Rational use actually deployed bed capacity (in the absence of overload) and compliance with the required period of treatment in departments, taking into account the specialization of beds, diagnosis, severity of pathology, concomitant diseases have great importance in organizing hospital work.
To assess the use of bed capacity, the following most important indicators are calculated:
1) provision of the population with hospital beds;
2) average annual hospital bed occupancy;
3) degree of bed capacity utilization;
4) hospital bed turnover;
5) average duration the patient's stay in bed.
Provision of population with hospital beds (per 10,000 population):
total number of hospital beds x 10,000 / population served.
Average annual occupancy (work) of a hospital bed:
number of bed days actually spent by patients in the hospital / average annual number of beds.
Average annual number of hospital beds is defined as follows:
number of actually occupied beds in each month of the year in a hospital / 12 months.
This indicator can be calculated both for the hospital as a whole and for departments. Its assessment is made by comparison with calculated standards for departments of various profiles.
When analyzing this indicator, it should be taken into account that the number of actually spent bed days includes days spent by patients in so-called attached beds, which are not taken into account in the number of average annual beds; therefore, the average annual bed occupancy may be greater than the number of days per year (over 365 days).
The operation of a bed less or more than the standard indicates, respectively, that the hospital is underloaded or overloaded.
Approximately this figure for city hospitals is 320 – 340 days a year.
Bed utilization rate (implementation of the plan for bed days):
number of actual bed days spent by patients x 100 / planned number of bed days.
The planned number of beds per year is determined by multiplying the average annual number of beds by the bed occupancy rate per year (Table 13).
Table 13
Average number of days of bed use (occupancy) per year
This indicator is calculated for the hospital as a whole and for departments. If the average annual bed occupancy is within the standard, then it is close to 30%; if the hospital is overloaded or underloaded, the indicator will be higher or lower than 100%, respectively.
Hospital bed turnover:
number of patients discharged (discharged + deaths) / average annual number of beds.
This indicator indicates how many patients were “served” by one bed during the year. The rate of bed turnover depends on the duration of hospitalization, which, in turn, is determined by the nature and course of the disease. At the same time, reducing the length of a patient’s stay in a bed and, consequently, increasing bed turnover largely depends on the quality of diagnosis, timely hospitalization, care and treatment in the hospital. The calculation of the indicator and its analysis should be carried out both for the hospital as a whole and for departments, bed profiles, and nosological forms. In accordance with planned standards for city hospitals general type Bed turnover is considered optimal within the range of 25 – 30, and for dispensaries – 8 – 10 patients per year.
Average length of stay for a patient in hospital (average bed day):
number of hospital stays spent by patients per year / number of people leaving (discharged + dead).
Like previous indicators, it is calculated both for the hospital as a whole and for departments, bed profiles, specific diseases. The approximate standard for general hospitals is 14–17 days, taking into account the profile of beds, it is much higher (up to 180 days) (Table 14).
Table 14
Average number of days a patient stays in bed
The average bed day characterizes the organization and quality of the diagnostic and treatment process and indicates reserves for increasing the use of bed capacity. According to statistics, reducing the average length of stay in a bed by just one day would allow over 3 million additional patients to be hospitalized.
The value of this indicator largely depends on the type and profile of the hospital, the organization of its work, the quality of treatment, etc. One of the reasons for the long stay of patients in the hospital is insufficient examination and treatment in the clinic. Reducing the length of hospitalization, which frees up additional beds, should be carried out primarily taking into account the condition of the patients, since premature discharge can lead to re-hospitalization, which will ultimately result in an increase rather than a decrease in the indicator.
A significant decrease in the average hospital stay compared to the standard may indicate insufficient justification for reducing the length of hospitalization.
Proportion of rural residents among hospitalized patients (Section 3, subsection 1):
the number of rural residents hospitalized in a hospital per year x 100 / the number of all admitted to the hospital.
This indicator characterizes the use of beds in a city hospital villagers and affects the security indicator rural population this territory with inpatient medical care. In city hospitals it is 15–30%.
MODULE 3.2. METHOD OF CALCULATION AND ANALYSIS OF STATISTICAL INDICATORS OF THE ACTIVITY OF HOSPITAL INSTITUTIONS
MODULE 3.2. METHOD OF CALCULATION AND ANALYSIS OF STATISTICAL INDICATORS OF THE ACTIVITY OF HOSPITAL INSTITUTIONS
Purpose of studying the module: emphasize the importance of statistical indicators for assessing and analyzing performance results hospital facilities.
After studying the topic, the student must know:
Basic statistical indicators of the performance of hospital institutions;
Basic accounting and reporting statistical forms used to analyze the activities of hospital institutions;
Methodology for calculating and analyzing statistical indicators of hospital institutions.
The student must be able to:
Calculate, evaluate and interpret statistical indicators of hospital performance;
Use the information obtained in hospital management and clinical practice.
3.2.1. Information block
Based on data presented in statistical reporting forms approved by the Ministry of Health and Social
development of the Russian Federation, statistical indicators are calculated to analyze the activities of hospital institutions.
The main reporting forms characterizing the activities of hospital institutions are:
Information about the medical institution (form 30);
Information about the activities of the hospital (form 14);
Information about medical care children and adolescent schoolchildren (f. 31);
Information on medical care for pregnant women, women in labor and postpartum women (f. 32);
Information on termination of pregnancy up to 28 weeks (form 13). Based on these and other forms medical documentation statistical indicators are being developed that are used to analyze the medical activities of the hospital and hospital care generally. These statistical indicators, calculation methods, recommended or average values are presented in Section 7 of Chapter 13 of the textbook.
3.2.2. Tasks for independent work
1. Study the materials of the corresponding chapter of the textbook, module, recommended literature.
2.Answer security questions.
3. Analyze the standard problem.
4.Answer questions test task module.
5. Solve problems.
3.2.3. Control questions
1.Name the main statistical reporting forms used to analyze the activities of hospital institutions.
2.What statistical indicators are used to analyze the activities of hospital institutions? Name the methods for calculating them, recommended or average values.
3.List statistical indicators for analyzing continuity in the work of outpatient clinics and hospital institutions. Name the methods for calculating them, recommended or average values.
4.Name the main statistical reporting forms used to analyze the activities of a hospital maternity hospital.
5. What statistical indicators are used to analyze the activities of a maternity hospital hospital? Name the methods for calculating them, recommended or average values.
3.2.4. Reference task
The state of inpatient care for the population of a certain constituent entity of the Russian Federation is analyzed. The table presents the initial data for calculating statistical indicators of the provision of inpatient care to the population, as well as the activities of the city hospital and maternity hospital.
Table.
End of table.
* Data taken as an example for calculating staff load indicators therapeutic department.
Exercise
1.1) indicators of satisfaction of the population of a constituent entity of the Russian Federation with inpatient care;
City Hospital;
Maternity hospital.
Solution
To analyze the state of inpatient care for the population of a certain constituent entity of the Russian Federation, we calculate the following indicators.
1. Calculation of statistical indicators of inpatient care for the population of a constituent entity of the Russian Federation
1.1. Indicators of satisfaction of the population of a constituent entity of the Russian Federation with inpatient care
1.1.1. Provision of population with hospital beds =
1.1.2. Bed structure =
We calculate similarly: surgical profile - 18.8%; gynecological - 4.5%; pediatric - 6.1%; other profiles - 48.6%.
1.1.3. Frequency (level) of hospitalization =
1.1.4. Provision of population with inpatient care per person per year =
1.2. Indicators of bed capacity utilization in a city hospital
1.2.1. Average number of bed occupied days per year (hospital bed function) =
1.2.2. Average length of stay of a patient in bed =
1.2.3. Bed turnover =
1.3. Indicators of the workload of staff in the inpatient department of a city hospital
1.3.1. Average number of beds per doctor position (average medical personnel) =
We calculate similarly: the average number of beds per position of nursing staff is 6.6.
1.3.2. Average number of bed days per doctor position (nursing staff) =
We calculate similarly: the average number of bed days per position of nursing staff is 1934.
1.4. Indicators of the quality of inpatient care at a city hospital
1.4.1. Frequency of discrepancy between clinical and pathological diagnoses =
1.4.2. Hospital mortality =
1.4.3. Daily mortality =
1.4.4. Postoperative mortality =
1.5. Indicators of continuity in the work of a city hospital and clinic
1.5.1. Hospitalization refusal rate =
1.5.2. Timeliness of hospitalization =
2. Performance indicators of the maternity hospital hospital 2.1. Share of physiological births =
2.2. Frequency of application caesarean section during childbirth =
2.3. Frequency of surgical aids during childbirth =
2.4. Frequency of complications during childbirth 1 =
2.5. Complication rate in postpartum period 1 =
We enter the results of calculating statistical indicators into a table and compare them with the recommended values or the existing average statistical indicators given in Section 7 of Chapter 13 of the textbook and recommended literature, after which we draw appropriate conclusions.
Table. Comparative characteristics of statistical indicators of inpatient care for the population of a constituent entity of the Russian Federation
1 The indicator can be calculated using certain species complications.
Continuation of the table.
End of table.
** As an example, the indicators are calculated for the therapeutic department.
Conclusion
The analysis showed that the provision of the population of the constituent entity of the Russian Federation with hospital beds - 98.5 0 / 000, the level of hospitalization - 24.3% and the provision of the population with inpatient care - 2.9 bed days exceed the recommended values, which is the basis for restructuring (optimization) network of healthcare institutions of a given subject of the Russian Federation.
Indicators of bed capacity utilization in a city hospital (average number of days a bed is occupied per year - 319.7, average
The average length of stay of the patient on the bed is 11.8, bed turnover is 27) also does not correspond to the recommended values. The average number of beds per position of medical personnel, calculated using the example of a therapeutic department, significantly exceeds the number of beds per position of nursing personnel compared to the recommended workload standards. Accordingly, the average number of bed days per position of nursing staff - 1934 bed days - is also significantly higher than the recommended standard. An analysis of the quality indicators of inpatient care in this city hospital indicates serious shortcomings in the organization of the treatment and diagnostic process: in-hospital (2.6%), daily (0.5%) and postoperative (1.9%) mortality rates exceed the recommended values. Indicators of the frequency of refusals in hospitalization (10.0%) and timeliness of hospitalization (87.6%) indicate shortcomings in the organization of continuity of work of this city hospital and outpatient clinics located in the medical service area of the population. Thus, an analysis of the activities of a city hospital inpatient unit revealed significant shortcomings in the organization of diagnostic and treatment care and the use of bed capacity, which, in turn, negatively affects the quality indicators of inpatient care.
An analysis of the results of the activities of the maternity hospital hospital showed that the statistical indicators calculated on the basis of the initial data given in the table correspond to the recommended and average statistical values, which is evidence of a good level of organization of preventive and diagnostic and treatment work.
3.2.5. Test tasks
Choose only one correct answer.1. Name the indicators characterizing the activities of hospital institutions:
1) the average number of days a bed is occupied per year;
2) the average length of stay of the patient in bed;
3)bed turnover;
4) hospital mortality;
5) all of the above.
2. What reporting statistical form used to analyze inpatient care?
1) medical card of an inpatient (f. 003/u);
2) information about the activities of the hospital (form 14);
3) a sheet of daily accounting of the movement of patients and hospital beds (f. 007/u-02);
4) information about injuries, poisoning and some other consequences of exposure external reasons(f. 57);
5) information on medical care for children and adolescent schoolchildren (form 31).
3. Indicate the data necessary to calculate the frequency (level) of hospitalization:
1) number of emergency hospitalizations, total number of hospitalizations;
2) the number of people admitted to hospitals, the average annual population;
3) the number of retired patients, the average annual population;
4) number planned hospitalizations, average annual population;
5) average number of hospitalized, number of registered patients per year.
4. Provide the data required to calculate the average number of days a bed is occupied per year:
1) the number of bed days spent by patients in the hospital; number of days in a year;
2) the number of bed days spent by patients in the hospital; number of patients leaving the hospital;
3) the number of bed days spent by patients in the hospital, the average annual number of beds;
4) the number of patients transferred from the department, the average annual number of beds;
5) average annual number of beds, 1/2 (admitted + discharged + deceased) patients.
5. What data is used to calculate the average length of stay of a patient in bed?
1) the number of bed days actually spent by patients; average annual number of beds;
2) the number of bed days spent by patients in the hospital; number of patients treated;
3) the number of patients who left, the average annual number of beds;
4) the number of actual bed days spent by patients, the number of days in a year;
5) the number of days in a year; average bed occupancy, bed turnover.
6. What formula is used to calculate the hospital mortality rate?
1) (Number of patients who died in the hospital / Number of patients discharged) x 100;
2)(Number of patients who died in the hospital / Number of admitted patients x 100;
3) (Number of patients who died in the hospital / Number of patients who left the hospital) x 100;
4)(Number of deceased patients in the hospital / Number of admitted patients) x 100;
5) (Number of patients who died in the hospital / Number of post-mortem autopsies) x 100.
7. What data is used to calculate the postoperative mortality rate?
1) the number of deaths in a surgical hospital; number of hospital admissions;
2) number of deaths; number of people operated on;
3) the number of deaths among those operated on; number of people discharged from hospital;
4) the number of deaths among those operated on; number of people operated on;
5) number of deaths; number of people discharged from hospital.
8. What data is needed to calculate the specific gravity of physiological labor?
1) number of physiological births; total number of births;
2) number of physiological births; number of live and stillbirths;
3) number of physiological births; number of births with complications;
4) number of physiological births; number of live births;
5) number of physiological births; number of women of fertile age.
3.2.6. Problems to solve independently
Problem 1
Table. Initial data for calculating statistical indicators of inpatient care for the population of a constituent entity of the Russian Federation
End of table.
* Data from the trauma department were used as an example to calculate personnel load indicators.
Exercise
1. Based on the initial data given in the table, calculate:
1.1) indicators of satisfaction of the population of a constituent entity of the Russian Federation with inpatient care;
1.2) statistical indicators of hospital performance:
City Hospital;
City maternity hospital.
2.Analyze the data obtained, comparing them with the recommended or average values given in the textbook and recommended literature.
Problem 2
Table. Initial data for calculating statistical indicators of inpatient care for the population of a constituent entity of the Russian Federation
End of table.
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LETTER from the USSR Ministry of Health dated 08-04-74 02-1419 (ALONG WITH METHODOLOGICAL RECOMMENDATIONS FOR INCREASING EFFICIENCY AND ANALYSIS... Relevant in 2018
4. Average bed downtime
t - average bed downtime (in days);
D is the average number of days a bed is occupied per year;
F - bed rotation.
For the N-skaya central district hospital, the average bed downtime was:
| 365 - 320 | = 1.6 days. |
| 27,3 |
The average downtime of a bed in urban hospitals of the USSR in 1972 was 2.2 days, in rural hospitals - 3.0 days, in the K region - 1.6 and 5.0 days, respectively.
To illustrate, all of the above indicators for the use of hospital beds for 1972 in the USSR, the K-region and its two districts are presented in Table. N 2.
table 2
USE OF BED FUNCTION IN 1972 (EXCLUDING BEDS IN PSYCHIATRIC HOSPITALS AND DEPARTMENTS)
| Bed occupancy per year (in days) | Average number of days a patient stays in bed | Bed turnover | Average bed downtime (in days) | |
| USSR | ||||
| city hospitals | 319 | 15,2 | 21,0 | 2,2 |
| rural hospitals | 297 | 13,1 | 22,7 | 3,0 |
| K-region | ||||
| city hospitals | 327 | 14,1 | 23,2 | 1,6 |
| rural hospitals | 268 | 13,7 | 19,5 | 5,0 |
| N-sky district | 289 | 13,8 | 21,0 | 3,6 |
| incl. N-skaya central district hospital | 320 | 11,7 | 27,3 | 1,6 |
| O-sky district | 294 | 12,5 | 23,6 | 3,0 |
| incl. O-skaya central district hospital | 322 | 12,2 | 26,3 | 1,6 |
It follows from the table that in the K region the use of beds in hospitals in urban settlements was better than the USSR average. On average, each city bed was used for 8 more days, its turnover was significantly higher (23.2 versus 21.0), and the average downtime of beds was significantly less: 1.6 versus 2.2 days.
At the same time, in rural hospitals in this region there was a sharp lag behind the average Union level of bed utilization. A bed in rural hospitals worked during the year on average only 268 days, the average downtime of a bed is high - 5 days, its turnover is low - 19.5.
You should also pay attention to the data given in the table for two rural districts of this region. If in general beds are underutilized in the districts, then the indicators of bed utilization in the central district hospitals approaching the city ones. However, the shorter length of stay of patients in these hospitals determined the high turnover of beds in them.
For an objective assessment and comparison of bed utilization rates in individual hospitals, it is necessary to proceed from the structure of the bed capacity by specialty, i.e. calculate the average number of days a bed is occupied taking into account their profile.
Reducing bed idling reduces hospital waste and reduces their cost per bed per day. Main reasons for downtime beds are the lack of uniform admission of patients, “missing” beds between discharge and admission of patients, preventive disinfection, quarantine due to nosocomial infection, repairs, etc.
The efficiency of using hospital beds is characterized by the following main indicators:
§ average annual occupancy (work) of beds;
§ hospital bed turnover;
§ average bed downtime;
§ average length of stay of a patient in hospital;
§ implementation of the hospital bed-day plan ,
These indicators make it possible to assess the efficiency of using hospital beds. The data necessary for calculating the indicators can be obtained from the “Report of the medical institution” (form No. 30-health) and the “Sheet for recording the movement of patients and hospital beds” (form No. 007-u).
Index AVERAGE ANNUAL EMPLOYMENT (WORK) BEDS is the number of days a bed is open per year, characterizing the degree of hospital utilization. The indicator is calculated as:
number of bed days actually spent by all patients in the hospital
average annual number of beds
This indicator is assessed by comparison with calculated standards. They are established separately for urban and rural hospital institutions, with clarification of this indicator for various specialties.
The optimal average annual bed occupancy can be calculated for each hospital separately, taking into account its bed capacity.
For example, for a hospital with 250 beds, the optimal bed occupancy per year will be 306.8 days
This indicator is used to determine the estimated cost of one bed day.
The average annual bed occupancy may be underestimated due to forced downtime of beds (for example, due to repairs, quarantine, etc.). If this figure is more than days a year, it means the department is working with overflow - on extra beds.
If we divide the average annual bed occupancy by the average number of days a patient stays in a bed, we get an indicator called function of a hospital bed.
The bed occupancy indicator is supplemented Indicator BED TURNOVER, which is defined as the relation:
number of patients discharged (discharged + deaths)
average annual number of beds
This indicator characterizes the number of patients who were in one hospital bed during the year. In accordance with planning standards for city hospitals, it should be considered optimal within the limits 17- 20 per year . The average annual number of beds should be taken as the bed capacity of the hospital. However, it is inappropriate for them to compare all hospitals and even single-profile institutions, because it depends on the structure of the bed capacity in a given hospital. It adequately characterizes the intensity of work of a bed of a certain profile within 1 institution.
Index SIMPLE BED (in connection with turnover) – calculated as the difference between:
number of days per year (365) - average number of days the bed is open
divided by the turnover of the bed
This is the time of “absenteeism” from the moment a bed is vacated by discharged patients until it is occupied by newly admitted patients.
Example: The average downtime of a therapeutic hospital bed due to turnover with an average annual occupancy of 330 days and an average length of stay in a bed of 17.9 days will be 1.9 days.
A simple bed larger than this standard causes economic damage. If the downtime is less than the standard (and with a very high average annual bed occupancy it can take a negative value), this indicates an overload of the hospital and a violation of the sanitary regime of the bed.
Example: If we calculate the economic losses from idle beds in a children's hospital with a capacity of 170 beds with an average annual bed occupancy of 310 days and hospital costs - 200,000 euros. That is, we find out that as a result of idle beds, the hospital suffered losses in the amount of 26,350 USD.
Important to characterize the activities of a medical professional, the duration of the patient’s stay in the bed, which to a certain extent reflects the effectiveness of the patient’s treatment and the level of work of the staff:
AVERAGE LENGTH OF STAY A PATIENT IN A HOSPITAL (average bed day) is defined as the following ratio:
number of bed days spent by patients in hospital
number of patients discharged (discharged + deaths)
The average bed day ranges from 17 to 19 days, but it cannot be used to estimate all hospitals. It is important for assessing the functioning of beds in specialized departments. The value of this indicator depends on the type and profile of the hospital, the organization of the hospital, the severity of the disease and the quality of the diagnostic and treatment process. The average bed day indicates reserves for improving the use of beds. By reducing the average length of stay of a patient in a bed, treatment costs are reduced, while at the same time reducing the duration of treatment allows hospitals to provide inpatient care more sick. In this case, public funds are used more efficiently (the so-called "conditional budget savings").
Indicator ACCOMPLISHMENT OF BED DAYS PLAN BY HOSPITAL it is determined:
number of actual bed days spent by patients× 100%
planned number of bed days
The planned number of bed days per year is determined by multiplying the average annual number of beds by the bed occupancy rate per year. Analysis of the implementation of planned bed performance indicators for the year is of great importance for the economic characteristics of the activities of hospital institutions.
Example: Budget expenses for a hospital with a capacity of 150 beds are 4,000,000 USD, including expenses for food and medicine - 1,000,000 USD. The average annual bed occupancy according to the standard is 330 days; in fact, 1 bed was occupied for 320 days, i.e. 97%. Underfulfillment - 3%: the hospital suffered economic losses associated with underfulfillment of the bed-day plan in the amount of 90,000 USD.
For assessing the work of a hospital it is important HOSPITAL MORTALITY RATE, which determines the percentage of deaths among all retired patients. This indicator depends on the profile of the department, i.e. the severity of the condition of incoming patients, the timeliness and adequacy of the treatment provided. It is advisable to use the indicator for equal departments. In addition, the mortality rate is calculated for a specific disease. It is important for determining the share of each nosology in the structure of mortality of all hospitalized patients. Since the main part deaths happens in intensive care units It is advisable to distinguish the lethality of this separation from others.
Competent use of methods for calculating relative performance indicators of health care facilities and the level of public health allows you to analyze the state of the healthcare system in the region as a whole, for individual health care facilities and their divisions. And based on the results obtained, optimal management decisions to improve healthcare in the region and individual healthcare facilities
Standard (normative) costs of health care facilities are established for each clinical and economic group (CEG) of patients for each completed case of patient treatment. The developed standards are used in the compulsory medical insurance system when developing regional tariffs for medical services and become medical and economic standards (MES). Their prices take into account standard (normative) costs, as the minimum standards of state-guaranteed free medical care depending on the disease.
Analysis of financial costs within the framework of Territorial Free Medical Care (FMC) programs in the regions shows that the structure of diagnostic and treatment activities, their frequency and duration have perfect view, and the costs are artificial minimized. This structure of payment for medical care in compulsory medical insurance does not reimburse the costs of health care facilities. The basic compulsory medical insurance tariff provides reimbursement only direct expenses for the BMP provided: medical staff salaries with accruals, medicines, dressings, medical expenses, food, soft equipment. In the new market conditions for the operation of health care facilities - under budgeting conditions, payment is made not per bed-day, but per discharged patient with payment for a completed case of treatment, which more accurately reflects the costs of the health care facility. When budgeting, it is limited only total amount allocations for certain types and volumes of activities with payment rates for the completed case, and the head of the healthcare facility can quickly transfer funds between items and periods of expenses. Having a fixed budget, the manager can make savings by streamlining activities. We just need to establish internal control over the expenditure of funds. The transition from estimated financing to results-oriented budgeting is a prospect for health care facilities
True, the concept of a “complete case” of treatment has different interpretation, it could be:
Payment mid-profile treatment (by type of specialized medical care);
Payment for MES by nosology(clinical diagnostic groups);
Payment by KEG standard(based on costs per group), which are determined by typical patients by clinical and economic costs, then these costs are normalized and ranked by level of care. A typical case includes data on the maximum permissible duration of treatment, the proportion of negative results (mortality) and positive results, coefficient of resource consumption and cost;
Payment in fact medical services provided within the approved volumes of medical care.
Currently payment for SMP in compulsory medical insurance it is carried out according to the MES for nosologies - this is payment for the actual number of cases of treated patients at minimum tariffs. Payment is made retrospectively upon presentation of invoices.
Payment for VTMP according to the state order, it is carried out according to the CEG - according to the actual number of cases of patients treated at standard costs and taking into account the results of providing VTMP, but payment is made in advance with subsequent additional reimbursement of expenses according to the standard. The KEG system sets restrictions only on the price and volume of MU, and the set of services is determined by the FGU. Thus, the budget of the Federal State Institution is calculated not on resources, but on the results of activities, expressed in the volume and structure of the services provided. At the same time, the volume of funding for FGU does not depend on the bed capacity and other resource indicators, i.e. from the power of the FGU. The amount of assistance is carried out on the basis of its own plan, using the resources that are necessary for this. The preliminary payment system for the treated patient according to the EEG meets the goals: predictability of costs, resource saving, efficient use resources.
For example, The average occupancy of a maternity bed (according to the standard) is 280 days, the average length of stay in a maternity bed according to the standard is 9.1 days. Bed function obstetric profile is:
F = D / P = 280 days / 9.1 days = 30.8 (31).
This means that an obstetric bed can serve 31 pregnant women during the year.
Average annual occupancy (work) of a hospital bed (actual employment) is calculated:
number of bed days actually spent by patients in the hospital / average annual number of beds.
This indicator is assessed by comparison with calculated standards. They are established separately for urban and rural hospital institutions, with clarification of this indicator for various specialties.
The optimal average annual bed occupancy can be calculated for each hospital separately, taking into account its bed capacity using the following formula:
where D is the average number of days a bed is open per year;
N – average annual number of hospital beds.
For example, for a hospital with 250 beds, the optimal bed occupancy per year will be:
This indicator is used to determine the estimated cost of one bed day.
The average annual bed occupancy may be reduced due to forced downtime of beds (for example, due to repairs, quarantine, etc.). In order to eliminate the cause of underutilization of bed capacity in such cases, the performance indicator of a functioning bed is calculated, i.e., excluding downtime days. The calculation is made according to the following method:
1) calculate the average number of beds closed during the year due to repairs:
number of days closed for repairs / number calendar days per year;
2) the average number of beds functioning during the year is determined:
average annual number of beds – the number of beds closed due to repairs.
The average number of days a bed is open per year, taking into account repairs, is calculated:
number of bed days actually spent by patients / number of beds functioning during the year (not closed for repairs).
Example. IN the hospital has 50 beds, the number of bed days actually spent by patients was 1250, the number of bed days closed for repairs was 4380. It is necessary to determine the average annual bed occupancy taking into account repairs:
1) average number of beds closed due to repairs:
4380 k/day / 365 = 12 beds;
2) average number of beds functioning during the year:
50 beds – 12 beds = 38 beds;
3) average annual occupancy of a functioning bed (including repairs)
1250 k/day / 38 beds = 329 days.
Thus, if repair days were not taken into account, the average annual bed occupancy would be only 250 days (1250 k/day / 50 beds = 250 days), which would indicate a large underutilization of bed capacity in the hospital.
The average bed idle time (due to turnover) is the time of “absenteeism” from the moment the bed is vacated by discharged patients until it is occupied by newly admitted patients.
T = (365 – D) / F,
where T is the downtime of a bed of a given profile due to turnover;
D – actual average annual occupancy of a bed of a given profile; F – rotation of the bed.
Example. The average downtime of a therapeutic hospital bed due to turnover with an average annual occupancy of 330 days and an average length of stay in a bed of 17.9 days will be:
F = D / P = 330 days / 17.9 days = 18.4.
T = (365 – D) / F = (365 – 330) / 18.4 = 1.9 days.
A simple bed larger than this standard causes economic damage. If the downtime is less than the standard (and with a very high average annual bed occupancy, T can take a negative value), this indicates an overload of the hospital and a violation of the sanitary regime of the bed.
Methodology for calculating economic losses from bed idling
Economic losses as a result of idle beds are calculated based on determining the difference between the estimated and actual cost of one bed day. The cost of a bed day is calculated by dividing the cost of maintaining a hospital by the corresponding number of bed days (calculated and actual). This excludes the costs of feeding patients and purchasing medicines, which do not affect the amount of losses from idle beds, since they are incurred only for the bed occupied by the patient.
The estimated number of bed days is calculated based on the optimal average annual bed occupancy.
Example. It is necessary to determine the economic losses from idle beds in a children's hospital with a capacity of 170 beds, if the average annual bed occupancy was 310 days, and hospital costs were 280,000 USD. e.
1. Determine the number of actual bedtimes spent by patients:
Kf = 170 beds x 310 days = 52,700 k/day.
The actual cost of one bed day = hospital expenses (without food and medications) / Kf = 280,000 USD. e. / 52,700 k/day = 5.3 cu. e.
2. Determine the estimated planned number of bed days (Kf):
Kf = 170 beds x 340 days (optimal occupancy) = 57,800 k/day.
Planned cost:
estimated cost of one bed day = hospital costs (without food and medications) / Cf.
3. The difference between the actual and planned cost of one bed day was:
5.3 USD e. – 4.8 cu. e. = 0.5 cu. e.
4. We determine the economic losses from idle beds:
0.5 USD e. x 52,700 k/day = 26,350 c.u. e.
Thus, as a result of idle beds, the hospital suffered losses in the amount of 26,350 USD. e.
Implementation of the hospital bed plan is defined like this:
number of actual bed days spent by patients x 100 / planned number of bed days.
The planned number of beds per year is determined by multiplying the average annual number of beds by the bed occupancy standard per year. Analysis of the implementation of planned bed performance indicators for the year is of great importance for the economic characteristics of the activities of hospital institutions.
Methodology for calculating economic losses from underfulfillment of the bedtime plan
Economic losses associated with the hospital’s failure to fulfill the plan for bed days (US) are calculated using the formula:
Us = (B – PM) x (1 – (Kf / Kp)),
where B – costs according to the estimate for maintaining the hospital;
PM – the amount of expenses for food for patients and medicines;
Кп – planned number of bed days;
Kf – actual number of bed days.
Us = 0.75 x B x (1 – (Kf / Kp)),
where 0.75 is a coefficient reflecting the average ratio of costs per empty bed compared to costs per occupied bed.
Example. Budget expenses for a hospital with a capacity of 150 beds are 4,000,000 USD. e., including expenses for food and medicine – 1,000,000 USD. e. The average annual bed occupancy according to the standard is 330 days; in fact, 1 bed was occupied for 320 days. Determine the economic losses associated with under-fulfillment of the bed plan.
1. Determine the planned (Kp) and actual (Kf) number of bed days:
Kp = 150 beds x 330 days = 49,500 k/day,
Kf = 150 beds x 320 days = 48,000 k/day.
2. Determine the share of underfulfillment of the plan:
Kf / Kp = 48,000 k/day / 49,500 k/day = 0.97.
3. We calculate economic losses due to the hospital’s failure to fulfill the bed plan:
Ус = (4,000,000 c.u. – 1,000,000 c.u.) x (1 – 0.97) = 3,000,000 x 0.03 = 90,000 c.u. e.
or simplified: Us = 4,000,000 u. e. x 0.75 x 0.03 cu. e. = 90,000 USD e.
Thus, due to the underfulfillment of the bed plan, the hospital suffered economic losses in the amount of 90,000 USD. e.
Average length of stay for a patient in hospital (average bed day) is defined as the following ratio:
number of bed days spent by patients in the hospital / number of patients discharged (discharged + deaths).
The average hospital stay ranges from 17 to 19 days (see appendix). The value of this indicator depends on the type and profile of the hospital, the organization of the hospital, the severity of the disease and the quality of the diagnostic and treatment process. The average bed day indicates reserves for improving the use of bed capacity.
By reducing the average length of stay of a patient in a bed, treatment costs are reduced, while at the same time reducing the duration of treatment allows hospitals to provide inpatient care to a larger number of patients with the same amount of budgetary allocations. In this case public funds are used more efficiently (the so-called conditional budget savings). It can be calculated using the formula:
E = B / Kp x (Pr - Pf) x A,
where E is the conditional budget savings;
B – costs according to the estimate for maintaining the hospital;
Kp – planned number of bed days;
Pr – estimated average length of hospital stay (standard);
