© Copyright Cengage Learning 2015 Chapter 11 Miscellaneous Rates

© Copyright Cengage Learning 2015 Miscellaneous Rates Health care facilities often compute rates in addition to the basic rates. Any rate can be calculated as long as the “basic rate formula” is followed: The number of times something does happen The number of times it could happen 2 × 100

© Copyright Cengage Learning 2015 Infection Rates Health care facilities try to prevent hospital- borne infections. Sterilized instruments are used, contaminated materials are appropriately discarded, and other measures are instituted to prevent the spread of infection. However, the danger of acquiring a hospital-based infection (also called a nosocomial infection) is always present. 3

© Copyright Cengage Learning 2015 Infection Rates Infection rates may include hospital-wide infection rates as well as more specific rates such as infection rates for independent clinical units (pediatrics, orthopedics) or rates for various types of infection. (Urinary tract infections or respiratory infections.) Ideally, the percentages will be low for infection rates. Rates should definitely fall below 10% and, optimally, below 5%. 4

© Copyright Cengage Learning 2015 Hospital-Acquired Infection versus Community-Acquired Infection A nosocomial infection is an infection that pertains to or originates in a hospital. Thus, a nosocomial infection is also called a hospital-acquired infection. Nosocomial infections include postoperative infections, as they are also hospital-acquired. 5

© Copyright Cengage Learning 2015 Hospital-Acquired Infection versus Community-Acquired Infection Hospital-acquired (nosocomial) infections - Infections manifested more than 72 hours post admission (more likely to have been acquired during the patient’s hospitalization). Community-acquired infections - Infections manifested within 72 hours of admission (were most likely present in the patient at the time of admission). 6

© Copyright Cengage Learning 2015 Nosocomial Infection Rate Total number of hospital-acquired infections >72 hours post admission Total number of discharges (including deaths) 7 × 100

© Copyright Cengage Learning 2015 Community-Acquired Infection Rate Total number of community-acquired infections ≤72 hours after admission Total number of discharges (including deaths) 8 × 100

© Copyright Cengage Learning 2015 Postoperative Infection A postoperative infection is, as the name states, an infection that develops postoperatively. A postoperative infection is also a nosocomial infection and is included in nosocomial infection rates. 9

© Copyright Cengage Learning 2015 Postoperative Infection Rate Total number of postoperative infections in clean surgical cases Total number of surgical operations performed 10 × 100

© Copyright Cengage Learning 2015 Postoperative Infection Rate Clean surgical cases are those not infected at the time of surgery. Wounds with prior contamination and infection would be excluded in this formula. Postoperative infection rates are based on infection in which the infectious agent was most likely introduced at the time of surgery. 11

© Copyright Cengage Learning 2015 Postoperative Infection Rate Also, note that the denominator in the postoperative infection rate is the number of surgical operations, not the number of patients operated on. A patient may have more than one surgical operation and each operation includes the possibility of acquiring an infection. The number of patients operated on was used in the postoperative death rate. 12

© Copyright Cengage Learning 2015 Hospital (Total) Infection Rate Hospital (total) infection rate –includes all infections manifested during a patient’s hospital stay –Includes nosocomial infections (which include postoperative infections) and community- acquired infections. 13

© Copyright Cengage Learning 2015 Hospital (Total) Infection Rate Total number of infections Total number of discharges (including deaths) 14 × 100

© Copyright Cengage Learning 2015 Consultation Rates A consultation is a deliberation by two or more physicians with respect to the diagnosis or treatment in any particular case. A patient’s attending physician may request a consulting physician see his/her patient and offer an opinion, either to confirm a diagnosis or treat a condition not in the attending physician’s area of expertise. The consultant evaluates the patient and prepares a consultation report that includes the findings and recommendations for treating the patient’s condition. 15

© Copyright Cengage Learning 2015 Consultation Rates Two types of consultation rates: –Ratio of patients receiving consultations (subsequently referred to as “patients seen”) to the number of patients discharged –Ratio of the total number of consultations provided to the number of patients discharged. This formula assesses the utilization of consultants in the health care facility. It may be used by accrediting organizations (the Joint Commission) to identify the percentage of consultations provided. Patients may be seen by more than one consultant during a specific hospitalization. 16

© Copyright Cengage Learning 2015 Patients Seen in Consultation (Rate) Total number of patients receiving consultations Total number of patients discharged 17 × 100

© Copyright Cengage Learning 2015 Consultations Provided (Rate) Total number of consultations provided Total number of patients discharged 18 × 100

© Copyright Cengage Learning 2015 Complication A complication is a condition that occurs during the patient’s hospital stay that extends the length of stay by at least one day in 75% of cases. A complication is an additional disorder that arises after admission to the hospital and that modifies the course of the patient’s illness or the need for additional medical care. Examples of complications are: infections, hemorrhages, wound disruptions, adverse drug reactions, transfusion reactions, falls, burns, and medication administration errors. 19

© Copyright Cengage Learning 2015 Complication Rate Total number of complications for a period Total discharges for the period 20 × 100

© Copyright Cengage Learning 2015 Comorbidity A comorbidity is a preexisting condition that will, because of its presence with a principal diagnosis, increase the length of stay by at least one day in 75% of cases. Examples of comorbidities are: diabetes, hypertension, obesity, and emphysema. 21

© Copyright Cengage Learning 2015 Comorbidity Rate Total number of comorbidities for a given period Total discharges for the period 22 × 100