HOSPITAL Statistics

> Definition of Statistics > Needs, Importance & Characteristics of Quality Hospital Statistics > Measures of Hospital Utilization > Measures of Hospital Performance > OPD Hospital Statistics > ER Hospital Statistics

> Flowchart of Procedures in the Preparation of 24-Hour Floor Census Report (for level 1-4 hospital) > Flowchart of Procedures in Coding of Diseases using ICD-10 (for level 1-4 hospital) > Flowchart in the Preparation of the Revised Hospital Statistical Report

Objectives: > A thorough knowledge and understanding about Hospital Statistics. > Assess which hospital statistics are to be used as measure of hospital performance. > Familiarization of Flowchart of Activities on the Preparations of 24-Hour Floor Census as well as Revised Hospital Statistical Report

STATISTICS – are numerical facts, which break down data into concise, useful form. - It involves the process of collection, analysis, interpretation and presentation of facts as numbers.

NEED FOR STATISTICS: 1. To provide data for management activities: Administrative Level Budgeting and resource allocation Cost Accounting Disbursement of funds Decision making and evaluation Organizing staffing levels Data for accreditation purposes Licensure approved hospital and their services

Clinical Level Assessment of the quality of care Appraisal of medical, nursing and allied health professionals’ performance Teaching purposes 2. Comparison of past and present performance of the hospital 3. Provide information both for internal and external agencies

4. Meet legal requirements 5. Research and education

IMPORTANCE OF HOSPITAL STATISTICS to ensure the generation of accurate hospital statistical report. hospital statistical reports shall be made available at all times. serves as a management tool in the effective management and operation of the hospital.

CHARACTERISTICS OF QUALITY HOSPITAL STATISTICAL DATA accuracy and validity of the original source data; reliability completeness legibility timeliness accessibility

4.1 INPATIENT - is a patient who is admitted to a hospital for treatment that requires at least one overnight stay. Definition based on American Heritage Dictionary.

4.1.1 Measures of Hospital Utilization Census – indicates the total number of inpatients present in the hospital at any given time. Census = (in patients remaining at midnight) + (admissions up to the next census hour) – (discharges/deaths between census taking hours) 4.1.1.1 Average Daily Census – the average number of inpatients per day.

4.1.1.1.3 Calculation of Average Daily Census 4.1.1.1.2 Inpatient Service Days – a unit of measure denoting the services received by one inpatient in one 24- hour period. 4.1.1.1.3 Calculation of Average Daily Census FORMULA: AVERAGE DAILY CENSUS = Total inpatient service days for the period Total days in the same period

4.1.1.2 Bed Occupancy Rate (BOR) – the ratio of the total inpatient service days over the authorized bed capacity in a given period. FORMULA: BOR = Total inpatient service days in a period x 100 (Total no. of authorized beds) x (Total days in the same period)

4.1.1.3 Bed Turnover Interval – the average period in days that an available bed remains empty between the discharge of one inpatient and the admission of the next. FORMULA: BTI = (Implementing beds x days in the period) – inpatient service days for the period Total discharges & deaths in the same period

4.1.1.4 Bed Turnover Rate – the number of times a bed, on average, changes occupants during a given period of time. FORMULA: BTR = Total no. of discharges(including deaths) for a period x 100 Average bed count during the period

4.1.1.5 Length of Stay –duration of single episode of hospitalization. In computing for the length of stay, the date of admission is counted but not the day of discharge. Average Length of Stay (ALOS) FORMULA: ALOS = Total length of stay of disch. patients for a given period Total discharges & deaths in the same period

4.1.2 Measures of Healthcare Facility Performance 4.1.2.1 Morbidity – the number of sick persons or cases of disease in relationship to specific population. 4.1.2.1.1 Infection Rate – maybe calculated separately for a specific infections such as surgical wound, puerperal and infections of respiratory, urinary tract, bloodstream and so on.

4.1.2.1.2 Gross Infection Rate – those infections which have occurred following clean wound operations or births, or have developed in medical cases after admission to the hospital. FORMULA: GROSS INFECTION RATE = Total no. of infections in the hospital (or ward) for a period X 100 Total discharges and deaths from hospital (or ward) for same period

FORMULA: NET INFECTION RATE = Total no. of infections debited against the health care X 100 facility (or ward) for a period Total discharges and deaths from health care facility (or ward) for same period

4.1.2.1.4 Post-Operative Infection Rate – these are infections occurring after a clean surgical operation or procedure. FORMULA: POST OPERATIVE INFECTION RATE = Total no. of infections occurring after a clean surgical O.P. X 100 Total number of clean surgical O.P. /procedure for the period

4.1.2.2.1 Consultation Rate – the ratio of consultation following an attending physician’s request to a consultant to examine a patient and give a second opinion. FORMULA: CONSULTATION RATE = Total consultations (all departments) for a period X 100 Total discharges and deaths

Total no. of caesarian sections in a given period X 100 4.1.2.3 Obstetrics 4.1.2.3.1 Cesarean Section Rate – the comparison of the number of caesarian section performed against the total number of deliveries FORMULA: CESARIAN SECTION RATE = Total no. of caesarian sections in a given period X 100 Total deliveries for the same period

4.1.2.4 Mortality – is the incidence of death in a specific population. 4.1.2.4.1 Death Rate - the proportion of inpatient hospitalizations that ends in death. 4.1.2.4.1 Gross Death Rate – this is the comparison of all inpatients deaths to all discharges for a given period. This is also known as mortality rate.

GROSS DEATH RATE (Mortality Rate)= FORMULA: GROSS DEATH RATE (Mortality Rate)= (Total deaths including newborn for a given period) X 100 (Total discharges and deaths for the same period)

4.1.2.4.2 Net Death Rate – the death rate excluding deaths under 48 hours of admission. It produces a lower figure than the gross death rate. Also known as “institutional death rate”. FORMULA: NET DEATH RATE (Institutional Death Rate) = (Deaths (including newborn) – (those under 48 X 100 hours for the period) Total no. of discharges (including deaths and newborn) – (death under 48 hours for the period)

4.1.2.4.2 Post-Operative Death Rate – is one occurring within 10 days after an operation has been performed FORMULA: POST-OPERATIVE DEATH RATE = Total post-operative deaths for the period x 100 Total patients operated for the same period

ANESTHESIA DEATH RATE = 4.1.2.4.3 Anesthesia Death Rate – a death that occurs while the patient is under anesthesia or caused by anesthetics or agent used by an anesthesiologist in the practice of his profession. FORMULA: ANESTHESIA DEATH RATE = Total no. of deaths caused by anesthetic agent for a period X 100 Total no. of anesthetics administered for the same period

4.1.2.4.4 Maternal Death – the death of any woman, from any cause, related to or aggravated by pregnancy or its management (regardless of duration or its site of pregnancy), but not from accidental or incidental causes. FORMULA: MATERNAL DEATH RATE = Total no. of direct maternal death for a period X 100 (Total no. of maternal (obstetrical) discharges including deaths for the period

4.1.2.4.4 .1 Direct Cause – these are deaths resulting from obstetric complications of the pregnancy state (pregnancy, labor, and puerperium) from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. 4.1.2.4.4.2 Indirect Cause – the death of a woman resulting from a (Indirect Obstetric Death) previously existing disease (or a disease that developed during pregnancy, labor, or the puerperium) that was not due to obstetric causes, although the physiologic effects of pregnancy were partially responsible for the death.

4.1.2.4.5 Perinatal Death – an all-inclusive term referring to both stillborn infants and neonatal deaths. 4.1.2.4.5.1 Fetal Death Rate (Stillbirth)– this is a death prior to complete expulsion or extraction of a product of conception from the mother irrespective of the duration of pregnancy. The death is indicated by the fact that after such separation, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles. (WHO definition)

FETAL DEATH RATE (Stillbirth Rate)= FORMULA: FETAL DEATH RATE (Stillbirth Rate)= Total no. of intermediate and/or late fetal deaths for the period X 100 Total no. of birth (including intermediate and late fetal deaths) for the period Note: 1. Below two percent (2%) is considered normal by western standards. 2. Fetal deaths are classified as: 2.1 Early Fetal Death – less than 20 weeks of gestation (500 gms. or less). 2.2 Intermediate Fetal Death – 20 weeks of gestation but less than 28 (501 to 1000 grams). 2.3 Late Fetal Death – 20 or more weeks of gestation (1001 gms–stillbirth)

4.1.2.4.5.2 Neonatal Death Rate/Infant newborn mortality rate – this is the death of a child whose heartbeat after complete expulsion of extraction from the mother, and died within 28 days of birth. FORMULA: NEONATAL DEATH RATE (Infant Newborn Mortality Rate) = Total no. of newborn deaths for the period X 100 Total no. of newborn infant discharges (including Deaths) for the same period

Neonatal Death could be divided into: Neonatal Period I – from the hour of birth through 23 hours and 59 minutes. Neonatal Period II – from the beginning of the 24th hour of life through 6 of days, 23 hours, and 59 minutes. Neonatal Period III – from the beginning of the 7th days of life through 27 days, 23 hours, and 59 minutes. FORMULA: INFANT DEATH RATE = Total no. of Infant deaths (neonatal and post neonatal during a period X 100 Number of live births for the period

Note: 1. Fetal deaths of less than 20 weeks should not be included as well as those who were admitted after their deliveries/births outside the healthcare facility. 2. For infant death rate, below 2% is acceptable in western standards.

4.2.2.6 Autopsy Rate – the ratio of autopsies performed in the hospital facility to all inpatient deaths. 4.2.2.6.1. Gross Autopsy Rate – the ratio of all autopsies performed in the hospital to all inpatient deaths. FORMULA: GROSS AUTOPSY RATE = Total no. of autopsies performed for the period X 100 Total no. of deaths for the period

4.2.2.6.2. Net Autopsy Rate – the ratio of all autopsies to all inpatient deaths less the unautopsied cases during the period. FORMULA: NET AUTOPSY RATE = Total no. of autopsies performed for a period X 100 Total deaths – Unautopsied cases Note: Exclusions: Stillbirth Dead on Arrival (DOA) Death at ER when patient is not admitted. (ER Death) Medico legal cases referred to the proper authority.

4.2 Outpatient – is a patient who is not confined but who visits a healthcare facility for treatment. 4.2.1 Total Number of Outpatient Visits – refers to the total number of outpatients attended and received health care services in the healthcare facility for a given period of time. 4.2.1.1 New – total number of outpatient first visit in the healthcare facility and grouped by age and sex 4.2.1.2 Revisits – total number of outpatient revisits in the healthcare facility and grouped by age and sex 4.2.2 Total Number of Encounters – the number of health care services given to outpatient during the visit.

4.2.3 Average Number of Outpatient Visits per OPD day – average number of out-patients who were given medical treatment and advice for a given period. FORMULA: AVERAGE NUMBER OF OUTPATIENT VISITS PER OPD DAY = Total no. of Outpatient visits/attended ( new + revisits) Total no. of OPD days in a given period

4.3 Emergency Room – the section of a hospital that provides initial treatment to patients in response to an increased need for rapid assessment of illnesses and injuries, some of which maybe life-threatening and requiring immediate action. 4.3.1 Total Number of Patients Attended – refers to the total number of emergency and non-emergency patients attended and received health care services in the emergency room for a given period. 4.3.1.1 Emergency patient – refers to an immediate threat to the patients airway, breathing and circulation that warrants immediate intervention within 10 minutes, otherwise, death will ensue. The vital signs of the patient are often unstable or the patient is not fully awake. 4.3.1.2 Non-Emergency patient – refers to patient with no immediate risk of death . The case where there is no threat to the airway, breathing and circulation.

4.3.2 Mortality – the death rate in relationship to a specific population. 4.3.2.1 Dead on Arrival (DOA) – diagnosis of a patient who arrives at the ER without cardio-pulmonary and brain functions. This will include patients who did not respond to initial resuscitation. Resuscitation is no longer done to patients with signs of Rigor Mortis, Algor Mortis and Decapitation. 4.3.2.2. ER Death – diagnosis of a patient who is not yet admitted occurring at the ER. These include patients who arrived at the ER with no detectable vital signs (BP, HR & RR) but revived by initial resuscitative measures, but eventually died, regardless of the time of stay. Postmortem care shall be done by the ER nursing personnel.

4.3.3 Average Number of ER Patients per day – refers to the average number of emergency and non-emergency patients who were attended for a given period. FORMULA: AVERAGE NUMBER OF ER PATIENT PER DAY= Total no. of Emergency and Non-Emergency Patient Total no. of days in a given period

Hospital Statistics with reference to Mortality and Morbidity Reporting Mortality Reporting Mortality reporting should be reported in accordance with the special tabulation listing located in volume 1, specifically, the general mortality condensed list. Steps: Identify the underlying cause of death. Assign ICD-10 code Refer to Mortality Tabulation List 1 or the General Mortality condensed list in volume 1. Assign mortality tabular code. Determine the top 20 among the list of diseases basing on the assigned mortality tabular code.

Morbidity Reporting Morbidity Reporting should likewise be reported in accordance with the Special Tabulation list for morbidity located in volume 1. Steps: Assign ICD 10 Code for the diagnosis. Refer to Special Tabulation list for morbidity in volume 1. Assign morbidity tabular code (In case of multiple diagnoses, select the main condition and assign morbidity tabular code. Identify the top 20 among the list of diseases basing on the assigned morbidity tabular code.

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