1. Department of Pediatrics
MONTHLY TRENDS
Department of Pediatrics
September 22, 2016

2. Emergency Room

3. 2016 ER Trends August 2822 698 3520 MONTH INFECTIOUS NON INFECTIOUS
TOTAL
January
2484
853
3550
February
2060
669
2904
March
1665
599
2264
April
982
488
1470
May
1127
579
1706
JUNE
1073
522
1771
JULY
1702
504
2206
August
2822
698
3520

4. MONTHLY ER CENSUS FOR 2015 AND 2016

5. AUGUST ER TRIAGE URGENT 2014 57% 1502 43% EMERGENT 4 0% 3520 100%
TRIAGE OF PATIENTS
URGENT
2014
57%
1502
43%
EMERGENT 4 0%
3520
100%

6. AUGUST ER DISPOSITION Disposition % Discharged 2917 83% Admitted 558
16%
DAMA 30 0%
THOC 13
PICU 5
NICU 1
Expired

7. DAMA/THOC Reasons For DAMA Number of Patients Percent
Transfer to another hospital 13
31%
Observe at Home with close follow-up
Will not wait for Lab results 7 1%
Non reason given 6
14%
Unsatisfied due to no rooms available 2 4%
Financial Difficulties

8. TOP 10 INFECTIOUS DISEASES
NUMBER OF PATIENTS
PERCENT
1. Systemic Viral Illness
1017
29%
2. Upper Respiratory Tract Infection
877
25%
3. Acute Gastroenteritis
193 5%
4. Pneumonia
126 4%
5. Non-Specific Viral Exanthem 89 3%
6. Acute Respiratory Tract Infection 88
7. Dengue Fever 77 2%
8. Acute Rhinitis 53 1%
9. Presumptive Urinary Tract Infection/ Acute Otitis Media 35 0%
10. Acute Nasopharyngitis 25

9. TOP 10 ER INFECTIOUS CASES
JULY, 2016
AUGUST, 2016
Upper Respiratory Tract Infection
49%
Systemic Viral Illness
29%
14%
25%
Acute Gastroenteritis
12% 5%
Pneumonia 3% 4%
Skin Infections
Non-Specific Viral Exanthem
Acute Otitis Media
Acute Respiratory Tract Infection
Nonspecific Viral Exanthem 1%
Dengue Fever 2%
Urinary tract Infection
Acute Rhinitis
Conjunctivitis
Presumptive Urinary Tract Infection/ Acute Otitis Media 0%
Roseola
Acute Nasopharyngitis

10. TOP 10 NONINFECTIOUS DISEASES
NUMBER OF PATIENTS
PERCENT
1. Acute Urticaria 77 2%
2. Bronchial Asthma 56 1%
3. Food Intolerance 52
4. Animal Bite 35 0%
5. Functional Constipation 26
6. Non-Ulcer Dyspepsia 23
7. Simple Febrile Convulsion 22
8. Well Child 18
9. Costochondritis/ Functional Constipation 9
10. Allergic cough 7

11. TOP 10 ER NONINFECTIOUS CASES
JULY, 2016
AUGUST, 2016
Food Intolerance
13%
1. Acute Urticaria 2%
Acute Urticaria
10%
2. Bronchial Asthma 1%
Animal Bite
3. Food Intolerance
Dyspepsia 7%
4. Animal Bite 0%
Foreign Body 4%
5. Functional Constipation
Bronchial Asthma 3%
6. Non-Ulcer Dyspepsia
Functional Constipation
7. Simple Febrile Convulsion
Well Child
8. Well Child
Musculoskeletal Strain
9. Costochondritis/ Functional Constipation
Impacted Cerumen
10. Allergic cough

12. NON URGENT CASES DISPOSITION PERCENT DISCHARGED 93% ADMITTED 6.5%
DAMA/THOC 0%

13. TOP 10 NONURGENT INFECTIOUS CASES
JULY 2016
AUGUST 2016
Upper Respiratory Tract Infection
54%
48%
Systemic Viral Illness
16%
20%
Acute Gastroenteritis
12%
10%
Acute Otitis Media 3%
Acute Tonsillitis
Nonspecific Viral Exanthem
Dengue Fever
Pneumonia 2%
Conjunctivitis
Roseola 1%
Acute rhinitis
Infected Wound
Non-specific viral Exanthem
Impetigo
Acute Respiratory tract infection

14. TOP 10 NONURGENT NON INFECTIOUS CASES
JULY, 2016
AUGUST 2016
Animal Bite
15%
Bronchial Asthma
12%
Acute Urticaria
13%
Food Intolerance
11% 9%
Dyspepsia 5%
Well baby/ Animal Bite 8%
Musculoskeletal Strain 3%
Functional Constipation/ Non ulcer dyspepsia
Well Child
Allergic cough
Functional Constipation 2%
Functional abdominal pain
Impacted Cerumen
Foreign body, Nose 1%
Allergic Conjunctivitis
Impacted cerumen/ Anterior epistaxis
Anterior Epistaxis
Allergic rhinitis/ Atopic dermatitis 0%

15. WARDS

16. TOTAL ADMISSIONS MONTH TOTAL JANUARY 700 FEBRUARY 487 MARCH 373 APRIL
319
MAY
344
JUNE
320
JULY
455
AUGUST
615
From the ER
Direct Admissions
558 52

18. Top 10 Ward Infectious Cases
August 2016
No.
Percentage
Upper Respiratory Tract Infection
147
24%
Pneumonia
119
19%
Dengue Fever without warning signs 62
10%
Acute Viral Illness 53 9%
Acute Gastroenteritis 51 8%
Bronchiolitis 11 2%
Urinary Tract Infection 10
Dengue Fever with warning signs 8 1%
Acute Bronchitis 4
Facial Cellulitis 3
0.5%

19. Top 10 Ward Non-Infectious Cases
August 2016
Number
Percentage
Bronchial Asthma 17 3%
Benign Febrile Convulsion 14 2%
Food Intolerance 8 1%
Congenital Heart Disease 5
Acute Lymphocytic Leukemia
Functional Constipation 4
Acute Appendicitis
Complex Febrile Seizure
Acute Urticaria
Seizure Disorder 3
0.5%

20. PICU

21. PICU ADMISSIONS FOR 2016
55% increase

22. 66% of last year
----- Meeting Notes (9/19/16 18:00) -----
CAN WE COMPARE IT TO THE NUMBER OF ADMISSIONS?

23. Cases by Admitting Unit
Total PICU Admissions 14
Admitting Unit
# of Patients
Percentage
Emergency Room 6
43%
Floors (Post-OR) 2
14%
Floors 5
36%
Direct Admission 1 7%

24. Distribution by Subspecialty
Infectious 1
Hepatobiliary- GI 3
Cardiology 2
Pulmonology
Neurology 4
Others (ENT)
Total 14
Majority of the admissions were postoperative referrals from other subspecialties, followed by pulmonology and GI-hepatobiliary cases

25. Distribution by Age Age N=14 6 1 4 2 0-1 infant 2-3 toddler
3-6 pre-school
6-12 school-age 4
12-18 adolescent 2
----- Meeting Notes (9/19/16 18:00) -----
BASE AGE ON NELSON's GROWTH and DEVELOPMENT
0-1 infant
2-3 toddler
3-6 pre-school
6-12 school-age
12-18 adolescent
p52 NELSONS

26. Cases from the Wards Length of stay prior to PICU admission
Range: 1-5 days

27. Length of Stay at PICU
Range: 1 day to 13 days
Mode: 1-2 days

28. Bed Occupancy Rate (or rate of vacancy)
The number of hospital beds occupied by patients expressed as a percentage of the total beds available in the ward, specialty, hospital, area, or region.
It is used to assess the demands for hospital beds and hence to gauge an appropriate balance between demands for health care and number of beds.
Total number of inpatient days for a given period x 100
Available beds x Number of days in the period
62 x 100
4 x 31
50% BED OCCUPANCY RATE
----- Meeting Notes (9/19/16 18:00) -----
ASK HOW THE HOSPITAL COMPUTES

29. Outcomes Outcome Number TROC and Eventually Discharged 10
TROC and Still Admitted 1
THOC
Discharged from PICU
Expired
Still admitted 2
----- Meeting Notes (9/19/16 18:00) -----
Remove when expired
*TROC – transferred to room of choice
*THOC – transferred to hospital of choice

30. NICU

31. Figure 1. TMC LIVEBIRTHS: COMPARISON OF YEARS 2015 VS. 2016
Monthly%
17%
14%
6%
16%
8%
↓17%
3%
Yearly %
5%
↓6%
↓25%
↓5%
7%
↓21%
↓11%

32. Distribution of Total Births According to Manner of Delivery
NSD
56/139 CS
83/139

33. Deliveries by Levels
Level I
Level II
Level III
AUG 2016 53 73 10

34. Level I Admissions

35. Level II Admissions

36. Top Reasons for Level II

37. Level III Admissions

38. Top Diagnosis for Level III1 1 6

39. Admissions at Referral
Hyperbilirubinemia is the main reason for admission at referral

40. Top Diagnosis for Referral1 1 7

41. Isolation Admissions

42. ISOLATION ADMISSION 1
Multi-Organ dysfunction; Complex cyanotic heart disease CAVSD with DORV moderate pulmonary stenosis s/p Modified Right Blalock Tausig shunt 8/1/16; Heterotaxy Syndrome 2
Complete Gut Obstruction secondary to internal herniation and perforation of Illeum;
Meckel's Diverticulum t/c G6PD
s/p Lysis of adhesions, Segmental ileal resection, Double Barrel Ileostomy (8/15/16) 3
Double Outlet Right Ventricle with Tetralogy of Fallot, with Severe Pulmonic Stenosis;
S/P Tetralogy of Fallot Repair (8/16/16)

43. Breastfeeding Rates: 2016
Month
BFHI
JCIA
AUG
87.50%
87.16%

44. Figure 2. Large for Gestational Age babies
Infant of
Type II DM mothers
n = 0
Symptomatic n=0 Asymptomatic n = 0
Gestational diabetes
n = 4
Symptomatic n =0
Asymptomatic n = 4
No maternal risk factors
n = 10
Symptomatic n = 0 Asymptomatic n = 10

45. Breastmilk/Breastfeeding Jaundice
HYPERBILIRUBINEMIA
Hyperbilirubinemia
n=9
ABO Incompatibility
N= 7
AO: n=1
BO: n = 6
Unspecified
N=1
Breastmilk/Breastfeeding Jaundice
Breastmilk n = 1
Breastfeeding n = 0

46. OPD

47. General Census Number of Cases Well baby/child 24 Infectious Cases 42
Non-Infectious Cases 31
Total Patients seen 97
Total Cases
Total number of patients seen at the OPD for the month of July was 97 while the total number of cases was 97.
Infectious and non infectious cases are 42 and 31% respectively. 24% of the general census were well baby or child consults.

48. OPD Census 2016 Month Infectious Well Child Total January 65 36 16 117
Non Infectious
Well Child
Total
January 65 36 16
117
February 47 38 18
103
March 66 32 6
104
April 28 98
May 29 43 9 81
June 50 52 13
115
July 15
August 42 31 24 97

49. Monthly Census ( )
In comparison to previous month, there was a decreased number of total cases seen

50. Top 3 Infectious Cases Upper Respiratory Tract Infection 34 33%
Rank
Diagnosis
Number of Cases
Percentage 1
Upper Respiratory Tract Infection 34
33% 2
Acute Gastroenteritis 4 4% 3
Viral Infection, unspecified 2%
The most common cause for consult is for Upper Respiratory Tract Infection, comprising 33% of cases seen, majority of which is from the 2-5 years age group.
There were 4 cases of acute gastroenteritis and 2 cases of unspecified viral infection.

51. Top 4 Non-Infectious Cases
Rank
Diagnosis
Number of Cases
Percentage 1
Infected Wound 7 7% 2
Allergic Rhinitis 5 5% 3
Developmental Assessment 4 4%
Bronchial Asthma not in Excaterbation 2%
Top on the list of Non infectious cases are infected wound, allergic rhinitis, consults from Developmental Pediatrics, coming in for developmental screening and assessment prior to enrollment to special education center, as well as follow ups of patients with bronchial asthma not in exacerbation

52. Subspecialty Referrals
Neurology 29% (2); Pulmonology 14% (1); Developmental Pediatrics 57% (4)
Majority of subspecialty referral are with Developmental Pediatrics – Known cases of Autism, ADHD for developmental assessment prior to enrolment to SPED; Majority are suspect for delay hence for Dev Peds Assessment
Neuro referrals comprise of patients who were noted to have previously diagnosed cerebral palsy and seizure disorder.
Pulmonology referral composed of …

53. Department of Pediatrics
MONTHLY TRENDS
Department of Pediatrics
September 22, 2016

54. MORBIDITY and MORTALITY
Department of Pediatrics
September 22, 2016

55. NICU Mortality
Pre term baby girl delivered via Stat CS for nonreassuring fetal status (decelerations)
To a 43 yo G2P2 (0202) at 28 2/7 weeks AOG
BW 830 AS 9,9 MT 29 AGA
Probable sepsis
Pulmonary hemorrhage
Respiratory distress syndrome
Pneumoperitoneum probably secondary to gastrointestinal perforation
Resident in charge:
Dr. Laddale Sy*, Dr. Iris Tagaro
Attending Physicians:
Dr. Carina Quimbo
Multi-Organ dysfunction; Complex cyanotic heart disease CAVSD with DORV moderate pulmonary stenosis s/p Modified Right Blalock Tausig shunt 8/1/16; Heterotaxy Syndrome
Dr Laddale Sy*, Dr. Iris Tagaro
Dr. Dexter Cheng, Dr. Catherine Chua
ER Mortality
Cardiopulmonary
Arrest secondary to Severe Pneumonia
Large ASD in Failure
Dr. Hannah Arce*
Dr. Cecil Acosta
PICU Mortality
Brain herniation syndrome; (Clinically brain dead)
Hydrocephalus secondary to Subdural Hematoma
s/p External Ventriculostomy Drain (8/2/16)
Multiple fractures secondary to Non-Accidental Trauma
Pneumonia, Bilateral r/o Lung Contussion
Hemolytic Anema (Microangiopathic)
Developmentally High Risk Infant
t/c Diabetes Insipidus, r/o Osteogenesis Imperfecta, Vitamin Deficiency and hypophosphatemia (genetics)
Right Popliteal Deep Vein Thrombosis, Resolved
Oral Thrush, Resolved s/p Subduroperitoneal Shunt Insertion, Left (8/18/16)
Dr. Pristine Bernardo*
Dr. Neva Batayola, Dr. Dexter Cheng, Dr. Jabson, Dr. Ace Prodgalidad, Dr. Vincent Alba, Dr. Therese Pernia, Dr. Teresita Rabanal, Dr. Marco Abad, Dr. Sumpaico, Dr. Jacqueline Navarro, Dr. Cynthia Aguirre, Dr. Eva Cutiongco-dela Paz