Hospital Statistics

A brief description on Hospital Statistics

1. HOSPITAL STATISTICS Col Zulfiquer Ahmed Amin M Phil, MPH, PGD (Health Economics), MBBS Armed Forces Medical Institute (AFMI)

2. Definition Information obtained from hospital indoor and outdoor facilities regarding quality of care, utilization of services, quantity of services delivered, workload and other hospital related administrative and logistic affairs is called Hospital Statistics.

3. Uses of Hospital Statistics Measure of evaluation of quality of care Helps in planning Allocation of resources in different areas Identify deficiencies at various levels; ie . Input, process and outcome o services Evaluate effectiveness and efficiency of the administration

4. Types of Hospital Statistics 1. Reports related to hospital beds Daily Census Daily Average Attendance Bed Occupancy Rate Bed Turn Over Interval Bed Turn Over Rate Total Patient Days Care Vacancy Rate Hospital Beds Sanctioned Beds Functional bed Bed Supply Rate

5. 2. Reports Related to Admission/ Discharge/ Death Admission: Daily Admission Total Admission over a period Discharge: Daily Discharge Total Discharge over a period Average length of stay Deaths Daily number of deaths Total deaths over a period Total deaths over 48 hours Total deaths under 48 hours Net death rate Gross death rate Post Operative death rate Anaesthetic death rate

6. 3. Work load statistics Total number of outputs New cases/ Repeat cases Total number of operations Total number of X-Rays Average OPD patients per day Total caesarean sections per day Average number of food served per day

7. 4. Hospital care Evaluation Statistics HAI Rate Post Operative complication rate Autopsy rate Percentage of agreement between final and pathological diagnosis Gross result of treatment; ie . Patients recovered, improved or not relieved

8. 5. Indices related to population at risk Admission Rate Hospitalization Rate per person Bed-Population Index

9. Other type of classification Patient movement statistics- Admission, discharge, deaths Morbidity statistics- Patients under various diagnosis Administrative statistics- Manpower, material, money-finance Hospital service statistics- No of operations, utilization indicators

10. Hospital Utilization Statistics

11. Admission The formal acceptance by a hospital or other inpatient health care facility of a patient who is to be provided with room , and continuous nursing service in an area of the hospital or facility where patients generally reside at least overnight . Admission Rate Number of admission per 1000 population in a year. Discharge Discharge from the hospital is the point at which the patient leaves the hospital and either returns home or is transferred to another facility such as one for rehabilitation or to a nursing home . Discharge involves the medical instructions that the patient will need to fully recover.

12. Hospital Beds WHO defines a hospital bed as a bed that is regularly maintained and staffed for the accommodation and full-time care of a succession of inpatients and is situated in wards or a part of the hospital where continuous medical care for inpatients is provided . Total number of beds excludes bed compliments of the hospital for normal, healthy newborn babies in maternity ward; but includes incubators used for premature babies. Sanctioned Bed It is the official bed capacity of the hospital. CMH Dhaka: 1100 beds (Soon to upgrade to 1500 beds) Functional Bed This is the actual functional status of beds in a hospital.

13. Bed-days or Patient-days A bed - day is a day during which a person is confined to a bed and in which the patient stays overnight in a hospital . It is the unit of measure denoting the services rendered to one in-patient day in the hospital. One full day is counted when admission before mid-day and discharge after mid-day . Patient-day should not include data for healthy new born infants. Bed Supply Rate (Bed to population ratio) BSR = (No of Beds available ÷ No of population served) x 1000 Bangladesh: 0.6 beds/1000 population WHO Standard: 5 beds/ 1000 population Vacancy Rate = 100% - Occupancy Rate

14. Bed Turnover Rate Average number of patients cared for a bed during a given period. BTR= (No of discharges including deaths for a given period of time ÷ Average bed count for that period of time) x 100 Indicates: An important measure of hospital utilization indices. Gives the net effect of changes in O ccupancy R ate and Average Length of Stay (ALS) Example : In a particular hospital, there were 2358 discharges in the year 2009. Number of beds in that hospital in 2009 was 300. Hospital Bed turnover rate = 2358/300 = 7.86

15. Average Bed Occupancy Average number of days during which the bed is occupied by a patient in the course of a given period of time. Average Daily Census (ADC) Average number o f patients in the hospital at a given time per day . This is the ratio of the total number of in-patient days (Excluding new born) to total number of days in the same period. ADC= Total Patient Days ÷ Number of calendar days in a period. For example, the total number of inpatient service days provided for the 1 st week of May is 1729. Average daily census is 1729/7 = 247.

16. Average Length of Stay (ALOS) Length of stay is a term which is used to calculate a patient's day of admission in the hospital till the day of discharge i.e. the number of days a patient stayed in a hospital for treatment . Formula for calculating average length of stay: ( TOTAL INPATIENT DAYS OF CARE / TOTAL Discharges ) = AVERAGE LENGTH OF STAY (IN DAYS ) - The average length of stay in hospitals (ALOS) is often used as an indicator of efficiency. - All other things being equal, a shorter stay will reduce the cost per discharge

17. Total Length of stay = 6 + 11 + 5 + 8 = 30 days Average Length of Stay = Total length of stay / Total number of discharges = 30 / 4 = 7.5 days Given, Number of patients = 4

18. Number of patients' day (service days) in a year Number of beds x 365 X 100 Bed Occupancy Rate (BOR ) BOR is the average occupancy of hospital beds in percentage. It is the ratio between beds used and beds provided . The beds occupancy rate is calculated based on the midnight bed census at each hospital. [For example, the BOR for Monday is based on the bed census taken at 0000 hrs Tuesday ]. 80-85% BOR is ideal for good quality of patient care. 15-20% beds are vacant for emergency, maternity, isolation, intensive care (Dead Space Beds ). 100% occupancy means over-utilization. Occupancy less than 80% is uneconomical

19. Example : In the month of June 4000 inpatients days were served in a hospital with 150 beds . Given, Total number of inpatient days = 4000. Available beds = 150. June has 30 days. So, number of days in the period = 30 BOR = Total number of inpatient days for a given period x 100 / Available beds x Number of days in the period = 4000 x 100 / 150 x 30 = 400000 / 4500 = 88.889 %

20. Bed Turn Over Interval (TOI) Turnover interval (TOI): Average length of time (in days) that elapses between the discharge of one inpatient and the admission of the next inpatient to the same bed. It is the average period in days, that a bed remains empty .

21. Calculation of Turnover interval ( TOI): TOI = (Available staffed bed days – Occupied bed days) / Inpatient discharges. Inpatient discharges include deaths, transfers out to other specialties/significant facilities and transfers out to other hospitals . Interpretation: Negative TOI indicates scarcity of beds and over-utilization. Long positive TOI s indicative of under-utilization because of defective admission procedures or poor quality medical care. Short positive TOI is indicative of optimum utilization. TOI is ‘zero’ when Bed Occupancy Rate is 100%.

22. Gross Death Rate: Ratio of total deaths to total discharges including deaths. In general hospital, it should not exceed 3%. Gross Death Rate= (Total death in a period ÷ Total discharge) x 100 Formula : r = ( n / t ) * 100 Where , r = (Hospital) Gross Death rate n = Number of Deaths of Inpatients in a Period t = Number of Discharges ( Including Deaths ) in the Same Period

23.   Net Death Rate: A death rate, also known as the institutional death rate, that does not include deaths, which occur within 48 hours of admission (24 hours of admission in some countries). Anaesthetic death rate = (No of deaths due to anaesthesia ÷ No of patients anaesthesized during that period) x 5000 It should be less than 1 in 5000 Post Operative death rate = (Deaths within 10 days of surgery ÷ Total operations during that period) x 100 Usual value is 1-2% (Depending on nature of surgery )

24. Autopsy Rate = (Number of pathological autopsies performed ÷ Number of deaths during that period) x 100 Patients who are dead on arrival (DOA) at the hospital and fetal deaths are excluded from both the numerator and the denominator. Autopsy Rate more than 15-20% indicates enquiry type of medical staff, progressive in outlook. Caesarean Section Rate = (Total CS performed ÷ Total live-births during that period) x 100 Normal value is 3-4 %. Between 2004 and 2014, the C - section rate in Bangladesh increased from 4% to 23%. A higher CS should be enquired into.