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Introduction to Health Statistics Learning Objectives At the conclusion of this chapter, you should be able to do the following: Recommend healthcare statistics e Assess sources of data o Compare and contrast between data and information, validity and reliability, descriptive and inferential statistics, and primary and secondary data sources ! Determine the users of healthcare statistics Key Terms Agency for Healthcare Research and Descriptive statistics Nursing facility _ Quality (AHRQ) Encounter Outpatient Ambulatory care facility Home health (HH) Primary data source Census Hospice Secondary data source Centers for Disease Control and Inferential statistics Visit Prevention (CDCQ) Inpatient Vital statistics Cenler§ for Medicare and Medicaid Inpatient census World Health Organization (WHO) Services (CMS) Managed care organization (MCO) :11: term statistics has two meanings. First, it is a number computed from a larger group of numbers, which collectively Stitute a sample of data—for instance, the average number of days that patients stay in the hospital overnight. Second, statistics i . f . . o o an;:;tzliCS lsd rr:ore broadly defined as a branch of mathematics concerned with collecting, organizing, summarizing, and - ng data, Statistics L ‘.\‘A‘P_‘ Originall .y Y, the term statistics referred to the collection of data about and for the “state.” The word comes from the Italian Word stato, meaning « ) ng “state.” One need only think of i istics- i izati 8s the Bureau of Labor Sl y our own government and its statistics-collecting organizations, such and Medicaid Services (CM stics, the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare S), for example.
m Chapter 1 Introduction to Health Statistics Health statistics provide information about the health of people and their use of healthcare services. Examples of healthcare statistics include average longevity; birth rates; death rates; number of people with a disease in a county, state, the US as a whole, or the world; and the frequency of usage of a particular type of service within a healthcare organization. Reasons for Studying Statistics Statistics is about using data for decision-making, which is required in every area of our lives. To make decisions, we must have information. In healthcare settings, information is often incomplete. As a result, we must learn to estimate the characteristics of a complete population using statistics based on a subset or sample of the population. Most organizations keep statistics to make decisions about their business. For example, an organization may use statistics to determine its markets; that is, to identify who is buying its products or using its services to decide how it can increase the availability and variety of products and services. Healthcare organizations use statistics to determine the use and cost of services as well as outcomes of patients. Many examples of healthcare data and statistics will be presented in this text. Healthcare Operations Needs In the healthcare industry, there are compelling reasons to collect and analyze data and compute statistics. For example, statistics kept on activities in the healthcare facility indicate why patients come to the facility and the costs of taking care of them. Patient care statistics and comparison of the values for different providers may be used to measure the quality of care provided. Many accrediting agencies require a data analysis system as part of accreditation, and many third-party payers require facilities to collect performance data. Organizational leadership also may use statistics for prioritizing needed services and to identify areas where efficiency and effectiveness might be increased. For example, laboratory data may show that most outpatients come in for blood work early in the day, so the lab may add more staff in the morning hours. Additionally, healthcare facilities are interested in the types of patients they have with respect to their diagnoses in order to maintain the optimum physician specialty and other professional staff mix they need to treat their patients. Public Health Needs Government agencies also need to maintain statistics on and about the population in order to provide services. For example, the CDC, a division of the Department of Health and Human Services (HHS), is recognized as the lead agency responsible for protecting the health of the US population by providing credible information to help individuals make the right healthcare decisions and promoting quality of life through the prevention and control of disease, injury, and disability (CDC 2019). The organization compiles and uses health statistics, such as birth and death statistics, to understand the conditions of life and health in our country. CMS is the division of HHS that is responsible for administering the Medicare program and the federal portion of the Medicaid program. CMS also publishes information on death rates among Medicare patients, and patients in diagnosis and procedure categories. Researchers use this information for studies, which may lead to improvement in patient care and services. The Agency for Healthcare Research and Quality (AHRQ), a part of HHS, tries to make healthcare safer; of higher quality; and more accessible, equitable, and affordable. For example, AHRQ publishes research-based fact sheets for patients and consumers on a variety of issues, such as patient safety and reducing errors when a patient is in the hospital. AHRQ also works within HHS and with other partners to make sure that the data and statistics are understood and used. AHRQ conducts research on the elderly, children, and various healthcare conditions to provide information to consumers and other HHS agencies so they may meet their objectives. For example, their work around how to reduce readmissions is intended to help hospitals by providing tools to identify causes of readmissions and aid in the development of prevention strategies (AHRQ 2017). g The World Health Organization (WHO), an international organization founded by the United Nations (UN), 18 the directing and coordinating authority on international health within the UN’s system. WHO provides leadership on critical health matters, works to support countries to ensure all of their citizens have accessible and safe healthcar® and helps prevent the spread of communicable diseases, especially vaccine-preventable diseases. They support gOOd health through the continuum of life and are working toward reducing quality of life disparities among countries: WHO supports healthcare research in maternal, child, and adolescent health; malaria; tuberculosis; HIV; Ebola; an Sources of Healthcare Statistics m other global healthcare issues (WHO 2019). For example, in 1988, WHO helped launch the Global Polio Eradication Initiative to help protect all children from polio. As a result of this immunization initiative, the number of polio cases has dropped by 99 percent. Today, 80 percent of the world’s population lives in polio-free regions (WHO 2019). importance of Data To obtain the knowledge they need to make decisions, organizations first must determine Wha:t data to gollect. Data are raw facts and figures that can pertain to a process or activity that an organization is interested in measuring. Inforn_uanon is derived from data for the purpose of making decisions. The data used to calculate these statistics must bc? .Vahd and reliable. Validity answers the question of whether one measured what one intended to measure, and rehab_111ty means that there is some consistency or ability to replicate results. For example, if a supervisor is checking the coding work of a new employee, the codes assigned should be the same for the supervisor as they were for the employee for the results to be considered reliable. Descriptive Statistics Versus Inferential Statistics e ———— The primary focus of descriptive statistics is to organize and describe the features of data in a study. Descriptive statistics describe what the data show about the characteristics of a group or population; in other words, they may be used to describe a particular population. For example, it might be necessary to know the average age of patients or which service is used most in a given facility. A database including the age of each patient may be useq to calculate the descriptive statistic average age. Inferential statistics, on the other hand, help organizations make inferences or decisions about a larger group of data by drawing conclusions from a small group of the population. The smaller group selected from the population is called a sample. The results obtained from the sample, if gathered carefully, are assumed to be representative of the entire population. Both types of statistics are used in healthcare. Sources of Healthcare Statistics e —————————— Healthcare data are derived from both primary and secondary data sources. It is important to understand the source of the data prior to using it to compute statistics for use in decision-making. Primary Data Sources In healthcare, primary data source refers to the record that was developed by healthcare professionals in the process of providing care or services to a patient. Health records are one of the most important primary sources of health statistics because they contain a systematic record of a patient’s medical history and care. The patient’s health record contains administrative data, such as admission and discharge dates, patient data, and billing data, as well as clinical data. Notes from physicians, such as orders, progress notes, operative reports, history and physical examination, and a discharge summary, may be included. Nurses’ documentation includes their notes and assessments on admission and throughout the hospital stay and medication records. Reports from clinical departments 1 the facility, such as laboratory, blood bank, radiology, pharmacy, rehabilitation services, and dietary services, may also be inf:luded in the health record. depal;{t?fiz::flmc;ep;nments also keep statistics on the activities they per'form for patients. For example, thfe: lllaboratfiry B o h')’ eep data on the_number of lab tests performed. The r?xd.lology department may keep track of the number decide wheth 1p X-rays. Th.e- physical t.herapy department may use statlstlc.al datg, such as thfe number of patient visits, to sed in tunn ;r l:;1 hire additional physical therapists or add ph-y§1cal therapist assistants to their staff. These reports may be produce y the managers of the departments for productivity measurement apd combined with other departments to areport of activity for the entire facility. The administration of a hospital might ask staff to keep data on the number of pati ) . o ‘5 1ents transferred to another hospital for procedures the facility does not offer in order to determine the need for that 1Ce at the facility. Another exam Of the Nationa] Ceple of a primary source of data is vital statistics. The National Vital Statistics System (NVSS) is part nter for Health Statistics (NCHS) of the CDC. These data are provided to the NCHS throughout the
m Chapter 1 Introduction to Health Statistics 50 states; Washington, DC; New York City; and the five territories of the US —Puerto Rico, the US Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands. Vital statistics refers to a special group of statistics that record important events in our lives, such as birth, marriage, death, divorce, and fetal death (CDC 2019). Healthcare facilities are interested in births and deaths, fetal deaths, and induced terminations of pregnancy to drive quality improvement initiatives. Facilities generally are responsible for completing certificates for births, fetal deaths, abortions, and occasionally, death certificates. All states have laws that require this data. The certificates are reported to the individual state registrars and maintained permanently. State vital statistics registrars compile the data and report them to the NCHS. The NCHS has developed standard certificates and procedures that states and territories must use to facilitate the reliable collection of data. The standard certificates represent the minimum basic data set necessary for the collection and publication of comparable national, state, and local vital statistics data. The standard forms are revised about every 10 to 15 years, and the latest adoption to the 2003 revisions of the US Standards Certificate of Live Birth were completed in 2015. The NCHS is currently working on the development of an e-Vital Standards Initiative (NCHS 2015) that will provide support for the development of vital statistics standards to enable an exchange of data regarding births and deaths from a healthcare facility’s electronic health record system directly to the state registrar and then to the NCHS. Data from the states and territories provide important information for use in medical research and are extremely valuable in estimating population growth areas of the country and essential in planning and evaluating maternal and child health programs. The NCHS prepares and publishes national statistics based on vital statistics data because the figures are important in the fields of social welfare and public health. Because of their many uses, the data on these certificates must be complete, reliable, and accurate. Censuses Another primary source of health data is the census. A census is defined as a survey of a population. The US government conducts a population census; that is, a count of the people residing in the US and their location. The US Constitution requires that a population census be taken decennially (every 10 years), mainly to determine the number of congressional representatives in the states. Over the years, Congress has authorized gathering more information about each person. The census now is used in many ways. For instance, the amount of government money given to school districts is based partly on the number of children in a district. Congress also has requested that other types of censuses be taken periodically. These include a census of the types of businesses and industries in the US; for example, farms and fisheries and construction, foreign trade, manufacturing, and energy companies. Aggregated census data, or data that have been clustered together, are available to the public. Healthcare researchers use the US census when they want to determine statistics about the population at large. For example, if resecarchers want to show the rate of maternal deaths in a population, they must know information about the size of the population, which the US census provides. Healthcare facilities also have a census, which is the count of patients present at a specific time and place. A hospital inpatient is a patient who is provided with room, board, and continuous general nursing services in an area of an acute- care facility where patients generally stay at least overnight. In hospitals, this census is referred to as the inpatient census. The hospital census is a source of primary data. Ambulatory care facilities also may keep a census. An ambulatory care facility is a healthcare facility that provides preventive or corrective healthcare services on a nonresident basis in a provider’s office, clinic setting, or outpatient setting. Patients treated in a hospital setting such as the emergency department or clinic are classified as outpatient. The census for this setting usually represents the number of visits or encounters during a specified period, usually one day. A visit is a single encounter with a healthcare professional that includes all the services supplied during the encounter. An encounter is defined as the direct personal contact between 2 patient and a physician or other person authorized by state licensure and, if applicable, by medical staff bylaws to order or furnish healthcare services for the diagnosis or treatment of the patient. Secondary Data Sources Secondary data sources are data derived from primary sources and may be reported by someone other than the primary user. For example, the disease and operation index is a secondary source of data. The disease index is a listing © patients discharged with a specific diagnosis code, and an operation index is similar to the disease index, but the patients are listed by the operation or procedure code. All data in the index comes f_ro.m a prim;}ry data source, the health Registries are also considered secondary data sources. A registry is a listing of patients who share‘a common characteristic. For example, data from patients’ health records may be used to f:re'ate a cancer or trauma Feglstry.’l_‘l'us is a listing of patients in the facility who have been diagnosed with cancer and will include their treatment information as well as follow-up information. record. Users of Health Statistics n e Exercise 1.1 Identify the following as either a primary or a secondary data source: Type of Healthcare Data il 2. 3. 4. 5. 6. 7. Type of Data Source Productivity reports pulled from patient visit report Tumor registry State vital statistics Hospital census Hospital disease index Patient health record Health insurance data pulled from national census Users of Health Statistics All healthcare entities and third-party payers collect and use statistics. Following are examples of individuals and organizations that collect statistics and how they use statistics: o Hospital leadership: Inpatient facilities use health statistics to help address staffing issues and to determine the types of services to provide. For example, if the number of patients in the intensive care unit is increasing, .the hospital administration may want to consider adding beds and staff to meet the growing need. Conver§ely, if a request is made to the hospital administration for new facilities and equipment that cannot be substamlatt':c.l _by the statistics, it is unlikely the request will be granted. Quality management departments in healtlgcare facnhtu?s collect data to determine how the facility is performing regarding patient care and how it can improve _thenr patient care services. Leaders also use statistics to determine if they have the correct mix of medical specialties to treat the citizens in their communities. Healthcare department managers: Individual department managers in healthcare organizations use statistics to implement their department goals. For example, a manager needs to know if he or she is staying within budget. If not, the manager will need to investigate. Cancer registries: A cancer registry may be maintained by a separate department or may be a functiop of the health information department. States may also have a state cancer registry that is responsible for collectmg.data about cancer. A cancer registry collects data about the diagnosis, treatment, and follow-up of cancer pgtlepts. These statistics are important in tracking cancer survival rates. Facilities may choose to undergo accred.ltatlon through the American College of Surgeons Commission on Cancer (ACS 2019). This is an evaluation by an independent team to determine whether the facility’s cancer registry meets their standards, which guide treatment and ensure patient-centered care. Statistics must show the facility is providing high-quality care and f°"°w"~}P to its cancer patients. Physicians and researchers conduct research studies to learn about the biology of eancer, investigate new treatments and tests, and learn how to prevent cancers from occurring. ':I‘“_'Sing i:acililies: Long-term care (LTC) or nursing facilities may use statistics to determine the types of payers CIr patients have. These statistics also are helpful in demonstrating to the public the types of patients being
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m Chapter 1 Introduction to Health Statistics cared for and the quality of care given. For example, an LTC facility will collect data on the number of patients who are incontinent. This will tell the facility if protocols need to be established for patients in order to help them void. The American Health Care Association, a nonprofit association of LTC associations, publishes statistics on the trends in nursing home care. e Home health (HH): HH agencies provide care to elderly, disabled, and convalescent patients in their homes. This is also called home care. These agencies keep statistics to determine the types of services used by their patients and their outcomes. For example, a HH agency would need to know the number of nursing visits, HH aide visits, physical therapy treatments, and patients using various types of equipment, such as oxygen machines or other respiratory aids. Additionally, agencies will report patient outcomes, such as the number of patients who have improved, the number of patients who were compliant with taking their medications, or the number of patients who had to be readmitted to a hospital. e Hospice: Hospice programs provide interdisciplinary programs of palliative care and supportive services that address the physical, spiritual, social, and economic needs of terminally ill patients and their families. These services may be given in either the home or an inpatient setting. A hospice needs to know types of illnesses in order to match the appropriate caregiver with each patient. e Mental health facilities: These may be inpatient or outpatient facilities. These facilities use health statistics to determine whether they are providing the proper services for patients in the community. Because the economic burden of psychiatric illness is great, the CDC collects data about mental illness and its impact on the country. e Drug and alcohol facilities: These programs may be inpatient, ambulatory, or a combination of the two. Statistics are important in this area to show the success rates of these facilities’ clients. The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism are centers in the National Institutes of Health that each collect statistics to conduct research. e Qutpatient facilities: These include physician clinics, surgery centers, emergency centers, and the like. Outpatient facilities often use statistics to determine whether they are providing the proper level of care to the community. e Managed care organizations (MCOs): An MCO is a type of healthcare organization that delivers medical care and manages all aspects of care or payment for care by controlling access to providers of care and negotiating discounted payment rates to providers of care. MCOs use statistics to determine whether they are providing an appropriate level of care and preventive services to their members. Additionally, MCOs contract with healthcare facilities to provide specific services to their members at a prenegotiated rate. The MCO pays the agreed-upon amount each time a member uses the service. e Healthcare researchers: Researchers depend on healthcare statistics to conduct research and help develop solutions to healthcare problems. Some examples include research in managed care, health law and regulations, mergers and acquisitions of healthcare facilities, physician practice issues, different types of illness and risk factors, telehealth issues, pharmaceutical research, drug and alcohol research, and so on. Healthcare statistics can also help researchers understand our quality of life. e Accreditation agencies: These organizations use healthcare statistics to determine the most common diagnoses and procedures and whether the resources are available to treat patients with those diagnoses. ¢ Federal government: The US government collects data for public health issues. For example, the CDC reports data on births, deaths, birth defects, cancer, and HIV/AIDS, just to name a few of the categories of data. CMS uses data collected by quality improvement organizations for its quality improvement projects. Legislators and other policymakers use healthcare statistics when working on new laws, conducting program oversight, and considering the amount of the budget that should be allotted to federal health agencies. Because health information management (HIM) professionals have a broad knowledge of healthcare facilities as well as immediate access to a wide range of clinical data, they are in the best position to collect, prepare analyze, and interpret healthcare data. HIM professionals must learn acceptable terminology, definitions, an computational methodology if they are to provide the basic and most frequently used health statistics. One important point to remember is that health statistics are dependent upon accurate reporting by those individuals responsible for the task. Chapter 1 Review n Chaptel' 1 MatChing QUiZ e Match the definitions with the terms. pefinitions: b. A type of healthcare organization that delivers medical care and manages all aspects of care or payment for care by controlling access to providers of care and negotiating discounted payment rates to providers of care A comprehensive term for facilities that provide nursing care and related services for residents requiring medical, nursing, or rehabilitative care The direct personal contact between a patient and a physician or other person authorized by state licensure law and, if applicable, by medical staff bylaws to order or furnish healthcare services for the diagnosis or treatment of the patient . A group of federal agencies that oversecs health promotion and disease control and prevention activities in the US An interdisciplinary program of palliative care and supportive services that addresses the physical, spiritual, social, and economic needs of terminally ill patients and their families Data related to births, deaths, marriages, and fetal deaths An umbrella term that refers to the medical and nonmedical services provided to patients and their families in their places of residence . Record developed by healthcare professionals in the process of providing patient care The UN’s specialized agency created to ensure the attainment or the highest possible levels of health by all peoples Data derived from the primary patient record, such as an index or registry Terms: Secondary data source Encounter __ Nursing facility WHO Home health Hospice Vital statistics MCO 1 R R S ©v ® N o Health record Chapter 1 Review e e L) Select the best answer to the following questions: 1. The CDC is the lead agency that . a. Accredits and licenses acute hospital facilities in the US b. Is responsible for providing vital statistics to various agencies, such as the NCHS C. Develops and updates ICD-10 for the world d. Isresponsible for protecting the health of the people of the US The type of statistics that make conclusions about a population by drawing conclusions from a sample 1s called a. Descriptive statistics - Inferential statistics Generalized statistics - Mathematical statistics an o
m Chapter 1 Introduction to Health Statistics 10. - Which of the following is a primary source of data? Inpatient census Vital statistics collected by the NCHS Health record a, b,and c P AN b and c only - The division of HHS that is responsible for administering the Medicare program is the a. CDC b. CMS ¢. AHRQ d. WHO . A secondary data source includes a. Vital statistics b. The health record €. The physician’s index d. A videotape of a counseling session - Which user of statistics has the primary job of supporting terminally ill patients and their families? a. Home health agencies b. Nursing facilities €. Hospice d. MCOs . The NCHS keeps statistics on a. The licensing information on all healthcare providers in the 50 states b. Cancer and other deadly diseases in the 50 states and the US-owned territories €. Vital statistics, such as births, deaths, and fetal deaths, in North America d. Vital statistics, such as births, deaths, and fetal deaths, in the 50 states and US territories Which of the following is not a primary source of data? a. Health record b. Vital statistics €. Hospital census d. Disease and operation index To be useful, the data used to calculate statistics must be a. Fair and exact b. Valid and reliable €. Honest and justified d. Simple and clear To be reliable, statistical data must a. Be reproducible b. Be applicable to what is being measured ¢. Be collected from one source only d. Have multiple meanings 11. 12. 13. 14. 15. Chapter 1 Review n Which of the following is a secondary use of a patient health record? a. Determining the results of a diagnostic test b. Identifying patients that have a cancer diagnosis ¢. Recording the health and physician information during an office visit d. Submitting diagnoses and procedures for claim submission Facilities may choose to pursue accreditation for their cancer registry with the a. American College of Physicians b. American Cancer Society c¢. American College of Surgeons d. National Institutes of Health The type of patient who receives care in a hospital-based clinic or department is called a(n) a. Inpatient b. Outpatient c. Hospice patient d. MCO patient The number of inpatients present in a healthcare facility at any given time is called a(n) a. Survey b. Census ¢. Sample d. Enumeration ' An international organization founded by the UN that is the directing and coordinating authority on international heath is called the a. CDC b. AHRQ c¢. NCHS d. WHO
ematics Review Learning Objectives At the conclusion of this chapter, you should be able to do the following: e Calculate using decimals, ratios, proportions, rates, and percentages Differentiate between a numerator and denominator Perform rounding of numbers / o Determine the proper methods to convert among fractions, decimals and percentages e Compute the average or mean Key Terms Average Numerator Ratio Decimal Percentage Rounding Denominator Proportion Whole number Fraction Quotient Mean Rate g‘:lfnbers may b_e expressed in a variety of ways for use in calculating statistics. As discussed in the previous chapter, rcv? anf(rl statistics are needed to help healthcare organizations make decisions. The following sections explain and willew actions, quf)tlents, decimals, proportions, how to round numbers, percentages, ratios, rates, and averages. We Kie these statistics in subsequent chapters. s bOlSel .hezfithcare data are collected and tabulated using software. There are a number of spreadsheet products fOrmzminm t ; tina.rket thgt may be used for this purpose: Microsoft Excel, Google Sheets, and Apple Numbers. The using M; cgr ::1 : ;s1c functlona.hty are very similar among these data tools. The examples in this text will be presented Standard by 21 ;n Xcg:l. Exct:)el is the most utilized spreadsheet program in the market and is considered an industry i y. dome basic con i i i i i subsequent i~ cepts of spreadsheets will be introduced in this chapter and expanded upon in Fractions e A fraction i 1 1S one or m, . the secong shows oneore parts of a whole. Figure 2.1 shows two circles; the first circle is split into two equal parts, and the secong circle (in dfr?(rt of the c‘ircle larger than the other part. The fraction of the first circle is ¥; the fraction of €r color) is %. The top number is called the numerator and the bottom number is called the
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n Chapter 2 Mathematics Review Figure 2.1. Fractions of a circle e ) i 4 denominator. The denominator tells us how many equal parts a whole is broken into. For example, if we have a fraction of %, the denominator is 2. That indicates there are two equal parts that make up the whole. The numerator tells us how many parts of the whole we have selected. In the fraction %, 1 of the two equal parts were selected. In figure 2.1, the first circle shows one part shaded black of the two equal parts. We can say that % or one out of the two parts is shaded black. The second circle in figure 2.1 depicts three out of four equal parts is selected and shaded in black. This represents % of the circle. Source: OAHIMA Example 2.1: Of the 40 patients with diabetes seen last month in a physician’s clinic, 20 were Caucasian, 10 were African American, and 10 were Asian American. The following fractions show the number of patients of each race compared with the total number of patients who visited the clinic: Caucasian, 2; African American, ; and Asian American, 4. Fractions should be converted to their simplest form. The simplest form of a fraction is when the numerator and denominator do not have any common factors. Each fraction can be converted by dividing both top (numerator) and bottom (denominator) by a common factor. In this example, 10 is a factor of both the numerator and the denominator: Caucasians, %; African American, 1; and Asian American, ;. The first fraction can be further simplified with the common factor of 2; thus, 2 can be expressed as 1. Factors are numbers that you multiply together to get another number. For example, 2 and 3 are factors of 6 (2 times 3 equals 6). If two numbers can be formed by using some of the same factors, those are called common factors. For “w example, 2x3=6 and 2x5=10, therefore 2 is a common factor of both 6 and 10. Exercise 2.1 Find the simplest form of each of the following fractions: . 20 40 2. 4 6 3, 12 54 3. 8 12 5. 16 28 vecimols - [EER Quotient M— A quotient is the number obtained by dividing the numerator of a fraction by the denominator. This number.n.lay be expressed in decimals. As a simple example, consider the fraction %2 (one half). Using your calculator, divide 1 by 2. The result is 0.5. This is a decimal representation of the quotient found by dividing the numerator 1 by the denominator 2. gxample 2.2: The 14 members of your health information class decide to participate in your college’s information day. The booth is going to be open for 21 hours over a three-day period. To find out how many _hours each student would need to attend to the booth, you would divide the numerator (21 hours) by the denominator (14 students). This could be expressed as a fraction, 21/14, or 3/2 when simplified by removing the common factor of 7 from the numerator and denominator. This is difficult to interpret in terms of hours per student. If we restate the fraction 3/2 as the quotient 1.5, we can easily see that the number of hours per student is 1.5. It is important to keep track of the units of measurement for data. The numerator and denominatqr in fraclior'ts may have different units. In example 2.2, the numerator is measured in “hours” and the denominator is measyred in W wsdents.” The resulting quotient is measured in “hours per student” or “units of numerator per units of denominator” in general. A decimal is a quotient derived from a fraction where the denominator is a multiple of 10. These fractions are sometimes called decimal fractions, but that term is rarely used in practice. The portion of the decimal to the left of the decimal point (.) is called a whole number. The most common use of decimals in the real world is the accounting of dollars and cents. If a syringe costs $2.49, we interpret that as 2 dollars and 49 cents. If we just consider the numeric portion of the cost, it is really a whole number with a decimal. The whole number is the 2, the number to the left of the decimal point. The decimal is the fractional portion to the right of the decimal point, 0.49. We convert 0.49 to 49 cents quickly, but we can also think of 49 cents as 49/100 of a whole dollar. The decimal fraction is then 49/100 that can be expressed as the decimal 0.49. ' Decimal fractions are typically expressed as decimals (no one says “49/100 cents”). The notation indicates a value that is less than one. In 14.37, for example, the digits to the right of the decimal point (3 and 7) are called decimal digits. The digit “3” in this example is in the tenths position and “7” is in the hundredths position. The decimal point is used t0 separate the fraction (.37) of a whole number from the whole number itself (14). The decimal point is not ordinarily used in whole numbers (for example, 14.0) unless the healthcare facility has a reason for doing so. Figure 2.2 displays the interpretation of digits to the left (whole numbers) and right (fractional portions) of the decimal point for a sample number measured to the ten thousandth place. Figure 2.2. |llustration of whole number and decimal positions Thousands Tenths Thousandths (1,000) \ Tens (10) \ (1/10) \ (1/1,000) Hundreds Hundredths Ten Thousandths (100) Ones (1) (1/100) (1/10,000) Source'. DAH IMA
m Chapter 2 Mathematics Review Decimal numbers without a value to the left of the decimal point are typically written with a leading zero to call attention to the decimal point. For example, .5 is typically written as 0.5. avicK e Example 2.3: Identify the following decimal positions in the number 3.492. 3 ones position 4 tenths position 9 hundredths position 2 thousandths position e Rounding Numbers Rounding is a process of approximating a number to a level of precision that is meaningful for the application. Numbers may be rounded to the nearest 10, 100, and so on. In healthcare facilities, rounding is commonly used when expressing data because staff must manage statistics measured as both parts of a whole number, as in length of stay, and in whole numbers, as in the number of patients or census. | Rounding can occur in either whole or decimal numbers. The level of rounding is expressed using the names of the whole number and decimal positions found in figure 2.2. When rounding to the nearest digit, examine the digit to the I‘ right of the level of rounding. If that digit is 0, 1, 2, 3, or 4, then round down. If that digit is 5, 6,7 8, or 9, then round up, One important rule to remember in rounding is that only the digit to the right of the position of the level of rounding; should be considered. These concepts are best explained through a series of annotated examples. The determination of rounding up or down when the digit to be rounded is 5 is not a uniform rule. For this text, we! will round up. You may encounter other texts or even situations in practice where the rule may differ. For example, W in this text 25 is rounded to the nearest 10 which is 30, but you may find other references that state 25 should be} rounded to 20 (the nearest even number). Example 2.4: Rounding to the nearest whole number or one: . 1.9 rounds to 2 since 9 is in the tenths place. . 1.905 rounds to 2 since 9 is in the tenths place and since we only consider the 9 when rounding. 0.5 rounds to 1 since 5 is in the tenths place. . 0.1 rounds to 0 since 1 is in the tenths place. . 9.496 rounds to 9 since 4 is in the tenths place. o oo o Example 2.5: Rounding to the nearest ten: . 31 rounds to 30 since the digit in the ones place is 1. . 31.9 also rounds to 30 since we only consider the 1 in determining the rounding. 35 rounds to 40 since the digit in the ones place is 5. . 439 rounds to 440 since the digit in the ones place is 9. . 2,257.92 rounds to 2,260 since the digit in the ones place is 7. o a0 o Example 2.6: Rounding to the nearest hundred: . 4,325 rounds to 4,300 since the digit in the tens place is 2. . 4,325.99 rounds to 4,300 since we only consider the 2 in the tens place. . 5,990 rounds to 6,000 since the digit in the tens place is 9. . 79,320.95 rounds to 79,300 since the digit in the tens place is 2. . 99 rounds to 100 since the digit in the tens place is 9. (LI =T e B w i Example 2.7: Rounding to the nearest thousand: . 45,025 rounds to 45,000 since the digit in the hundreds place is 0. . 96,591 rounds to 97,000 since the digit in the hundreds place is 5. 42.984.9 rounds to 43,000 since the digit in the hundreds place is 9. . 43,400 rounds to 43,000 since the digit in the hundreds place is 4. . 1,632.01 rounds to 2,000 since the digit in the hundreds place is 6. (G =N e R i gxample 2.8: Rounding to the nearest tenth: o0 oP %" (ones or whole number in this case). gxample 2.9: Rounding to the nearest hundredth: a. b. c. d. €. Example 2.8d is interesting. Because the 8 is in the hundredths place, 9 should be rounded up to 10. This is achieved | by rounding the 0.98 up to 1.0. When the digit to be rounded up is a 9, then the digit to the left must be incremented | \ I Rounding Numbers 1.39 rounds to 1.4 since the digit in the hundredths place is 9. 2.91 rounds to 2.9 since the digit in the hundredths place is 1. 9.3694 rounds to 9.4 since the digit in the hundredths place is 6. 0.98 rounds to 1.0 since the digit in the hundredths place is 8. | 0.06 rounds to 0.1 since the digit in the hundredths place is 6. 6.395 rounds to 6.40 since the digit in the thousandths place is 5. 3.209 rounds to 3.21 since the digit in the thousandths place is 9. 65.591 rounds to 65.59 since the digit in the thousandths place is 1. 0.009 rounds to 0.01 since the digit in the thousandths place is 9. 0.999 rounds to 1.00 since the digit in the thousandths place is 9. Exercise 2.2 Find the quotient in the following fractions. Round to two decimal places. 1. 2 5 2, 3 4 3. 7 8 g, 107 98 5. 54 65 Exercise 2.3 Round the following numbers to the nearest 10. e R Round the following numbers to the nearest hundred. 6. 7 S 8. 9. 10. 4 338 217 6,989 8,532 156 321 3,807 4,357 8,175
m Chapter 2 Mathematics Review Percentage m Round to the nearest whole number. 11. 381 12. 55.69 13. 147 14. 62523 15. 100.5 Round to the nearest tenth or one decimal place. 16. 19.76 17. 34.623 18. 172.87 19. 99.98 20. 125.969 Round to two decimal places. 21. 8.36801 22. 14.5264 23. 0.87642 24, 27.99999 25. 15.90176 When asked to provide an answer to one decimal (or more) and the resulting answer is a whole number, add (’s after the decimal point. For example, rounding 10 to one decimal is 10.0 and rounding 10 to two decimals is 10.00. Quick TP Percentage L ————————————————— The ratio of a part to the whole is often expressed as a percentage. A percentage is a value computed on the basis of the whole divided into 100 parts. It may help to remember that percent means “per 100” when interpreting percentagesi Percentages should be labeled with either the percent sign (%) or the word “percent” after the number value is stated. FoE example, 0.34 would be written as % and is equal to 34 percent. Percentages are a useful way to make fair comparison because the calculation of a percent essentially standardizes each value to be scaled to “per 100”. Example 2.10: If 20 patients died in Hospital A last month, and 50 patients died in Hospital B during the same period, one might conclude that it would be better to use the services at Hospital A because Hospital A had fewer deaths. However, that conclusion would be wrong if Hospital A had 100 discharges during the month and Hospital B had 500 discharges for the same period. Hospital A: 20/100 = 20% deaths Hospital B: 50/500 = 10% deaths In this case, the percent of deaths allows us to compare Hospital A and Hospital B on the same scale of deaths “per 100 Not all percentages are whole numbers. For example: —;— =0.125=12.5% percentages can be rounded to various levels just as decimals are. For example, if we wanted to round 12.5 percent to the nearest whole percent, the rounded value would be 13 percent (round digits 5 and up to the next number). common Transformations of Fractions, Decimals and Percentages Numbers may be expressed in a different format based on the context in which they are used. The same value may be expressed as a fraction (1/2), decimal (0.5), or percentage (50 percent). The following section contains guidance on how to convert between these formats. Converting a Fraction to a Percentage To convert a fraction to a percentage, divide the numerator by the denominator and multiply by 100. Example 2.11: Convert 1 to a percentage. Step 1: Divide 1 by 2. 1+2=0.5 Step 2: Multiply by 100. 0.5x100=5% Converting a Decimal to a Percentage To convert a decimal to a percentage, simply multiply the decimal by 100. The calculation changes the position of the decimal point two digits to the right. : I Example 2.12: Convert the decimal 0.29 to a percentage. 0.29x100 = 29% Converting a Percentage to a Fraction To convert a percentage to a fraction, eliminate the percent sign and multiply the number by 5+ A simpler method is 10 place the number in the numerator and 100 in the denominator. Example .2..13: Convert 5 percent into a fraction. Step 1: Eliminate the percent sign and multiply the value by 1/100. Step 2: Express the fracti . on in simplest form. Since 5 is a factor of both the numerator and denominator, the Simplest form is: 5+5 _i 100+5 20 Example 2.14. Convert 23 T8 : Step 1: Elimin at percent into a fraction. ¢ the percent sign and multiply the value by 1/100. L B 100 ~ 100
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m Chapter 2 Mathematics Review Step 2: Express the fraction in simplest form. There are no common factors for 23 and 100. Therefore, 23/100 is the simplest form for this fraction. Converting a Percentage to a Decimal To convert a percentage to a decimal, eliminate the percent sign and divide the remaining number by 100. This is the equivalent of moving the decimal point two places to the left. Hint: If the percentage is less than 10, place a 0 in front of the value and place the decimal point in front of the 0. Example 2.15: Convert 76 percent to a decimal. | Step 1: Eliminate the percent sign: 76. , Step 2: Divide the number by 100. | 76+100=0.76 Example 2.16: Convert 4 percent to a decimal. Step 1: Eliminate the percent sign: 4. Step 2: Divide the number by 100. 4+100=0.04 Example 2.17: Convert 109 percent to a decimal. Step 1: Eliminate the percent sign: 109. Step 2: Divide the number by 100. 109 +100=1.09 @ The decimal point in whole numbers is often not displayed, but it is still present. For example, 76, 76., and 76.0 arg all equivalent numbers. When the decimal point is not displayed, it is sometimes confusing to visualize moving it 1d QUICK whole number with the decimal point present for these conversions. Using Excel to Convert Fractions to Decimals and Percentages Using spreadsheet software such as Excel is very convenient when converting fractions to quotients and decimals OF percentages. First, let’s look at the anatomy of a spreadsheet to understand how we may use that tool to help with thi§ type of calculation. You can think of a spreadsheet as a table with rows and columns. In figure 2.3, the rows of the spreadsheet are labeled by the numbers 1 through 5. The columns are labeled witlh letters A through C. Excel spreadsheets can be very large. The most recent version of Excel can hold up to 1,048,578 rows by 16,384 columns. The cells are referenced by their row and column. The upper left cell is referred to as cell AR The cell below Al is A2 and the cell to the right of A1 is B1. Figure 2.4 shows the cells with their labels. The cells in a spreadsheet may hold either values or calculation instructions. For example, if we wanted to calculal§ the value in example 2.2 using Excel, we could put the numerator (21 hours) in cell A2, the denominator (14 studentsy into cell B2, and then the formula to calculate the value of dividing the numerator by the denominator in cell C2. Figui§ 2.5 shows the values that should be keyed into each cell. Figure 2.3. Spreadsheet example W' the left or right for the percent-to-decimal and decimal-to-percent conversions. It may be helpful to actually write the figure 2.4. Display of cell references in spreadsheet 4 A B c 1 A1 |B1 C1 2 A2 B2 c2 3 A3 [Bs c3 4 A4 B4 c4 5 A5 B5 c5 6 A6 IB6 c6 " Figure 2.5. Excel calculation example | 5 4 A B c D 1 |Hours Students 'Hours per Student ' 2 21 14/=A2/B2 << Keyed Values 3 21| 14;1.5 << Results Notice that the cells Al, B1, and C1 are used as title or label cells. They are not part of the calculation but are important to include so that the units and interpretation of the various values can be conveyed to the reader. The value in C2 is a calculation or formula. All calculation cells in a spreadsheet must begin with an equal sign or “=.” This is a signal to Excel that a calculation should be performed as opposed to simply displaying the values keyed into the cell. In addition to performing calculations, Excel has a number of formatting options that can make rounding and converting to percentages very easy. staff members with RHIT credentials, 5 staff members with RHIA credentials, and the remaining staff with no l Example 2.18: Suppose General Hospital’s health information management (HIM) staff of 48 includes 20 credentials. What percentage of the HIM staff has an RHIT credential? Round to the nearest tenth of a percent. Let’s walk through the steps in calculating a percent by hand: 1. Determine the numerator and denominator: a. Numerator number of RHITs b. Denominator - total staff 1 . Divide numerator by denominator. [ Multiply by 100 to convert to a percentage. - Round to the nearest whole percent. The steps i ite simi 4 ! €ps In Excel are quite similar, but the conversion to a percentage and rounding may be completed via formatting. EPS (displayed in figure 2.6): 5 ; Put the labels of each column in cells A1, B1, and C1. = Enter the numerator (20) into cell A2. 3. E i F nter the denominator (48) into cell B2. « Enter the formula “=A2/B2” into cell C2.
n Chapter2 Mathematics Review b Percentage b | Figure 2.6. Example 2.18 steps 1-4 7 4. 12 Formula version: 3 5. 4| A B c | 15 1 |RHITs Staff |RHIT Percent l ) ] o t |_A2iB2 | Convert the following decimals to percentages (round to one decimal place): ) | 6. 0.28 Calculated version: 7. 0.07 4 » | B | ¢ | 1 |RHITs |[Staff RHIT Percent 8. 01254 2 20 48| 0.416666667 9. 0.4299 3 ! 10. 0.9981 Figure 2.7. Format menu Convert the following percentages to fractions: : 11. 42% c2 | o Il =A2/R2 N | Calibri |11 "% Arg %9 E t ; 12. 58% A A B8 s 3 0 | . = e A el 0 g 13. 78% 1 JRHIT staff RHIT Perce [ = e L I | . 2 20 48]0.416666667 lec Raculte 14. 75% = T Y o " s 15. 20% Figure 2.8. Results for example 2.4 Convert the following percentages to decimals: 16. 12% 4l A i c 17. 27% 1 RHIT iStaff RHIT Percent 2 20 48 41.7% 18. 0.5% 19. 7.5% 5. Format the value in C2 as a percent. 20. 3.49 a. Highlight the value in cell C2 by clicking on the cell. . - b. Right click on the cell to display the format menu in figure 2.7. S exasg::!};igrr’e;ctgl;)rltir in };(;ur loc.al physician’s 'clinic saw 150 adults in one week for their annual physical ¢. Select the “%> icon from the format menu. T « & ose 150 patients, 67 {ecenved the flu vaccine. Express the rate of the flu vaccine . lon in percent. Round to one decimal place. Perform this calculation using a calculator and repeat d. Excel will round the nearest whole percent by default. the calculation using Excel. (Hint: Follow the steps in example 2.18.) e. Right click on the percentage value to display the format menu once again. 22. The physic; . o : ' _ _ L . physician practice you work for needs a new paper shredder. The t - , gallons. You did some investioati i : : _ ) ) o . ) | . gation and secured five offers from different companies. The shredd 1l The resulting value is 41.7 percent as displayed in figure 2.8. Repeat the calculation using your calculator to chet equal quality. Set A ; ) . P S MICHSHIEGIdETstateia of . g P play & p gy Y. Set up an Excel spreadsheet using the information here. Which company is giving you the best deal? Hint: Cal 1 : . discounted pr(i:cl:leat;[e thg dlscgunted price and then add in the shipping and handling where appropriate. Calculate the ¥y subtracting the discount dollar amount from the list price. Exercise 2.4 Complete the following conversions. C‘"“pany % $ o -[)'i'scoumq _.D.'Slc)(:illztul ShHll;[::(lllEl:ig"d. Convert the following fractions to percentages (round to one decimal place): gz:g::y B $625:()0 ig;/: g;eoioo-()@ . 2 C()mpani f) $551.00 15%, $33OO 8 Company £ $584.00 25% i 2_ _3_ $57900 200/0 5 5 Local $00.00 3. 2 4
m Chapter 2 Mathematics Review 23. Using the information found in the scenario below, complete the following tables using Excel. Forty patients were seen in the Hematology/Oncology Clinic last Tuesday. Twenty patients had sickle-cell anemia, | 12 patients had hemophilia, 6 patients had Ewing’s sarcoma, and 2 patients had Wilms’ tumor. Express in counts, decimals (round to two places), and percentages (round to whole percent) the number of patients with each condition compared with the number of patients who visited the clinic last Tuesday. —_M—M | Sickle cell ' Hemophilia Ewing’s Wilms’ 1 Total Ratios Sre— ; A ratio is a number found by dividing one quantity by another; also, a general term that can include a number of specific measures such as proportion, percentage, and rate. Ratios typically express the relationship of ongd quantity to another. To calculate ratios, one quantity is compared to another. The number can be greater than or less than 1. Ratios may be expressed in a fractional form, but they have a different interpretation than fractiong ,' Fractions are essentially numbers: ¥ is a fraction and its representation might be %2, 0.5, or even 50 percent, ag we demonstrated earlier in the chapter. It is an expression of a part of a whole. Ratios are a comparison of twg subsets. l Example 2.19: If seven men and five women were in a group, the ratio of men to women would be £ . This ratio also may be written as 7:5 and verbalized as 7 to 5. ratio of men to women is a different value than the percentage of men. The fractiol Notice in example 2.19 that the the group or 7/12. We may express this as @ of men in this case would be the number of men divided by the total in decimal, 0.58, or a percentage, 58 percent. Ratios should be expressed in their simplest form just like fractions, and they may be applied to a particulal situation by multiplying the numerator and denominator by the same factor. Suppose we wanted to recruit a foclis group of 36 members and wanted to maintain the ratio of men to women of 7:5 found in example 2.19. Table 2.1 shoW how the ratio of men to women can be maintained for focus groups of various sizes. Table 2.1. Focus groups of various sizes Focus Group Size | Number of Men | Number of Women | 12 7 S 24 (multiply by 2) 14 10 36 (multiply by 3) 21 15 48 (multiply by 4) 28 20 Example 2.20: If an HIM department of 16 staff includes 6 RHIAs and 10 RHITs, what is the ratio of RHIAs 10 RHITs? The ratio of RHIAs to RHITs is 6 to 10 or 6:10 or 6/10. All of these are equivalent expressions of the same ratids Notice that 2 is a factor of both 6 and 10. This ratio should be expressed in its simplest form: E:Eizgoflfi or “3to05” 10 102 5 Ratios 23 e gxercise 2.5 1. Express the following ratios in their simplest form. 8:96 3:15 8:16 12:72 e. 57 2. A group of 15 men and 20 women have diabetes. Express the ratio i i n of i diabetes. Calculate it to its simplest form. P B e oo er o 3. Your college bookstore reported that of the 1,000 books sold durin . e g enrollment, 320 were HIM books. E the ratio of HIM books to the total number of books sold. Calculate it to its simplest form. L 4. There are 12 1r}structors i_n your HIM program. Five of these are male instructors, and the rest are female Express the ratio of male instructors to female instructors. Calculate it to its simplest form . 5. ((j)f the 1]:% instruc;lors in' ‘[hef [t))revious example, three have a master’s degree and the rest have a bachelor’s egree. Express the ratio of bachelor’s degree prepared instructors to master’ i xpress th ster’s de Calculate it to its simplest form. B 6. Community Hospital reported 16 births this past month. Four wer i i . . ¢ male. What i female births? Calculate it to its simplest form. i Proportions chl):g:gl:nofi 1sda type of ratio in WhiCl:l x is a portion of the whole (x + y). In a proportion, the numerator is always in the denominator. A proportion may be expressed as a percentage, a decimal, or a fraction. Ex : ample 2.21: If 2 women out of a group of 10 over the age of 50 have had breast cancer, what is the proportion of women who have h i e o ad breast cancer in the over-50 age group? Express the proportion as a gzep 1: Find the size of the whole group: 10. St:p g: Iélnd the number of women who had breast cancer: 2. P 3: Calculate the proportion as portion/whole. Portion of women over 50 that had breast cancer _ 2 Number in group of women over 50 10 Step 4: Convert to a decimal. 2 —=2+10=02 10 8 a;Ir‘:able 2.2 shows a sam e aclte-care facilit o €Istand which d y re admiteq on days, P;fi gomsglttl‘f‘:’tl:edhslallstlcal report provided by the information systems (IS) department ays admissions ek SE OW. t.he dgpartment uses proportions expressed as percentages to Mondays or Saturises Xamining this table, we can see that less than 10 percent of the patients ays. This type of report can guide staffing levels during high- and low-volume
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m Chapter 2 Mathematics Review Table 2.2. Administrator's semiannual reference report A dministrator’s Semiannual Reference Repor dmissions by Day of Weel 711/20XX-12/31/20X Number of Patients Sunday 1,283 18.7 Monday 577 8.4 : Tuesday 1,126 16.4 | Wednesday 1,301 189 | Thursday 1,240 18.0 Friday 702 10.2 | Saturday 645 9.4 Totals 6,874 100.0 Exercise 2.6 1. A school district wants to know the proportion of students who have deferrals for mandated vaccines. District School #1 has 237 students. Of the 237 students, 225 students are up to date on their vaccines. There are 12 students with deferrals. What is the proportion of students with deferrals who have not been vaccinated? Round to two decimal places. 2. At Community Clinic, 50 patients were seen in one day. Of those, 6 have type 2 diabetes mellitus. What i the proportion of people in the group who have diabetes? Express as a decimal and round to two decimil places. 3. At Community Clinic, Dr. Clark treats only diabetic patients. He has 650 active patients. Of those, 458 ha/@i attended his specialized training session for newly diagnosed diabetes. What proportion of Dr. Clark’s patieni8 have undergone his training? Express as a decimal and round to two decimal places. 4. At Community Clinic, Dr. Simpson, an interventional cardiologist, saw 270 patients last quarter. Of those, I performed stent procedures on 182 patients. What is the proportion of Dr. Simpson’s patients who have stent procedures? Express as a decimal and round to two decimal places. 5. Dr. Rutan, an internist at Community Clinic, asked that 14 of the 35 patients he saw last week get their x-ré and lab work completed the day before their appointments. What is the proportion of Dr. Rutan’s palien who had preliminary work completed prior to their appointments? Express as a decimal and round to 18 decimal places. Rates A rate is a fraction that is formulated to express the relationship between the numerator and denominator. A medsis of time is often an intrinsic part of the denominator. For example, number of patients treated per day or charts el per shift are rates that are used in healthcare. Healthcare facilities calculate many types of rates to determine hoW 3 are performing compared to benchmark or best practice value. i The term rate is often used loosely to refer to rate, proportion, percentage, and ratio. Indeed, many books ,' organizations use these terms interchangeably. For this reason, it is important to be aware of how any measure repd! r is defined and calculated. For rates, proportions, and ratios, the numerator and denominator must be clearly defl and documented to communicate the interpretation of the value to the reader. The basic rule of thumb for calculatin, i indi i [ g rates is to indicate the number of times something actually h i . - a relation to the number of times it could have happened (actual/potential or part/base). The nun%ber of tiymesptieen:\(fle;r: occurred is the part that we would like to measure; the number of ti . ; imes the event could have i we use for comparison. The formula for determining rates is as follows: N Part P Rate = , or R=— B Base Example 2.22: If 10 of the 35 patients visitin ician’s offi i : g a physician’s office receive i i i for that set of patients? Round to two decimal places. 2 fluvaccine, whatls the vaccine rate Step 1: Determine the event to be measured: flu vaccines. Step 2: Determine the number that actually happened (part): 10. Step 3: Determine the number that could have happened (base): Step 4: Calculate the rate: PP (base): 35 ] 10 Vaccine Rate = E =10+35=0.285 round to 0.29 211[ .calclulazjt(;ns should be checked to make sure they are reasonable in the context of the calculation. Misplaced &Y decima points agi a common source of mathematical errors. For example, a hospital death rate of 25 percent should w seem unreasonable because it indicates that one of every four patients treated at this hospital died. Thus, the decimal S ) placement in this calculation should be checked. The correct d } j B oot wioch mouad bewoors rectitin rect death rate for this hospital may be 2.5 percent or 0.25 Averages e —— A ; . L n average or mean is the value obtained by dividing the sum of a set of numbers by a count of the number of values in ] l f " f . . e . i 101€ A€ [Eul mn :hzll: tE] 10') The symbol X (pronounced “ex bar”) is used to represent the mean in this formula. K= Sum of all values Count of value Exampl tLet’ i Ple 2.23: Let’s say that you completed six medical terminology tests. Your scores are 82, 78, 94, 56 91, and 85. Accordi i i l o ording to the calculation displayed below, your average score on the medical terminology 82+78+94+56+91+85 486 6 =68 X= 81 There ar e several different ¢ ] ] Other types Ofavera'fire " ypes of averages used in healthcare. The arithmetic mean or average is presented here. - ges may be encountered in healthcare and will be presented in later chapters. E ACel may be yseq to calculat S e averages also. To solve example 2.23 using Excel, follow these steps: o ues into column A as displayed in cells A2 through A7 in figure 2.9. : €y the formula dis Wlth an “=* he 8 cells A ffiffigtl;ese tep 1: Enter the test val Sign o thgia%fed in cell B8 in figure 2.9 into cell A8. Notice that this is a formula and therefore xcel knows to evaluate the formula. The Excel function is called “average” and the S are the ce] ] BB A7 ells that we want to average. The range of cells is written as A2:A7. Excel interprets this
m Chapter 2 Mathematics Review Chapter 2 Review 27 Figure 2.9. Calculating an average using Excel d. A measure used to com c : cd 10 are an t . . (numerator) with the nurfiber of tienZZ;larcl) Z:/re;}[me, fiicomparlson olgthcanumbergot-imesyanyeyent-did.happen A B e. The relation of c'>rn'em art to th : could have happened (denominator) ; ] | . B e p 0. ! e whole with respect to magnitude, quantity, or degree ; | f§. The value obtained by dividing the sum of a set of numbers by the number of values i 2 32\ g The part of a fraction below the line signifying division that functi i Ya uesin the set. 3 gj ll nto how many parts the unit is divided ctions as the divisor of the numerator and indicates - 56l h. The nufnber re'sulting from the division of one number by another 6 o1 i. A quotient derived from a fraction where the denominator is a multiple of 10 7 85| . j. The process of approximating a number 8 81 | <<=average(A2:A7) Terms | Exercise 2.7 R umemitor 6. ____ Whole number 2. Rate . 0 . 5 1 . 1. Community Hospital reported the following birth weights, in pounds, for babies born January 30, 20XX: 3 Fraction ____Proportion 6.9,3.7,7.7,6.6,7.3, 5.5,9.9,7.0,5.5, and 7.7. What was the average birth weight for the day? Round to two © S 8. _ Decimal decimal places. 4. Average 9 Ui - ing 2. A patient’s temperature for five days after surgery taken at 7:00 a.m. each morning was recorded as 101.7§ 5. _ Denominator 10 Quoti 100.4, 98.9, 100.2, and 98.6. What was the patient’s average temperature after surgery? Round to two decimal i uotient places. Chapter 2 Review - 3. A patient’s blood sugar was recorded for seven days at 8:00 a.m. and recorded as the following: 164, 15§ 172, 145, 138, 136, and 142. What was the patient’s average blood sugar at 8:00 a.m.? Round to a whol§ Complete the following exercises. number. 4. A patient’s systolic blood pressure was recorded from February 1 through February 7 at 6:30 a.m. ea 5 1. C : : moFr)ning N th}é Following: P y & y onvert the fraction 1 to a quotient and then a percentage. 2. Round the followin : February 1 130 . g percentages to two decimal places. February2 135 b 13‘ b February3 132 - 13.655% February4 126 €. 0.569% February 5 120 d. 98.990% February 6 122 e. 98.9999, February 7 124 : , o ) ’fl? «3. Round the following percentages to deci Create an Excel spreadsheet to calculate the patient’s average systolic blood pressure at 6:30 a.m. Round @ a. 0.6989% g one decimal place. whole number. N b. 53.123% 5. There are five health record analysts in the HIM department where you are working. Their hourly wages at ¢. 0.075% $13.87 $14.02, $15.56, $15.75, and $16.32. What is the average salary for the health record analysts? Perform U d. 343 Z calculation both by hand and using Excel. Round to two decimal places. gie<:337% €. 3.876% 4- C()m 1 . a Cz: P following conversions: . . ' vert Lt . Chapter 2 Matching Quiz B - (;6: a percentage with two decimal places. —_— i R 3;”/ to a percentage with two decimal places. Match the definitions with the terms. d. ° 10 a fraction. Calculate it to its simplest form. Convert 34% to a decimal Definitions: a. One or more parts of a whole b. A type of ratio in which x is a portion of the whole (x + ). ¢. Aninteger with no fractional or decimal parts
m Chapter 2 Mathematics Review 5. Convert the following fractions to their simplest form: 12. H a 3 | 9 ! 13 b. 4 14. 8 ¢ 1 5 d 3 ' 5 e. 124 248 6. Recreate the following table in Excel. Use an Excel formula to calculate each percentage to verify that th calculations are correct. If any are incorrect, note which ones and provide the correct answers. i - Community Hospital -ator’s Semiannual Reference -‘e]_) Discharges by Day of Week g BRSO QIR il y Day [T " Porcent of Paticnts. Sunday 1,187 19.1% Monday 755 11.3% . Tuesday 1,085 16.3% | Wednesday 1,031 15.5% Thursday 1,024 17.0% Friday 808 12.1% Saturday 773 11.6% Totals 6,663 100.0% 7. A physician on your staff performed 44 cardiac catheterizations last month. Thirty-four of those treated Wel male. What is the ratio of male patients to female patients who had cardiac catheterizations? What is i proportion of males? Round to one decimal point. 8. It was reported in your department meeting that over the past year your hospital decreased the number s employees by 4 percent. Last year there were 389 people employed; how many fewer employees are there " year? Round to a whole number. $1,100. The local supply company gives the facility a 13 percent reduction on all items they purchase. "8 price will your manager pay? P Your beginning salary as an analyst in the HIM department is $14.50 per hour. You are due to !'e‘fe'v 3.4 percent cost-of-living raise in your next paycheck. Your performance evaluation is coming up I . month, and you believe you should get an additional 5 percent increase based on your excellent perfOl'ma F What should your hourly wage be after your next paycheck, and what do you anticipate it will be after performance evaluation? : I8 Last year, you purchased equipment in the HIM department for $14,250. You have been told that equipment you bought has depreciated in value by 20 percent. What is the value of the equipment noW 10. 11. Chapter 2 Review n You just scored 40 points out of a possible 50 on your health informati i ornte did yow caaa] y! rmation test. What percentage of available . Last year, the number of hospitals in your state decreased from 320 to 240. What is the percentage of decrease? Use Excel and the data in the following table to determine the average bi i rth mother. Round to one decimal place. B L s A March 1 through March ! 5.6 1 185 z 6.7 2 193 3 59 3 155 4 6.0 4 342 5 39 5 25.6 6 9.2 6 29.7 7 10.3 7 248 8 113 8 26.6 9 6.9 9 17.3 10 7.1 10 26.5 i 5.9 1 24.7 12 5.7 12 232 13 52 13 21.4 14 6.9 14 229 15 102 15 3L Totals o For t g ' he following questions, refer to the following Quarterly Coding Professional Accuracy Report. 15, Are the i - calculations of the o ; percentage of records accurately coded 9. Your manager needs to purchase a computer for the new receptionist in your department. The usual pricey 16. g y S —— Coding professi . Tecalcslgte 1iieSrSI;)nal D determined her accuracy rate for the quarter to be 95.9 percent. She would like you to Ccuracy rate because she thinks it is incorrect in the report.
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m Chapter 2 Mathematics Review [e] (=] Qo ° 5 (Gl E L - : = FEE EE 8 Patient Census N o0 \O | g | ug : S EWME EWc & - > < < %0 o = 0 5 & 2 B & |9 = = ~ ° ° ° P 32 4 2 8 1 & % g 8 |3 (&2 K - . B 8 Learning Objectives & S & o . . ) I M 2 At the conclusion of this chapter, you should be able to do the following: P o 3 e g‘ s Perform the calculations of the following healthcare utilization statistics: inpatient admission, inpatient census, complete o o @ S n < Py master census, daily inpatient census, inpatient service day, total inpatient service days, and admission and discharge on S the same day (A&D) £ Q 9 2 ® R R e Differentiate between an interhospital (interfacility) transfer and an intrahospital transfer o > > S =% o o P y P é < a = o S ol e Calculate daily census and inpatient service days using the admission and discharge data provided : = ) a . : . . . = e Calculate census and inpatient service days with data given for newborns and transfers = | Calculat d inpatient days with data g f b d transf : < BNz [c |8 | e =) ¥ A Y B Key Terms - = o~ 0 o~ o Admission date Discharge Interhospital transfer 3 & 3 b < < Average daily inpatient census Discharge date Intrahospital transfer gcnsus day Inpatient admission Newborn . I B . o Omplete master census Inpatient census Patient care unit (PCU) R R N N N s Daily inpatient censu i i ient d S S =} S e} S Inpatient service day Patient day s (g s S (S Hospi . e . . tha?zl:,alsbkeep track of patient census statistics to*determine when they have the largest number of patients and when g = = 2 ‘§ 3; there 'IT - dr0P§. They can then tell when the busiest times of the year are to determine increasing staffing, whether A s < " PN in pati‘cy(:tfml){ Patient care units being overburdened by a large number of patients, and which units have a decrease Pétients ;o : esources al}ocated to those units may change throughout the year to accommodate the units with more - = L - 2 off. H<)s:pit'1lICI§S fegardlpg low census staffing may be enforced when needed, and staff may be asked to take time 2 § = Q % & intereste i‘n ufl (llmmslrapon also reviews the census by individual physician and patient care units because they are fderstanding trends in the patient admission process and the factors that may be driving those trends. <Nl O ey o Inpatient Census T % g % % g Hosp't | - 1 -] o o o Ita Manage ob '@ eb@m 8 o Uelldgemen ; : 4 ; ; 3 ; .%D 2 g g £8% 228 £ S 4 of patiens in the h _l uses census data for various purposes, including planning, budgeting, and staffing. The accounting Se |w 9E Bg 85 2 CAre facilir: ospital is an import istic t i ) : 2 o s 86 &8¢ &9 8 e 8 g fi in cility’s formal acc portant statistic tracked by hospital leaders. An inpatient admission is when an acute Oa UVa Lea = N;n A8€a Of the fi); ‘i‘l,)l;ance of a patient who is to be provided with room, board, and continuous nursing service S admigre g to anz ass?re Patnents. generally stay at least overnight. The inpatient census indicates the number of igned to an inpatient bed in the facility at a particular point in time.
m Chapter 3 Patient Census A staff member, usually 2 member of the nursing staff, on each patient care unit (PCU) is designated to count the patients on that unit each day. A PCU is an organizational entity of a healthcare facility organized both physically and functionally to provide care. For example, the intensive care unit (ICU) would be considered a PCU. In some facilities, PCUs may be designated by location, such as 2-West or 3-North, or by specialties such as oncology, neurology, or surgery. The inpatient census-taking time is usually at midnight but may occur at any time as long as the time is consistent for the entire facility; that is, each PCU conducts the census at the same time. Around midnight is a good time to take the census because patients are usually in their beds. It would be difficult to account for all patients at 8:00 a.m., for example, becausg they might be in an exam room, with radiology, in surgery, with their healthcare provider, or just taking a walk in the hospital, The necessary data are first entered into the computer as admissions, discharges, or intrahospital transfers and then verified at the designated time by the responsible person on each PCU. In this context, an admission date is the day a patient first enters the hospital as an inpatient. A discharge date is the day the patient leaves the hospital. Discharges include patients who are sent home, those who die in the hospital, and interhospital transfers. Interhospital transfers are events when a patient leaves one hospital and is immediately admitted to another hospital or healthcare facility, Intrahospital transfers are transfers within the hospital from one PCU to another during an inpatient admission. Figure 3.1 shows a form for a manual daily census summary for a nursing home. Although most census data are now collected via electronic forms or custom spreadsheets, the contents are essentially the same as displayed in the pape form in figure 3.1. Figure 3.1. Daily census summary at Community Manor Nursing Home Community Manor Nursing Home Daily Census Summary To be completed daily at 12:01 a.m. by charge nurse Hall: A B C D Date Initial admits—New residents Date Time a.m.—p.m. a.m.—p.m. 4.m.~p.m. a.m.—p.m. Time a.m.—p.m. a.m.—p.m. a.m.—p.m. Time Discharged to home or transfer Date Transfer to hospital Location Date a.m.—p.m. a.m.—p.m. a.m.—p.m. a.m.—p.m. Time Returned Time a.m.—p.m. a.m.—p.m. a.m.—p.m. Qut on leave—Pass Date Left a.m.—p.m. a.m.~p.m. a.m.—p.m. Time of Death a.m,—p.m. a.m.—p.m. a.m.—p.m. Time a.m.—p.m. a.m.—p.m. a.m.—p.m. a.m.—p.m. Deceased Date Return from hospital stay Date Charge nurse: Source: ©OAHIMA Inpatient Census m complete Master Census [n addition to reporting the head count to the central collection area, each PCU reports, the number of patients admitted discharged, and transferred into or out of the PCU that day. This is commonly referred to as the admission discharge and, (ransfer (ADT) system in a facility. The transfers tabulated in the ADT system are intrahospital transfers. The fentral collection area then uses the census from all the units to compile a total census for the facility, sometimes r;aferred to as the complete master census. The complete master census shows the names of patients present at a particular point in time and their location. In most facilities this is a computerized process that is linked with the facility’s master patient index, billing system, and other electronic health record systems. g The spreadsheet template presented in figure 3.2 may be used to calculate the inpatient census. Figure 3.2- Inpatient census template & A B 1 Data Element Value 2 |Starting inpatient census (@12:01 am) 3 | Admissions (Not discharged same day) 4 |Discharges (Not admitted same day) 5 | Ending inpatient census (Midnight) =B2+B3-B4 l Exal_nple 3.1 The'number o’f patients in General Hospital at midnight on May 1 is 230. Two patients are admitted and 40 patients are discharged on May 2. What is the inpatient census for General Hospital on May 2?7 Manual calculation: 230 + 2 40 = 192 Using Excel: 44 A B 1 Data Element Value 2 |Starting inpatient census (@12:01 am) 230 3 |Admissions (Not discharged same day) 2 4 |Discharges (Not admitted same day) 40 5 |Ending inpatient census (Midnight) 192 6 Exercise 3.1 ADnswer the following questions. 1. APCUL : Could th;iglfr?;nllt of 20 Patle_rlts at 1:90 a.m. on September 1, and 30 patients at the same time on September 2. a2, ave been different if the PCU had taken a census at 12:01 a.m. on both days? Would A you accept the di i i i : : consistent Withil?itself? ifferent PCUs in the hospital taking censuses at different times as long as each unit is A patient i transferre . ; . i . additional e d at 5:00 p.m. to unit A from unit B is counted in unit A’s 12:01 a.m. census as one tient ; < ; . » d;t)resent. Would that patient still be included in unit B’s 12:01 a.m. census? e . ; : 5. On) 0 describe a patient who is transferred from one PCU to another within the same facility? U|y 1 your ¢ : L) om : i i231 Patients haye cor::::nini, hospital h§s 124 inpatients who are staying overnight in their facility. In addition, neluded in 1o bt nto the hospital for various tests and treatments. Which of these patients would be census, the 124 patients, the 231 patients, or the 355 patients?
m Chapter 3 Patient Census Inpatient Census m Figure 3.3. Spreadsheet template for daily inpatient census calculations . e P 4 Exercise 3.2 ) A 2 1 Data Element Value 1. The census at 12:01 a.m. on June 1is 110. Three patients were admitted on June 1 at 6:00 a.m. and discharged 2 |Starting inpatient census (@12:01 am) later that same day. One patient admitted at 6:00 a.m. died at 5:30 p.m. the same afternoon. What is the 3 |Admissions (Not discharged same day) 3 PCU’s daily inpatient census for June 1? 4 |Admitted & Discharged Same Da ) o , , _ o I 5 |Discharges (Not ad?nitted same d);y) 2. Which statistic is more useful in understanding the patients served at a facility, census or daily inpatient census? Why? 6 |Daily inpatient Census =B2+B3+B4-B5 i 3. Community Hospital’s census at 12:01 a.m. on September 19 was 327. On that day, 12 patients were admitted and 10 patients were discharged. Calculate the inpatient census for September 19. \ 4. Community Hospital’s Critical Care Unit (CCU) census at 12:01 a.m. on December 2 was 14. Four patients Figure 3.4. Example daily inpatient census calculation were admitted to the CCU on December 2, one patient was transferred to the medicine unit, and one patient died. Calculate the inpatient census for the CCU for December 2. 4 A B 5. The census in the telemetry unit at Community Hospital on May 1 was 26 patients. Two patients were admitted 1 Data Element Value after stent insertions and three patients were transferred into the unit from the ICU. On the same day, four 2 [Starting inpatient census (@12:01 am) 20 ' patients were discharged and one patient was transferred to the ICU. One patient was admitted at 7:00 p.m. 3 |Admissions (Not discharged same day) 0 ; and was discharged and transferred at 9:00 p.m. to another facility. What will the daily inpatient census of the ‘4 |Admitted & Discharged Same Day 1 telemetry unit be for May 1? 5 | Discharges (Not admitted same day) 0 6 iDT“Y inpatient Census 21 = . | Inpatient Service Days An inpatient service day is a unit of measure denoting the services received by one inpatient in one 24-hour period . . or any portion of that 24-hour period. The 24-hour period is the time between the census-taking hours on two Dally Inpatlent Census successive days. The usual 24-hour reporting period begins at 12:01 a.m. and ends at midnight. One inpatient service The daily inpatient census is 2 statistic that measures the number of patients admitted to the hospital or unit at an§ day is counted for each inpatient admission when a patient is admitted and discharged on the same day because they time during a given day. Therefore, it includes the number of inpatients present at census-taking time each day, pli§ received services during that stay. Failure to account for this time will result in lost credit for the services provided to any inpatients who were both admitted and discharged after the census-taking time the previous day. Thus, a patieii§ that patient. . admitted to the hospital at 8:00 a.m. on June 1 and discharged at 10:00 p.m. that same day would not be present fo There are a number of important issues concerning inpatient service days. These include the following: the midnight head count. Therefore, he or she would not appear on the census report. However, the patient must b . . . & accounted for separately in some manner. For an example, in an ICU, a patient could be admitted at 8:00 a.m. an§ ® One unit of one service day is not usually divided or reported as a fraction of a day. consume a high volume of services and staff time before passing away. This resource intensity would not be v181b_ ® The ‘day of admission is counted as an inpatient service day, but the day of discharge is not. Therefore, no patient | on the midnight census but is critically important in determining staffing. Figure 3.3 displays an example spreadshed admitted to an inpatient unit can have a zero-service day stay. template that is useful when calculating daily inpatient census. - . da Tllll lnPatlen't service day may also be referred to as a patient day, inpatient day, bed occupancy day, or census ¥ The operative word here is service; that is, the number of patients who received service on a particular day. Using Example 3.2: Twenty patients are on a PCU. One patient was admitted at 10:00 a.m. and.dlscharged at 7:00_p-m~ ::ll‘:aflllll term “inpatient service day” reflects the hospital function of providing services to patients each day and more I If there are no other discharges, the daily inpatient census for this day is 21. The patient that was admitte Scrvl;c)é %efmes the quantity counted. If 20 patients are provided services in one 24-hour period, the number of inpatient and discharged on that day is added to the 20 patients already on the unit. differemays for that calendar day is 20. Although inpatient service days and the daily inpatient census are used for two . ~ the PUrposes., the calculation is the same for both statistics. The daily inpatient census is a statistic representing Manual Calculation: 20 + 1 =21 . N mber of patients (people) that were t in the hospital at any time during the day, while the inpatient servi Figure 3.4 shows how to use the Microsoft Excel template in figure 3.3. SIS A statistic measur present in the hospital at any time during the day, while the inpatient service inpatient service 4 ed in days. Therefore, the template displayed in figure 3.2 may also be used to determine the Presented i figureag,sstxlith one minor change in the title listed in cell A6. The revised inpatient service day template is
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m Chapter 3 Patient Census Figure 3.5. Spreadsheet template to calculate inpatient service days A B Data Element Value Starting inpatient census (@12:01 am) Admissions (Not discharged same day) Admitted & Discharged Same Day Discharges (Not admitted same day) Inpatient Service Days =B2+B3+B4-B5 oo & WiN = Exercise 3.3 Differentiate among census, inpatient census, daily inpatient census, and inpatient service days. If a facility has 129 inpatient service days, would 129 also be the daily inpatient census or inpatient census? Total Inpatient Service Days The term total inpatient service days refers to the sum of all inpatient service days for each of the days during a specified: period of time. For example, if the inpatient service days for June 1,2, and 3 are 100, 105, and 101, the total for the three days is 306. Typically, total inpatient service days are calculated monthly, quarterly, semiannually, or annually. Example 3.3: Given the following inpatient service days for Community Hospital, a 75-bed facility, what is the total number of inpatient service days provided during these 10 days in June? Date 1-Jun 2-Jun 3-Jun 4-Jun 5-Jun Inpatient 70 71 72 68 69 Service Days 6-Jun 7-Jun &-Jun 9-Jun 10-Jun 71 73 74 69 70 l Total inpatient service days = 704+71+72+68+69+71+73+74+69+70 = 707 days Be sure to note the units of measure for each statistic calculated. Total inpatient service days are measured in dayss Census statistics (daily, inpatient, master) are measured in people or patients. QuickK TP Exercise 3.4 Complete the following exercises. 1. The time for taking the inpatient census must always be a. Variable b. Consistent c. 12:00 p.m. d. 11:39 a.m. 2. 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 Calculation of Inpatient Service Days m 3. The inpatient census at 12:01 a.m. is 24. Two patients were admitted at 1:00 p.m. One patient died at 3:15 p.m., and the other patient was discharged at 10:00 p.m. The inpatient service days for that day are 3 a. 22 b. 24 c. 25 d. 26 4. The difference between the census and the daily inpatient census is that any patients admitted and discharged the same day are added to a. The census to calculate the daily inpatient census b. The 12:01 a.m. (or other designated time) head count to calculate the daily census c¢. Bothaandb d. Neither anorb 5. Which of the following should be used when calculating the number of inpatients who received service on a particular day? a. Inpatient census b. Daily inpatient census ¢. Total inpatient service days d. Census Calculation of Inpatient Service Days e ——————————————— The calculation of inpatient service days is the measurement of services received by all inpatients in one 24-hour period (the time between the census-taking hours on two successive days). The usual reporting period begins at 12:01 a.m. and ends at 12:00 a.m. (midnight). Moreover, one inpatient day must be counted for each inpatient admitted and discharged on the same day between two successive census-taking hours. The definitions of census, inpatient service day, and total inpatient service days provide clues for actual computation. The sample shown in table 3.1 includes all of a hospital’s inpatient care units. A summary of all such units helps the administration review the hospital’s overall level of activity. Table 3.1. Sample inpatient service days display Sample Inpatient Service Days r:;:?'ber of patients in hospital at 12:01 a.m. on November 1 257 i ; the number of paticnts admitted on November 1 + 45 Subtoty] Miflus \he numb . . 302 Numb mber of patients discharged (including deaths) on November 1 24 e - . Plus lh<: :igéll)tlents in hospital at 11:59 p.m. on November 1 (subtotal) 278 .- er of Patlents both admitted and discharged on November 1 et patient service days for November 1 T Someti), . nes yo - . . Q inpatien; Sezviger;ay be qsked by administration to exclude PCUs such as ICUs and obstetrical units from the Varies greatly fro ayz- Umts s_uch as these are often studied separately because the intensity of service on these units m the intensity of services provided on medical and surgical units. Tab'e 3.2 shOWS a Perf . .. . . . 3 : Orman Zample of how hospital administration can use inpatient service days data to determine emonstrates that the spreadsheet template from figure 3.5 may be used to perform the same c‘“fiulalion‘fe‘ Figure 3.6
m Chapter 3 Patient Census Table 3.2. Year-to-date inpatient service days Medicine 13,762 15,000 15,608 Surgery 8,953 13,500 11,634 2,681 ICU 3874 3,500 3,623 251 Step-down 679 1,500 -821 1,278 -599 Rehabilitation 1,646 2,500 -854 2,136 490 Obstetrics 1,730 2,200 —470 2,188 —458 Psychiatry 1,002 1,800 798 872 130 Newborn 1,689 1,800 -111 2,099 -410 Neonatal ICU 2,875 3,900 -1,025 2,643 232 Pediatrics 645 1,000 -355 833 —188 Total 36,855 46,700 -9,845 42,914 —6,059 Figure 3.6. Sample inpatient service days calculation using spreadsheet template in figure 3.5 4l A B 1 Data Element Value 2 | Starting inpatient census (@12:01 am) 257 3 | Admissions (Not discharged same day) 45 4 | Admitted & Discharged Same Day 4 5 | Discharges (Not admitted same day) 24 6 | Inpatient Service Days 282 ) Hospital statistics are often tabulated separately for adults and children and newborns. Newborns (NB) are defil to be an inpatient who was born in a hospital at the beginning of the current inpatient hospitalization. auick TIP This medical center’s analysis of its inpatient service days can be examined to determine how well the facility i doi year to date and to compare its performance with the previous year. This can lead to discussions by hospital leaders concerning marketing of their services or examination of whether there are enough practitioners in those services. Before beginning the actual calculation of census data and inpatient service days, it is important to undef?m the calculation of transfers. The calculation of transfers occurs on the PCU census. Transfers in and out of the unité shown as subdivisions of patients admitted to and discharged from the unit. The hospital may be referred to as the “house,” as in “How many patients are in the house?” This refers 10 number of patients in the hospital. QUICK AL @ The census for the next day must begin with the 11:59 p.m. census data and not inpatient service days. Calculate undet assumption that the patients admitted and discharged on the same day and the transfers are not newborns. QuICK TP Summary of Census Data ufl: gxample 3.4: Figure 3.7 displays census calculation data in a format frequently used by hospitals. Key to abbreviations used in this example W_ Adults and children NB Newborns (born during the hospital stay) Adm Admissions (includes transfers into the hospital) Bir Births Trf Intra-hospital Transfers—may be into a unit (in) or out of a unit (out). Dis Discharges (including transfers out of hospital and deaths) A/D Admitted and discharged on same day Transfers may also be abbreviated as TX and discharges may also be abbreviated as DC. OUT$K In this example, a patient head count at 12:01 a.m. on June 1 shows 48 adult and child inpatients and two newborns. This type of display allows a unit manager to view the flow of patients into and out of the unit. The last three columns are discussed later in this chapter. Note that the end census of 49 A/C patients and 1 NB may be used as the starting census for the next day. Flgure 3.7. Example census tracking table Start Activity into unit Activity out of unit End . 12:01 a.m. 11:59 p.n;. Serv Census Adm Trf Total Dis Dis Trf Census Days Day A/C NB AJC Bir in AIC NB A/IC NB out AIC NB A/D A/IC NB 1-Jun 48 2 2 1 1 51 3 1 2 1 49 1 1 50 1 The following points are important to keep in mind: . Th.e teljms. transfers in and transfers out refer to intrahospital transfers, that is, transfers between inpatient units w1th1n the hospital. Transfers in and out of the hospital (called interhospital or interfacility transfers) are included in admissions and discharges. I:ansll’ers in .and out of any specific medical care unit may or may not be equal, but they must be equal for the 5 fc;ra 'l?OSpltgl summary. Every patientstransferred into a unit on any given day must have been transferred out nother unit. Failure of these data to balance may mean that a unit neglected to report transfers correctly. New : . Sep';?z:)(nl‘s are considered separately for all computations based on census data. They should be reported (4 . by . . . . - . Producedy upless otherwise directed by administration, medical staff, or other persons using the statistical data ed. Births are considered newborn admissions. The cen COmmOnslus a; the close of one day (11:59 p.m.) is the inpatient census at the beginning of the next day and is y reierred to as the number of patients remaining. Summary of Census Data The PIOCEsS of verifyi : if Monthly o year| gn Ny - and bo a?: :-rz l'l(;m this sum, the ny num ; Sount g 1.5 p.:xerlgg ;l)atlents remaini LIRATIOS '_- v sum§n ;‘:t; ((l)i;ti obtained by the process of Falculating census statistics on a daily basis is called the 8 during the moe;:;us data, meaning a concise summary of the data. The total number of patients ik or year is a'dded to the patients-remaining census with which the month or year er of discharges (including deaths) during the month or year is subtracted. The resulting o ioht of 1 ng at the end of the month or year. This number should equal the actual head of that month or year. Table 3.3 shows a sample monthly census summary. Notice ddmitteg
Chapter 3 Patient Census Table 3.3. Sample monthly census summary 0|.n,|,m‘|ni‘ty \Hospiltl' | Number of patients in hospital at 12:01 a.m. on October 1 48 2 Add the number of patients admitted in October + 100 + 7 Subtotal 148 9 Subtract the number of patients discharged (including deaths) in October - 110 -5 Number of patients in hospital at 11:59 p.m., October 31 38 4 that patients admitted and discharged on the same day are not included in the monthly census calculations in table 3.3 The monthly census is intended to measure the patients actually present at the census-taking time and not the patientg: actually served during the month. This demonstrates the key difference between census calculations and inpatienf service days. When you summarize monthly or annual census data, you are verifying that the columns have been added correctly; This procedure also verifies that no error was made in the original data on one or more lines. This verification i accomplished by taking the 12:01 a.m. inpatient ccnsus at the beginning of the period, adding total admissions ang transfers in, and subtracting total discharges and transfers out. The resultant data represent the ending census on thg last day of the period (month or year). Exercise 3.5 Complete the following exercises. 1. Using the data given in example 3.4, create a spreadsheet to calculate the census for June 2. Then, fill in the blanks in the table below. = ot @ : FM) | servbn ' = Jays “A/C | NB | AIC | NB | out | AIC_[ NB_LAD AIC | il T A/C | NI 1 2 6/2 3 4 1 2 2. What data will you use to begin June 3, and why? 3. Fill in the blanks in the table below. What are the inpatient service days for June 2 and 3? 6/1 48 2 2 1 1 51 3 1 2 1 49 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 4. Would a newborn ever be considered an A/D? . excludt 5. At this point, you have inpatient service days for three successive days. The total of these data, Il pitd newborns, for June 1,2, and 3 is 145 (50 + 49 + 46). What will you need to know and do to get the hos inpatient service days for the entire month of June? Summary of Census Data n gxercise 3.6 Using the information supplied for June 1, fill in the blanks in the table below. = !l_ ] -';* : l‘A‘ i AR 230 12 20 5 5 " 19 6/1 4 3 62 21 4 1 19 4 1 0 6/3 23 6 0 24 5 0 3 6/4 25 5 1 23 4 1 1 6/5 24 4 2 18 %) 2, 2 Exercise 3.7 Two hundred and fifty adults and children were in the hospital at 12:01 a.m. on August 1. There were 23 newborns at 12:01 a.m. on August 1. During August, the following data were compiled: Adults and children 1,353 Newborns 73 Discharges (including deaths): _ Adults and children 1,348 Newborns 65 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 317 3. Can the inpatient service days be calculated with the information supplied in the previous question? Explain Wwhy or why not. 8. The surgery unit in Community Hospital has reported the following data. Do these data look correct? Explain *tin | oL | ou 4 2 26 2 your answer. » OnM : . ] Dllrinarlc\:/lll 1, the telemetry unit at Community Hospital has reported the 15 patients on the unit at 12:01 a.m. March, the following data were collected: Admissions 240 Discharges (including deaths) 232 What would the ; th i - Inpatient census be on March 31 at 11:59 p.m. in the telemetry unit? Exercise 3.5 This ¢ $ ACICise consi Us;i Consi SIng the dag, Sts of two wo 4 provided fo, e rksheets for calculating a month’s inpatient census and inpatient service days. 1, complete the first worksheet. If your findings do not match the data for May 31, h
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n Chapter 3 Patient Census Average Daily Inpatient Census you have made an error either in your column additions or on one or more of the horizontal lines above the worksheet 2 total. You must correct this error to ensure the validity of the monthly totals. If the column additions are correct, F Monthiv Datao rAdult d Child Mav 20X i th d worksheet for the recap. Use a spreadsheet to complete these worksheets. ecap of Monthly Data for Adults and Children: Yiay continue on to the second worksheet [o p p P o e (PRE k Worksheet 1 ' 12:01 a.m. Census A/C 165 ' Admissions Adult and Children + I ]L Adm @ Disc I ! s || Serv days Transfers in ¥ Y “arc | NB | in | AC | NB | AC [ NB | ou | A I NB LA LA/C LN [ _ = 1 TEERL IS Dol O g 202 A oW LY TRORN SR SSIESEE R RS S | Discharges Adult and Children = 2 185 3 24 4 7 12 3 6 1 Transfers out = 3 18 3 3 16 ) ) 0 \ 11:59 p.m. Census A/C on May 31 = ' «ap of Monthly Data for Newborns: 4 17 2 5 15 2 4 0 l Recaj 5 13 0 il 12 1 3 0 ) 12:01 a.m. Census NB 6 20 0 6 19 o 4 0 | Newborn Admissions + 7 21 0 14 17 0 12 0 Total NB = 8 27 1 10 23 3 8 3 Discharges NB = 9 23 4 6 %) 3 14 o) 11:59 p.m. Census NB on May 31 = 10 2 ) 8 15 1 10 1 Serv Days A/C (total inpatient service days excluding newborns) 11 17 3 7 14 4 5 3 Serv Days NB (total newborn service days) 12 19 3 6 17 2 4 0 {Total inpatient service days 13 14 1 4 12 2 2 0 j ] ‘. 14 el ) & 9 3 7 0 Average Daily Inpatient Census o ————————————— 6 1 L2 £ 1+ B i i The average daily inpatient census is the average or mean number of inpatients present in the hospital each day for a - 16 23 3 6 15 4 2 0 givep period of time. The total inpatient service days for any period (usually a month or a year) represent the inpatient 17 17 1 3 13 3 1 1 service days for all the calendar days in that period. The formula for calculating the average daily inpatient census is: 18 1 g 2 2] 1 8 2 ; Total inpatient service days (excluding newborns) 19 17 0 7 25 3 2 1 Ave Daily Inp Census = - - Total number of days in the period 20 13 2 3 27 4 4 0 1 12 1 5 21 2 5 3 Whenhcalculating the average daily inpatient census for a month, you need to know how many days there are in each " 2 10 0 1 17 4 1 2 11O 23 9 2 4 18 1 4 0 EIAmple 3.5: If a h . ¢ . . . i . . 24 23 4 3 12 3 2 2 e, : If a hospital had 6,653 inpatient service days for adults and children and 155 inpatient service days for 25 15 5 4 2 5 3 1 oS for the month of May, what was the average daily inpatient census in May? Round to the nearest whole number. 26 13 3 2 9 1 4 0 Ave Daily Inp C Total inpatient service days (excluding newborns) | np Census = 2 = L . 22 1 0 2 P Total number of days in May | 28 29 2 5 22 4 4 3 29 23 4 1 25 3 2 1 Ave Daily Inp Census = (N 214.61 rounded to 215 patients 30 15 1 4 21 2 3 0 31 hox ASmentioneq earlier, adul : 31 16 4 2 18 3 2 3 ‘Dbpn.al‘s administratio, ,N ults and children are calculated separately from newborns unless otherwise directed by the Totals oz?lalmain anewborn m.l ewborn census data can distort statistics related to resource use. For example, it costs less { €L a specifieq period. it rsery than it doe.s to staff other PCUs. If the average daily inpatient census is consistently low 1 » It may be appropriate to close PCUs to reduce expenses. Whether w— With g round 1o a whole numbper ; the indivi ital’ jsi i j ; o atq represening e is the individual hospital’s decision. There is a difference between working "t'ullrl Present numpey M[,D 2 ecause you cannot have a portion of a person ) and working with percentages icare statisyjc, (Ref: ny facilities use a whole number when calculating the census and fractions with other er to chapter 2 to review rounding.)
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'h " Chapter 3 Patient Census Example 3.6: A 150-bed hospital reports 3,489 inpatient service days for December. Calculate the average daily inpatient census for December. Round to the nearest whole number. Total inpatient service days (excluding newborns) Ave Daily Inp Census = - Total number of days in December Ave Daily Inp Census = % =112.54 rounded to 113 patients Again, this number is important to administration because they will want to know how many patients are being served eaclj month to determine staffing and supply needs for practitioners and to monitor the overall financial performance of the facility, Average Daily Newborn Census The formula for calculating the average daily newborn census follows the same pattern as the formula for calculatip the average daily inpatient census of adults and children. Total newborns inpatient service days Ave Daily NB C = M ensus Total number of days in the period Example 3.7: A hospital with 20 bassinets had 552 newborn inpatient service days during April. What was th average newborn daily census in April? Round to the nearest whole number. Total newborns inpatient service days Ave Daily NB C = M ensus Total number of days in April Ave Daily NB Census = % = 18.4 rounded to 18 newborns Assume all exercises in this text do not occur on a leap year. A leap year is a year in which an extra day is add o to the calendar at the end of February, giving February 29 days. Therefore, regular years have 365 days; leap yel % have 366. Leap years only occur on an even-numbered year, so if the example is an odd year, one not need consi ' a leap year as a possibility. Average Daily Inpatient Census for a Patient Care Unit The hospital’s administration often finds it helpful to know the average use of a specific medical care unit (for exampl to know whether additional beds are needed for the ICU). Statistics are the basis for decision-making. The formulal calculating the average daily inpatient census for a care unit is the same used in the overall average daily inpatient CeNi8 The difference here is that the inpatient service days specific to the PCU measured should be included in the numerdd Example 3.8: A hospital with a 24-bed CCU reports 740 inpatient service days for July. Calculate the average da inpatient census. Round to the nearest whole number. Total inpatient service days for the CCU Ave Daily Inp C CCU= VoDl e Total number of days in July Ave Daily Inp Census for CCU = % =23.87 rounded to 24 patients 1s IS O Do not confuse the terms regarding the census and inpatient service days. Inpatient census refers to patien -,pfl"d i at the census taking time. Some healthcare facility staff may just say “census”—they are referring to the Nl Wk census. The average inpatient census is the mean number of hospital inpatients present in the hospital €3<" i . . . . ; . : . . cant a given period. The inpatient service days include any patients who were admitted and discharged on the 5@ Chapter 3 Matching Quiz . Exercise 3.9 Complete the following exercises. 1. Community Hospital has 200 beds and 25 newborn bassinets. The total inpatient service days for M 5,297 for adults and children and 486 for newborns. ) ys tor May were a. What is the average daily inpatient census for adults and children? Round to a whole number. b. Determine the average daily newborn census. Round to a whole number. 2. A 150-bed, 15-bassinet hospital has 4,350 inpatient service days for adults and children and 360 newborn service days during June. a. What is the average daily inpatient census, excluding newborns? Round to a whole number. b. Determine the average daily newborn census. Round to a whole number. 3. Calculate the average daily newborn census for a 125-bed, 10-bassinet hospital with 3,001 inpatient service days for adults and children and 298 inpatient service days for newborns during February (not a leap year). Round your answer to a whole number. 4. If you neefi to calculate the average daily inpatient census of the surgical unit, where can you obtain the surgical unit’s inpatient service days? 5. Community Hospital’s burn unit has 12 beds. The inpatient service days for the burn unit in December were 358. What is the average daily inpatient census for the burn unit during December? Round your answer to a whole number. Chapter 3 Formulae for Calculation of Bed Occupancy Statistics m Numerator Denominator Inpatient bed occupancy rate Total number of inpatient service days Total number of inpatient bed count for a given period days for the same period Newborn bassinet occupancy e Total number of newborn inpatient . Total number of bassinet bed count days service days for a given period for the same period Bed k s Wover rate (direct Number of discharges (including For Average bed count during the period , mula) deaths) for a period et S umover rate (ind; i FOrmula) ate (indirect I())ecrciggancy rate X number of days in Average length of stay for period Chapter 3 Matching Quiz May : ch the deflnitions with the terms Definitions: a. Th b €day that 4 patien t fir : : : SMean or 4y, St enters the hospital as an inpatient. numb deois : . . . ot e er of hospital inpatients present in the hospital each day for a given period of time ents §o o . . after the Censu‘s).rteie'm at. census-taking time each day plus any inpatients who were both admitted and Mumbe, ¢ inpa aking time the previous day tie : . NS occupying a bed in a healthcare facility at any given time age
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Chapter 3 Review u n Chapter 3 Patient Census c. The same hospital provided 12,345 newborn days of service in its 35-bassinet nursery during the year. What e. A change in medical care unit or medical staff unit during an inpatient stay was the average daily newborn census? i i i i to provide care f. An organizational entity within a healthcare facility organized both phySle‘“)' a“dzf:';‘ctil(:-“a:)i’og p o g. A unit of measure equivalent to the services received by one inpatient during one 24-hour p . i i i i ified period of time B. 32 h. The sum of all inpatient service days for each of the days during a specificd P < D. 34 Terms: i sfer d. The same hospital’s new surgery unit has 50 beds. During July, the unit provided 1,705 days of service. R Inpatient census > IRICE What was the average daily inpatient census for the surgery unit in July? daily inpatient census 2. PCU 6 Average A 5 3. Total inpatient service days 7. Admission day - 4. Daily inpatient census 8. Patient day C. 54 D. 55 e. Do you think the hospital’s administration provided enough beds for the new surgery unit? Chapter 3 Review 7. Using the statistics from the following monthly report from the nursing administration of Community Hospital, an acute-care facility, use Excel to calculate the current month’s (November) average daily inpatient census for 1. Whatis an intrahospital transfer? each nursing unit and the totals. Note: This facility’s policy is to round to a whole number. 2. Differentiate between the terms inpatient census and daily inpatient census. h ) | 'I 3. Isit possible that the transfers into a PCU may not equal the transfers out of the same PCU on the same da P T—— 4. When must transfers in and transfers out be equal? s i i 427. On February 2, 37 patients | | 5. At 11:59 p.m. on February 1, the Community Hospital census was R ays npatient Census d the answers to whole numbe who died later that day in the CCU. Answer the following questions and roun a. Calculate the hospital inpatient census for February 2. Medicine/Surgery 40 1,108 admitted, 33 were discharged, and 2 were admitted and discharged that (ciiay.hir; télglgxilcgl’etgzsczg:]l;‘ u{ Uit February 1 was 16. On February 2, six patients were admitted, four were discharged, . | Wfi B Pediatrics 40 997 C D E F G b. Calculate the hospital daily inpatient census for February 2 Obstetrics 25 733 ¢. Calculate the CCU inpatient census for February 2. Rehabilitation 15 400 d. Calculate the CCU inpatient service days for February 2. 2. 0p il i CCU 20 592 . On Ju 18 3 6. In 20XX, a hospital had 175 beds for adults and children from J anuaryhllgirc‘;‘;rglgei‘;rlle During theyfirsl Surg%c?ll ICU (SICU) 15 445 hospital increased its beds to 250 and the number remained at 25.0 tflrouglt N children. During the pas Medicine ICU (MICU) 20 585 months, 30,875 patient days of service were provided to the hospital’s adl} : oy t.he answers to Wi Total Adult and Children 175 months: 36:982 days of service were provided. Answer the following questions an rou | B Nevborn = s 588 numbers. This is a non-leap year. J Special Car B Nursery 10 201 ily inpatient for the first six months? & a. What was the average daily inpatient census 1or K Neonatal [CU (NICU) T e A. 169 Yotal Nursery B. 170 8 Community Hosp; : C. 171 ¥ Hospital reported the following for the month of July 20XX. Round your answers to whole numbers. D. 172 b. What was the average daily inpatient census for the entire year? A. 184 B"&iuning cens us on July 1 B. 185 Admmissions y 92 53 Disch. 301 C. 186 Eharges ang Deaths 286 50 D. 187 o Patien, Service Days
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m Chapter 3 Patient Census - . Chapter 3 Review 49 - a. Calculate the average daily inpatient census for adults and children. 13. University Hospital is a 765-bed facility with 250,415 inpatient service days for the past year. What thei . What was their b. Calculate the average daily inpatient census for newborns. average daily census for the period? Round to a whole number. ] c. What will the census for adults and children be at 11:59 p.m. on July 317 14. In February 20XX (a leap year), Children’s Hospital reported they had 500 inpatient service days in thei s in their d. What will the nursery census be at 11:59 p.m. on July 31? neurosurgery unit. What was the average daily inpatient census? Round to a whole number | 9. Metropolitan Hospital has a large, busy rehabilitation unit. The 30-bed unit reported the following inpatientg 15. Of the 500 inpatient service days in the above example, 386 were Dr. Smith’s patients. What percentage of service days for the week of April 6. Use the information that follows to determine the average daily inpatienf census for the week of April 6 through April 12. Round to three digits after the decimal. inpatient service days did Dr. Smith have in the neurosurgery unit? Round to one decimal place Metropolitan Hospital i Rehabilitation Unit Inpatient Service Days pril 6-April 12, 20XX - | Inpatient Service Days April 6 29 April 7 28 April 8 29 April 9 26 April 10 27 April 11 28 April 12 29 10. Children’s Hospital reported the following statistics for March 20XX. Use an Excel spreadsheet to calculd the average daily inpatient census for each unit and the total. Round each calculation to a whole number. Children’s Hospital ~ Average Daily Inpatient Censu: - Pediatrics Surgical Hematology Oncology 20 566 Neurology/Neurosurgical 30 756 Renal/Gastroenterology/Endocrinology 20 555 Respiratory 30 897 Cardiac Medicine/Surgical 20 589 Infant Care Unit 10 281 Pediatric Intensive Care 20 540 Total 180 11. Community Hospital has 15 bassinets with 286 newborn inpatient service days during October. What i average daily census for October? Round to a whole number. 12. The planning committee for Metropolitan Hospital is studying the activity of their burn unit, W.h'Chfi 15 beds. During the third quarter of the year (July, August, and September), there were 1,356 “‘Paoly service days. What is the average daily census for this period? How could this information be importa™ planning committee at Metropolitan Hospital? Round to a whole number.
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