Performance Indicators for Hospitals
- Niladri Majumder
Roadmap
Operationa perationall Excellen Excellence ce ± Demand Demand of the Hour Hour
Importance of Indicators in Hospitals
Types of Hospital Performance indicators
Discussions on Key Indicators
2
Challenges
to Healthcare
Providers
Improving patient safety Improving clinical outcomes through error reduction and process automation Improving communications & trust between physicians and hospitals
Reduction in cost of healthcare
Making hospitals more operationally efficient
Strategies for curbing Healthcare Associated Ass ociated Infections
Incorporating technology into medicine
3
Shrinking
Margins : Hospital Expenses vs. Revenues
4
Hospitals have to be operationally efficient to ensure their sustainability in the long run. Performance Indicators helps quantify performance w hich facilitates process improvement init in itia iati tive vess sy syst stem emat atiically 5
Ex cellence results from Better Quality O perational
6
Wh y
INDICATOR S ???
7
What
is Indicator?
An indicator or measure refers to numerical information that quantifies input, output, dimensions dimensions of processes and outcomes. The measurement relates to performance but is not an exclusive measure of such performance (e.g., the number of complaints is an indicator of dissatisfaction, dissatisfaction, but not an exclusive indicator of it) The measurement is a predictor or ³leading indicator´ of more significant performance (e.g., a gain in patient satisfaction might be a leading indicator in HMO retention 8
Indicators
9
Patient Satisfaction Indicators Accessibility of the Hospital Behavior & Promptness of Hospital Staff
Availability & Services Availability Waiting Time PATIENT SATISFACTION INDEX
Doctor Patient Communication
Hygiene & Cleanliness Facilities, Amenities & Infrastructure
10
Patient Satisfaction Indicators
Apart from the Patient Satisfaction Index there are multiple indicators which reflect patient satisfaction in a hospital:
Repeat Visits in OP / Ambulatory Care
Elective Surgery Cancellations
Leave Against Medical Advice (LAMA)
Inward Referrals
OP / IP Conversion Rates
Emergency / IP Conversion Rates
11
Clinical Outcomes
Indicators
Hospital Acquired Acquired Infection
Urinary
Tract Infection ( UTI)
Blood Stream Infection (BSI)
Respiratory Tract Infection ( RTI)
Surgical Site Infection ( SSI)
Quality of Nursing Care
12
Clinical Outcomes
Indicators
Average Length of Stay
Bed Turnover Rate
Unplanned Returns to OR within 24hrs
Cancelled / Postponed Surgeries
Wrong Site / Wrong Patient / Wrong Procedure Surgery Incident Reporting
Gross / Net / Anesthesia Death Rate
13
Business Performance Indicators
Bed Occupancy Rate EBITA ( Earnings before Tax, Interest, Depreciation and Amortization) Net Operating Margin Daily Daily Collection Collections s ± IP, OP, Lab & Radiology, OT, ICU Clinical Specialty wise Earnings 14
Important Indicators for Detailed Discussion
Inpatient Bed Count
Average Length of Stay
Bed Count Days
Bed Occupancy Rate
Bed Turnover Rate
Bed Turnover Interval
Death Rate 15
Inpatient Bed Count
The number of available facility inpatient beds, both occupied and vacant, on any given day
In a hospital this includes beds set up for f or normal use, whether or not they are occupied May be reported for the entire hospital or for any of its units
In a hospital, the number of available beds in a facility f acility or a unit may remain constant for long periods of time
16
Inpatient Bed Count
Other names
Bed complement
Bed capacity
This may be confusing as this also denotes the number of beds that a facility has been designed and constructed to contain
The number can and often does change
Some beds may be unavailable during a major remodeling or renovation project May increase after the project is completed
17
Inpatient Bed Count
Excludes beds in
Treatment rooms
Examining rooms
Emergency services
Physical therapy
Labor rooms
Recovery rooms
Newborn beds, called bassinets, are computed separately from the bed count 18
Newborn Bassinet Count
The number of available hospital newborn bassinets, both occupied and vacant, on any given day
19
verage A
Length of Stay
The total number of patient days for an inpatient episode. The duration of an inpatient's hospitalization is considered to be one day if he is admitted and discharged on the same day and also if he is admitted on one day and discharged the next day. day. The day day of admission should be counted but not the day of discharge.
Total No of Inpatient Bed days for Discharged patients ___________________________________________________
Total No of Discharges and Deaths
20
Bed Count Days
A unit of measure denoting the presence of one inpatient bed (either occupied or vacant) set up and staffed for use in one 24-hour period
Refers to the sum of inpatient bed count days for each of the days in the period under consideration May be referred to as the maximum number of patient days or potential days because they represent a statistical probability of every bed being occupied every day
If every hospital bed were filled each day the occupancy rate would be 100 percent
21
Bed Occupanc y Rate
The ratio of inpatient service days to bed count days in the period under consideration The inpatient census represents the actual occupancy (number of occurrences)
The bed count represents the possibility for occupancy (number of times it could have occurred or the maximum possible) 22
Bed Occupanc y Rate ( BOR) The Bed Occupancy Rate is always expressed as a percentage. percentage.
The BOR is calculated for a specific time period ( week, month month or year ). It can be calculated either for the entire hospital or ward / specialty specific
Total Inpatient Inpatie nt Admissions x Average Length of Stay ___________________________________________________
X 100
Total Inpatient Inpatie nt Beds x Total No of Days
23
Bed Occupanc y Rate ( BOR) The BOR of an acute care hospital should not exceed 80% 8 0%.. The rationale is that no deserving patient should be refused admission at any point of time. The buffer buff er allows scope for emergent admissions and absorbs time loss between discharge and bed preparation for the next patient
The BOR of Intensive Care Settings such as ICU, NICU, PICU, Burn Unit should not exceed 75%. This implies that some beds should always be unoccupied. This ensured greater probability to admit deserving patients at any point of time.
24
Bed Turnover Rate
The number of times a bed, on average, changes occupants during a given period of time, OR
The average number of admissions per bed per time period
Useful
because two time periods may have the same percentage of occupancy, but the turnover rates may be different diff erent
25
Bed Turnover Interval Average Average period period in days that an available available bed bed remains empty empty between the discharge of one inpatient and the admission of the next. Indicates the time that available beds are free. Indicates a shortage of beds when negative, and under-use of the hospital or an inefficient admission system, if positive.
Available Available beds x days in the period - patient patient days for the period Number of discharges, including deaths, including deaths, in the period
26
Hospital Death Rate Note: Patients who are dead on arrival (DOA) at a hospital are not included when calculating these rates. A ratio of all inpatient deaths for a given period to the total t otal number of discharges and deaths in the same period.
otal T otal
number number of deaths of inpatients in a given period x 100
otal T otal
number number of discharges and deaths in the same period
27
Net Death Rate & Post O perative Death Rate
NET DEATH DEATH RATE - A death rate, also known as the institutional institutional death rate, that does not include deaths, which w hich occur within 48 hours of admission (24 hours of admission in some countries). reviously, P reviously,
it was that those deaths that occur within 48 hours of admission should not be counted because not enough time had lapsed to allow the health care providers adequate time to directly affect the patient¶s condition. However, with today¶s technology, this concept is no longer thought to be valid. T herefore, herefore, it is recommended that net death rates not be calculated unless there is a special order to do so.
POST OPERATIVE PERATIVE DEATH DEATH RATE - The ratio of of deaths within 10 days after surgery to the total number of patients operated on during that period.
28
29
Common Indicators in E.M.R
30
Hospital Performance Dashboard
31
Indicators in E.M.R
32
33
THANK YOU
34
