exams and been successful, but until recently they had to travel to Ireland in order to gain this qualification. However ten years ago, the Part I Membership examination was held in Muscat for the first time. Not only Omani graduates but also candidates from Saudi Arabia, Egypt, Jordan, Sudan, India, Pakistan, Sri Lanka and other countries have taken the exam in Oman. In March 2002 the Part II written examination was held for the first time in Oman, followed in May 2003 by the Part II Clinical examination. The College has formed a College Chapter of the GCC States, which will be based in Oman. This Chapter will organize the College activities in the region and advise the College regarding relevant policy. Many people have been involved in the setting up of the examinations and the Chapter particularly appreciated the efforts and leadership of Dr. Kadhim Jaffer Suleiman, who was appointed the Chairman of the new Gulf Chapter.

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