Performance Indicators for

Hospitals

- Niladri Majumder

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Roadmap

Operational Excellence – Demand of the Hour Importance of Indicators in Hospitals Types of Hospital Performance indicators Discussions on Key Indicators

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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 Infections■ Incorporating technology into medicine

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Shrinking Margins : Hospital Expenses vs. Revenues

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Hospitals have to be operationally efficient to

ensure their sustainability in the long

run. Performance Indicators

helps quantify performance which facilitates process

improvement initiatives systematically

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Operational Excellence results from Better Quality

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Why INDICATORS ???

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What is Indicator? An indicator or measure refers to numerical information

that quantifies input, output, 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, but not an exclusive indicator of it)

The measurement is a predictor or “leading indicator” of more significant performance (e.g., a gain in patient satisfaction might be a leading indicator in HMO retention

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IndicatorsCare Provider Organization (CPO)

Performance

Clinical Outcomes

Business Performance

Patient Satisfaction

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Patient Satisfaction Indicators

Services Availability & Waiting Time

Hygiene & Cleanliness

Facilities, Amenities & Infrastructure

Doctor Patient Communication

Behavior & Promptness

of Hospital Staff

Accessibility of the Hospital

PATIENT SATISFACTION

INDEX

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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

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Clinical Outcomes Indicators Hospital Acquired Infection

Urinary Tract Infection ( UTI)

Blood Stream Infection (BSI)

Respiratory Tract Infection ( RTI)

Surgical Site Infection ( SSI)

Quality of Nursing Care

Patient Falls

Bed Sores

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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

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Business Performance Indicators Bed Occupancy Rate

EBITA ( Earnings before Tax, Interest, Depreciation and Amortization)

Net Operating Margin

Daily Collections – IP, OP, Lab & Radiology, OT, ICU

Clinical Specialty wise Earnings

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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

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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 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 or a unit may remain constant for long periods of time

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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

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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

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Newborn Bassinet Count

The number of available hospital newborn bassinets, both occupied and vacant, on any given day

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Average 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. The 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

___________________________________________________

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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

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Bed Occupancy 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)

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Bed Occupancy Rate ( BOR)

Total Inpatient Admissions x Average Length of Stay

Total Inpatient Beds x Total No of Days

___________________________________________________ X 100

•The Bed Occupancy Rate is always expressed as a percentage.

•The BOR is calculated for a specific time period ( week, month or year ). It can be calculated either for the entire hospital or ward / specialty specific

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Bed Occupancy Rate ( BOR)• The BOR of an acute care hospital should not

exceed 80%. The rationale is that no deserving patient should be refused admission at any point of time. The buffer 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.

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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

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Bed Turnover IntervalAverage period in days that an available bed remains 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 beds x days in the period ‑ patient days for the periodNumber of discharges, including deaths, in the period

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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 number of discharges and deaths in the same period.

Total number of deaths of inpatients in a given period x 100

Total number of discharges and deaths in the same period

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Net Death Rate & Post Operative Death Rate 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).

Previously, 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. Therefore, it is recommended that net death rates not be calculated unless there is a special order to do so.

POST OPERATIVE DEATH RATE - The ratio of deaths within 10 days after surgery to the total number of patients operated on during that period.

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Common Indicators in E.M.R

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Hospital Performance Dashboard

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Indicators in E.M.R

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THANK YOU