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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.
Average annual number of beds (item 5): 
Average annual number of beds
Number of beds at the beginning of the year
Number of new beds deployed A Robot was then put on scales.
m - number of months of operation of the new bed in the first year
For hospitals and dispensaries in rural areas:
58+((66-58)*7/12) = 63 - average annual number of surgical beds
49+((55-49)*6/12) = 52 - average annual number of children’s beds
60+((78-60)*8/12) = 72 - average annual number of therapeutic beds
+((40-40)/12) = 40 - average annual number of maternity beds
+((80-70)*3/12) = 73 - average annual number of other beds
90+((100-90)*5/12) = 94 - average annual number of surgical beds
100+((110-100)*7/12) = 106 - average annual number of children’s beds
140+((180-140)*9/12) = 170 - average annual number of therapeutic beds
+((135-120)*5/12) = 126 - average annual number of maternity beds
+((110-100)*3/12) = 103 - average annual number of other beds
The number of bed days (item 8) is calculated as the product of the average annual number of beds (item 5) by the number of days of operation (item 7).
For hospitals and dispensaries in rural areas:
63320 = 20053 - surgical
320 = 16640 - children's
340 = 24480 - therapeutic
330 = 13200 - maternity
300 = 21750 - other
For hospitals and dispensaries in cities:
94300 = 28250 - surgical
320 = 33867 - children's
310 = 52700 - therapeutic
330 = 41663 - maternity
300 = 30750 - other
Expenses per year on food (clause 11) are determined as the product of the number of bed days (clause 8) by the rate of food expenditure per 1 bed day (clause 9).
Expenses per year on medicines (clause 12) are determined as the product of the number of bed days (clause 8) by the rate of expenditure on medicines per 1 bed day (clause 10).
2. Outpatient visit plan. Medication Planning
|
Job title |
Number of job rates |
Calculation of service rate per hour |
Number of hours work in day |
Number of working days in a year |
Number of doctor visits |
Average cost of medicines per visit |
Amount of expenses for medicines, rub. |
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in the clinic |
at home |
in the clinic |
at home |
in half gr.3* gr.5 |
at home gr.4* gr.6 |
total gr.7+ gr.8 |
gr.10* gr.9 |
gr.11* gr.2 |
gr.13*gr12 |
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1. Therapy | |||||||||||||
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2. Surgery | |||||||||||||
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3. Gynecology | |||||||||||||
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4. Pediatrics | |||||||||||||
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5. Neurology | |||||||||||||
| Name of beds | Number of hospitalizations per 1000 inhabitants per year | Average duration hospital stay (days) | Number of bed days per adult resident per year |
| Cardiology | 10,6 | 10,8 | 108,7 |
| Rheumatology | 1,0 | 13,1 | 12,6 |
| Gastroenterology | 2,9 | 10,8 | 12,6 |
| Pulmonology | 3,2 | 11,3 | 29,8 |
| Endocrinology | 2,0 | 11,6 | 14,7 |
| Nephrology | 1,2 | 11,5 | 8,7 |
| Hematology | 0,8 | 13,0 | 8,0 |
| Allergology and immunology | 0,5 | 10,1 | 4,4 |
| Therapy | 20,3 | 10,1 | 205,0 |
| Cardiovascular surgery(cardiac surgery beds) | 0,9 | 9,8 | 8,1 |
| Traumatology and orthopedics (trauma beds) | 7,1 | 11,0 | 69,8 |
| Traumatology and orthopedics (orthopedic beds) | 0,8 | 12,1 | 7,7 |
| Neurosurgery | 2,3 | 10,7 | 22,7 |
| Maxillofacial Surgery, dentistry | 1,1 | 7,7 | 6,9 |
| Thoracic surgery | 0,4 | 13,3 | 4,9 |
| Cardiovascular surgery (beds vascular surgery) | 1,1 | 10,4 | 11,1 |
| Otorhinolaryngology | 4,1 | 7,6 | 20,8 |
| Total | 193,0 | 11,9 | 2297,4 |
Hospital planning consists in determining the following indicators:
1. hospital capacity;
2. scope of activity;
3. personnel and performance indicators of the medical position;
4. finances necessary to maintain the hospital.
Hospital capacity(hospitals, clinics) is determined by the number of beds in the entire institution and, accordingly, in departments.
Volume medical activities by hospital is determined by the total number of bed days in the hospital and departments. The plan for bed days is obtained by multiplying the established average annual number of beds in a hospital or department by the average number of days a bed is open per year according to the plan (Table 6).
To calculate the required number of beds it is necessary to recalculate the absolute number of bed days according to bed profiles (Order of the Ministry of Health and social development RF dated May 17, 2012 No. 555n “On approval of the nomenclature of bed capacity by profile medical care") on the population of a constituent entity of the Russian Federation.
The number of beds is calculated using the formula:
Under planned function of a hospital bed or its turnover should be understood as the average number of patients that it can serve for given (calculated) bed utilization rates per year. The actual data for a hospital is determined by these indicators based on annual report hospitals (form No. 30).
The indicator of the average length of stay of a patient in a bed is used for planning; it cannot be confused with the average length of treatment of patients. The average number of days a patient spent in bed is determined as the quotient of the total number of days spent by all patients divided by the number of patients who left:
Personnel planning. The modern methodology for calculating the need for medical personnel involves the identification of separate professional groups.
"Treatment group"– doctors who directly provide care to the population (outpatient doctor, hospital doctor, day hospital). The “treatment group” also includes a “reinforcement group”, which includes doctors who take part in the provision of medical care to the population, but in a specific form (heads of departments, consultant doctors, doctors on duty, shop doctors). These doctors make up a significant number of the system's workforce.
The need for doctors providing medical care in inpatient conditions, first of all, includes the estimated number of doctors of the “medical” and “paraclinical” groups. Calculation of the required number of doctors " treatment group» is carried out taking into account the indicator of the calculated number of beds and the standard of beds per 1 doctor, which can be specified by the subject of the Russian Federation.
"Paraclinical group" includes two subgroups: “therapeutic and diagnostic” and “management”. The treatment and diagnostic group includes laboratory doctors, doctors functional diagnostics, endoscopists, pathologists, physiotherapists, ultrasound diagnostic doctors, anesthesiologists-resuscitators, doctors physical therapy, emergency department doctors, reflexotherapists, etc. Management group - chief doctors, deputy chief doctors, methodologists, statisticians, etc.
The calculation methodology is based on Guidelines, published in the form of a Letter by the Ministry of Health and Social Development of the Russian Federation dated December 26, 2011 No. 16-1/10/2-13164 “Methodology for calculating the needs of the constituent entities of the Russian Federation for medical personnel” (Fig. 2).
Figure 2. Algorithm for calculating the hospital’s need for medical personnel.
SAMPLES OF SOLUTION TO SITUATIONAL PROBLEMS
SAMPLE 1.
Let's demonstrate how to calculate the turnover of a bed. Let us remind you that the turnover of the bed is one of the most important indicators efficiency of bed use. Bed turnover is closely related to bed occupancy rates and duration of patient treatment. On average in a hospital, this figure can range from 17 to 20 or more patients.
For example, the total number of patients treated per year, including admissions, discharges and deaths, was 12,500 people, and the average annual number of beds was 800. We calculate bed turnover using the formula:
| Bed turnover | = | 12500 | =15,6 |
| 800 |
Thus, on average, 15.6 patients were treated in 1 bed per year, which is clearly less than generally accepted indicators and indicates the need to optimize work.
SAMPLE 2.
We will demonstrate how to calculate the average number of days a bed is occupied per year (hospital bed function). Let us recall that the function of a hospital bed characterizes the efficiency of use of financial, material, technical, human and other resources hospital facilities.
For example, the total number of bed days spent by patients in a multidisciplinary hospital was 150,000 bed days per year, with an average annual number of beds equal to 800 hospital beds. The function of the bed, i.e. The average annual bed occupancy on average for a multidisciplinary hospital is calculated using the formula:
Substituting the data we already know into the formula for calculating the indicator of interest, we get:
| Average annual bed occupancy | = | 150000 | =187,5 |
| 800 |
Having compared the data obtained with the recommended standards presented in Table 6, we conclude that during the calendar year the average annual bed occupancy did not correspond to the recommended indicators (from 285–336 depending on the profile). To improve the indicator, it is necessary to either increase the flow of hospitalizations by reducing the length of hospital stay.
SAMPLE 3.
We will demonstrate how the chief physician can calculate the required number of beds for a hospital in order to find out whether it is necessary to deploy additional beds or, conversely, whether there is a need to reduce them. Let us remind you that the calculation is made in accordance with the recommendations of the Ministry of Health of the Russian Federation (Order No. 555n dated May 17, 2012 “On approval of the nomenclature of hospital beds according to medical care profiles”).
For example, according to reporting form No. 30 “Information about the medical organization”, the total number of bed days at the end reporting year amounted to 250,000 with an average bed working 335 days a year. In total, this hospital has 800 beds of various profiles. We calculate the indicator we are interested in using the formula:
Substituting the data we already know into the formula for calculating the indicator of interest, we get:
Taking into account the initial number of inpatient beds (800 beds) and the estimated number of beds (746), we can conclude that it is advisable to optimize the activities of the hospital by reducing the bed capacity by 54 beds.
SAMPLE 4.
We will demonstrate how to calculate the required number of doctors in the “treatment group”. Let us remind you that "treatment group"– doctors who directly provide care to the population (outpatient doctor, hospital doctor, day hospital doctor). The calculation is made in accordance with the recommendations of the Ministry of Health of the Russian Federation (Letter dated December 26, 2011 No. 16-1/10/2-13164 “Methodology for calculating the needs of the constituent entities of the Russian Federation for medical personnel”).
For example, the estimated number of beds in a hospital is 760 beds, and the average standard number of beds per doctor is 20.
Substituting the data we already know into the formula for calculating the indicator of interest, we get:
Thus, to ensure the treatment and preventive activities of a hospital with a total capacity of 760 beds, only 38 doctors of the “treatment group” will be required.
SAMPLE 5.
For example, total The number of bed days spent in a therapeutic hospital is 260,000, and the number of patients who have left a therapeutic profile is 12,000. The average number of days a patient stays in a bed is determined as the quotient of dividing the total number of days spent by all patients by the number of patients who have left:
Substituting the data we already know into the formula for calculating the indicator of interest, we get:
Let us compare the obtained data with the tabular data recommended by the Ministry of Health of the Russian Federation (Table 6) and conclude that the average number of stays in a therapeutic bed exceeds the standard by approximately 1.4 times, which indicates the need to reduce the number of days patients stay in a therapeutic bed.
SITUATIONAL TASKS
TASK 1. Calculate required number of doctors in the “treatment group”, using the recommendations of the Ministry of Health of the Russian Federation (Letter No. 16-1/10/2-13164 dated December 26, 2011 “Methodology for calculating the needs of the constituent entities of the Russian Federation for medical personnel”), if:
– estimated number of beds in the hospital – 1100 beds
– the average standard number of beds per doctor is 15.
TASK 2. Calculate required number of beds for a hospital, to find out whether it is necessary to deploy additional beds or, conversely, there is a need to reduce them, using the recommendations of the Ministry of Health of the Russian Federation (Order No. 555n dated May 17, 2012 “On approval of the nomenclature of beds according to medical care profiles”), if:
– according to reporting form No. 30 “Information about the medical organization”, the total number of bed days at the end of the reporting year was 350,000
– the average bed work was 336 days a year
– there are a total of 1000 beds in this hospital
TASK 3. Calculate the average number of days a bed is occupied per year (hospital bed function) and draw appropriate conclusions, provided that:
– the number of bed days spent by patients in the hospital for the year amounted to 180,000
– the average annual number of hospital beds is 1100
TASK 4. Calculate the bed turnover and evaluate the efficiency of using the bed capacity of a multidisciplinary hospital, if approximately on average for city hospitals this figure ranges from 17 to 20 or more patients.
Initial data for calculation:
– the total number of patients treated during the year, including admissions, discharges and deaths, amounted to 1,800 people
– average annual number of hospital beds – 800
TASK 5. Calculate the average length of stay of a patient in bed to plan the work of the cardiac surgery department of a hospital if:
– the number of bed-days spent in the hospital by cardiac surgery patients is 20,000, and the number of cardiac surgery patients who left the hospital is 1,800.
Evaluate the data received.
TEST TASKS
Choose the correct answer:
1. SPECIALIZED MEDICAL CARE IS:
A. medical care aimed at achieving a specific goal in the process of providing highly qualified medical care
B. medical care aimed at improving health through special methods diagnosis, treatment and prevention of diseases
B. medical care provided by medical specialists in the prevention, diagnosis and treatment of diseases and conditions (including during pregnancy, childbirth and postpartum period), requiring the use of special methods and complex medical technologies, and medical rehabilitation
D. medical care provided by medical specialists in a hospital setting
D. medical care provided by medical specialists in a hospital and clinic
2. HIGH-TECH MEDICAL CARE IS:
A. – part of specialized medical care
B. – part of primary health care
V. – part of palliative care
G. – part of the emergency medical service
D. – an independent species medical assistance to the population
3. INPATIENT MEDICAL CARE INCLUDES:
A. – primary health care
B. – specialized medical care
V. – specialized, including high-tech medical care
G. – high-tech medical care
D. – palliative care
4. INPATIENT MEDICAL CARE MAY BE PROVIDED AT ALL OF THE FOLLOWING LEVELS, EXCEPT:
A. – federal
B. – republican
V. – municipal
G. – departmental
D. – urban
5. MEDICAL ORGANIZATIONS PROVIDING INPATIENT MEDICAL CARE:
A. – Hospital, including children’s
B. – Emergency Hospital
V. –Leper colony
G. – District hospital
D. – Hospice
6. SPECIALIZED MEDICAL CARE IS PROVIDED TO CITIZENS FOR:
A. – any pathological conditions, which, in accordance with the views of the attending physician at the clinic or outpatient clinic, require mandatory hospitalization in a hospital to receive specialized medical care
B. – any pathological conditions that, in accordance with the ideas of a doctor or any other medical worker ambulances require mandatory hospitalization
V. – any diseases, including acute, exacerbations chronic diseases, poisoning, injuries, pathologies of pregnancy, childbirth, abortion, as well as during the neonatal period, which require round-the-clock medical supervision, the use of intensive treatment methods and (or) isolation, including epidemic indications or when special diagnostic methods are required using complex, unique or resource-intensive medical technologies
G. – any diseases that require treatment, diagnosis, or prevention for health reasons in a specialized hospital
D. – any diseases that, by the patient’s own choice and the guarantees of the law, can be effectively treated in a specialized hospital.
7. PROCEDURE FOR HOSPITALIZATION OF A PATIENT IN A HOSPITAL:
A. – on the direction of the attending physician
B. – on the recommendation of a doctor at the Health Center
V. – emergency medical teams
G. – on the direction of the center doctor medical prevention
D. – upon self-referral
8. REGISTRATION AND EXAMINATION OF A PATIENT DELIVERED TO A MEDICAL ORGANIZATION FOR EMERGENCY MEDICAL INDICATIONS MUST BE CARRIED OUT BY A MEDICAL PROFESSIONAL:
A. – instantly
B. – immediately
V. – as quickly as possible
G. – taking into account the throughput capacity of the reception department
D. – in order of priority reception department
9. REGISTRATION AND EXAMINATION OF A PATIENT SENDED TO A MEDICAL ORGANIZATION IN A ROUTINE ORDER IS CARRIED OUT BY A MEDICAL WORKER:
A. – within 1 hour after the patient’s admission
B. – within 1.5 hours after the patient’s admission
V. – within 2 hours after the patient’s admission
G. – within 2-3 hours after the patient’s admission
D. – immediately
10. CHOOSE THE LIST OF WHAT RUSSIAN CITIZENS SHOULD BE PROVIDED WITH INPATIENT MEDICAL CARE:
A. - bedding
B. – drugs for medical use included in the list of vital and essential medicines
V. – blood products and medical devices included in the list approved by the Government of the Russian Federation medical products implanted into the human body for medical reasons
G. – personal hygiene and sanitation products in accordance with the law
D. – therapeutic nutrition When providing medical care in a hospital setting, patients, women in labor, postpartum women and nursing mothers are provided free of charge.
11. ORGANIZATION OF HOSPITAL ACTIVITIES MUST BE CARRIED OUT IN ACCORDANCE WITH:
A. – with procedures and standards for the provision of medical care to adults and children, approved by federal authorities executive power
B. – with protocols for the provision of medical care to adults and children, approved by the federal legislative bodies
V. – with procedures for providing medical care to adults and children, approved by regional executive authorities
G. - with procedures and standards for the provision of medical care to adults and children, approved by regional executive authorities
D. – with clinical protocols for the provision of medical care to adults and children, approved by specialized leaders public associations(organizations)
12. SPECIALIZED MEDICAL CARE IS PROVIDED:
A. – medical specialists of various profiles working in medical organizations providing inpatient medical care to the population
B. – medical specialists of one profile working in medical organizations that provide inpatient medical care to the population
V. – specialist doctors of a special profile working in medical organizations that provide inpatient medical care to the population
G. – medical specialists of several professions, working in hospitals and having undergone special retraining
D. – doctors of any profile who have a specialist certificate
13. A MANDATORY PRE-CONDITION FOR MEDICAL INTERVENTION CARRIED OUT IN A HOSPITAL IS:
A. – giving mandatory informed consent of a citizen or his legal representative to medical intervention
B. – giving informed voluntary consent of a citizen or his legal representative to medical intervention
V. – giving oral consent of a citizen or his legal representative to medical intervention
G. – giving written consent of a citizen or his legal representative to medical intervention
D. – this requirement is not mandatory
14. ACCORDING TO FUNCTIONAL PURPOSE, A STATIONARY INSTITUTION IS DIVIDED INTO THE FOLLOWING DIVISIONS (BASIC BLOCKS):
A. – economic
B.– administrative
V. – managerial
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 reducing the duration of treatment allows hospitals to provide inpatient care with the same amount of budgetary allocations 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 has 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.
A variety of indicators are used to analyze hospital performance. Conservative estimates suggest that more than 100 different indicators of hospital care are widely used.
A number of indicators can be grouped, as they reflect certain areas of the hospital’s functioning.
In particular, there are indicators characterizing:
Provision of population with inpatient care;
Load medical personnel;
Material, technical and medical equipment;
Use of bed capacity;
Quality of inpatient medical care and its effectiveness.
Provision, accessibility and structure inpatient care are determined by the following indicators: 1. Number of beds per 10,000 population Calculation method:
_____Number of average annual beds _____·10000
This indicator can be used at the level of a specific territory (district), and in cities - only at the level of the city or health zone in the largest cities.
2. Hospitalization rate of the population per 1000 inhabitants (territorial level indicator). Calculation method:
Total number of patients admitted· 1000
Average annual population
This group of indicators includes:
3. Availability of beds of individual profiles per 10,000 population
4. Bed structure
5. Structure of hospitalized patients by profile
6. Hospitalization rate of the child population, etc.
To the same group of indicators in last years They also include such an important territorial indicator as:
7. Consumption of inpatient care per 1000 inhabitants per year (number of bed days per 1000 inhabitants per year in a given territory).
The workload of medical personnel is characterized by the following indicators:
8. Number of beds per 1 position (per shift) of a doctor (nursing medical personnel)
Calculation method:
Number of average annual beds in a hospital (department)
(nursing medical personnel)
in a hospital (department)
9. Staffing of the hospital with doctors (nursing medical personnel). Calculation method:
Number of occupied doctor positions
(secondary medical
____________staff in the hospital)· 100% ____________
Number of full-time positions of doctors
(nursing staff) in hospital
This group of indicators includes:
(Gun G.E., Dorofeev V.M., 1994), etc.
Large group compile indicators use of bed capacity, which are very important for characterizing the volume of hospital activity, the efficiency of using beds, for calculating the economic indicators of the hospital, etc.
11. Average number of days a bed is open per year (bed occupancy per year) Calculation method:
Number of bed days actually spent by patients in hospital Number of average annual beds
The so-called overfulfillment of the plan for the use of beds exceeding the number calendar days per year is considered a negative phenomenon. This situation is created as a result of the hospitalization of patients in additional (additional) beds, which are not included in the total number of beds in the hospital department, while the days of hospitalization of patients in additional beds are included in the total number of bed days.
An estimated average bed occupancy rate for city hospitals has been set at 330-340 days (without infectious and maternity ward), for rural hospitals - 300-310 days, for infectious diseases hospitals- 310 days, for urban maternity hospitals and departments - 300-310 days and in rural areas - 280-290 days. These averages cannot be considered standards. They are determined taking into account the fact that some hospitals in the country are renovated annually, some are put into operation again, while different time year, which leads to underutilization of their bed capacity during the year. Planned targets for the use of beds for each individual hospital should be set based on specific conditions.
12. Average length of stay of a patient in bed. Calculation method:
Number of bed days spent by patients
Number of patients who left
The level of this indicator varies depending on the severity of the disease and the organization of medical care. The duration of treatment in a hospital is influenced by: a) the severity of the disease; b) late diagnosis of the disease and initiation of treatment; c) cases when patients are not prepared by the clinic for hospitalization (not examined, etc.).
When assessing the performance of a hospital in terms of duration of treatment, departments of the same name and duration of treatment for the same nosological forms should be compared.
13. Bed turnover. Calculation method:
Number of patients treated (half the sum of those admitted,
_________________________________discharged and deceased)__________
This is one of the most important indicators of the efficiency of bed use. Bed turnover is closely related to bed occupancy rates and duration of patient treatment.
Indicators of bed capacity utilization also include:
14. Average bed downtime.
15. Dynamics of bed capacity, etc.
Quality and efficiency of inpatient medical care is determined by a number of objective indicators: mortality, frequency of discrepancies between clinical and pathological diagnoses, frequency postoperative complications, duration of hospitalization of patients requiring emergency surgical intervention(appendicitis, strangulated hernia, intestinal obstruction, ectopic pregnancy and etc.).
16. General hospital mortality rate:
Calculation method:
Number of deaths in hospital· 100%
Number of patients treated
(admitted, discharged and deceased)
Each case of death in a hospital hospital, as well as at home, must be examined in order to identify shortcomings in diagnosis and treatment, as well as to develop measures to eliminate them.
When analyzing the level of mortality in a hospital, one should take into account those who died at home (mortality at home) due to the disease of the same name, since among those who died at home there may be seriously ill people who were unreasonably early discharged from the hospital or were not hospitalized. At the same time, a low mortality rate in the hospital is possible with a high mortality rate at home for the disease of the same name. Data on the ratio of the number of deaths in hospitals and at home provide certain grounds for judging the availability of hospital beds for the population and the quality of out-of-hospital and hospital care.
The hospital mortality rate is calculated in each medical department hospital, at certain diseases. Always analyzed:
17. Structure of deceased patients: by bed profiles, by individual disease groups and individual nosological forms.
18. Proportion of deaths on the first day (mortality on the 1st day). Calculation method:
Number of deaths on day 1· 100%
Number of deaths in hospital
Special attention deserves to study the causes of death of patients on the first day of hospital stay, which occurs due to the severity of the disease, and sometimes due to improper organization emergency assistance(reduced mortality).
The group is of particular importance indicators, characterizing surgical work hospital. It should be noted that many indicators from this group characterize the quality of surgical inpatient care:
19. Postoperative mortality.
20. Frequency of postoperative complications, as well as:
21. Structure of surgical interventions.
22. Surgical activity indicator.
23. Length of stay of operated patients in the hospital.
24. Indicators of emergency surgical care.
Operation of hospitals under conditions of compulsory health insurance identified an urgent need to develop uniform clinical and diagnostic standards for the management and treatment of patients (technological standards) related to the same nosological group sick. Moreover, as the experience of most European countries that are developing one or another health insurance system for the population shows, these standards should be closely linked to economic indicators, in particular to the cost of treating certain patients (groups of patients).
Many European countries are developing a system of clinical statistical groups (CSGs) or diagnostic related groups(DRJ) in assessing the quality and cost of patient care. The DRG system was first developed and introduced into legislation in US hospitals in 1983. In Russia, in many regions in recent years, work has intensified to develop a DRG system adapted for domestic healthcare.
Many indicators influence the organization of inpatient care and must be taken into account when scheduling hospital staff.
These indicators include:
25. Proportion of electively and urgently hospitalized patients.
26. Seasonality of hospitalization.
27. Distribution of admitted patients by day of the week (by hour of day) and many other indicators.
