How to calculate the bunk function. Medical and economic indicators of hospital performance. Medical care in a hospital setting

Determine the quality indicators of the activity of polyclinic No. 2 in city B, serving 50 thousand people. In the 1995 report It is indicated that residents made 130,000 visits to therapists per year, of which 90,000 to their local doctors. Medical assistance was provided to 8,000 residents of rural suburbs (attached to the hospital). Targeted screening to detect tuberculosis was carried out on 2,500 people. Of the 300 registered patients, 150 patients with gastric and duodenal ulcers were taken for clinical observation.

Compliance with the principle of locality in the work of local doctors in the clinic:

=

Conclusion. The district staff in the clinic is not sufficiently organized (the higher the percentage of district staff, the more correctly the work of the clinic is organized. 80-85% or more should be considered a good indicator).

Share of visits made by rural residents:

=

This figure should not be lower than 7%; it indicates the volume of medical care received by rural residents in city hospitals.

Coverage of the population with targeted examinations to detect tuberculosis:

=

The resulting figure is quite low.

Dispensary observation coverage (peptic ulcer):

=

Volume of hospital work is usually defined in the so-called bed days.

The number of bed days spent by patients per year is calculated by summing the number of patients registered at 8 a.m. each day.

For example, on January 1 there were 150 patients in the hospital, on January 2 - 160 patients, and on January 3 -128. During these 3 days, bed days were spent: 150 + 160 + 128 = 438.

Based on the actually spent bed days, determine average annual bed occupancy or bed utilization rate, or the average number of days a bed is occupied per year.

For example, 4088 patients (of which 143 died) spent 65,410 bed days, the number of average annual beds deployed was 190:

Average annual bed occupancy:

= day

Bed availability in urban hospitals for less than 340 days a year indicates poor, insufficiently efficient hospital performance. For rural district hospitals and maternity wards, a lower standard has been adopted: 310-320 days.

Rational use of the actually deployed bed capacity (in the absence of overload) and compliance with the required period of treatment in the departments, taking into account the specialization of beds, diagnosis, severity of pathology, and concomitant diseases are of great importance in organizing the work of a hospital.

To assess the use of bed capacity, the following most important indicators are calculated:

1) provision of the population with hospital beds;

2) average annual hospital bed occupancy;

3) degree of bed capacity utilization;

4) hospital bed turnover;

5) the average length of stay of the patient in bed.

Provision of population with hospital beds (per 10,000 population):

total number of hospital beds x 10,000 / population served.

Average annual occupancy (work) of a hospital bed:

number of bed days actually spent by patients in the hospital / average annual number of beds.

Average annual number of hospital beds is defined as follows:

number of actually occupied beds in each month of the year in a hospital / 12 months.

This indicator can be calculated both for the hospital as a whole and for departments. Its assessment is made by comparison with calculated standards for departments of various profiles.

When analyzing this indicator, it should be taken into account that the number of actually spent bed days includes days spent by patients in so-called attached beds, which are not taken into account in the number of average annual beds; therefore, the average annual bed occupancy may be greater than the number of days per year (over 365 days).

The operation of a bed less or more than the standard indicates, respectively, that the hospital is underloaded or overloaded.

Approximately this figure for city hospitals is 320 – 340 days a year.

Bed utilization rate (implementation of the plan for bed days):

number of actual bed days spent by patients x 100 / planned number of bed days.

The planned number of beds per year is determined by multiplying the average annual number of beds by the bed occupancy rate per year (Table 13).

Table 13

Average number of days of bed use (occupancy) per year

This indicator is calculated for the hospital as a whole and for departments. If the average annual bed occupancy is within the standard, then it is close to 30%; if the hospital is overloaded or underloaded, the indicator will be higher or lower than 100%, respectively.

Hospital bed turnover:

number of patients discharged (discharged + deaths) / average annual number of beds.

This indicator indicates how many patients were “served” by one bed during the year. The rate of bed turnover depends on the duration of hospitalization, which, in turn, is determined by the nature and course of the disease. At the same time, reducing the length of a patient’s stay in a bed and, consequently, increasing bed turnover largely depends on the quality of diagnosis, timely hospitalization, care and treatment in the hospital. The calculation of the indicator and its analysis should be carried out both for the hospital as a whole and for departments, bed profiles, and nosological forms. In accordance with planning standards for general urban hospitals, bed turnover is considered optimal within the range of 25 - 30, and for dispensaries - 8 - 10 patients per year.

Average length of stay for a patient in hospital (average bed day):

number of hospital stays spent by patients per year / number of people leaving (discharged + dead).

Like previous indicators, it is calculated both for the hospital as a whole and for departments, bed profiles, and individual diseases. The approximate standard for general hospitals is 14–17 days, taking into account the profile of beds, it is much higher (up to 180 days) (Table 14).

Table 14

Average number of days a patient stays in bed

The average bed day characterizes the organization and quality of the diagnostic and treatment process and indicates reserves for increasing the use of bed capacity. According to statistics, reducing the average length of stay in a bed by just one day would allow over 3 million additional patients to be hospitalized.

The value of this indicator largely depends on the type and profile of the hospital, the organization of its work, the quality of treatment, etc. One of the reasons for the long stay of patients in the hospital is insufficient examination and treatment in the clinic. Reducing the length of hospitalization, which frees up additional beds, should be carried out primarily taking into account the condition of the patients, since premature discharge can lead to re-hospitalization, which will ultimately result in an increase rather than a decrease in the indicator.

A significant decrease in the average hospital stay compared to the standard may indicate insufficient justification for reducing the length of hospitalization.

Proportion of rural residents among hospitalized patients (Section 3, subsection 1):

the number of rural residents hospitalized in a hospital per year x 100 / the number of all admitted to the hospital.

This indicator characterizes the use of city hospital beds by rural residents and affects the provision of inpatient medical care to the rural population of a given territory. In city hospitals it is 15–30%.

The average annual number of beds is calculated using the formula:

Ksr. = K01.01.+ (11)

where Ksr is the average annual number of beds;

K01.01 - number of beds at the beginning of the year;

Кн - number of new beds deployed;

m is the number of months of operation of the new bed in the first year. Barrels of the Ekaterinburg bathhouse

Thus, the average annual number of surgical beds in hospitals in rural areas:

Surgical beds: Csr.= 70+((86-70)*8 months/12)=81

Children's beds: Ksr.= 55+((60-55)*7/12)=58

Therapy beds: Ksr.= 60+((5-60)*8/12)=70

Maternity beds: Ksr.= 45+((45-45)*x/x)=45

Other beds: Ksr.= 75+((75-750)x/x)=75

The average annual number of surgical beds in cities will be:

Surgical beds: Ksr.= 85+((95-85)*5/12)=89

Children's beds: 90+((100-90)*8/12)=97

Therapeutic beds:130+((150-130)*9/12)=145

Maternity beds:120+((140-120)*4/12)=127

Other beds:90+((110-90)*2/12)=93

Number of bed days = number of days of bed operation * Ksr (12)

Surgical beds:81*310=25 110

Children's beds:58*315=18,270

Therapy beds:70*330=23,100

Maternity beds:45*320=14,400

Other beds:75*300=22,500

Surgical beds:89*310=27,590

Children's beds:97*305=29,585

Therapy beds:145*300=43,500

Maternity beds:127*310=39,370

Other beds:93*330=30,690

Amount of expenses per year on food = number of bed days* rate of expenses per 1 bed day on food (13)

Hospitals and dispensaries in rural areas:

Surgical beds: 25,110*25=627,750

Children's beds:18 270*24=438 480

Therapeutic beds:23 100*20=462 000

Maternity beds:14,400*21=302,400

Other beds:22,500*21=472,500

Total:2,303,130

Hospitals and dispensaries in cities:

Surgical beds: 27590*22=60980

Children's beds:29585*23=680455

Therapy beds:43500*21=913500

Maternity beds:39370*25=984250

Other beds:30690*20=613800

Total:606980+680455+913500+984250+613800=3798985

Amount of expenses per year on medicines = number of bed days* rate of expenses per 1 bed day on medicines (14)

Hospitals and dispensaries in rural areas:

Surgical beds: 25110*20=502200

Children's beds:18270*28=511560

Therapy beds:23100*19=438900

Maternity beds:14400*23=331200

Other beds:22500*25=562500

Total:502200+511560+438900+331200+562500=2346360

Hospitals and dispensaries in cities:

Surgical beds:27590*23=634570

Children's beds:29585*25=739625

Therapy beds:43500*22=957000

Maternity beds:39370*27=1062990

Other beds:30690*27=828630

Total:634570+739625+957000+1062990+828630=4222815

Table 9. Outpatient and proclinical visit plan. Medication Planning

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.

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 staff work, is important for characterizing the medical activity:

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

number of patients discharged (discharged + deaths)

The average bed day ranges from 17 to 19 days, but it cannot be used to estimate all hospitals. It is important for assessing the functioning of beds in specialized departments. The value of this indicator depends on the type and profile of the hospital, the organization of the hospital, the severity of the disease and the quality of the diagnostic and treatment process. The average bed day indicates reserves for improving the use of beds. By reducing the average length of stay of a patient in a bed, treatment costs are reduced, while at the same time reducing the duration of treatment allows hospitals to provide inpatient care to a larger number of patients with the same amount of budgetary allocations. In this case, public funds are used more efficiently (the so-called "conditional budget savings").

Indicator ACCOMPLISHMENT OF BED DAYS PLAN BY HOSPITAL it is determined:

number of actual bed days spent by patients× 100%

planned number of bed days

The planned number of bed days per year is determined by multiplying the average annual number of beds by the bed occupancy rate per year. Analysis of the implementation of planned bed performance indicators for the year is of great importance for the economic characteristics of the activities of hospital institutions.

Example: Budget expenses for a hospital with a capacity of 150 beds are 4,000,000 USD, including expenses for food and medicine - 1,000,000 USD. The average annual bed occupancy according to the standard is 330 days; in fact, 1 bed was occupied for 320 days, i.e. 97%. Underfulfillment - 3%: the hospital suffered economic losses associated with underfulfillment of the bed-day plan in the amount of 90,000 USD.

For assessing the work of a hospital it is important HOSPITAL MORTALITY RATE, which determines the percentage of deaths among all retired patients. This indicator depends on the profile of the department, i.e. the severity of the condition of incoming patients, the timeliness and adequacy of the treatment provided. It is advisable to use the indicator for equal departments. In addition, the mortality rate is calculated for a specific disease. It is important for determining the share of each nosology in the structure of mortality of all hospitalized patients. Since the majority of deaths occur in intensive care units, it is advisable to distinguish the mortality rate of this department from others.

Proper use of methods for calculating the relative performance indicators of health care facilities and the level of public health allows us to analyze the state of the health care system as a whole in the region, for individual health care facilities and their divisions. And based on the results obtained, optimal management decisions can be developed 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, only the total amount of appropriations for certain types and volumes of activities is limited with payment tariffs for a completed case, and the head of a 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 interpretations, it can 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, the resource and cost ratio;

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 of resources.

5. Analysis of the efficiency of using the final fund

Hospitals are the most expensive healthcare institutions, so rational use of bed capacity is of great importance. The idleness of hospital beds not only reduces the volume of hospital care and worsens the health care of the population as a whole, but also causes significant economic losses, since the cost of maintaining a hospital bed also occurs in cases where the beds are not functioning. The cost of an empty bed is 2/3 of the cost of maintaining an occupied bed. The lower cost per bed day occurs in those hospitals where the bed capacity is used most intensively. Reducing bed idling reduces hospital waste and reduces the cost of hospital beds.

The main reasons for the idle time of beds are the lack of a uniform intake of patients, bed vacancy 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: hospital bed turnover, average annual occupancy (work) of a bed, average idle time of beds, implementation of the hospital bed plan, average length of stay of a patient in a hospital. The data necessary for calculating the indicators can be obtained from the “Report of the medical institution” (form No. 30-health) and the “Record sheet for the movement of patients and hospital beds” (form No. 007 - y).

Hospital bed turnover is defined as the relation:

number of patients discharged (discharged + deaths) / average annual number of beds.

When calculating all indicators, the average annual number of beds must be taken as the bed capacity of the hospital.

This indicator characterizes the number of patients who were in a hospital bed during the year. In accordance with planning standards for city hospitals, it should be considered optimal within the range of 17 – 20.

The ability to serve one or another number of patients with one bed is determined hospital bed function (F), which is calculated as the quotient of the average annual occupancy of a bed taking into account its profile (D) by the average number of days a patient stays in a bed of the same profile (P).

For example, The average occupancy of a maternity bed (according to the standard) is 280 days, the average length of stay in a maternity bed according to the standard is 9.1 days. The function of an obstetric bed is:

F = D / P = 280 days / 9.1 days = 30.8 (31).

This means that an obstetric bed can serve 31 pregnant women during the year.

Average annual occupancy (work) of a hospital bed (actual employment) is calculated:

number of bed days actually spent by patients in the hospital / average annual number of beds.

This indicator is assessed by comparison with calculated standards. They are established separately for urban and rural hospital institutions, with clarification of this indicator for various specialties.

The optimal average annual bed occupancy can be calculated for each hospital separately, taking into account its bed capacity using the following formula:

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

N – average annual number of hospital beds.

For example, for a hospital with 250 beds, the optimal bed occupancy per year will be:

This indicator is used to determine the estimated cost of one bed day.

The average annual bed occupancy may be reduced due to forced downtime of beds (for example, due to repairs, quarantine, etc.). In order to eliminate the cause of underutilization of bed capacity in such cases, the performance indicator of a functioning bed is calculated, i.e., excluding downtime days. The calculation is made according to the following method:

1) calculate the average number of beds closed during the year due to repairs:

number of bed days closed for repairs / number of calendar days per year;

2) the average number of beds functioning during the year is determined:

average annual number of beds – the number of beds closed due to repairs.

The average number of days a bed is open per year, taking into account repairs, is calculated:

number of bed days actually spent by patients / number of beds functioning during the year (not closed for repairs).

Example. IN the hospital has 50 beds, the number of bed days actually spent by patients was 1250, the number of bed days closed for repairs was 4380. It is necessary to determine the average annual bed occupancy taking into account repairs:

1) average number of beds closed due to repairs:

4380 k/day / 365 = 12 beds;

2) average number of beds functioning during the year:

50 beds – 12 beds = 38 beds;

3) average annual occupancy of a functioning bed (including repairs)

1250 k/day / 38 beds = 329 days.

Thus, if repair days were not taken into account, the average annual bed occupancy would be only 250 days (1250 k/day / 50 beds = 250 days), which would indicate a large underutilization of bed capacity in the hospital.

The average bed idle time (due to turnover) is the time of “absenteeism” from the moment the bed is vacated by discharged patients until it is occupied by newly admitted patients.

T = (365 – D) / F,

where T is the downtime of a bed of a given profile due to turnover;

D – actual average annual occupancy of a bed of a given profile; F – rotation of the bed.

Example. The average downtime of a therapeutic hospital bed due to turnover with an average annual occupancy of 330 days and an average length of stay in a bed of 17.9 days will be:

F = D / P = 330 days / 17.9 days = 18.4.

T = (365 – D) / F = (365 – 330) / 18.4 = 1.9 days.

A simple bed larger than this standard causes economic damage. If the downtime is less than the standard (and with a very high average annual bed occupancy, T can take a negative value), this indicates an overload of the hospital and a violation of the sanitary regime of the bed.