Calculating and reporting health statistics Chapter 3

2. What is an intrahospital transfer ?

2. An Intranhospital transfers is where patients move from on PCU to another within the facility.

3. Is it possible that the transfers into a patient care unit may not equal the transfers out of the same patient care unit on the same day?

3. Yes

5. At 11:59 pm on Jan 1 the Community Hospital census was 321. On Jan 2 73. patients were admitted, 24 discharged , and 3 were admitted and died that day. In their ICU unit the census on the Jan 1 was admitted and later that day died in the ICU . Answer the following questions and round the answers to whole number. a. calculate the inpatient census for Jan 2 b. calculate the hospital daily inpatient census for Jan 2 c. calculate the ICU intranet service days for Jan 2

a. 370 (321+73)-24= 370 b. 373 (321+73)-24}+3=373 c. 14 (12+4)-3}+1=14

Exercise 3.9 This exercise consists of two worksheets for calculating a month's inpatient census and inpatient service days. Using the data provided for May 1, complete the first worksheet. If your findings do not match the data for May 31, you have made an error either in your column additions or on one or more of the horizontal lines above the total. You must correct this error to ensure the validity of the monthly totals. If the column additions are correct, continue on to the second worksheet for the recap. This exercise could be placed on an electronic spreadsheet. The answers (in bold) are on the following pages:

1 162 2 22 1 10 194 3 19 0 10 165 3 1 166 3 2 165 3 29 0 8 202 3 23 1 8 171 2 0 171 2 3 171 2 14 2 3 188 4 24 0 3 161 4 1 162 4 4 161 4 24 0 5 190 4 25 0 5 160 4 0 160 4 5 160 4 11 1 6 177 5 25 2 6 146 3 0 146 3 6 146 3 20 0 1 167 3 16 0 1 150 3 0 150 3 7 150 3 29 0 10 189 3 17 0 10 162 3 0 162 3 8 162 3 24 2 13 199 5 20 0 13 166 5 3 169 5 9 166 5 23 1 7 196 6 22 1 7 167 5 1 168 5 10 167 5 19 0 10 196 5 17 0 10 169 5 0 169 5 11 169 5 11 0 5 185 5 22 3 5 158 2 1 159 2 12 158 2 16 0 6 180 2 24 0 6 150 2 0 150 2 13 150 2 18 1 5 173 3 25 0 5 143 3 0 143 3 14 143 3 29 0 5 177 3 19 0 5 153 3 0 153 3 15 153 3 28 0 8 189 3 22 2 8 159 1 1 160 1 16 159 1 26 3 6 191 4 19 0 6 166 4 0 166 4 17 166 4 26 0 7 199 4 19 2 7 173 2 0 173 2 18 173 2 18 0 10 201 2 25 0 10 166 2 0 166 2 19 166 2 12 0 6 184 2 33 0 6 145 2 0 145 2 20 145 2 22 1 8 175 3 16 3 8 151 0 1 152 0 21 151 0 26 0 3 180 0 17 0 3 160 0 1 161 0 22 160 0 32 2 11 203 2 25 0 11 167 2 1 168 5 23 167 2 29 2 14 210 4 27 0 14 169 4 0 169 4 24 169 4 22 0 10 201 4 21 2 10 170 2 0 170 2 25 170 2 20 3 13 203 5 34 0 13 156 5 0 156 5 26 156 5 14 0 6 176 5 37 1 6 133 4 1 134 4 27 133 4 23 0 5 161 4 16 0 5 140 4 0 140 4 28 140 4 26 2 4 170 6 18 2 4 148 4 0 148 4 29 148 4 17 0 6 171 4 22 1 6 143 3 1 144 3 30 143 3 19 0 7 169 3 21 1 7 141 2 0 141 2 31 141 2 21 1 12 174 3 16 0 12 146 3 1 147 3 Tot 670 22 686 21 14 4868 91 Recap of Monthly Data for Adults and Children: May 20XX (Enter numbers from Worksheet #1) 12:01 a.m. Census A/C 162 Adm A/C + 670 Trf In + 230 Total A/C = 1,062 Disch A/C - 686 Trf Out - 230 11:59 p.m. Census A/C = 146 Recap of Monthly Data for Newborns: 12:01 a.m. Census NB 2 Bir + 22 Total NB = 24 Disch NB - 21 11:59 p.m. Census NB = 3 Serv Days A/C (total inpatient services days excluding newborns): 4,868 Serv days NB (total newborn service days): 91 Total inpatient service days: 4,959

Exercise 3.4 Given the following inpatient service days for a 65-bed hospital, what is the total number of inpatient service days provided in June? Date Inpatient Date Inpatient Date Inpatient June Service Days June Service Days June Service Days 1 62 11 58 21 63 2 62 12 57 22 59 3 63 13 55 23 52 4 61 14 52 24 56 5 59 15 51 25 54 6 58 16 49 26 58 7 60 17 54 27 53 8 61 18 56 28 54 9 64 19 58 29 59 10 59 20 59 30 63

1,729 The correct answer is 1,729, which is the result of adding all the inpatient service days in June. If students answered 58, they may be thinking ahead because 58 is the average of all the inpatient service days. If students answered 63, they gave the inpatient service days for only June 30. If student answers are different from the ones above, they may have simply made an error in their computation. Suggest that they use a calculator to check their arithmetic.

Exercise 3.10 Complete the following exercises. 1. Community Hospital has 200 beds and 25 newborn bassinets. The total inpatient service days for February, in a non-leap year, were 4,879 for adults and children and 658 for newborns. What is the average daily census (rounded to a whole number)? 2. A 150-bed, 15-bassinet hospital has 3,264 inpatient service days for adults and children and 365 newborn service days during November. What is the average daily census, excluding newborns? Round to a whole number. 3. Compute the average daily newborn census for a 100-bed, 10-bassinet hospital with 2,589 inpatient service days for adults and children and 257 inpatient service days for newborns during September. Round your answer to a whole number. 4. If you need to calculate the average daily census of the Surgical unit, where can you obtain the Surgical unit's inpatient service days? 5. Community Hospital's Burn unit has 7 beds. The inpatient service days for January were 199. What is the average daily census for the Burn unit during January? Round your answer to a whole number. 6. Community Hospital reports the following: Community Hospital December, 20XX Adults and children Nursery Beginning Census on December 1 86 8 Admissions 248 62 Discharges and deaths 217 59 Inpatient service days 2,022 248 a. Calculate the average daily inpatient census for adults and children. b. Calculate the average daily inpatient census for the nursery. c. What will the census for adults and children be at 11:59 p.m. on December 31? d. What will the newborn census be at 11:59 p.m. on December 31? 7. Go back to the information given in No. 1 and determine the newborn average daily census. Round to a whole number.

1. 174 174.25 = 174 If students arrived at any other answer, they should review these steps: 1. The numerator is 4,879 (adults and children only). 2. Divide the numerator by the number of days (denominator) in February (28). 3. Carry the answer to one place beyond the decimal and round back. If the decimal is less than .5, drop it when rounding; if the decimal is .5 or larger, add 1 to the whole number. Remember not to include newborn inpatient service days. Consider newborns separately. Watch the decimal point. In a 200-bed, 25-bassinet hospital, an average daily census of 21 or 2,099 would not make sense. An average daily census of 21 would mean the hospital has 179 empty beds every day. An average daily census of 2,099 would mean that 11 patients are in each bed every day. Always evaluate your answers for common sense. 2. 109 The average daily census, excluding newborns, is 109. The 3,264 inpatient service days for adults and children were divided by 30 (the number of days in November). If students answered 117, they may have divided by 28 (the number of days in February), instead of 30 (the number of days in November). They should exclude newborn inpatient service days. If students answered 108, they did not round to a whole number. If students answered 120, they either did not exclude newborn patient days from their calculations or made an error in computation. If they answered 129, they may have included newborn inpatient service days in their calculation in addition to dividing by 28 instead of 30. If students were unable to arrive at the correct answer, they should review the following steps: 1. Use only the adult and children inpatient service days. 2. Divide the inpatient service days by the number of days in November. 3. Round your answer to the nearest whole number. 4. Rework the problem and determine another answer. 3.9 The average daily newborn census is 9. Dividing 257 by 30 results in 8.5, which rounds up to 9. Students who answered 85 should recalculate and watch the decimal point. 4..The number of patients both admitted and discharged on that same day are added to the 11:59 p.m. census. This gives the inpatient service days for that particular PCU. Adding these over a period of time gives the total inpatient service days. This is not a new process but, rather, the same one followed for calculating total inpatient service days. 5.6 199 (inpatient service days)/31 (number of days in January) = 6.4 = 6 6. a.65 2,022/31 = 65.2 = 65 2,022 is the number of inpatient service days for the month. There are 31 days in December. b.8 248/31 = 8 There were 248 inpatient services days for December, and 31 days in December. c.117 86 + 248 - 217 = 117 Add the number of admissions to the census and subtract the discharges and deaths. d.11 8 + 62 - 59 = 11 7.24 There were 658 inpatient service days for February. Divide the inpatient services days by the number of days in February (28). 658/26 = 23.5

Exercise 3.1 Answer the following questions. 1. Unit A has a count of 20 patients at 1 a.m. on September 1 and 30 patients at the same time on September 2. Would the counts have been different if unit A had taken a census at 12:01 a.m. on both days? 2. Would you accept the different PCUs in the hospital taking censuses at different times as long as each unit is consistent within itself? 3. A patient transferred at 5 p.m. to unit A from unit B is counted in unit A's 12:01 a.m. census as one additional patient present. Would that patient still be included in unit B's 12:01 a.m. census?

1. Yes. The counts could have differed. Any number of admissions, discharges, or transfers could have occurred between 12 midnight and 1 a.m. on either day. 2. No. The total hospital census would be inconsistent. Every PCU in the hospital should follow the same administrative procedures. 3. No. The patient cannot be in two places at the same time. If both units are counting heads only once a day at midnight, the patient is counted as being present in unit A only. However, the patient is indicated in unit B's census as a transfer.

Exercise 3.2 Answer the following questions. 1. The census at 12:01 a.m. on June 1 is 107. Two patients are admitted on June 1 at 6:00 a.m. and discharged at 7:00 p.m. that same day. One patient admitted at 3:00 p.m. died at 5:30 p.m. the same afternoon. What is the PCU's daily census for June 1? 2. Which would be the better form of data to keep permanently, census or daily inpatient census? Why? 3. Community Hospital's census at 12:01 a.m. on September 16 was 256. On that day, eighteen patients were admitted and twenty-two patients were discharged. Calculate the census for September 16. 4. Community Hospital's ICU census at 12:01 a.m. on December 2 was 19. Four patients were admitted to the ICU on December 2, one was discharged to the medicine unit, and two patients died. Calculate the census for the ICU for December 2.

1. 110 107 + 3 = 110 The unit's daily census on June 1 is 110. If students answered 107, remind them that the daily inpatient census is not always the same as the census. It can differ (and often does) when patients come in after the 12:01 a.m. head count and are discharged before the next 12:01 a.m. head count. Patients who are both admitted and discharged on the same day must be included in the daily inpatient census. If students answered 105, remind them that the daily inpatient census includes patients who are both admitted and discharged on the same day and that death is considered a type of discharge. Thus, the patient who was admitted and died on the same day also is included in the daily inpatient census. 2.Daily inpatient census. In the previous exercise, for example, although only 107 patients are in the PCU at the time of the 12:01 a.m. census, the number of patients who actually received medical care in the unit on June 1 was 110. The daily inpatient census is the only way to really see the number of patients who received medical care. 3. 252 Add the number of admissions (18) and subtract the number of discharges (22) to the census from the previous day. The census for September 16 is 252. (256 + 18) - 22 = 252. 4. 20 To the beginning census of 19, add the number of admissions to the ICU (4) and subtract the number of patients who were discharged or transferred (1) or died (2) from the ICU census. The ending census for December 2 is 20. 19 + 4 (admissions) - 1 (transfer) - 2 (deaths) = 20

Chapter 3 Test 1. Differentiate between the terms inpatient census and daily inpatient census .

1. Inpatient census is the number of patients present. Daily inpatient census is the number of present at census taking and patient admitted after census taking and discharged before next census taking.

Exercise 3.5 Complete the following exercises. 1. The difference between the census and the inpatient daily census is that any patients admitted and discharged the same day are added to: a. The census to compute the daily census b. The 12:01 a.m. (or other designated time) head count to compute the daily census c. Both a and b d. None of the above 2. Which of the following should be used when calculating the number of inpatients who received service on a particular day? a. The census b. The daily census c. Total inpatient service days d. None of the above 3. The time for taking the inpatient census must always be: a. Midnight b. Consistent c. 12:00 p.m. d. 11:59 a.m. 4. At census-taking time, a patient who has been transferred into a unit is: a. Counted where he or she is b. Counted where he or she came from c. Not counted d. Counted in both units 5. Patient day or inpatient day is more correctly termed: a. Inpatient service day b. Daily inpatient census c. Total inpatient service day(s) d. Census 6. The inpatient census at 12:01 a.m. is 57. Two patients were admitted at 1 p.m. and one died at 3:15 p.m. and the other was discharged at 10:00 p.m. The inpatient service days for that day are: a. 50 b. 55 c. 57 d. 59 Add the 2 patients who were both admitted and discharged the same day to the inpatient census for the day. 7. Define the following terms. a. Census The number of inpatients present in a healthcare facility at any given time b. Daily census The number of inpatients present at the census-taking time each day, plus any inpatients who were both admitted after the previous census-taking time and discharged before the next census-taking time c. Inpatient service day A unit of measure equivalent to the services received by one inpatient during one 24-hour period d. Total inpatient service days The sum of all inpatient service days for each of the days during a specified period of time

1. c 2. c 3. b 4. a 5. a 6. d 7. a

Exercise 3.8 Two hundred adult and children were in the hospital at 12:01 a.m. on August 1. There were 42 newborns at 12:01 a.m. on August 1. During August, the following data are compiled: Admissions: Adults and children Newborns 1,567 97 Discharges (including deaths): Adults and children Newborns 1,572 107 1. What would the inpatient census for adults and children be on August 31 at 11:59 p.m.? 2. What would the inpatient census be for newborns on August 31? 3. Can the inpatient service days be computed with the information supplied in the previous question? Explain why or why not. 4. The surgery unit in Community Hospital has reported the following data. Do these data look correct? Explain. 12:01 a.m. Day census Adm Trf In Total Disch Trf 11:59 p.m. Out Census A/D Serv Days 6/1 50 6 3 59 9 1 49 1 50

1.patient census for adults and children at 11:59 p.m. on August 31, not including newborns should be 195. Add the adult and children admissions to the patients remaining (200), then subtract the adult and children discharges and deaths. Adult and children: [(200 + 1,567) - 1,572] = (1,767 - 1,572) = 195 2.32 The inpatient census for newborns should be 32. Add the newborn admissions to the remaining (42), then subtract the newborn discharges and deaths. Newborn: [(42 +97) - 107] = (139 - 107) = 32 3.The total number of patients admitted and discharged on the same day is needed to calculate inpatient service days. 4. The data are correct. Students who said the data were incorrect may have noted the difference between transfers in and transfers out. The unit does not have to balance; however, the entire hospital's transfers in and transfers out do have to balance. The absence of newborns is attributed to the fact that a surgical unit would not have newborns. If a newborn is transferred to a surgical unit for an operation, he or she is then reclassified as a surgical patient.

4. When must transfers in and transfer out equal.

4. The transfer in number must match the transfer out number.

Exercise 3.7 Using the information supplied for June 1, fill in the blanks in the table below.

6/1 250 18 20 4 2 272 22 25 3 2 245 19 1 246 19 6/2 245 19 22 6 1 268 25 24 5 1 243 20 0 243 20 6/3 243 20 24 5 0 267 25 23 4 0 244 21 3 247 21 6/4 244 21 22 3 1 267 24 22 3 1 244 21 1 245 21 6/5 244 21 25 4 2 271 25 25 3 2 244 22 2 246 22

Exercise 3.6 Complete the following exercises. 1. Using the data given on page 31, calculate the census for June 2. Then fill in the blanks in the table below. Did the transfers in and transfers out balance? 2. What data will you use to begin June 3, and why? June 3 will begin with 48 and 1. The 11:59 p.m. census at the close of one day is the inpatient census at the beginning of the next day. 3. Fill in the blanks in the table below. What are the inpatient service days for June 2 and 3? 4. Would a newborn ever be considered an a/d? 5. At this point, you have inpatient service days for three successive days. The total of these data, excluding newborns, for June 1, 2, and 3 is 145 (50 + 49 + 46). What will you need to know and do to get the hospital total inpatient service days for the entire month of June?

Exercise 3.6 Complete the following exercises. 1. Using the data given on page 31, calculate the census for June 2. Then fill in the blanks in the table below. Did the transfers in and transfers out balance? 49 A/C, 1 Nb; 54 A/C, 2 Nb; 48 A/C, 1 Nb. The 49 adults and children and one newborn remaining from June 1 should becarried to the beginning of June 2; admissions, births, and transfers should be added in for a total of 54 and 2; and discharges and transfers out should be subtracted for a census of 48 adults and children and one newborn. Yes, the transfers in (2) and transfers out (2) did balance. If students had any other answer, they may have calculated incorrectly. Have them review the following questions to help clarify the procedure: 1. Did you carry down the previous night's census to begin June 2? The 11:59 p.m. census at the close of one day is the inpatient census for the beginning of the next day. Thus, June 2 begins with the ending census for June 1 (49 A/C, 1 Nb). 2. Did you add the admissions (3) and transfers in (2) to the adults and children (49) remaining? 3. Did you add the June 2 birth (1) to the newborn remaining (1)? 4. Did you subtract the discharged adults and children (4) and transfers out (2) from the total A/C (54 - 6 = 48)? 5. Did you subtract the newborn discharges (1) from the total newborns (2 - 1 = 1)? 6. Did you add and subtract correctly? 2. The 11:59 p.m. census at the close of one day is the inpatient census at the beginning of the next day. 3. 12:01 am. census Day A/C Nb adm A/C b trf in total dis A/C Nb A/C dis Nb trf out 11:59 p.m. census A/C Nb a/d serv days A/C Nb 6/1 48 2 2 1 1 51 3 1 2 1 49 1 1 50 1 6/2 49 1 3 1 2 54 2 4 1 2 48 1 1 6/3 1 1 1 3 0 1 0 49 A/C, 1 Nb; 46 A/C, 2 Nb. The patients admitted and discharged on the same day should be added to the 11:59 p.m. census data for each day to compute the inpatient service days. If students had any other answer, they should review the following steps: 1. Begin June 2 with the number of patients remaining (11:59 p.m. census), not the number of inpatient service days. 2. Add the number of admissions and transfers in and subtract the number of 3. discharges and transfers out. 4. Add the number of remaining patients admitted and discharged on the same day to the 11:59 p.m. census at the end of each day for the inpatient service days without newborns. 5. Carry the newborns from the 11:59 p.m. census to the inpatient service days column. Each newborn is counted as a service day, too. 6. Begin June 3 with the patients remaining (11:59 p.m. census) from the previous day. June 3 should read across: 48 A/C, 1 Nb; 1A/C; 1 b; 1 trf in; 50 A/C; 2 Nb; 3 dis A/C; 0 Nb dis; 1 trf out; 46 A/C; 2 Nb; 0 a/d. 7. Because no patients were admitted and discharged on June 3, the 11:59 p.m. census equals inpatient service days for June 3. The layout below is correct. 12:01 am. census Day A/C Nb adm A/C b trf in total dis A/C Nb A/C dis Nb 11:59 p.m. trf census out A/C Nb serv days a/d A/C Nb 6/1 48 2 2 1 1 51 3 1 2 1 49 1 1 50 1 6/2 49 1 3 1 2 54 2 4 1 2 48 1 1 49 1 6/3 48 1 1 1 1 50 2 3 0 1 46 2 0 46 2 4. Yes, if he or she were born and died between census-taking times on two successive days. A newborn transferred out of or discharged from the hospital on the same day he or she was born also could be considered an a/d. 5. Students need to calculate the inpatient service days for each of the remaining 27 days of June, and then total the data from the column of inpatient service days for all 30 days of the month.

Using the Statistics from the following monthly report from the nursing administration of Community Hospital m, an acute care faculty, calculate the current months June average daily inpatient census for each nursing unit and the total .

Inpatient service days / # of Days = average daily inpatient census a. 520/30= 17 b. 87/30= 3 c. 6176/30=206 d. 383/30= 13 e. 307/30= 10 f. 603/30= 20 g. 725/30= 24 h. 213/30= 7 i. 475/30= 16 j. 135/30= 5 k. 408/30= 14

Exercise 3.3 Compare the definition of inpatient service day to the definitions of inpatient daily census and census. Will the figure representing an inpatient service day for any one day be the same as the figure for a daily cesus or census?

Yes. Inpatient daily census will be the same as the figure representing an inpatient service day for any one day. The census represents the number of patients present in the hospital at any one time; it does not refer to the census-taking hour nor does it reflect the patients admitted and discharged the same day. Students are working with the same data in each case and calculating the same answer. The difference is that inpatient service day is a unit of measure (of service given). Therefore, the term inpatient service days is used here as a measuring device for all computations based on census. This may seem merely a trap in terminology, but there is a fine distinction between a term that represents a total (daily census) and one that represents a unit of measure (inpatient service day), even though they are the same numerically. A comparable situation might be that of measuring personnel service with man-hours instead of hours worked.

6. In 20XX a hospital had 150 beds for adults and children from Jan 1 through June 30 . On July 1 the hospital increased its beds to 200 and the number remained at 200 through Dec 31 . During the first six months number remained at 200 through Dec 3 . During the first six months 27813 patient days of service were provided to the hospitals adults and children . During the last six months 35873 days of service were provided . a. what was the average daily inpatient census for the first six month : 153,154,155 or 156 b. What was the average daily inpatient census for the entire year : 173,174,175,193 c. The same hospital provided 7890 newborn days of service in its 30 bassinets nursery during the year . What was the average daily newborn census :20,21,22 or 23 d. The same hospital surgery unit has 45 beds During July the unit provided 2002 days of service . What was the average daily inpatient census for the surgery unity in July : 60,62,63 or 65

a. 27813/181= 154 b. 27813+35873(63686)/ 365= 174 c. 7890/365 = 22 d. 2002/31 = 65