Standard Operating Procedure for Hospital Surprise Visits

This document is a Standard Operating Procedure (SOP) that outlines the protocol for conducting surprise visits and inspections of empanelled hospitals. The SOP aims to establish a uniform, transparent, and accountable mechanism for these inspections, which assess various factors including the availability and quality of medical services, compliance with ESIC/CGHS norms, and the infrastructure and manpower available at the hospitals. The scope of the SOP applies to all empanelled hospitals and includes guidelines for routine monitoring, complaint-based verification, and random quality assessments. The document specifies the constitution of the inspection team, the frequency of visits, focus areas, and the records to be reviewed during inspections. It also includes a checklist for inspectors to follow, covering aspects such as patient care, clinical practices, billing, and fraud checks. Post-inspection actions and timelines for compliance by hospitals are also detailed.