Measurement of Hospital Services

Measurement of Hospital Services

Introduction

·       Hospitals are complex organizations providing diverse medical, nursing, diagnostic, and support services.

·       For effective planning, management, budgeting, performance evaluation, and quality improvement, it is essential to measure hospital services accurately.

·       Why measure hospital services?

• To assess the utilization of hospital resources (beds, staff, equipment).
• To evaluate efficiency and effectiveness of services.
• To provide a basis for comparison across departments, hospitals, and time.
• To guide policy decisions and optimize resource allocation.
• To ensure accountability and transparency.

·        Measurement can be done in terms of:

·        Inputs → resources consumed (e.g., beds, staff, drugs, finances).

·        Outputs → services delivered (e.g., admissions, outpatient visits, surgeries).

·        Outcomes → impact on patient health and satisfaction.

Inputs in Inpatient Department

Inputs are the resources that enable inpatient care:

1. Physical Resources
• Number of beds (general, ICU, specialty).
• Availability of operating theatres, ICUs, diagnostic labs.
• Infrastructure (wards, nursing stations, pharmacy).
2. Human Resources
• Doctors (resident doctors, consultants).
• Nursing staff.
• Allied health professionals (technicians, physiotherapists).
• Administrative and support staff.
3. Financial Resources
• Cost of drugs, medical consumables, equipment.
• Capital and operational expenses.
4. Other Inputs
• Utility services (water, power, sanitation).
• Information systems (EMR, HIS).

Outputs in Inpatient Department

Outputs reflect the services delivered to patients:

1. Service Utilization Indicators
• Number of admissions per month/year.
• Average length of stay (ALOS) = Total inpatient days ÷ Total discharges.
• Discharge rate = Discharges × 100 / Bed strength.
• Bed Occupancy Rate (BOR) = (Bed days utilized ÷ Bed days available) × 100.
• Turnover Interval (TOI) = (Bed days available – Bed days utilized) ÷ Number of discharges.
2. Quality Indicators
• Readmission rate within 30 days.
• Hospital-acquired infection rate.
• Surgical site infection rate.
• Inpatient mortality rate.
3. Specialized Outputs
• Number of surgeries performed.
• ICU admissions and outcomes.
• Number of deliveries (normal vs. C-section).

Example:
If a hospital has 200 beds and in one year:

• 70,000 bed days available (200 × 365).
• 50,000 bed days utilized.

Then, Bed Occupancy Rate = (50,000 ÷ 70,000) × 100 = 71.4%.

Inputs in OPD

Inputs determine OPD capacity and efficiency:

1. Physical Resources
• Number of consultation rooms.
• Diagnostic and treatment facilities (lab, imaging, minor OT).
• Waiting area and registration counters.
2. Human Resources
• Consultants and specialists.
• Residents and interns.
• Nurses and paramedical staff.
• Administrative staff (registration, billing).
3. Financial and Logistical Inputs
• Cost of consumables, drugs, and diagnostic support.
• IT systems for appointment and record management.

Outputs in OPD

OPD outputs are measured in terms of patient load, efficiency, and quality:

1. Service Utilization Indicators
• Number of OPD visits (daily, monthly, yearly).
• New vs. repeat patients ratio.
• Consultation time per patient.
• Average waiting time before consultation.
2. Quality and Performance Indicators
• Patient satisfaction scores.
• Referral rate to IPD (admissions from OPD).
• No-show rate (patients missing appointments).
3. Specialized Outputs
• Number of diagnostic tests advised.
• Number of procedures performed (e.g., endoscopy, dressings, immunizations).

Example:
If an OPD sees 1,000 patients/day, with 700 new and 300 follow-up cases:

• New patient ratio = 70%.
• Repeat patient ratio = 30%.

Tools & Methods for Measuring Hospital Services

• Hospital Information System (HIS) – digital data capture.
• Standardized indicators from WHO, NABH, and Joint Commission International (JCI).
• Hospital statistics – admission registers, OPD registers, discharge summaries.
• Patient feedback surveys – for quality and satisfaction.
• Benchmarking – comparing indicators with similar hospitals.

Video Description

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