OPD process flow in an Indian hospital, from the first call to the pharmacy

Every OPD runs on the same chain of steps, whatever its size. A patient calls or walks in, gets a slip, pays, has their vitals taken, waits, sees the doctor, may go for tests and come back, collects medicines and, ideally, leaves with a date for the next visit. Each hand-off is a place to wait, or to give up. Here is that chain as a flow chart, the measured waits at each step from Indian studies, and one fix for each.

The OPD process flow at a glance

1. Call or booking: the patient phones to ask and book, books online, or just walks in.
2. Arrival and registration: a new patient gets a registration number and an OPD slip (पर्ची); a returning one is looked up.
3. Billing: the consultation fee is paid, or a panel or insurance patient’s papers are checked.
4. Vitals: a nurse records weight, blood pressure, pulse and the main complaint.
5. Waiting: the patient waits outside the doctor’s room for their number.
6. Consultation: the doctor examines, advises, prescribes or orders tests.
7. Investigations: blood samples, X-rays, scans or an ECG, each often with its own bill and queue.
8. Review: the patient returns to the doctor with the reports, the same day or another day.
9. Pharmacy: the patient collects the prescribed medicines.
10. Follow-up booking: the patient leaves with a date for the next visit, or doesn’t.

Not every patient goes through every step. A follow-up patient with no tests skips 7 and 8, and an eye patient usually has a vision check where others have vitals.

Where patients wait: times at each step from Indian studies

Few studies time every step, and most were done in government teaching hospitals, so read these as the waits patients know rather than as your own. The fix is the one we’d start with.

At the North Indian hospital, the whole journey, from arrival to the end of the pharmacy, took 318.6 minutes on average: more than five hours, of which the doctor had 12.8 minutes.

Step by step: what goes wrong, and one fix

1. Call or booking

What happens: the patient phones to ask whether the doctor is in, what the fee is and when to come, or books online, or simply turns up. Where it goes wrong: the line is busiest in the morning rush, when the same staff are facing a queue at the counter. There is no published Indian figure for unanswered OPD calls. In the UK, NHS Lothian’s outpatient booking teams saw 30.1% of 446,012 calls abandoned in a year, with staff on the phones. A caller who can’t get through either joins the 9 am crowd or goes elsewhere. One fix: answer every call, or call back every missed one the same day, and end each booking with a time window rather than “come in the morning”.

2. Arrival and registration

What happens: a new patient’s details are typed in and a registration number and slip printed; a returning patient is looked up. Where it goes wrong: this is the first queue and often the worst. Patients waited 38.2 minutes to register at a tertiary hospital in Faridabad, 23.7 minutes at a tertiary hospital in Maharashtra and 45 minutes at PGIMER Chandigarh. In a CAG audit of four Delhi government hospitals, 28% of the 149 patients surveyed had waited more than an hour to register. One fix: take the details on the booking call or by a QR scan before the patient reaches the counter. The government says ABDM’s Scan and Share service cut registration waits from about an hour to 2 to 5 minutes, citing an IIHMR study (PIB, 2026).

3. Billing

What happens: the consultation fee is paid, usually at registration. Panel patients (CGHS, ECHS, company panels) and insurance patients may need their papers checked at a separate desk. Where it goes wrong: separate bills for the consultation, each test and the medicines mean a new queue each time. In the Maharashtra study, patients sent for tests waited 11.15 minutes at the cash counter. One fix: collect the fee with registration, take UPI and cards at every counter, and bill all of a patient’s tests at once.

4. Vitals

What happens: a nurse or assistant records weight, blood pressure, pulse and sometimes blood sugar. Where it goes wrong: one nurse serving several doctors becomes a second queue, and patients called out of order lose their place. None of the studies we found timed this step on its own, so time yours. One fix: take vitals in token order at a station beside the rooms, while patients are waiting anyway, and record them where the doctor will see them.

5. Waiting for the doctor

What happens: patients wait outside the room for their number. Where it goes wrong: at the North Indian hospital this was the longest wait of the visit, 196.3 minutes from registration. It was 98.6 minutes from registration at a medical college hospital in Kolkata and 41.3 minutes in Faridabad. Patients crowd the door asking “मेरा नंबर कब आएगा?” (when will my turn come?), and staff stop work to answer. One fix: give each patient a time window when they book, show the queue on a screen or on their phone, and tell them the expected wait.

6. Consultation

What happens: the doctor examines, explains and writes the prescription or orders tests. Where it goes wrong: it is short, 6.5 minutes in Kolkata, 6.9 in Maharashtra and 12.8 at the North Indian hospital, and interruptions eat into it: the next patient walking in, a relative with a question, old reports nobody can find. One fix: protect it. Keep one patient in the room, have their old records ready before they walk in, and save time in the queues around it, not here.

7. Investigations

What happens: the patient goes for blood tests, an X-ray, a scan or an ECG. Where it goes wrong: each has its own counter, bill and queue. Patients waited 49.6 minutes for sample collection in Faridabad; in Maharashtra, they waited 43.8 minutes at radiology and 23.7 for an ECG. One fix: bill all tests at once, collect samples close to the OPD, and give scans a booked time instead of a queue.

8. Review with reports

What happens: the patient goes back to the doctor with the reports, the same day or another day. Where it goes wrong: review patients either queue again from the start or squeeze in between tokens, which starts arguments at the door, and late reports turn one visit into two. None of the studies we found timed this step separately. One fix: give review patients their own slot, such as the last half-hour of the session, and let the doctor see reports on screen.

9. Pharmacy

What happens: the patient collects the prescribed medicines, often from the hospital’s own pharmacy. Where it goes wrong: waits vary more here than anywhere. In Faridabad, patients waited 61 minutes and rated “promptness at the medicine distribution counter” the lowest-scoring part of their visit. At the North Indian hospital the pharmacy stage took 119.4 minutes, largely because the bill, the payment and the medicines were three stops in three places and one central pharmacy served every speciality. In the Maharashtra study, done during the COVID period, it took 3.39 minutes, so long waits are not inevitable. In the CAG survey, 27% waited one to two hours for medicines and 9% more than two. One fix: one window for the bill, payment and medicines, counters set aside for women, the elderly and people with disabilities as the Indian Public Health Standards ask, and prescriptions that reach the pharmacy before the patient does.

10. Follow-up booking

What happens: the doctor says “दो हफ़्ते बाद दिखाना” (come back in two weeks) and the patient leaves. Where it goes wrong: without a date, the follow-up depends on the patient’s memory. At AIIMS New Delhi, 34% to 60% of follow-up bookings went unattended from 2015 to June 2017, depending on how they were booked. NABH’s standards ask that outpatients be told their next follow-up where appropriate (AAC.5.b). One fix: book the date and time before the patient leaves the building, and remind them the evening before. Our guide to patient no-shows covers reminders in detail. Here is how that booking can sound at the exit desk, in an example written for this guide:

How to map your own OPD flow in a week

Before you change anything, time it. A checklist:

1. Pick three days: a quiet one, a normal one and your busiest, often Monday.
2. Print a slip with a box for each step, and have staff write the clock time as the patient enters and leaves each one: gate, registration, billing, vitals, called in, out of the room, tests, pharmacy.
3. Do it for every patient, or for at least 50 a day spread across the session.
4. For each step, work out the median wait and the share of patients who waited over an hour.
5. Note where patients drop out: calls not answered, people who left the queue, tests not done, follow-ups not booked.
6. Fix the step with the longest wait first, and time it again a month later.

For the wait to see the doctor, use NABH’s definition so your figures match accreditation: the 6th-edition standards count from arrival at the OPD (or the appointment time) to when the consultant begins, monthly, for every outpatient. Our guide to reducing OPD waiting time works through an example.

Where DrMate fits

DrMate covers both ends of this flow and the queue in between. Its AI receptionist answers your OPD line day and night in Hindi and Hinglish, books into genuinely free times and tells patients when to come. Its front desk puts every doctor’s queue on one screen, adds walk-ins in seconds and shows each patient their place and expected wait on their phone. At the pharmacy end, every prescription DrMate prints carries a private link and QR code from which patients can order its medicines from your hospital’s own pharmacy, which confirms each order by phone. It runs alongside your HIS; nothing is replaced.