Quality Indicators

(Performance of Hospital Processes)

1
Patient Assessment related quality
indicators
Time for initial assessment of indoor and
emergency patients
Percentage of cases (in-patients) wherein care
plan with desired outcomes is documented
and counter-signed by the clinician.
Percentage of cases (in- patients) wherein
screening for nutritional needs has been done.
Percentage of cases (in- patients) wherein the
nursing care plan is documented.
Lab related quality indicators
Number of reporting errors/1000
investigations
Percentage of re-dos
Percentage of reports co-relating with clinical
diagnosis
Percentage of adherence to safety precautions
by employees working in diagnostics

Medication related quality indicators
Incidence of medication errors
Percentage of admissions with adverse drug
reaction (s)
Percentage of medication charts with error
prone abbreviations
Percentage of patients receiving high risk
medications developing adverse drug event

Anaesthesia related quality indicators
Percentage of modification of anaesthesia
plan
Percentage of unplanned ventilation following
anaesthesia
Percentage of adverse anaesthesia events
Anaesthesia related mortality rate

OT related quality indicators (1)
Percentage of unplanned return to OT
Percentage of re-scheduling of surgeries
Percentage of cases where the MPUH's procedure to prevent
adverse events like wrong site, wrong patient and wrong
surgery have been adhered to
Percentage of cases who received appropriate prophylactic
antibiotics within the specified time frame
Percentage of transfusion reactions
Percentage of wastage of blood and blood products
Percentage of blood component usage
Turnaround time for issue of blood and blood components
OT related quality indicators (2)
Urinary tract infection rate
Pneumonia rate
Bloodstream infection rate
Surgical site infection rate
Mortality rate
Return to ICU within 48 hours
Return to Emergency department within 72 hours with similar
presenting complaints
Re-intubation rate
Research related quality indicators
Percentage of research activities approved by
Ethics committee
Percentage of patients withdrawing from the
study
Percentage of protocol violations/ deviations
reported
Percentage of serious adverse events (which have
occurred in the organisation) reported to the
ethics committee within the defined timeframe.

Purchase related quality indicators
Percentage of drugs and consumables
procured by local purchase
Percentage of stock outs including emergency
drugs
Percentage of drugs and consumables rejected
before preparation of Goods Receipt Note
Percentage of variations from the
procurement process

Safety related quality indicators
Number of variations observed in mock drills

Patient Safety related quality
indicators
Incidence of falls
Incidence of bed sores after admission
Percentage of employees provided pre-exposure
prophylaxis
Number of sentinel events reported, collected
and analysed within the defined timeframe
Percentage of near misses
Incidence of blood/body fluid exposures
Incidence of needle stick injuries


Patient Satisfaction related Quality
Indicators
Nurse-patient ratio for ICUs and wards
Out patient satisfaction index
In patient satisfaction index
Waiting time for services including diagnostics
and out- patient consultation
Time taken for discharge
Utilization and Services related quality
indicators
Bed occupancy rate
Average length of stay
OT Utilisation rate
ICU Equipment Utilisation
ICU Bed Utilisation rate
Critical equipment down time


Medical Records related Quality
Indicators
Percentage of medical records not having
discharge summary
Percentage of medical records not having
codification as per International Classification
of Diseases (ICD)
Percentage of medical records having
incomplete and/or improper consent
Percentage of missing records

HR related Quality Indicators
Employee satisfaction index
Employee attrition rate
Employee absenteeism rate
Percentage of employees who are aware of
employee rights, responsibilities and welfare
schemes