Hospital Utilization Statistics

Dr Sona Bedi MHA (AIIMS) DNB (HAH) ESIC, N. Delhi

04/17/12 1

What you cannot measure, you cannot improve

04/17/12

Introduction

The volume and scope of any activity is determined by the means of statistics Statistics is the science of collecting, classifying, summarising, analysing and interpreting quantitative data Statistical data-essential tool for hosp admn to gain vital quantitative information concerning the wide scope of hosp activities

Introduction

Every hospital has to have a system, which can provide management with information necessary to plan and control efficient patient care and efficiently manage the hospital. Such information will include trends and data that will improve decision-making. Occupancy, patient mix, patient movement, and supportive services utilization reports, form the basic ingredients of the framework for decisions with long-term implications as well as short-term impact.

Such information offers operational and policy alternatives to the administrator. Many factors affecting utilization when used carefully help in identifying aspects of complex interdepartmental relationships that are sensitive to changes, by relating their linkages to utilization. Different indices are used in the assessment of hospital utilization but, taken singly, none of them can give a proper picture of the utilization pattern.
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Objectives
Effective administration and operation to provide proper care for its patients Planning, organisation and coordination of hosp services Economic utilization of hosp facilities Assessment of prevailing morbidity in the population Evaluation of medical care Training and research

Classification
1. Those related to the population under cover, or community indices. 2. Those related to the hospital resources, viz. beds, diagnostic and therapeutic facilities and their utilization. 3. Hospital morbidity and mortality statistics They relate to patients and diseases and are collected from medical records. (viz. age, sex, occupation, marital status, etc.), and other data such as complications and outcome of hospital stay (viz. cured, died, improved, 7 etc.).

Classification of Hosp Statistics

Statistics relating to hospitals

Statistics relating to patients

Statistics relating to hospitals

Beds-imp resources info provider-distribution, type, accomodation, utilization A hospital bed is one that is designed, staffed and equipped for overnight use by an in-patient It does not include observation beds, examination beds and beds in staff chambers for the use of staff. Uses

Plan max. use of beds Indicate overuse/underuse of beds Adjust allocation of beds among units Assess adequacy of accomodation Control and monitor length of stay

Departmental service statistics

workload of various depts, labs, imaging, kitchen, A& E, OPD, laundry etc Uses

Plan

space and epqmt Establish basis for fee for service Relate resources to workload Plan future range of services Assess staff productivity levels
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Hosp Personnel statistics

Number employed, qualifications, working conditions, hours worked, remuneration, leaves etc Uses

Plan

hosp needs Evaluate personnel policies Review wage levels Reappropriation staff internally Reveal misuse of trained manpower
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Hosp training facilities statistics

Deputations, courses, conferences, CMEs, seminars, costs involved, types of existing training programmes Uses

Evaluate

hosp training commitments Plan training programs Determine need for training and research

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Statistics of Hosp revenues and expenditure

Financial statements, budgets Use for generating revenue, fee for services, investments etc

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Statistics relating to patients

Terms
Inpatient Outpatient Hospital

bed Bed complement

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Inpatient statistics
Derived from pt movements-admissions and discharges Normal new born babies are not counted as admissions but are mentioned separately, premature and sick babies are counted as admissions

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Patient day
Hospital census is taken at 12 midnight. Pt day or bed-day denotes the services rendered to one pt on census taking hrs on two successive days Admission and discharge on same day is counted as 1 day

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Admission
Admission is the acceptance of a patient for inpatient care either or investigation or treatment, or both. Healthy newborn babies are not considered as admissions. Universal practice to show data on babies born in hospital separately. Premature babies requiring intensive care, and the diseased newborn should be counted as admissions.
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Discharge

Discharge is the conclusion of a period of inpatient care, whether the patient returned to his home, was transferred to another inpatient facility or died. The number of admissions/discharges excludes:

a transfer from one department to another one at the same hospital; day-cases of day patients; weekend leave when the patient has been released temporarily and the hospital bed is still reserved; cases where treatment is provided by hospital personnel at the patients home. Newborns are not included

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Average daily census

Total no. of pt days No. of calender days in the same period

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Bed Occupancy Rate (BOR) or percentage occupancy

Bed occupancy rate indicates the relationship between availability and utilization of hospital beds and facilities. Expressed as percentage by either of the following two methods.
i.

ii.

Ratio of actual patient days to the maximum possible patient days during a given period. Ratio of the average daily census to the bed complement. BOR = Average daily census x 100 Bed complement

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BOR

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BOR
A low rate is indicative of underutilization of facilities. .

In many public hospitals, because of the perpetual shortage of beds, patients are put on the floor when a regular bed is not available in which case the occupancy rate goes up to 110 or 120 per cent.

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Average Length of Stay (ALS) (ALOS)

Average length of stay (ALS) is the average period in hospital (in days) per patient admitted, i.e. the average number of days of service rendered to each inpatient. ALS = Number of inpatient days care (excluding Healthy newborn) during the year Total number of discharges and deaths

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2. ALS = Total no. of bed-days in the yr

Total number of admissions in the year

3.

ALS = Total no. of bed-days in the yr (admissions+ discharges+ deaths) Another method- random survey on a single day- shows mean time from admission

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ALS
The formula is quite satisfactory in acute general hospitals with quick patient turnover. But is unsatisfactory where there is considerable difference between the number of patient admitted and those discharged during the year, e.g. in chronic disease hospitals. In calculation of ALS, the day of admission is included, but the day of discharge is excluded.
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Factors influencing ALS

1. Patient characteristics, sex, age and also educational and socio-economic status. 1. Disease characteristics such as chronic disorders and certain other diseases will account for longer hospital stays. 2. Hospital characteristics such as teaching and research hospitals tend to have longer ALS than others. Cumbersome admission and discharge procedures of the hospital also 26 influence ALS.

Decreasing ALS makes available more pt days Serves as an indicator of hosp efficiency Indicates hosp characteristics bottlenecks and other

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Bed Turnover Interval

Average no. of days a hosp bed remains vacant between one discharge and another admission Max. possible pt days-actual pt days in a given period Total discharges during the same period Will be 0 when BOR=100 Will be negative when BOR >100 Should be calculated separately for diff wards or hosps Consistently short or negative BTR indicates a possible shortage of beds Ideal is 0.5, BTI>2 indicates underutilization

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Bed turnover Rate

Shows the number of discharges per hospital bed over a given period of time Total no. of pts discharged (incl deaths) Bed complement

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Dead bed space

Refers to bed unoccupied in a hosp due to a rigid compartmentalization of nursing units among specialities Can be upto 15% in some cases

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DERIVED FROM PATIENT MORTALITY

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Hospital Death
Hospital death is the death of any admitted patient during his or her stay in the hospital. Deaths occurring in the casualty department or emergency room or in ambulance while on way to hospital are not considered as hospital deaths. Calculation Net death rate: sometimes referred to as institutional death rate, relates to deaths occurring 48 hours or more after admission. Gross death rate includes all deaths in hospital.
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Mortality statistics are indirectly related to the management of hospitals. Deaths occurring in the emergency room in the casualty or in the ambulance while on way to hospital are not included in hospital mortality statistics. 1. Gross death rate =
No. of deaths in a period No. of discharges including deaths in the period 2. Net death rate = No. of deaths occurring 48 hrs. or later No. of deaths and discharges
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Mortality Services

x 100

x 100

3.

Post-Operative death rate =

No. post-operative of deaths in a period No. of patients operated during the period x 100

All deaths either attributable to to, or precipitated by a surgical operation such as due to hemorrhage, shock, infection, embolism, etc. and occurring within the post-operative of up to 10 days are classified as post-operative deaths.

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4.

Maternal Death Rate: Deaths of mother attributable to pregnancy, child birth or its complication including death resulting from abortions No. of deaths of obstetrical patients x 100 No. of discharges (including deaths) of obstetrical patients Infant death rate (viable infants up to 28 weeks No. of deaths of infants born in hospital No. of viable newborn infants (including deaths)

x 100

6.

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Neonatal death rate No. of infant deaths within 28 days of birth x 100 No. of viable newborn infants discharged (including deaths)

Out Patient Services

A person attending a PHC unit or outpatient department in an outpatient establishment or hospital and who makes use of the diagnostic or therapeutic service but does not occupy a regular hospital bed. Outpatient services data is extracted from the registers maintained at the registration counters in the outpatient department, specialty clinics and casualty service.

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1. 2. 3. 4. 5. 6.

Number of new cases Number of repeat cases Specialty-wise break-up of cases Unit-wise break-up of cases Age and sex distribution of cases Diagnostic statistics

Daily average outpatient attendance

Total number of outpatient attendance during the period Number of OPD working days during the period Average outpatient attendance per patient (Average duration of the spell of sickness treated in OPD) Total number of outpatient attendances Total number of new cases
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Day-patient

Definition of day patient: A patient who does not require inpatient care but who needs specialized observation or health care or treatment from hospital during a limited number of hours of the day and who returns to his home for the the night. These patients can occupy specialized beds (e.g. recovery beds, beds for special purposes or belonging to special health devices). If a day patient occupies a regular hospital bed, then this case is not considered as a case of hospitalization and thus consumed bed days are not included in the number of regular days of stay. Day-patient care is one of the forms of ambulatory care.

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Surgical Services
1. Total number of operations 2. Break-up of major and minor operations. There is still no unanimity among surgeons about the nature of operation, i.e., major or minor. Some hospitals consider any operation requiring general anesthesia as major, while as others consider the time duration as main variable in deciding whether an operation is major or minor.

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In-pt statistics related to quality

Post-operative infection rate Post-operative complication rate Caesarian section rate Autopsy rate Consultation rate Rate of normal tissue removed % disagreement between final and pathological diagnosis

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Factors affecting hosp utilization

Availability of hosp beds Method pf payment for hosp services Age of the population Service coverage and bed distribution Availability of extra-mural medical services Hosp bottlenecks

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Medical customs and social practices, level of education Supply of physicians Research and trng Existence of proprietary hosp Housing Morbidity Internal organisaton

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In all cases, a trend analysis is more important than visualizing a single statistic

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140 120 100 80 60 40 20 0 5.8 6.1 4.7 3.9 4.1 4.5 4.8 4.8 4.5 5.1 4.3 4.6 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec ALS 96.3 114.1 107 115 108.1 88.5 115.2 116.1 119.8 119.2 91.2 90.2

Bed Ocupancy

Bed Occupancy and ALS statistics for 2004

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250000 200000 150000 100000

232216 208396 196826

218399 223862

187063 37205 28630 28979

42544 39499 50000 40098

Days of care

OPD attendance

2002

2003

2004

ESI Hospital NOIDA statistics for the year 2002,2003,2004

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Casualty Attendance

Lab tests

20000 15000 10000 5000

9531 9696 8577 8522 8115

18451 18562 18490 10058 9908 7925 5315 5689 4434

8249

4186 3514 3829

Admissions

X-rays

USG 2004

Discharges

2002

operations

2003

ESI Hospital NOIDA statistics for the year 2003-2004

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ECG

23534 12218 14516

9167 6988

56554

22003 35511 27905 Surgical Eye Skin Ortho ENT Dental

Medical Obs&gyn Paed

Specialty Wise OPD Attendance for the year 2004

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716

177 1450

933 907

Sugery

Ortho

Gynae

Eye

ENT

Department wise distribution of operations for the year 2004

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600 500 400 300 200 100 0 0 2001 Phaco 2002 2003 Total 470 259 245 112 470 504 394 506 489

584

95

2004

ECCE with IOL

Statistics of Cataract Surgeries in Eye Dept

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