The norm of work of a bed in a hospital. Medical statistics: lecture notes (30 pages)

Active Edition from 08.04.1974

LETTER of the Ministry of Health of the USSR dated 08.04.74 N 02-14/19 (TOGETHER WITH "METHODOLOGICAL RECOMMENDATIONS FOR INCREASING THE EFFICIENCY AND ANALYSIS OF THE USE OF THE BEDDING FUND OF HOSPITALS OF MEDICAL INSTITUTIONS", APPROVED BY THE MINISTRY OF HEALTH OF THE USSR 05.04.74)>

II. CALCULATION OF THE PLANNED NUMBER OF DAYS OF EMPLOYMENT OF BEDS PER YEAR

It was noted above that the average number of bed occupancy days per year for individual hospitals is determined primarily on the basis of the structure of the bed fund by specialty. This is due to the fact that in different departments the average duration of treatment of patients is not the same, and therefore the turnover of beds is also different, on which the value of the bed occupancy rate largely depends.

Transforming the formula that is proposed to calculate the average bed downtime:

You can determine the average number of days a bed is occupied per year:

D \u003d 365 - (t x F),

t is the average idle time of a bed (in days);

F - bed turnover.

However, in this formula, the average bed downtime t is given as a whole, without subdivision into the constituent parts discussed above, namely downtime due to repair and folding of beds for other reasons, as well as downtime due to other circumstances. Meanwhile, in order to plan the average number of days a bed is occupied per year, these two types of downtime must be taken into account separately.

The average downtime of a bed due to repairs and other closures is more or less constant. Over the past years, its value in hospitals of urban medical institutions (including psychiatric beds) does not exceed 8-10 days a year. So, for example, a simple city bed due to repairs or their closure for other reasons in the USSR amounted to: in 1968 - 9.2 days, in 1969 - 9.5 days, in 1970 - 8.6 days , in 1971 - 8.1 days, in 1972 - 8.0 days. The average downtime of a bed due to repairs and other closures can be determined separately for each bed profile. Besides, in medical institutions there is a simple bed, depending on the rate of bed turnover and necessary to prepare the bed for the reception of a new patient. The value of this indicator can also be calculated.

The higher the turnover of a bed, the greater, ceteris paribus, is its downtime during the year.

Thus, the optimal indicator of the average number of days of occupancy of beds per year for each hospital can be determined by the following formula:

D \u003d 365 - tr - (tp x F),

D is the average number of days a bed is occupied per year;

tr is the average downtime of a bed due to repair and other reasons for curtailment (in days);

tp - average bed downtime due to other circumstances (in days);

F - bed turnover.

So, for example, the average number of days of occupancy of a therapeutic bed per year for a given hospital is determined by:

365 - 9.3 - (1 x 17.9) = 338 days,

provided that the average downtime of beds is calculated due to curtailment for repairs and other reasons (tр) 9.3 days and due to other circumstances (tп) - one day, and bed turnover (F) - 17.9 patients during of the year.

When calculating the average number of bed occupancy days per year for most specialized beds, it is rational to take a bed downtime equal to one day as the optimal value of the indicator of the average bed downtime tp (excluding downtime due to repairs and closing of beds for other reasons). This is explained by the need for sanitary preparation of a bed for the reception of a new patient and the existing practice of calculating the number of bed-days of a patient's hospitalization, in which the day of admission and the day of discharge are taken into account as one day.

At the same time, there is a very high turnover of beds in some specialties. So, for example, the turnover of gynecological beds in 1971-1972 amounted to. 48.9, and the turnover of abortion beds - 122.3. In this regard, it was considered expedient to take for gynecological beds and beds for abortions (in total) the average idle time of beds due to other circumstances (tp) at the level of 0.5 days, i.e. approximately at the level actually last years.

The small value of the accepted average idle time of beds for abortions is explained by the existing organization of the work of gynecological hospitals, in which, due to the planned referral for abortion, conditions are created for women to enter the hospital immediately after the beds are vacated.

In the total calculation, the turnover of gynecological beds and beds for the production of abortions in 1971-1972. amounted to 60, and the average time of their downtime due to repairs and curtailment for other reasons was 12.0 days. Under these conditions, the average number of days occupied by a gynecological bed, including abortion beds, will be 323 days during the year: 365 - 12.0 - (0.5 x 60).

At the same time, it should be noted that in a number of specialties the use of beds depends on objective factors that are outside the scope of the operating conditions of hospital institutions. So, for example, a decrease in the incidence of infectious disease causes an incomplete workload of beds in infectious diseases and tuberculosis hospitals.

However, it should be borne in mind that the actual bed downtime (tp) in these specialties, even taking into account the need for careful sanitary preparation of the bed for the reception of a new patient, can be reduced due to a number of organizational measures. Therefore, when determining the average annual bed occupancy, it is possible to plan a reduction in the actual average idle time of beds between patients in infectious diseases hospitals for children up to 3 days, in infectious diseases hospitals for adults, for the treatment of tuberculosis patients, as well as in maternity hospitals and offices - up to 2 days.

In this case, the average annual TB bed occupancy will be 348 days: 365 - 9.7 - (2.0 x 3.5). A similar calculation for beds with an infectious profile for adults shows that they should be occupied during the year for 311 days, and beds for pregnant women and women in childbirth, including beds for women with pathology of pregnancy, - 292 days: 365 - 13.8 - (2.0 x 29.4).

The indicators of the average idle time of a bed (tp) used in the proposed calculations in tuberculosis, infectious disease hospitals, as well as maternity hospitals and departments should be considered as approximate. Their optimal value can only be obtained as a result of a special study, taking into account local conditions.

The proposed calculations of the average annual bed occupancy allow us to determine the average use of beds per year for different profiles. Table N 3 shows approximate calculations of this indicator for the main types of specialties. At the same time, for greater reliability of the indicators required for the calculation, all of them are calculated as averages for two years.

Table No. 3

EXAMPLE CALCULATIONS OF THE AVERAGE ANNUAL OCCUPATION OF BEDS OF DIFFERENT PROFILES IN HOSPITAL INSTITUTIONS LOCATED IN URBAN SETTLEMENTS<*>

<*>The data given in the table are approximate calculations, and they cannot be taken as the norm for all territories.

Depending on the operating conditions of hospitals and in the presence of sharp differences in the turnover of beds and the average downtime due to repairs (or their curtailment for other reasons), for each Union and Autonomous Republic, Territory or Region, according to the proposed methodology, the estimated average indicators of the number days of bed occupancy per year ("D") for different profiles for hospitals in urban settlements. These indicators may be different in individual years and in each Union or Autonomous Republic, region, territory.

The proposed calculation method also makes it possible to periodically update the indicators of the average annual occupancy of beds of various profiles, depending on changes in the turnover of beds and the average downtime due to repairs or curtailment for other reasons.

The use of the proposed calculations and indicators of the average annual bed occupancy for hospitals located in rural areas requires the use of a correction factor that takes into account the peculiarities of hospitalization of patients in these medical institutions. The level of hospitalization of the population in rural hospitals primarily depends on the radius of service of the population by this hospital. The remoteness of hospitals from the place of residence of the population affects both the increase in the average idle time of beds and the decrease in their turnover compared to beds of a similar profile in urban hospitals.

However, these factors mainly have an impact on the activities of district hospitals, because Rural district hospitals are approaching urban hospitals in terms of their capacity, conditions and forms of work. At the same time, individual small hospitals located in small towns and urban-type settlements are in conditions similar to district hospitals, and in terms of their work and the use of beds they are close to district hospitals.

As an indicative correction factor for calculating the average annual bed occupancy in district hospitals and similar hospitals, the difference expressed in percentages (or fractions of a unit) between the recommended indicator of bed utilization during the year in urban hospitals (330-340 days) and rural (310 days) is proposed. , i.e. 6-9% (0.06-0.09 in fractions of a unit).

In order to obtain the estimated average number of days of bed occupancy for district hospitals, it is necessary to reduce by this percentage the average annual bed occupancy calculated for different profiles for city hospitals.

Table 4 shows the calculation of indicators for district hospitals and similar hospitals using a correction factor of 0.07.

Table No. 4

EXAMPLE CALCULATIONS OF THE AVERAGE ANNUAL OCCURRENCE OF BEDS OF DIFFERENT PROFILES IN DISTRICT HOSPITALS AND SIMILAR HOSPITALS

Using the final data on the average number of days of occupancy of beds of different profiles during the year (Tables 3, 4), this indicator can be calculated for an individual hospital.

Tables 5 and 6 present examples of calculating the average annual bed occupancy for two central district hospitals in the K-region with a capacity of 300 and 260 beds.

If the hospital department includes beds of different profiles, then the estimated number of bed-days for each specialty is first determined, and then the average bed occupancy rate for the entire department is displayed.

For example, in order to determine the rate of bed occupancy of the surgical department of the N-th Central District Hospital, which, in addition to surgical beds, includes urological, oncological and ophthalmological beds, it is necessary to multiply the number of average annual beds of each profile by the calculated average number of days of bed occupancy in year (column 5 of table 3):

In order to determine the average number of days of bed occupancy in the surgical department, it is necessary to divide the total (number of bed days) by the number of average annual beds, i.e. 13440: 40 = 336 days.

The same calculation method is used to determine the average number of days of bed occupancy in the whole hospital, consisting of various departments (table 5).

Table 5

EXAMPLE OF CALCULATION OF AVERAGE ANNUAL BEDDING OCCUPATION FOR N-SKY CENTRAL DISTRICT HOSPITAL

Similar calculations for the O Central District Hospital (Table 6) show that in this hospital the average bed occupancy should be 330 days a year, i.e. 5 days more than in the N hospital.

Table 6

EXAMPLE OF CALCULATION OF AVERAGE ANNUAL BEDDING OCCUPATION IN THE O-SKY CENTRAL DISTRICT HOSPITAL

This is explained by the fact that in the O-hospital, unlike the H-hospital, there are departments (tuberculosis and children's somatic) with long periods of treatment of patients in the hospital, and, consequently, with a smaller number of beds, which generally determines the these departments have a higher bed occupancy per year.

If there is no need to calculate data for each department of the hospital, then the calculations can be simplified and carried out only for bed profiles. The sum of the number of bed days for each profile gives the number of bed days for the hospital as a whole. As an example, we give a calculation for the O-sky Central District Hospital:

The sum of all bed days divided by the number of average annual beds in the hospital gives the average bed occupancy for the hospital as a whole - 85790: 260 = 330 days.

It should be noted that the bed occupancy of hospitals established in this way is optimal in the specific conditions of the prevailing average duration of treatment of patients at the present time and the current turnover of beds.

The average bed occupancy per year obtained from the above calculations assumes the systematic closure of a part of the hospital beds for repairs. The existing practice in some districts of carrying out repairs without closing beds, i.e. placement of beds for the period of repair in the corridors and other utility rooms or their relocation to other departments of the hospital violates the sanitary and hygienic standards established for hospitals and worsens the conditions for the stay and treatment of patients.

However, if a hospital does not plan to renovate in a given year, then the bed occupancy rate in that hospital should be higher than the optimal value calculated for it.

Calculations of the average bed occupancy, performed without taking into account the closure for repairs, only on the basis of its turnover and the average downtime not related to repairs, allow you to determine the maximum duration of the possible occupancy of the bed.

Such a calculation for the beds of each profile can be carried out using a slightly modified formula:

D \u003d 365 - (tp x F).

The notation is the same as in the main formula above.

However, in this case, the bed turnover (F) is calculated as the maximum possible value obtained by dividing the number of days in a year (365) by the average duration of the patient's stay:

Then the average duration of bed occupancy (maximum) for beds of a therapeutic profile will be equal to:

D = 365 - (1 x 18.25) = 346.75 days ~= 347 days.

Similar calculations made for pediatric beds determine their maximum average annual employment at the level of 342 days, surgical - 337 days, urological and nephrological - 345 days, traumatological, burn and orthopedic - 347 days, oncological - 352 days, tuberculosis - 356 days, neurological - 349 days, ophthalmic - 346 days, otolaryngological - 330 days, dermatovenerological - 348 days, dental - 341.

The shorter the average duration of treatment, the higher the maximum turnover of beds per year and, consequently, the lower the maximum average annual bed occupancy. Therefore, for example, beds of a surgical profile (maximum turnover 28.1) and beds for otolaryngological patients (maximum turnover - 34.8) should be occupied for fewer days than, for example, therapeutic, neurological, ophthalmological beds, the maximum turnover of which, from taking into account the average duration of treatment of patients, for 1971-1972. is 18.25, 16.2 and 19.3, respectively.

Based on these figures, it is possible for each hospital, taking into account the profile of beds in the hospital as a whole or for each department, if it includes beds of different profiles, to calculate the maximum bed occupancy during the year.

For example, we will carry out such calculations in relation to the surgical department of the N-th Central District Hospital, which has highly specialized beds in its composition:

Thus, the optimal bed occupancy in the surgical department of the H-hospital is below its maximum value by 5 days (341-336 days). However, in fact, the average bed occupancy in this department was at the level of 360 days, i.e. 19 days more than the maximum calculated value. This means that the department worked with a large overload.

In order to objectively evaluate the value of this overload (360 days), it is necessary to take the maximum allowable bed occupancy (341 days) as 100% and calculate the actual value of its use as a percentage:

Consequently, the bed in the surgical department of the H hospital was used 6% more in relation to the maximum allowable value.

So, the calculations carried out for two central district hospitals, taking into account the specific structure of their bed fund, showed that the optimal indicator of the use of the bed fund of the N hospital is the bed occupancy for 325 days a year and the O hospital for 330 days .

In fact, a bed in the N-th hospital was occupied for 320 days during the year, i.e. 5 days less than it should be, in O-sky - 322 days, or 8 days less than the calculated one.

Reducing bed downtime reduces overhead costs for hospitals and reduces the cost of their bed-day. Top reasons for downtime beds are the lack of uniform admission of patients, "truancy" of the bed between discharge and admission of patients, preventive disinfection, quarantine due to nosocomial infection, repairs, etc.

The efficiency of using the hospital bed fund is characterized by the following main indicators:

§ average annual employment (work) of a bed;

§ turnover of a hospital bed;

§ average idle time of beds;

§ average length of stay of the patient in the hospital;

§ implementation of the plan of bed-days in the hospital ,

These indicators make it possible to evaluate the effectiveness of the use of hospital beds. The data necessary for calculating the indicators can be obtained from the "Report of the medical institution" (form No. 30-zdrav.) and the "Sheet for registering the movement of patients and hospital beds" (form No. 007-y).

Index AVERAGE ANNUAL EMPLOYMENT (WORK) BEDS- this is the number of days of bed operation in a year, characterizing the degree of use of the hospital. The indicator is calculated as:

the number of bed-days actually spent by all patients in the hospital

average annual number of beds

The assessment of this indicator is carried out by comparison with the calculated standards. They are established separately for urban and rural hospitals with the specification 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 would be 306.8 days

This indicator is used in determining 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 in a year, then the department is working with overflow - on side 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 rate is supplemented indicator BED TURNOVER, which is defined as a ratio:

the number of retired patients (discharged + deceased)

average annual number of beds

This indicator characterizes the number of patients who were in one hospital bed during the year. In accordance with the planned standards for city hospitals, it should be considered optimal within 17- 20 per year . The bed capacity of the hospital should be taken as the average annual number of beds. However, it is inappropriate for them to compare all hospitals and even single-profile institutions, because it depends on the structure of the bed fund in a given hospital. It adequately characterizes the intensity of work of a bed of a certain profile within one institution.

Index Idle BED (due to turnover) – calculated as the difference between:

the number of days in a year (365) - the average number of days a bed works

divided by bed turnover

This is the time of "truancy" from the moment the bed is vacated by discharged patients until it is occupied by newly admitted patients.

Example: The average downtime for a therapeutic hospital bed due to turnover with an average annual bed occupancy of 330 days and an average bed stay of 17.9 days is 1.9 days.

A simple bed more 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 expenses - 200000 c.u. e. - then we learn that as a result of idle beds, the hospital suffered losses in the amount of 26,350 c.u.

The duration of the patient's stay in bed is important for characterizing the activities of the medical profession, to a certain extent reflecting the effectiveness of the patient's treatment and the level of work of the staff:

AVERAGE STAY PATIENT IN HOSPITAL (average bed-day) is defined as the following ratio:

number of retired patients (discharged + deceased)

The average bed-day ranges from 17 to 19 days, but it cannot evaluate 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 treatment and diagnostic process. The average bed-day indicates the reserves for improving the use of the bed fund. With a decrease in the average duration of a patient's stay in a bed, the cost of treatment decreases, while a reduction in the duration of treatment allows hospitals to provide inpatient care to a larger number of patients with the same amount of budget allocations. In this case, public funds are used more efficiently (the so-called "conditional savings of budgetary funds").

PERFORMANCE OF THE PLAN OF BED-DAYS BY HOSPITAL it is determined:

the 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 the planned indicators of the work of the bed for the year has great importance for the economic characteristics of the activities of hospitals.

Example: Budget expenditures for a hospital with a capacity of 150 beds are 4,000,000 USD, including expenses for food and medicines - 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%. Shortfall - 3%: the hospital suffered economic losses associated with the shortfall in the plan of bed-days in the amount of 90,000 c.u.

To evaluate the work of the 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. It is advisable to use the indicator for equal branches. In addition, the fatality 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 bulk of deaths occur in intensive care units, it is advisable to distinguish the lethality of this unit from others.

Proper use of methods for calculating the relative performance of health facilities and the level of public health makes it possible to analyze the state of the health care system as a whole in the region, for individual health facilities and their divisions. And on the basis of the results obtained, optimal management decisions can be developed to improve the health care of the region and individual health facilities.

Standard (normative) costs of health care facilities are set for each clinical and economic group (CEG) of patients for each completed case of patient treatment. The developed standards are used in the MHI system when developing regional tariffs for medical services and become medical and economic standards (MES). Their price takes into account the standard (normative) costs, as the minimum standards of state-guaranteed free medical care depending on the disease.

An analysis of the financial costs within the framework of the Territorial Free Medical Care Programs (BMP) in the regions shows that the structure of diagnostic and treatment measures, their frequency and duration have perfect look, and the costs artificially minimized. Such a structure of payment for medical care in the MHI does not reimburse the costs of health facilities. The basic MHI tariff provides for reimbursement only direct costs for the provided BMP: salary of medical staff with accruals, medicines, dressings, medical expenses, food, soft inventory. In the new market conditions for the operation of a medical facility - in terms of budgeting, it is paid not for a bed-day, but for a retired patient with payment for a completed case of treatment, which more accurately reflects the costs of a medical facility. When budgeting, only the total amount of appropriations for certain types and volumes of activities is limited with payment rates for the completed case, and the head of the health care facility can quickly transfer funds between items and periods of expenditure. With a fixed budget, the manager can save money by streamlining activities. It is only necessary to establish internal control over the spending of funds. Moving from budget financing to performance-based budgeting is an opportunity for hospitals

True, the concept of a “finished case” of treatment has different interpretation, it could be:

Payment medium-profile treatment (by type of specialized MP);

MES payment nosology(clinical diagnostic groups);

Payment by CEG standard(by costs per group), which are determined by typical patients by clinic and economic costs, then these costs are normalized and ranked by level of care. The typical case includes data on the maximum permissible duration of treatment, the proportion of negative results (lethality) and positive results, coefficient of resource and cost costs;

Payment in fact rendered medical services within the approved volumes of BMP.

Currently payment for SMP CHI is carried out according to the MES for nosologies - this is payment for the actual number of cases of treated patients at minimum rates. Payment is made retrospectively upon presentation of invoices.

Payment VTMP according to the state order, it is made according to the CEG - according to the actual number of cases of treated patients at standard costs and taking into account the results of the provision of HTMP, but payment is made in advance with subsequent additional reimbursement of expenses according to the standard. The CEG system sets limits only on the price and volume of MU, and the set of services is determined by the FGU. Thus, the budget of the FGU 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 amount of FGU financing does not depend on the bed fund 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 with the involvement of those resources that are necessary for this. The preliminary system of payment for a treated patient according to CEG meets the goals: predictability of costs, resource saving, efficient use of resources.

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LETTER from the Ministry of Health of the USSR dated 08-04-74 02-1419 (TOGETHER WITH METHODOLOGICAL RECOMMENDATIONS FOR INCREASING THE EFFICIENCY AND ANALYSIS ... Relevant in 2018

4. Average bed downtime

t is the average idle time of a bed (in days);

D is the average number of days a bed is occupied per year;

F - bed turnover.

For N CRH, the average bed downtime was:

The average idle time of a bed in urban hospitals of the USSR in 1972 was 2.2 days, in rural hospitals - 3.0 days, in the K oblast - 1.6 and 5.0 days, respectively.

To illustrate, all of the above indicators of the use of the bed fund for 1972 in the USSR, the K-region and its two districts are presented in Table. N 2.

table 2

1972 BEDD USE (EXCLUDING PSYCHIATRIC BEDS AND DEPARTMENTS)

From the table it follows that in the K-oblast, better than the average for the USSR, the number of beds in hospitals in urban settlements was used. On average, each city bed was used more by 8 days, its turnover was significantly higher (23.2 vs. 21.0), and the average idle time of beds was significantly less: 1.6 vs. 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 capacity. A bed in rural hospitals worked during the year on average only 268 days, the average idle time of a bed is 5 days, and its turnover is low - 19.5.

You should also pay attention to the data given in the table of two rural areas this area. While beds are underutilized across districts overall, bed utilization rates in central district hospitals approaching the city. 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 fund by specialty, i.e. calculate the average number of days a bed is occupied, given their profile.

This group of indicators characterizes the efficiency of hospital beds.

1. Average annual bed occupancy (average number of bed days per year, or hospital bed function):

Number of bed-days spent by patients in a hospital during the year: Average annual number of beds

The indicator characterizes the volume of activities of the hospital and the efficiency of the use of the bed fund.

Numerous factors influence the use of a bed in various hospitals and in various profiles: hospitalization of non-core patients, admission of planned patients on Saturday and Sunday, discharge of patients on pre-holiday and holidays, pre-hospital outpatient examination of patients in a hospital, untimely appointment of diagnostic tests and complex treatment, untimely discharge from the hospital, etc.

reserves for more effective use bed fund are:
improving the quality of preparation of patients from the outpatient clinic for inpatient treatment and better continuity between the clinic and the hospital;
improvement of the hospitalization system, uniform admission of patients to the hospital on all days of the week;
hospitalization of patients as directed, i.e., to hospitals and departments of the profile that corresponds to the diagnosis, nature and complexity of the disease;
wider and more timely use in clinics and hospitals advisory assistance specialists;
timely examination and treatment of not only the main, but also concomitant diseases.

Rational ways to reduce the shortage of round-the-clock inpatient beds are:
introduction of hospital-replacing forms of inpatient care;
continuous improvement of the quality and efficiency of out-of-hospital and hospital care, advanced training of medical personnel;
carrying out comprehensive measures for primary, secondary and tertiary prevention of diseases of the population;
improving continuity in the work of hospitals and polyclinics.

2. Average length of stay of patients in the hospital:
Number of bed-days spent by patients in the hospital during the year: Number of patients who left the hospital (discharged and died)

The indicator of the average length of stay of patients in the hospital is calculated for each department and for the hospital as a whole.

The average length of stay of patients in a hospital depends on a number of parameters, in particular, on the specialization of the hospital bed, gender, age, the nature of the pathology and severity of the patients' condition, continuity with polyclinic institutions, the level of qualification of medical personnel, the organization of the treatment and diagnostic process, the equipment of the hospital diagnostic equipment, degree of implementation modern technologies, the organization of admission and discharge of patients, the degree of patient satisfaction with the organization and quality of treatment and the conditions of stay in the hospital, the organization of departmental and non-departmental quality control of the treatment and diagnostic process, the degree of development of hospital-replacing types of medical care.

table 2 Average approximate terms of bed occupancy per year and the duration of the patient's stay in bed

3. Average duration of treatment of patients in a hospital (in days):
Number of bed-days spent in the hospital by discharged patients with this diagnosis: Number of discharged patients

This indicator is calculated for certain classes of diseases and nosological forms only in relation to patients discharged from the hospital. The average duration of treatment of patients in a hospital is affected by gender, age, severity of patients' diseases, as well as the correct organization of the hospital's work (examination time, timeliness of diagnosis, treatment efficiency, quality of disability examination, etc.).

Reducing the duration of treatment of patients in a hospital due to pre-hospital examinations, the introduction of new medical technologies, etc., makes it possible to treat an additional number of patients on existing beds, reduce or re-profil the unclaimed number of beds, allocate beds to fulfill volumes in excess of the territorial program of state guarantees on a paid basis.

4. Bed turnover The indicator is calculated in two ways:
a) ____ Average annual bed occupancy ___ ;
Average length of stay of a patient in a hospital

B) The number of patients who left the hospital: Average annual number of beds

For greater accuracy of calculation in the second method, half of the sum of admitted, discharged and deceased patients is taken in the numerator, and the average annual number of beds is taken in the denominator, taking into account the actually deployed and curtailed for repairs.

The bed turnover rate gives an idea of ​​the average number of patients treated during the year on one bed. The bed turnover is calculated both for the hospital as a whole and for each department, as a rule, it is estimated in dynamics and characterizes the intensity of the use of the bed fund. The lower the average length of hospital stay, the higher the bed turnover. For example, in the maternity ward, the bed turnover is much higher than in the TB ward.

5. Average bed downtime:
Number of days in a year - average annual bed occupancy: Bed turnover

The indicator allows you to determine the average number of days of bed vacancy from the moment of discharge of the previous patient to the arrival of the next patient. The average downtime of a bed ranges from 0.5 to 3 days, while this figure can be higher, for example, for maternity beds - up to 13–14 days. The amount of bed downtime is considered in conjunction with other indicators of the use of the bed fund.

6. Dynamics of the bed fund, in percent:
Number of beds at the end of the reporting year × 100: Number of beds at the beginning of the reporting year

This indicator can be calculated not only in relation to the reporting year, but also for a longer (smaller) time interval.

Indicators of the quality and effectiveness of inpatient care

1. Mortality in a hospital (hospital mortality), in percent:
Number of deaths in the hospital × 100: Number of patients who left the hospital

This indicator characterizes: the quality of inpatient and outpatient care for patients treated in a hospital; level of qualification of medical personnel; the quality of the medical diagnostic process. The indicator is influenced by factors related to the composition of patients (gender, age, nosological form, severity of the condition, etc.), as well as factors in managing the quality of medical care (timeliness of hospitalization, adequacy of treatment, etc.).

For a deeper analysis, a number of indicators of hospital mortality are used.
a) Mortality in the hospital for certain diseases, in percent:
The number of deaths from this disease× 100: Number of people with the disease during the year.

Mortality in the hospital, both general and for individual diseases, is analyzed over the years in comparison with the indicators of similar hospitals and departments. In recent years, the hospital mortality rate in Russian Federation is 1.3–1.4%.

b) Annual mortality, in percent:
Number of patients who died within a year after the diagnosis of the given disease × 100: Number of patients with the given disease

This indicator is especially relevant for oncological diseases. Despite the fact that annual mortality is not directly related to inpatient care, it can be considered in this section, given the significant use of inpatient care in oncological practice. For an in-depth analysis of the quality of inpatient medical care at certain stages of its provision, special mortality rates are calculated:

c) Daily mortality rate, in percent:
Number of deaths in the first 24 hours of hospital stay × 100: Total number of patients admitted to the hospital

d) Postoperative mortality rate, in percent:
The number of deaths after surgical interventions × 100. Total number of operated patients
The analysis of hospital mortality should be accompanied by the calculation of the proportion of deaths at home with certain diseases:

e) The proportion of deaths at home (with certain diseases), in percent:
Number of deaths at home with a specific disease × 100: The number of all deaths with a specific disease (in hospital and at home) from people living in the service area
Comparison of hospital mortality with the proportion of deaths at home has importance with long-term diseases (hypertension, neoplasms, rheumatism, tuberculosis, etc.). In this case, a parallel decrease in hospital mortality and the proportion of deaths at home should be considered as a positive phenomenon. Otherwise (with a decrease in hospital mortality and a simultaneous increase in the proportion of deaths at home), patients are selected to the hospital with relatively mild cases of diseases and, accordingly, more severe patients are left at home.

2. The share of post-mortem autopsies in the hospital, in percent:
Number of autopsies in the hospital × 100: Number of deaths in the hospital (total)

3. Structure of causes of death, according to autopsy data, in percentage:
Number of autopsies that died from a given disease × 100: Total number of post-mortem autopsies

4. Frequency of discrepancy between clinical and pathoanatomical diagnoses, in percent:
Number of clinical diagnoses not confirmed by autopsy × 100: Total number of autopsies

The indicator characterizes the quality of medical and diagnostic work in a hospital, the level of qualification of hospital doctors. On average in the Russian Federation, the value of the indicator ranges from 0.5 to 1.5%.

5. Quality indicators surgical care
For the analysis of surgical care, along with the listed indicators, the following are used:

a) The number of operations per 100 operated patients:
Total operations performed in the hospital × 100; Number of operated patients in the hospital

b) Surgical activity, in percent:
Number of operated patients × 100. Total number of retired patients (discharged and deceased) from the surgical hospital

The value of the index of surgical activity depends on the qualifications of the surgical staff, the technical equipment of operating units, departments of anesthesiology and intensive care, compliance with the standards of treatment of surgical patients, as well as from the contingent of hospitalized patients. Mean this indicator is 60–70%.
The surgical activity of surgical doctors is also assessed in terms of the number of operations performed per 1 doctor position:

c) The number of operations per 1 position of a surgical doctor:
Total operations performed in the hospital (department); Number of occupied positions of surgical doctors in a hospital (department)

d) The structure of surgical interventions, in percent:
The number of patients operated on for this disease × 100; Total number of operated patients

e) Frequency postoperative complications, in percents:
The number of operations after which complications were registered × 100; Total number of transactions (The value of the indicator ranges from 3–5%.)

f) The proportion of patients with postoperative complications, in percent:
Number of patients with postoperative complications × 100; Total number of operated patients

g) Lethality of operated patients, in percent:
The number of deaths after operations × 100; Total operated patients in the hospital

h) The share of endoscopic (minimally invasive) operations, in percent:
Number of surgeries performed using endoscopic (laparoscopic) technique × 100 . The total number of operations performed in the hospital

The indicator reflects the activity of introducing a promising direction in the development of surgery. The value of this indicator has recently increased and reached 7-10% in certain areas of the country.

Various indicators are used to analyze the performance of a hospital. According to the most conservative estimates, more than 100 different indicators of inpatient care are widely used.

A number of indicators can be grouped, as they reflect certain areas of hospital functioning.

In particular, there are indicators that characterize:

Provision of the population with inpatient care;

The workload of medical personnel;

Logistics and medical equipment;

Use of the bed fund;

The quality of inpatient care and its effectiveness.

The provision, accessibility and structure of inpatient care are determined by the following indicators: 1. Number of beds per 10,000 people 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. The level of hospitalization of the population per 1000 inhabitants (indicator of the territorial level). Calculation method:

Received patients total 1000

Average annual population

This group of indicators includes:

3. Provision of individual profiles with beds per 10,000 people

4. Structure of the bed fund

5. Structure of hospitalized by profiles

6. The level of hospitalization of the child population, etc.

In recent years, such an important territorial indicator as:

7. Inpatient care consumption per 1,000 inhabitants per year (number of bed-days per 1,000 inhabitants per year in a given territory).

The load of medical personnel is characterized by indicators:

8. Number of beds per 1 position (per shift) of a doctor (middle medical staff)

Calculation method:

Number of average annual beds in a hospital (department)

(middle medical personnel)

in hospital (department)

9. Staffing of the hospital with doctors (middle medical personnel). Calculation method:

Number of occupied positions of doctors

(secondary medical

____________staff in the hospital)· 100% ____________

Number of full-time positions of doctors

(middle medical staff) in a hospital

This group of indicators includes:

(Gun G.E., Dorofeev V.M., 1994) and others.

A large group consists of indicators use of the bed fund, which are very important for characterizing the volume of activities of the hospital, the efficiency of using the bed fund, for calculating the economic performance of the hospital, etc.

11. Average number of bed days per year (bed occupancy per year) Method of calculation:

The number of bed-days actually spent by patients in the hospital Number of average annual beds

The so-called overfulfillment of the plan for the use of beds, exceeding the number of calendar days in a year, is considered a negative phenomenon. This provision 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 stay of patients in the hospital in additional beds are included in the total number of bed-days.

An approximate indicator of the average bed occupancy for urban hospitals is 330-340 days (without infectious diseases and maternity wards), 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 of the hospitals in the country are repaired annually, some are put into operation again, and at different times of the year, which leads to incomplete use of their bed fund during the year. Planned targets for the use of beds for each individual hospital should be set based on specific conditions.

12. The average duration of the patient's stay in bed. Calculation method:

Number of bed-days spent by patients

Number of dropped out patients

The level of this indicator varies depending on the severity of the disease and the organization of medical care. The indicator of the duration of treatment in a hospital is affected 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 evaluating the activities of the hospital in terms of the duration of treatment, one should compare the departments of the same name and the duration of treatment with the same nosological forms.

13. Bed turnover. Calculation method:

The number of treated patients (half the sum of those admitted,

________________________ discharged and deceased) __________

Average annual number of beds

This is one of the most important indicators of the effectiveness of the use of the bed fund. Bed turnover is closely related to bed occupancy rates and duration of patient treatment.

The indicators of the use of the bed fund also include:

14. Average bed downtime.

15. Dynamics of the bed fund, etc.

Quality and efficiency of inpatient care determined by a number of objective indicators: mortality, the frequency of discrepancies between clinical and pathological diagnoses, the frequency of postoperative complications, the duration of hospitalization of patients requiring emergency surgical intervention(appendicitis, strangulated hernia, intestinal obstruction, ectopic pregnancy, etc.).

16. Hospital-wide mortality rate:

Calculation method:

Number of deaths in the hospital· 100%

Number of treated patients

(admitted, discharged and deceased)

Each case of death in a hospital hospital, as well as at home, should be analyzed 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 (lethality at home) for the disease of the same name, since among those who died at home, there may be seriously ill patients who were unreasonably early discharged from the hospital or were not hospitalized. At the same time, it is possible low rate mortality in the hospital with a high level of mortality 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 provision of the population with hospital beds and the quality of extracurricular and hospital care.

The hospital mortality rate is calculated in each medical department hospital, with certain diseases. Always parsed:

17. Structure of deceased patients: by bed profiles, by individual disease groups and individual nosological forms.

18. The proportion of deaths on the first day (mortality on the 1st day). Calculation method:

Number of deaths on the 1st day· 100%

Number of deaths in the hospital

special attention deserves to study the causes of death of patients on the first day of hospital stay, which comes as a result of the severity of the disease, and sometimes - improper organization emergency assistance(reduced lethality).

The group is of particular importance. indicators, characterizing surgical work of the hospital. It should be noted that many indicators from this group characterize the quality of surgical inpatient care:

19. Postoperative mortality.

20. The frequency of postoperative complications, as well as:

21. The structure of surgical interventions.

22. Index of surgical activity.

23. Length of stay operated in the hospital.

24. Indicators of emergency surgical care.

The work of hospitals under the conditions of compulsory medical insurance has revealed the urgent need to develop uniform clinical and diagnostic standards for the management and treatment of patients (technological standards) belonging to the same nosological group sick. Moreover, as the experience of most European countries that develop this or that system of medical insurance for the population shows, these standards should be closely linked with economic indicators, in particular with the cost of treating certain patients (groups of patients).

Many European countries are developing a system of clinical statistical groups (CSG) or diagnostically related groups (DRJ) in assessing the quality and cost of treating patients. For the first time, the DRG system was developed and introduced in US hospitals by law since 1983. In Russia, in many regions, work has intensified in recent years on the development of a DRG system adapted for domestic healthcare.

Many indicators affect the organization of hospital care, they must be taken into account when scheduling the work of hospital staff.

These indicators include:

25. Share of planned and emergency hospitalized.

26. Seasonality of hospitalization.

27. Distribution of admitted patients by days of the week (by hours of the day) and many other indicators.