Kgm Kasus.docx

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. 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. 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

Indikator pelayanan RS dapat dipakai untuk mengetahui tingkat pemanfaatan, mutu, dan efisiensi pelayanan RS. Indikator2 berikut bersumber dari sensus harian rawat inap: 1. BTO (Bed TurnOver) / Angka perputaran tempat tidur a. Average number of patients cared for a bed during a given period. b. BTR= No of discharges including deaths for a given period of time Average bed count for that period of time

c. Indicates: i. An important measure of hospital utilization indices. ii. Gives the net effect of changes in Occupancy Rate and Average Length of Stay (ALS) d. Example i. 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 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 of 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. Huffman (1994): the net effect of changed in occupancy rate & length of stay. Depkes RI (2005): adalah frekuensi pemakaian tempat tidur pada satu periode, berapa kali tempat tidur di dalam satu satuan waktu tertentu. Idealnya dalam satu tahun satu tempat tidur rata rata dipakai 40-50 kali Yang lain: >30 kali.

2. AVLOS / ALOS (Average Length of Stay) (rata2 lamanya pasien dirawat) a. 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.

b. Formula for calculating AVERAGE LENGTH OF STAY (IN DAYS) = ALOS = =

TOTAL INPATIENT DAYS OF CARE TOTAL Discharges Jumlah lama dirawat . Jumlah pasien keluar (hidup + mati)

c. Average length of stay in hospitals (ALOS) is often used as an indicator of efficiency. d. All other things being equal, a shorter stay will reduce the cost per discharge

e. Example:

i. Given number of patients = 4, Total Length of stay = 6 + 11 + 5 + 8 = 30 days ii. Average Length of Stay = Total length of stay / Total number of discharges = 30 / 4 = 7.5 days Menurut Huffman (1994): The average hospitalization stays of inpatient discharged during the period under consideration Menurut Depkes R1(2005): Rata-rata lama rawat seorang patient Indikator ini memberi gambaran tingkat efisiensi, & gambaran mutu pelayanan apabila diterapkan pada DX tertentu dapat dijadikan hal yang perlu pengamatan yg lebih lanjut. Nilai yang ideal antara 6-9 hari (Depkes, 2005); (Yang lan : 3-12 hari)

3. BOR (BED OCCUPANCY RATIO) 

Huffman (1994) : the ratio of patient services day to inpatient bed count days in a period under consideration.

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Depkes RI (2005) : persentase pemakaian tempat tidur pada satuan waktu tertentu

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Indikator ini memberikan gambaran tinggi rendahnya tingkat pemanfaatan tempat tidur RS.

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Nilai parameter BOR idealnya = antara 60-85% (Depkes RI 2005)

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Yang lain : 75 – 85% 

BOR is the average occupancy of hospital beds in percentage.

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It is the ratio between beds used and beds provided.

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The beds occupancy rate is calculated based on the midnight bed census at each hospital.

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[For example, the BOR for Monday is based on the bed census taken at 0000 hrs Tuesday]. BOR =

Number of patients' day (service days) in a year Number of beds x 365

x 100

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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).

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100% occupancy means over-utilization.

-

Occupancy less than 80% is uneconomical

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 %

4. TOI (Turn over Interval) Rata-rata hari di mana tempat tidur tidak ditempati dari telah diisi ke saat terisi berikutnya. TOI = (Available staffed bed days – Occupied bed days) Inpatient discharges (Jumlah tempat tidur X Periode) - Hari perawatan Jumlah pasien keluar (hidup + mati)

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Gambaran tingkat efisiensi penggunaan tempat tidur.

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Ideal: tempat tidur kosong tidak terisi pada kisaran 1-3 hari.

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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

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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.

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Long positive TOI s indicative of under-utilization because of defective admission procedures or poor-quality medical care.

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Short positive TOI is indicative of optimum utilization.

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TOI is ‘zero’ when Bed Occupancy Rate is 100%.

5. GDR (Gross Death Rate) 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, r = (Hospital) Gross Death rate n = Number of Deaths of Inpatients in a Period t = Number of Discharges (Including Deaths) in the Same Period Depkes RI (2005) adalah angka kematian umum untuk setiap 1000 penderita keluar. Indikator memberi gambaran mutu pelayanan di RS.

6. NDR (Net Death Rate) Depkes RI (2005) adalah angka kematian 48 jam setelah dirawat untuk setiap 1000 penderita keluar. 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).

Net Death Rate

=

Total death in 48 hours Total discharge

x 100

Formula: r = ( n / t ) * 100, r = (Hospital) Gross Death rate n = Number of Deaths of Inpatients in 48 hours t = Number of Discharges (Including Deaths) in the Same Period 

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Anesthetic death rate = (No of deaths due to anesthesia ÷ No of patients anaesthetized during that period) x 5000 o 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 o Usual value is 1-2% (Depending on nature of surgery)