CLINICAL AUDIT FOR

THE MONTH OF
JANUARY,2022

Moderator: Dr.Abubeker (R1)

Prepared by: Dr.Abdi G.(MI)
Dr.Adnan G. (MI)

1
 Outlines

 Objectives

 Operational definitions

 Methodology

 Results and discussions

 Challenges

 Recommendations

2
 Objectives
 To assess National Key Performance Indicators in Internal
medicine department.

 To assess trends of Admissions, Deaths, Referrals and

Discharges

 To look overall activities at EOPD, ROPD, Wards and ICU

 To compare with previous months report

 To identify common causes of Morbidity and Mortality in

wards

 To set some recommendations

3
 Operational definitions
 Average length of stay
 Measures the No. of days that each patient averagely stay in
the hospital in the study period.
ALS = sum of total length of stay
number of patients.
 Bed occupancy rate
 Is a measure of efficiency of inpatient services
 It indicates the average percentage of occupied beds during the
reporting period.

BOR:= Total No. of inpatient days for a given period x 100

Available beds x Number of days in the period
4
 Bed turn over rate

BTOR= Number of discharges in a given time period

Number of beds in the hospital during that time period

 Emergency room mortality

ERM =number of deaths in ER X 100

number of ER visits

 It does not include death on arrival.

5
 Inpatient mortality

 it is a measure of quality of care provided by the hospital

IM= No. of Deaths x 100

Total number of Admissions

 Patients transferred to the next month- are patients admitted

and whose outcomes are not known before the end of the
month.

 Primary diagnosis- Major problem which make the patient

seek admission.

 Infectious disease-any disease caused by pathogenic micro-

organisms 6
 Abbreviations
• ALOS: Average Length of Stay

• BOR: Bed Occupancy Rate

• HMIS: Health Management Information System

• IPM: Inpatient Mortality

• ERM: Emergency Room Mortality

• LAMA: Left Against Medical Advice

• NCOD: National classification of diseases

• KPI: key performance indicator

7
 Methods
Data Includes cases admitted, discharged, referred, died and EOPD

& ROPD visits, from TAHSAS 23 – TIR 22

• Data was collected from:

– HMIS log-books from ward, ICU and OPD

– Death summary

– Review of charts

– Discharge summary

– November and December 2021 clinical audits 8

WARD

9
 Total Beds
Ward ICU Total No Beds

1 Male 26

2 Female 30

3 Total 56 6 62

10
 Total ward activities in
January, 2022
Activity Number
Total Admissions 149
Patients from the previous 26
month
Discharged improved 114
Left against medical advice 7
Transferred to ICU 1
Transferred to Covid center 0
Referred 7
Deaths 6
Patients transferred to the next 28
month
11
 Data summary

 76.51% of patients in the ward were discharged improved.

 4.69% of patients left against medical advise.

 4.6% of patients were referred.

 4.02% of patients died during the month of December.

12
Comparison of ward activities in
November , December and
January months
200

172 180

160
146 149
142
140

114 120
109

100

80

60

40

20
8 9 6 7 7 7 4 6 7
0 2 1 0 2 0
0
Total improved Death Transferd to LAMA Transfferd to Referred
3
admission ICU COVID center
13
November december january
 Age ranges of patients admitted to
the wards
Age Range Wards

Female Male Total

15-26 20 15 35
27-38 17 9 26
39-50 16 9 25
51-62 20 8 27
63-74 6 12 18
75-86 6 9 15
87-98 0 2 2
Total 85 64 149
14;
 Data Summary
 In age group from 15-62 females are dominant.

 57.71% of total admissions are in the age range of 15-

50 years.

 62.35% of female ward admissions are less than 50

years.

 51.56% of patients admitted to male ward are less than

50 years

15
 Comparison of female and male
wards
Activity Female W Male W

Total Admissions 85 64

Discharged improved 67 47

Left against medical advice 4 3

Transferred to ICU 1 0

Referred to Covid center 0 0

Referred 4 3

Deaths 4 2

Patients transferred to the next 17 11

month
16
 Female ward Vs Male ward
85

69
67

4 4 3 4 3
2 1 0

TOTAL DISCHARGED DEATH LAMA TRANSFERRED REFERRED

ADMISSION IMPROVED TO ICU

Female Male
17
 Comparison of Female ward
activities with previous months

97

85
81 79

60 67

4
4 4 4 3 4 2 2

ADDMISION DISCHARGED DEATH LAMA REFFERED 18

NOVEMBER December January
Comparison of male Ward activities with
previous months
75

65 64 63

49
47

4 5 2 4 3 3 2 4 4

ADMISSION DISCHARGE DEATH LAMA REFERRED

november december january

19
Age ranges of patients who died
in wards
Age range Wards

Female Male Total

15-26 0 0 0
27-38 0 0 0
39-50 2 0 2
51-62 1 1 2
63-74 1 1 2
75-86 0 0 0
87-98 0 0 0
Total 4 2 6

20
 Common causes of admission to the ward
System ward
Female Male Total
Cardiovascular Ds 34 20 54

Respiratory Ds 5 4 9
Disease of GI/Liver 1 3 4

Ds of kidney 3 3 6
Endocrine Ds 11 9 20
Neurologic Ds 7 5 12
Infectious Ds 22 19 41
Hematologic Ds 1 0 1
Other(prostatic ca 1 1 2
and breast ca)

Total 85 64 149 21
 Common diseases admitted to
the wards
S.N DISEASES Diagnosis
1 Cardiac CHF 2ry to (IHD=15,CRVHD 13,Corpulmonale=10,
DCM=2,HHD=2) HTN(3), DVT(8), Cardiogenic
shock(1)
2 Renal CKD (1) ,AKI(5)
3 Respiratory Asthma(3), COPD (2) , ARDS (3), aspiration
pneumonia(1)
4 GI CLD(4)
5 Neurology Stroke (12)
6 Infectious Tuberculosis(9), SCAP(21), Meningitis(6), RVI(5)

7 Hematology Polycythemia (1),

8 Endocrinology DM(19), thyrotoxicosis(1)

9 Others Prostatic ca(1) , breast ca (1) 22
 Data summary
 CVS and Infectious are the leading cause of
admission contributing 36.2% and 27.5 %
respectively
40.00%
36.24%

35.00%

30.00%
27.51% OTHERS

25.00% RESP
RENAL
20.00% CNS
GI
15.00% 13.42%
CVS
10.00% infectious
6.04% 8.05%
hematology
5.00% 4.02%
2.68% endocrinology
1.16% 0.67% 0
0.00%

23
 Bed Occupancy Rate

 BOR = Total number of inpatient days for a given period x 100

Available beds x Number of days in the period

WARD BOR

MALE WARD 79.05%

FEMALE WARD 86.44%

24
 Bed Occupancy rate

86.44
79.05
76.5

66.4
61.7 62.9

NOVEMBER DECEMBER JANUARY

MMW FMW

25
 Bed Turnover Rate
BTOR= Number of discharges in a given time period

Number of beds in the hospital during that time period

WARD DECEMBER

Male 1.5

Female 2.03

26
Comparison of Bed Turnover
Rate with the previous months

WARD November December January

Male 2.5 2.8 1.5

Female 2.7 3.2 2.03

27
 Average length of stay
ALOS=Sum of total length of stay (discharged, deaths and transfer)
Number of patients (discharged, death, transfers out)

WARD ALOS in days

Male 7.83
Female 8.93

28
 Average length of stay

WARD November December January

Male 7.6 6.76 7.83

Female 8.03 7.49 8.93

29
 Inpatient mortality
 IM = No of deaths X 100

[No of deaths + discharged +transfer]

 No. of death= 6

 No. of discharge=114

 Transferred to ICU=1

 Transfer to COVID = 0

 Referred=7

 LAMA=7

 Inpatient mortality of December is 4.65%

30
Comparison of Inpatient Mortality with
previous months

Months November December January

Ward 6.25% 5.23% 4.65%

31
 Causes of death at wards
Age Admission Diagnosis Done Immedia Main Lengt
/sex te system h of
Cause of affected say
death
55/ Right side hemiparesis Bed Cardi CNS , 3
M 2 to ? Cardioembolic elevation respirato CVS,Resp days
stroke + increased ICP Mannitol, ry arrest iratory
+ Afib with NVR INO2, 2 to
increase
NGT d ICP 2to
feeding,Ator ischemic
vastatin,aspr stroke
in,bed side
physiotherap
y,
32
Age Admission Diagnosis Done Immediate Main system Length
/sex affected of say
Cause of
death

70/ Poorly controlled HTN + Ceftazidime,van Multiorgan kidney 3 days

M severe anemia 2 to ACD + comycin,amilodi failure 2 to
AKI r/o CKD + urogenital pine,KCL, sepsis
sepsis + mild hypokalemia omeprazole
+ BOO 2to BPH

65/F Right side hemiplegia 2 to Atrovastatin,cim Cardiorespira CNS , 1day

ischemic stroke with
involvement of MCA &
ACA + global aphasia
+increased ICP +
aspiration pneumonia
etidine,ceftriaxo tory arrest 2 respiratory &
ne,metronidazol to increased cardiac
e,Manitol , bed ICP
elevation,INO2,
NGtubefeeding,
physiotherapy

33
Age Admission Diagnosis Done Immediate Main
/sex system Length
Cause of
affected of say
death

60/F Complicated Cefipime, cardioRespirat Respirator 1 days

tb/pyogenic meningitis Vancomycin ory failure 2 to y ,CVS,
+ severe hyponatremia Ampicilline, increased ICP CNS
+ ? Post covid ADEM +? metronidazole,
Increased ICP + mannitol,bed
aspiration pneumonia elevation,
INO2,anti TB,
Table salt,

34
 Referred cases
Age/s Diagnosis Hospital stay Done Reason
ex

50/F Disseminated TB(lung, 9 days Ceftriaxone, For dialysis

pleura) superimposed azithromycin
pneumonia + AKI on
CKD

50/F chronic PVT + massive 3 days Tramadol Bone marrow

splenomegaly 2 to ?CML biopsy +
r/o essential further
thrombocytosis + ? evaluation and
necrotizing pancreatitis management
40/M Pancytopenia 2 to 14 days Ceftazidime , Hematologic
hematologic vancomycin,o evaluation(im
malignancy(? AML) + meprazole, munohistoche
neutropenic paracetamol mistry) and
fever(treated) management 35
 Left against medical advices
Age Admission Diagnosis Done Length of reason
/sex stay
55/M Impending RF 2 to ARDS 2 to Ceftazidime , 2 days Family
SCAP r/o covid 19 pneumonia vancomycin,,dexamet preferenc
+ non cardiogenc pulmonary hasone, UFH, e
edema tramadole , facemask
10l

35/M Right proximal DVT + Heparin,warfarin, 3 days Decided

community acquired ceftriaxone to visit
pneumonia other
hospital

36
 LAMA
Age Admission Diagnosis Done Length of reason
/sex stay
55/F Left side hemiparesis 2 to ? Lasix, metoprolol, 9 days Financial
Cardioembolic stroke + NYHA spironolactone,warfari reason
class IV stage C CHF 2 to n, Heparin,
CRVHD + LV thrombus Atorvastatin,

20/F Nephrotic syndrome + acute Lasix, ceftriaxone 4 days Patient

pyelonephritis preferenc
e

37
 LAMA
Age Admission Diagnosis Done Length of reason
/sex stay
75/ NYHA class IV stage C Lasix, atorvastatin, Asprin 3 days Financial
M CHF to ICMP + severe
biventricular systolic
dysfunction + Afib with
FVR +cardiogenic
pulmonary edema

38
ICU

39
 Total ICU activities in
january2022
Activity Number

Total Admissions 9 (6F,9M)

Patients from previous month 2

Transferred to medical ward 5

Left against medical advice 0

Deaths 2

Transferred to covid center 0

Referred 0

Patients transferred to the next 3

month 40
 Total ICU activities in
JANUARY, 2022
ICU
6

0
transferred to ward death LAMA Refered to nxt month
41
Series 1
 Data summary
 55.55% of patients in ICU were transferred
improved to medical ward.

 22.2% of patients who were admitted to ICU are

dead

42
Age of patients admitted to the
MICU
Age Number

<20 1

21-30 1

31-40 1

41-50 2

51-60 2

61-70 1

>70 1

43
 Causes of admission to the M-
ICU
Cause Number

Cardiovascular Ds 2

Respiratory Ds 1

Disease of GI/Liver 1

Diseases of kidney
Endocrine Ds 1

Neurologic Ds 3

Infectious Ds 1

Toxicology
Hematologic Ds
44
 Data summary
• From the age ranges who admitted to MICU 41-50 &
51-60 accounts for 44.5% of total admissions

• Accounts neurologic diseases were found to be the

commonest (33.3%) causes of MICU admissions
which was followed by CVD(22.2%).

45
 Inpatient mortality
 Inpatient mortality = No of deaths X 100

[No of deaths + discharged +transfer]

 No. of death= 2

 Transferred to medical ward=5

 LAMA=0

 Referred=0

 Inpatient mortality of January in ICU is 28.5%

46
Comparison of Inpatient Mortality of ICU
with previous months

Months Novembe December January

r

ICU 42.8 12.5% 28.5%

47
 Death at MICU
Age/se Admission Done Immediate Main Length
x Diagnosis Cause of system of say
death affected

51/m TlRF 2ndry vancomysin Massive PE resp 01 day

to Ceftazidime
SCAP+R/O
PTB+?PE+ Cimetidine

moderate Diazepam,
hyperkalemia ketamine ,
morphine,
RL&40% dextrose
NGtube feeding

48
 DEATH AT MICU
Age/se Admission Done Immedate Main Lengt
x Diagnosis cause of system h of
death affected say
38/F ?Impending ASA Sudden CVS 01 day
thyroid storm Atrovastatin cardiac arrest
with score of
30+NSTEM Metoprolol
E+TMNG+ UFH 12,500 iu sc
multiple BID
elec.abnorma PTU 100 mg po
lity(severe TID
hyponatremi
Calcium gluconate
a,hypocalce
mia,hypokale Clopidogrel
mia,hypochl mgso4
oremia )
43
OUT PATIENT

50
 Out Patient
Out patient services Number of patients

General OPD 1096

Follow up clinic 480

DM clinic 962

EMOPD 580

Total 3118

51
 Comparison with previous months

Out patient department activities

3500 3332
3118
3000

2500
2249

2000

1500
1187
1096
1006 962
1000
757 820
659
540 580
480
500 378
294

0
november december january

Total General OPD DM Clinic Follow up EOPD 52

 MEOPD

Medical EOPD Number of patients

Total visitors 580

death 4

To covid center 4

referred 0

53
 Emergency Room Mortality
 ERM = no of deaths in ER X 100

no of ER visits

 No. of death in ER=4

 No. of ER visit=580

 Emergency room mortality of january is 0.69%

 Death on arrival is not included

54
 Causes of death at EOPD
Age/sex Admission Diagnosis Done Immediate Main system Length of
Cause of death affected stay

70/m Coma 2ndry to 10l of face respiratory Respiratory 12hr

hemorragic mask arrest 2ndry to CNS
stroke+known Bed raised ICP
hypertensive+
elevation
Aspiration
pnemonia+Raised ICP
mannitol
Ceftraxone
Metrondazol
NGtube
feeding
cimetidine
28/F T1RF2ndry to respiratory respiratory 3 days
ARDS2ndry to SCAP 10 Lof Face Failure 2ndry to system
+Advanced breast ca mask ARDS 2ndry to
with malignant NG tube SCAP
pleular effusion on feeding
chemo Morphine
Ceftazidime 55
vancomysin
RVI SCREENING

56
 RVI PREVALENCE
• Globally,37.7 million people were living with HIV at the end of
2020.
• Estimated 0.7%of adult aged 15-49 years world wide are living
with HIV.
• Among all countries world wide those in Subsaharan Africa
have highest rate of HIV
• The adult(15-59) HIV prevalance in Ethiopia is 0,9%.
• The Ethiopian demographic and health survey(EDHS)2016
report shows Gambella region (4.8%)and Addis Ababa(3.4%)
to have highest HIV prevalance rate.
• According to Study done in Oromia region in 2019,
• estimated HIV prevalence rate in study area was 0.89%.
• out of 1,005 HIV positive individuals 567 (56.42%) of them
were females and 438 of them males(43.58%)
RVI Screening for Inpatients &
EOPD

Total Eligible Reactive Non

admission &Tested reactive

Regular 1096 177 5 172

OPD
MICU 9 1 0 9

EOPD 580 139 4 135

Total 1685 317 9 316

59
 Data summary
• Out of 139 eligible patients from EOPD 2.87%
tested positive for HIV.

• Out of 177 eligible patients from ROPD 2.82%

tested positive for HIV.

60
 Covid-19 positive patients

november december january

ICU 0 0 0

MEOPD 3 6 4

Total 3 6 4

61
 Challenges
• Poor recording and reporting on HMIS log books.

• Admission and discharge diagnoses aren’t

documented carefully

• Some charts are not available at card room.

• Difficult to retrieve patient charts from medical

record unit.

62
 Recommendations
• Implementation of digital medical recording
system.

• Increasing the number of bed at MICU

• facilitating intubation setup at MEOPD

• Dialysis ,CT scan,Bone marrow biopsy

• Social worker for those who lack insurrance

• HMIS log book ,medical records should be clear

on admission and discharge diagnosis

63
 References
• National hospital performance monitoring and
improvement manual , medical services
directorate, Ethiopian hospital management
initiatives, July 2011E.C.

• HMIS log-books from Ward, ICU, ER, Follow up

clinic, DM clinic, ROPD and COVID center

• Clinical audit of month of november & december.

• Ethiopia Public Health Training Initiative

• Natinal RVI guidline 2020

64
 Thank
you
65