Chapter 4Administrative Data
Copyright © 2017 by Elsevier, Inc. All rights reserved.
Ambulatory vs. Acute Care vs.
Long-Term Care
Ambulatory care facilities treat outpatients
➢ Outpatients are those we intend to care for within
the same calendar day
➢ Examples are doctor’s offices, diagnostic services
(radiology and laboratory), same-day surgery
centers, and emergency departments
Acute care facilities treat inpatients, who are
hospitalized an average of 30 days or less
Long-term care facilities treat inpatients who
tend to stay 30 days or more
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2
Encounter
The scheduled face-to-face meeting of a
patient and a health care provider for reasons
of medical care
Occur in outpatient facilities like physicians’
offices, ambulatory surgery centers, and
hospital emergency departments
Measured in simple whole numbers
Calculations on encounter data compare the
patient volume by physician, by specialty,
and/or by a specific time period
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3
Beds and Bed Counts
Hospitals have a number of licensed beds for patients that could
be used
➢
The maximum number of beds a hospital is allowed to have
➢ The number of beds may be much lower
Bed count: The actual number of beds that a hospital has
staffed, equipped, and otherwise made available for occupancy
on a specific day
➢
The number of physical beds in the facility and bed count days are
not the same
➢ Beds: potential for hospital usage
Bed count day: One bed set up for a patient for one 24-hour
period
➢
Measure of the usage of a hospital resource
➢ Hospitals routinely sum bed count days over a period of time to
determine the quantity of their resources used
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4
Types of Beds
Bassinets: used for newborns
Bassinet count day: an occupied bassinet or
one that is ready for a newborn on a specific
day
Swing beds: different uses depending on
what is needed (acute or long-term care)
Observation beds: used for care that may
extend overnight but does not merit an actual
hospital admission
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5
Inpatient Census
Counting the patients who occupy those beds that
are set up and staffed for use
The number of patients who occupy those beds at a
uniform time every day
A hospital’s daily census is the number of “heads in
bed,” usually at midnight
Adult and child census is calculated separately from
the bassinet census
To account for patients who may be transferred
between units, the adherence to one uniform time is
important (midnight, for example)
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6
Inpatient Census
A patient discharge is the formal release of a patient
from the hospital through the act of a doctor’s written
order
A patient being admitted to the hospital is added to
the total census, while a discharge is subtracted
An interhospital transfer sends the patient to another
facility altogether and is a discharge, subtracted from
the hospital total census
An intrahospital transfer moves the patient between
units within the same facility, subtracted from the unit
he/she came from and added to the unit he/she goes
to
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7
Happy Valley Hospital Surgical
Service
Admissions/Discharges Census at Midnight
20
Admissions
+
3
Discharges
−
6
Patients at 11:59 pm
Total
17
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8
Inpatient Service Day
Admitted and Discharged Same Day (A&D)
➢ A patient is admitted to the hospital and discharged before
the 24-hour period elapses
➢ Occurs when a patient is admitted and dies, is transferred, or
decides to leave against medical advice
➢ Add patients who were admitted and discharged the same
day in a separate calculation to report total inpatient service
days (IPSDs)
• An IPSD is a measure of the use of hospital services
• An IPSD represents the care provided to one inpatient during a
24-hour period
Total IPSDs show how much work the hospital has
done in that 24-hour period.
Copyright © 2017 by Elsevier, Inc. All rights reserved.
9
Happy Valley Hospital Surgical
Service
Admissions/Discharges Census at Midnight
20
Admissions
+
5
Discharges
−
8
Patients at 11:59 pm
Total
17
A&D Same Day
+
2
Inpatient Service Days
=
19
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10
Average Daily Census
Average daily census: total number of inpatient
service days for a period divided by the days in the
period
The number of bed count days in a month depends
on how many days are in the month
The patients need to be admitted in order to qualify
as part of the “count”
Outpatients, patients who arrive at the emergency
department as DOA, and fetal deaths are not
inpatients, so are not included as inpatients
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11
Occupancy
Ratio of the number of occupied beds to the number
of available beds
Occupancy rates for a single day fluctuate too much
to be useful for planning services
The occupancy for adults and children is calculated
separately from the bassinet occupancy rate
The percentage is usually expressed as a whole
number
The calculation needs to take into account any
changes in bed count in order to compare the
number of beds that were actually occupied to those
that were truly available for occupancy
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12
% Occupancy
total inpatient service days
× 100
total inpatient bed count days
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13
Examples of Occupancy Rate
Happy Valley Hospital is a small facility, with 100
beds staffed on Monday
= 100 bed count days
75 patients in the census, 2 patients who were
admitted that same day and died = 77 IPSDs
(77/100) × 100 = 77%
Another example with rounding is: 0.708333 × 100 =
70.833%
➢ Occupancy rates are usually expressed as a whole number
➢ Round any number greater than or equal to 5 to the next
nearest whole number, giving us 71%
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14
Length of Stay
How long the patient is using the facility’s
services
Measured from the day of admission to the
day of discharge
A patient admitted on Monday and
discharged on Tuesday is said to have a 1day length of stay
A patient admitted on Monday and
discharged on Monday is said to have a 1day length of stay
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15
Average Length of Stay (ALOS)
Total number of discharge days divided by
the number of patients
ALOS with a certain diagnosis can project
how long we expect patients with that
diagnosis to be hospitalized
Example: if the ALOS for appendicitis is 2.7
days, we anticipate that patients at our
hospital with an admitting diagnosis of
appendicitis will stay 2 or 3 days
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16
Leave of Absence (LOA) Days
Patient’s treatment includes a time period
when he/she is not in the hospital
A weekend “pass” may be given, the time a
patient spends outside the facility
LOA days are considered to be part of
treatment and are therefore included in total
length of stay
LOA days do not count as IPSDs because the
patient is not present at census-taking time
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17
Bed Turnover Rate
Gives a sense of how often an individual bed
changes its occupant during a given time period
Measures how fast you get patients in and out
Direct bed turnover rate is the total number of
discharges for a period divided by the average bed
count for that same period
Indirect bed turnover rate is the occupancy rate
multiplied by the number of days in the period in the
numerator and the average length of stay in the
denominator
Copyright © 2017 by Elsevier, Inc. All rights reserved.
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