Management and organisation in hospital notes 4

Management

1. SYB303 Management and
Organizationin Hospital
Lecturernotes4

2. Deathrates
Crudedeathrate
Net deathrate
Maternalmortalityrate
Hospitalinfantmortalityrate
Postoperativemortalityrate
Anesthesiamortalityrate
Infectionrates
Crudeinfectionrate
Net infectionrate
Postoperativeinfectionrate

3. Mortalityratesareoneoftheimportantcriteriausedtoevaluatethelevelofservice
providedinhospitals.Inordertomakeasoundassessmentofdeathsandtoplan
appropriateservice,thereisaneedtoknowthecharacteristicsofthedeceasedand
thecausesofdeathaccurately.
Example
Information comingfrom
healthinstitutionsand
transferredtoofficial
institutionsis very
important.

4. Crudedeathrate-in hospital
Crudedeathrate is therate calculatedbydividingthetotal numberof
patientswhodiedin clinicsin a givenperiodbythenumberof patients
discharged(includingthosewhodied) in thesameperiod.
❖Crudedeathrate can be calculatedseparatelyforadultpatients, pediatric
patientsandwards.
❖Babiesbornanddiedin hospitalsshouldnot be takenintoaccountin the
calculationof crudedeathrate.
❖Hospitalinfantmortalityrate shouldbe calculatedforbabiesbornanddied
in thehospital.

5. DeathRate in hospital
Ittakesacertainamountoftimeforahospitalizedpatienttobediagnosed
withthediseaseandforthetreatmenttoshowitseffect.Itisgenerally
acceptedthat48hoursaresufficientforthisperiod.Forthisreason,itis
acceptedthatthequalityofhospitalservicecannothaveaneffectonthe
deathsoccurringwithinthefirst48hoursafteradmissiontotheward,and
therealpatientcarequalityisshownbythedeathsoccurringafter48hours.

6. MaternalDeathRate-in hospital
Maternaldeath;isthedeathofthemotherduetopregnancy,miscarriageand
childbirth.Maternalmortalityrateistherateobtainedbydividingthe
numberofmaternaldeathsthatoccurredinahospitalinacertainperiodof
timebythenumberofobstetric(branchofmedicineexaminingpregnancy,
birthandpuerperium)cases(includingthosewhodied)dischargedinthesame
period.Itisoneofthemainindicatorsofthequalityofcareinobstetricsand
gynecologyservices.
Ifpossible,maternaldeathshouldnotoccuratall.Ifnotpossible,itis
desirablethatitbeverylow.

7. Infantmortalityrate -in hospital
Infantmortalityrateisoneofthecriteriathatshowsthequalityofpatient
care.Itiscalculatedbydividingthenumberofbabiesbornanddiedinthe
hospitalinagivenperiodbythenumberofbabiesdischarged(includingthose
whodied)inthesameperiod.Stillbirthsandbabiesfromoutsideshouldnot
beincludedinthecalculation.

8. PostoperativeDeathRate in hospital
Someofthepatientshospitalizedfortreatmentaretreatedwithsurgeryfor
diagnosisandtreatment.
Postoperativecare(postoperativecare)ofpatientswhohavehadsurgeryis
importantandspecial.Incasethepost-operativecareisnotgood,negative
effectssuchasinfection,disabilityanddeathofthepatientareexperienced.
Theratecalculatedbydividingthenumberofpatientswhodiedinthefirst
10daysaftersurgeryinahospitalbythetotalnumberofsurgeriesiscalled
thepostoperativemortalityrate.
Itisoneofthebasiccriteriathatshowsthequalityofpatientcare.
**Accuratecalculationof anesthesiadeathrate is possiblebywellresearchingand
recordingthecausesof death.

9. INFECTION RATES
NosocomialInfections, alsoknownas "NasocomialInfections", is an importanthealthproblem
thatnocountryororganizationin theworldhas beenabletosolvecompletely.
Hospitalinfections;Itincreasesthenumberofsickdaysinthehospital,causeslong-term
laborloss,increasestheresistanceofmicroorganismstoantimicrobialagents,bringsa
seriousadditionalcosttothehealthsystem,causesaseriouscostforthepatientandhis
family,andmayevenresultindeath;Forthesereasons,itisattheforefrontofpatient
safetyissues.
Hospitalinfectionsthreatenhealthworkersas wellas patients. Duetothisimportance, it is
necessarytotakethenecessarymeasuresforthewell-knownandpreventionof nosocomial
infections.
Nosocomialinfectionis definedas “allinfectionsthatdevelopin inpatienttreatment
institutionsrelatedtohealthservices” in InpatientTreatmentInstitutionsInfectionControl
Regulation.

10. Infectionrate in hospital
“Infectionsthatarenot presentat thetime of admissiontothehospital, arenot in the
incubationperiodanddevelop48-72 hoursafterhospitalizationoroccurwithin10 days
afterdischargein a patienthospitalizedforvariousreasons”
Allinfectionsthatdevelopin thehospitalshouldbe constantlymonitoredandrecorded.
CrudeInfectıonRateinhospital
Theratethatgivesinformationaboutthetotalnumberofinfectionsseeninahospitalina
giventime,regardlessofwhetheritbelongstothehospitalornot,iscalledthecrude
infectionrate.

11. Sincehospitalinfectionisinterpretedasanindicatorofthequalityofpatientcare,
itisnecessarytoexaminewhethertheinfectionwastakeninthehospitalinorder
tomaketheassessmentcorrectly.Therefore,thenetinfectionrateisahealthier
criterionintheevaluationofnosocomialinfections.
Thenetinfectionrateiscalculatedonlyforinfectionsproventobehospitalized.
Thedevelopmentofaninfectioninawardwhereapatientishospitalizedfor
treatmentmeansthatthereareproblemswithpatientcareinthatward.Therefore,
thenetinfectionrateisanimportantmeasureofpatientcarequality.

12. Itisdesirablethatnohospital-acquiredinfectiondevelops,thatis,nocalculationof
thenetinfectionrate.
Developmentofhospitalinfection;Thereareriskfactorssuchasinterventional
treatmentpractices,notpayingattentiontocleaningrules,physicalinadequacies,
personnel-relatedproblemsandfactorsthatnegativelyaffectthepatient'simmune
system.
Theriskfactorsofthedevelopinginfectionshouldbeinvestigated.

13. Post-surgeryInfectıonRate in hospital
❖Postoperativecare(postoperativecare)ofpatientswhohavehadsurgeryis
importantandspecial.
❖Postoperativeinfectionrateisalsoconsideredasoneofthecriteriathatgives
anideaaboutthepatientcarequalityofthehospital.
❖Theratecalculatedbydividingthenumberofinfectionsincleansurgicalcases
inahospitalwithinacertainperiodoftimebythetotalnumberofsurgeriesin
thesameperiodiscalledthepost-operativeinfectionrate.
Amongtheriskfactorsforhospitalinfections,surgerieshaveaspecial
importance.Becauseintheintervention;Nosocomialinfectionscandevelopdueto
reasonssuchashand,tool,medicalinstrument,applicationenvironmentand
inadequatecleaningofthewoundarea.Therefore,itisnecessarytopay
attentiontopatientcareinthepostoperativeperiod.

14. Hospitalinfections
Hospitalinfectionsareveryimportantintermsoftheinstitutionsthatprovidehealt
carreservices.Therearemanypositiveeffectsonthehealthcarequalityofeffective
preventionofhospitalinfections.Themostimportantofthesepositiveeffectsis
patientsafety.Becausethemostimportantpointintheinstitutionsthatprovide
healthservicesistoprovidepatientsafetybypreventinghospitalinfection.
Hospitalinfectionscausemorbidity,mortalityandeconomicloss.Hospitalinfections
reducepatientcarequalitybythreateningpatientsafety.Because,patientsafetyisa
prioritythathealthcareinstitutionsmustpayattentiontoimprovequalityofcare,
safetyandoutcomes,.Hospitalinfectionsareespeciallyreportedtoincreasetherisk
ofdeathbyincreasinghospitalizationperiodandriskofinfections.Healthcare
associatedinfectionsareamajorpatientsafetyissueinhospitals.

15. HAIareconsideredanundesirableresultinhealthcare.AlsoHAIisasignificant
indicatorofqualityofcareinhealthservices.Itis,therefore,crucialtoconduct
worldwideresearchonmethodsonpreventingandcontollinghospitalinfections,.The
CentersforDiseaseControlandPreventionestimatesthat%5-%10ofhospitalized
patientsdevelopahealthcareassociatedinfection.HAIhavebeenreportedtobea
seriousprobleminthehealthservices,.TheworldwideincreasingprevalenceofHAIisan
extraordinarychallengetohealthcare.HAIsaffectalmost1millionpatientseachyear.
ThemajortypesofHAIarecentrallineassociatedbloodstreaminfection(CLABSI),
cathederassociatedurinarytractinfection(CAUTI),surgicalsiteinfection,methicilin
resistantandclostridiumdifficileinfection(CDI),.Inthehospitals,therearemany
reasonsthatleadtohospitalinfections,whichareconsideredaslargelypreventable.For
example;inadequatehandwashing,unnecessaryuseofmedicaldevices,loworganizational
cultureandHAIpreventionpractices,andinadequetenursetopatientratioscanbegiven
asthefactorsthatincreasetheincidenceofHAIs.

16. Patientsafetyisanimportantcomponentofhealthservicequality.Health
institutionsimplementqualityimprovementactivitiesinordertomaintainquality
ofcare.Thesepracticesincludeeffectivepreventionstrategiesforhospital
infections,becauseitnegativelyaffectshealthcarequalityandcompromise
patientsafety.
HospitalAcquiredInfectionsdonotonlynegativelyaffectthehealthof
population,butalsoincreasecostofprovidedmedicalcare.Inorderto
preventHospitalAcquiredInfectionandtoimprovepatientsafety,guidelines
andcomprehensivecarequalityimprovementprogramsshouldbeprepared.
HospitalshavemadeeffortstodiminishHAIsbygettinginvolvedinregional
andnationalpatientsafetylearningcollaboratives.Activepatientsafety
learningcollaborations,suchasadoptedandimplementedguidelinesandcare
qualityimprovementschemes,inhospitalsareassociatedwithsignificant
improvements.Unifiedimplementationofthesefundamentalinfection
observation,controlandpreventionrecommendationswillguideimprovements
inhospitalsinfectionratesandpatientsafetyprograms.