Annual Hospital Statistical Report – PH DOH – 2014Jan7

annex_e_hospital_stat_report_revised_7jan2014

ANNUAL HOSPITAL STATISTICAL REPORT

YEAR __________

 

 

Name of Hospital: _____________________________________________ Street Address: _____________________________________

Municipality: __________________   Province ______________ Region: ______________________________

Contact No.: __________________________________ Fax Number:__________________________________

Email Address: _____________________________________________________________________________

(PLEASE FILL OUT ALL ITEMS.  PUT N/A IF NOT APPLICABLE.)

  1. GENERAL INFORMATION
  2. Classification
    1. Service Capability
  • Service capability: Capability of a hospital/other health facility to render administrative, clinical, ancillary and other services

 

General:                                                          Specialty:  (Specify)

[    ] Level 1 Hospital                                       [    ] Treats a particular disease (Specify):_______________

[    ] Level 2 Hospital                                       [    ] Treats a particular organ (Specify):________________

[    ] Level 3 Hospital (Teaching/ Training)      [    ] Treats a particular class of patients (Specify):________

[    ] Others (Specify):____________

Trauma Capability:    [    ] Trauma Capable               [    ] Trauma Receiving           

  1. Nature of Ownership

Government:                                                  Private:

[    ] National –DOH Retained/ Renationalized            [    ] Single Proprietorship/Partnership/Corp.

[    ] Local (Specify):                                       [    ] Religious

[    ] Province                                       [    ] Civic Organization

[    ] City                                              [    ] Foundation

[    ] District                                         [    ] Others (Specify):________________

[    ] Municipality

[    ] DND/ DOJ

[    ] State Universities and Colleges (SUCs)

[    ] Others (Specify):_________________

  1. Quality Management
  • Quality Management/ Quality Assurance Program: Organized set of activities designed to demonstrate on-going assessment of important aspects of patient care and services

 

[    ] ISO Certified (Specify ISO Certifying Body and

area(s) of the hospital with Certification)       Validity Period ____________

[    ] International Accreditation                                 Validity Period ____________

[    ] PhilHealth Accreditation                                     Validity Period ____________

[   ] Basic Participation

[   ] Advanced Participation

[    ] PCAHO                                                               Validity Period ____________

 

  1. Bed Capacity/Occupancy

 

  1. Authorized Bed Capacity: _____ beds
  • Authorized bed: Approved number of beds issued by BHFS, the licensing agency of DOH.

 

  1. Implementing Beds: _____ beds
  • Implementing beds: Actual beds used (based on hospital management decision)

 

  1. Bed Occupancy Rate (BOR) Based on Authorized Beds: ______%

(Total Inpatient service days for the period)**

(Total number of Authorized beds) x (Total days in the period) X 100

  • Bed Occupancy Rate: The percentage of inpatient beds occupied over a period of time.  It is a measure of the intensity of hospital resources utilized by in-patients.
  • Inpatient Service days: Unit of measure denoting the services received by one in-patient in one 24 hour period.
  • **Inpatient Service days (Bed days) = [(Inpatients remaining at midnight + Total admissions) – Total discharges/deaths) + (number of admissions and discharges on the same day)].

 

  1. HOSPITAL OPERATIONS

 

  1. Summary of Patients in the Hospital

For each category listed below, please report the total volume of services or procedures performed.

*Inpatient:  A patient who stays in a health facility while under treatment.

*Bed day: Bed used for a continuous 24 hours by an inpatient.

 

 

 

 

                                                                                                                                                                            

 

 

 

 

Inpatient Care

 

Number
Total number of inpatients (admissions, including newborns)
Total Discharges (Alive)
Total patients admitted and discharged on the same day
Total number of inpatient bed days (service days)
Total number of inpatients transferred TO THIS FACILITY from another facility for inpatient care
Total number of inpatients transferred FROM THIS FACILITY to another facility for inpatient care
Total number of patients remaining in the hospital as of midnight last day of previous year
  1. Discharges

Kindly accomplish the “Type of Service and Total Discharges According to Specialty” in the table below.

 

 

 

    Type

of

Service

 

 

 

No of

Pts

 

 

 

Total

Length

of

Stay/ Total No. of Days Stay

Type of Accomodation Condition on Discharge
                   

Non- Philhealth

 

Philhealth

 

HMO O

W

W

A

 

R/

I

T H A U Deaths Total Dis-charges
 

Pay

    

 

Service

Charity

 

Total

 

 

  Pay

 

 

Service

Total
< 48 hrs > 48 hrs Total
Member/ Dependent Indi-gent  
Medicine                                        
Obstetrics                                        
Gynecology                                        
Pediatrics                                        
Surgery:                                        
     Pedia                                        
     Adult                                        
Others, Specify                                        
TOTAL                                        
Total Newborn                                        
-Pathologic                                        
-Non-Patho                                        
* R/I – Recovered/Improved T- Transferred U – Unimproved
H- Home Against Medical Advice A – Absconded D – Died (died upon admission)

 

  1. Average Length of Stay (ALOS) of Admitted Patients

Total length of stay of discharged patients (including Deaths) in the period   = _________________

Total discharges and deaths in the period

  • Average length of stay: Average number of days each inpatient stays in the hospital for each episode of care.
  1. Ten Leading causes of Morbidity based on final discharge diagnosis

For each category listed below, please report the total number of cases for the top 10 illnesses/injury.

Cause of Morbidity/Illness/Injury Number ICD-10 Code (Individual)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.


Cause of

Morbidity (Underlying)

  Age Distribution of Patients  

 

Total

ICD-10

CODE/

TABULAR  LIST

Under 1 1 – 4 5 – 9   10 -14   15 –19   20 – 24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70 & over Subtotal
Spell out.  Do not abbreviate. M F M F M F      M F    M F M F   M F M F      M F M F M F M F M F M F M F M F M F
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Kindly accomplish the “Ten Leading Causes of Morbidity/Diseases Disaggregated as to Age and Sex” in the table below.

  1. Total Number of Deliveries

For each category of delivery listed below, please report the total number of deliveries.

Deliveries

 

Number ICD-10 Code
Total number of in-facility deliveries
Total number of live-birth vaginal deliveries (normal)
Total number of live-birth C-section deliveries (Caesarians)
Total number of other deliveries

 

  1. Outpatient Visits, including Emergency Care, Testing and Other Services

For each category of visit of service listed below, please report the total number of patients receiving the care.

Outpatient visits Number
Number of outpatient visits, new patient
Number of outpatient visits, re-visit
Number of outpatient visits, adult
Number of outpatient visits, pediatric
Number of adult general medicine outpatient visits
Number of specialty (non-surgical) outpatient visits
Number of surgical outpatient visits
Number of antenatal care visits
Number of postnatal care visits
Emergency visits

 

Number
Total number of emergency department visits
Total number of emergency department visits, adult
Total number of emergency department visits, pediatric
Total number of patients transported FROM THIS FACILITY’S EMERGENCY DEPARTMENT to another facility for inpatient care
Testing Number
Total number of medical imaging tests (all types including x-rays, ultrasound, CT scans, etc.)
Total number of laboratory and diagnostic tests (all types, excluding medical imaging)
Other services and diseases seen Number
Total number of outreach or home visits
Total number of immunization doses administered to children 0-59 months at this facility or during outreach or home visits.  Include immunizations administered during child health weeks.
Total number of newly diagnosed cases of TB

 

Total number of confirmed cases of dengue
  1. Deaths

 

For each category of death listed below, please report the total number of deaths.

Types of deaths Number
Total deaths
Total number of inpatient deaths
§  Total deaths < 48 hours
§  Total deaths > 48 hours
Total number of emergency room deaths
Total number of cases declared ‘dead on arrival’
Total number of stillbirths
Total number of neonatal deaths
Total number of maternal deaths
  1. Gross Death Rate ____________%

Gross Death Rate = Total Deaths (including newborn for a given period)

Total Discharges and Deaths for the same period x 100

  1. Net Death Rate ____________%

                        Net Death Rate = Total Death (including newborn for a given period) – death <48 hours for the period

Total Discharges (including deaths and newborn) – death<48 hours for the period x 100

  1. Ten Leading Causes of Mortality/Deaths and Total Number of Mortality/Deaths.
Mortality/Deaths

 

Number ICD-10 Code (Individual)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.


Kindly accomplish the “Ten Leading Causes of Mortality/Deaths Disaggregated as to Age and Sex” in the table below.

Cause of

Death (Underlying)

Age Distribution of Patients  

 

Total

ICD-10

CODE/

TABULAR LIST

Under 1 1 – 4 5 – 9   10 -14   15 –19   20 – 24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70 & over Subtotal
Spell out.  Do not abbreviate. M F M F M F      M F    M F M F   M F M F      M F M F M F M F M F M F M F M F M F
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
  1. Healthcare Associated Infections (HAI)

HAI are infections that patients acquire as a result of healthcare interventions.  For purposes of Licensing, the four (4)

major HAI would suffice.

For All Hospitals (Levels 1, 2, 3 General and Specialty)

  INFECTION RATE = Number of Healthcare Associated Infections   x 100

                                            Number of Discharges

 

  1. Device Related Infections

 

  1. Ventilator Acquired Pneumonia (VAP) = Number of Patients with VAP x  1000

                  Total Number of Ventilator Days

 

  1. Blood Stream Infection (BSI) = Number of Patients with BSI x  1000

                  Total Number of Central Line

 

  1. Urinary Tract Infection (UTI) = Number of Patients with UTI x  1000

                Total Number of Catheter Days

 

  1. Non-Device Related Infections

Surgical Site Infections (SSI) = Number of Surgical Site Infections   x 100

                                                                         Total number of Procedures

 

 

  1. Surgical Operations
  2. Major Operation refers to surgical procedures requiring anesthesia/ spinal anesthesia to be performed in an operating theatre. (The definition of a major operation shall be based on the definitions of the different cutting specialties.)
  3. Minor Operation refers to surgical procedures requiring only local anesthesia/ no OR needed, example suturing.
10 Leading Major Operations (excluding Caesarian Sections) Number ICD-10 Code
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
10 Leading Minor Operations

 

Number ICD-10 Code
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
  • STAFFING PATTERN (Total Staff Complement)
 

Profession/ Position/ Designation

Total staff working full time

(at least 40 hours/week)

 

Total staff working part time

(at least 20 hours/week)

 

Active Rotating or Visiting/ Affiliate

(For Private Facilities)

Out-sourced
Number of permanent staff Number of contractual staff Number of volunteer staff Number of permanent staff Number of contractual staff Number of volunteer staff
A.     Medical                
1.      Consultants (indicate One-Peso consultant)
1.1.Internal Medicine
a.       Generalist
b.      Cardiologist
c.       Endocrinologist
d.      Gastro-Enterologist
e.       Pulmonologist
f.       Nephrologist
g.       Neurologist
h.      Others (Specify)
1.2.Obstetrics/ Gynecology (and subspecialty)
1.3.Pediatrics (and subspecialty)
1.4.Surgery (and subspecialty)
1.5.Anesthesiologist
1.6.Radiologist
1.7.Pathologist
2.      Post-Graduate Fellows
(Indicate specialty/     subspecialty)
3.      Residents
3.1.Internal Medicine
3.2.Obstetricts-Gynecology
3.3.Pediatrics
3.4.Surgery
3.5.Others (Specify)
B.     Allied Medical
1.      Nurses
2.      Midwives
3.      Nursing Aides
4.      Nutritionist
5.      Physical Therapist
6.      Pharmacists
7.      Medical Technologist
8.      Others (Specify)
C.     Non-Medical
1.      Social Workers
2.      Medical Records Officer/ Hospital Health Information Officer with formal training in medical records management
3.      Laboratory Technicians
4.      X-Ray Technicians
5.      Administrative Officer
6.      Accounting/ Finance Officer
7.      General Support Staff (maintenance, janitorial, secretarial) – indicate if outsourced

 

 

  1. EXPENSES

Report all money spent by the facility on each category.

Expenses

 

Amount in Pesos
Amount spent on personnel salaries and wages
Amount spent on benefits for employees (benefits are in addition to wages/salaries. Benefits include for example: social security contributions, health insurance)
Allowances provided to employees at this facility (Allowances are in addition to wages/salaries.  Allowances include for example: clothing allowance, PERA, vehicle maintenance allowance and hazard pay.)
TOTAL amount spent on all personnel including wages, salaries, benefits and allowances for last year (PS)

 

Total amount spent on medicines funded by the Revolving Fund
Total amount spent on medicines funded by the Government of the Philippines (from any level of government, including the central, provincial and municipal governments)
Total amount spent on medical supplies (i.e. syringe, gauze, etc.;  exclude pharmaceuticals)
Total amount spent on utilities
Total amount spent on non-medical services (For example: security, food service, laundry, waste management)
TOTAL amount spent on maintenance and other operating expenditures (MOOE)

 

Amount spent on infrastructure (i.e., new hospital wing, installation of ramps)
Amount spent on equipment (i.e. x-ray machine, CT scan)
TOTAL amount spent on capital outlay (CO)
  1. REVENUES

Please report the total revenue this facility collected last year.  This includes all monetary resources acquired by this facility from all sources, and for all purposes.

 

Revenues

 

Amount in Pesos
Total amount of money received from the Department of Health
Total amount of money received from the local government
Total amount of money received from donor agencies (for example JICA, USAID,  and others)
Total amount of money received from private organizations (donations from businesses, NGOs, etc.)
Total amount of money received from Phil Health
Total amount of money received from direct patient/out-of-pocket charges/fees
Total amount of money received from reimbursement from private insurance/HMOs
Total amount of money received from other sources (PDAF, PCSO, etc.)
TOTAL Revenue

 

 

Report Prepared by                                   : ____________________________

Designation/Section/Department              : ____________________________  Date: _______

 

 

Report Approved and Certified by : ____________________________  Date: _______

Chief of Hospital/Medical Director

 

 __________________________________________________________________________________________________________

 

 

 

PREPARED BY:

 

 

STANDARDS DEVELOPMENT DIVISION (SDD)

BUREAU OF HEALTH FACILITIES AND SERVICES (BHFS)

DEPARTMENT OF HEALTH (DOH)

 

 

APPROVED BY:

                                                                   

 

ATTY. NICOLAS B. LUTERO III, CESO III

ASSISTANT SECRETARY

DOH

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