Based on discharge data, a list is prepared of all patients who died during their hospital stay.

. From these lists

DEATH RATES

or counts the death rate can be determined. Remember that, upon discharge, a patient is classified as being
discharged either alive or dead and that the term discharge includes death. However, look at the data carefully,
because the term live discharges is also used, in which case the live discharges must be added to the deaths to
determine the total discharges.
Example: On January 15, fifteen patients were discharged. Of these 15, two were deaths and 13 were live
discharges.
Gross Death Rate
Formula:
Total number of deaths (including NB) for a period
———————————————————–— × 100
Total number of discharges (including deaths) for the period (NB and A&C)
 
Example: If 100 patients are discharged in a certain month and three of these were deaths, the result is a gross
death rate of 3% (3 ÷ 100 = 0.03, which is multiplied by 100).
• Net Death Rate or Institutional Death Rate

• Formula:

• Total IP deaths (incl. NB) minus those under 48 hours for a period

• ————————————————————————————— × 100

• Total discharges minus deaths under 48 hours for the period

• Example: A total of five patients expired in June, of which two died less than 48 hours following admission
and three died more than 48 hours after admission. A total of 450 inpatients were discharged in June. Gross
death rate is total deaths over total discharges (5 divided by 450), then multiplied by 100, which gives a gross
death rate of 1.11%. Net death rate only includes patients who died at least 48 hours after admission, or 3
divided by 450 minus 2 (3 ÷ 448), multiplied by 100, which gives a net death rate of 0.67%.

• Hospital deaths are reviewed by a medical staff committee to determine whether appropriate care was
administered and to evaluate whether other measures may have helped to save the patient’s life, in hopes that
lives might be saved in the future. This points to another role of statistical treatment of data. Not only are
statistics important for administrative decisions (such as whether to close down a wing of the hospital) but for
peer review and better patient care as well.
• Postoperative Death Rate

• Formula

• Total surgical deaths within 10 days postoperative for a period

• —————————————————————————–—— × 100

• Total patients operated upon for the period

• Also, few surgical patients nowadays are still hospitalized less than ten days post-op because of the trend to
ever shorter inpatient stays. Only patients in critical condition and those who develop major complications
are likely to exceed ten postoperative days.
 • ADMISSIONS
• Admission : a patient accepted for inpatient service in a hospital.
• Admission process : Level of care
• Intensive care unit (ICU): Generally reserved for the sickest people, those who require close nursing
supervision, or those who require a ventilator to help them breathe.
• Cardiac care unit (CCU): Like the ICU, but reserved for people with heart problems
• Surgical intensive care unit: For people who have had surgery
• Paediatric intensive care unit (PICU):For children
• Neonatal intensive care unit (NICU):For new-borns
• Telemetry or step-down unit: For people who need close nursing support or cardiac monitoring but not
intensive care
• Surgery floor: A general floor for people who need surgery
• Medical floor: A general floor for medical care
• Types of Hospital Admissions
There are two major types of admissions, 1) elective and 2) emergency admissions, but there are some variations.
The following is a brief description of the major and other admission types:
• Elective admission: You have a known medical condition or complaint that requires further workup, treatment, or
surgery.
 The admission itself may be delayed until a time is convenient for both you and your doctor.
 In most cases of elective admission, you will come to the hospital's admitting office.
 You may be instructed go to the hospital several days in advance for lab work, X-rays, ECGs, or other pre-
screening tests.
 If you require elective surgery and think you may need a blood transfusion during surgery, ask your doctor if you
can set aside or donate blood for yourself, in advance, in case it is required.
• Emergency admission: This occurs through the emergency department. You may be admitted to a floor, a
specialized unit (for example, the medical or surgical intensive care unit), or a holding ( observation) unit
• Same-day surgery: Technically, this is not an admission.
 With same-day surgery or ambulatory surgery, your doctor will schedule a procedure that will be performed at the
hospital.
 You are discharged home the same day after you recover from the procedure.
• Holding unit or observation admission: This admission often takes place through the emergency
department. In this case, you are admitted for diagnostic testing. Unless something shows up positive, you
will be discharged within 23 hours.

• Direct admission: You have spoken to or seen your doctor, who feels you need to be admitted.

 Your doctor may arrange an ambulance to take you to the hospital or may request that you go to the hospital
yourself.

 In cases of direct admission, ask your doctor which hospital to go to.

 Your doctor may reserve a bed and want you to go directly to the floor (or admitting office).
 DISCHARGE

• Discharge from the hospital is the point at which the patient leaves the hospital and either returns home or is transferred to
another facility such as one for rehabilitation or to a nursing home. Discharge involves the medical instructions that the
patient will need to fully recover. Discharge planning is a service that considers the patient's needs after the hospital stay, and
may involve several different services such as visiting nursing care, physical therapy, and home blood drawing (taking blood
test at home ie, home service).

Before leaving the hospital, the patient will receive discharge instructions that should include:

 an explanation of the care the patient received in the hospital

 a list of medications the patient will be taking (the dosage, times, and frequency)
 a list of potential side effects of any newly prescribed medications
 a prescription for any newly prescribed medications
 when to see the primary care physician for a follow-up appointment
 home care instructions such as activity level, diet, restrictions on bathing, wound care, as well as when the patient can
return to work or school, or resume driving
 signs of infection or worsening condition, such as pain, fever, bleeding, difficulty breathing, or vomiting
 an explanation of any services the patient will now be receiving, such as for a visiting nurse, and to include contact
information
1.2.5 LOCATION, DESIGN & LAYOUT
• The Medical Records Department should be located adjacent to the Front Office. The Medical Record department has to
function 24 hours on all the days to cater the Medical Records immediately.

Size and location:

• Physical facilities: Location - near main entrance in close proximity with OPD & Emergency,

 Admission & enquiry space- 125 -175 sq.ft .

 Space - medical record office for 50beddedHospital 175sq.ft ,medical record office for 100, bedded Hospital 240sq.ft
medical record office for 200 bedded Hospital 500sq.ft medical record office for 500 bedded hospital 1200sq.ft

 Storage - 120-500sq.ft with shelving.

 Retention Schedule OPD -5yrs IPD -10yrs

 MLC -lifelong
1.2.6 STAFFING & MEDICAL RECORDS COMMITTEE

• Staffing

• The average staffing for 250 beds and 500 beds hospital should be as under. 25% for leave reserve extra.

• S.NO. MANPOWER 250 BEDS 500 BEDS 1000 BEDS

• 1. MRO 1 1 1

• 2. M.R Technician 4 6 8

• 3. M.R Assistant 4 6 8

• 4. Nursing Staff 3 6 10

• 5. Admission Clerk 2 4 10

• 6. Helping Staff 2 3 5
• Medical Records Committee: The term of the committee is two years. Meeting : The committee to meet once a month and minutes
circulated to different departments.

• Function : Training policies & procedures for medical record Examine adequacy, quality and quantity of patient care.

• Medical Superintendent (Convener)

• Three Sr.Consultants (various specialties)

• Administrator

• HOD – Medical Records Department

• HOD - Quality Systems

• Nursing Superintendent / Representative

• HOD – OP/IP Services.

1.2.7 TECHNOLOGY ADVANCEMENT

• EMR: An EMR is a digital version of a paper chart in a clinician's office. It contains the medical and treatment history of the patients in one practice.
The Medical Record has been a collection or package of handwritten or typed notes, forms & reports. Automation has made possible to capture,
store, retrieve present clinical data.

• “On line Systems” – The hospital staff can directly access the databases through communication terminals connected by Local Area Network (LAN).

• Backup system – Backup can be taken in Floppies, CDs or in Double Hard disk system.

• Scanners – Records are scanned and stored in Hard disks or CDs. A software helps to retrieve and analyses the cases.

• Computer Entries

• The entries such as issues, receipts, updates, indexing (diseases and procedures) are done on a daily basis.

• This plays vital to view the location of the various files.

• The file types such as Volumes No, IP, OP, MLC, EXPIRED are also to be included in the entries.

• The monthly and yearly statistics are to be prepared.

MICROFILMING & smart cards OF MEDICAL RECORDS

•  Medical records may be microfilmed at any time including immediately after completion. Microfilming may be done
on or off the premises. If done off the premises, the dept shall take precautions to assure the confidentiality and
safekeeping of the records. The original of microfilmed medical records may not be destroyed until the medical records
service has had an opportunity to review the processed film for content.

• Uses

 Space saving

 Easy accessibility

 Safe preservation

 Elimination of misfiring(fail to have the intended result or effect)

 Saves time & manpower

 Clean & easy handling

Smart card

• The new Smart Card is the first phase of a pilot program and will consist of a patient's ID photo and a computer chip housing the patient's
medical history, personal and insurance information. Smartcard reader stations will be located in the admissions area at Hospital, in the
emergency department and in cardiology offices on the campus. Smartcard technology will provide patients with faster registration and easily
accessed medical history.

• "One of the most difficult things patients encounter when visiting doctors or hospitals is the very lengthy process of registration. This new
technology will decrease the time spent on forms and expedite their entry into various parts of the hospital in minutes.

• "I-AM", an Internet personal health record, combined with the world-leading patented I-AM Smart card in the fourth quarter of 2005. The
application allows people to carry their entire medical history on a smart card.

• The I-AM personal health record stores an individual's lifelong health data securely on the Internet along with a synchronized copy on the I-
AM Smart card giving Instant Access to Medical data whenever and wherever the patient, or their physician, needs it regardless of access to
the Internet.

• The patient controls access so the data is only available when the patient activates the I-AM Smart card. All access to the personal health record
is logged and entered in an audit trail. For even greater security a fingerprint reader is available.

•
• The card is applicable at home and overseas. For those away from home, I-AM displays the health data in a
multi-lingual format, providing foreign doctors access to all pertinent medical history to ensure proper care is
administered. The I-AM personal health record is based on

• Health One Global's international professional electronic health record software. The software is built around
international standards, and is already used by physicians in the USA, Ireland, Belgium, France, Switzerland
and South Africa. The I-AM Smart card patented technology is an ISO-approved design and is supplied by Intel
Card Inc. Health One Global Ltd is the exclusive healthcare Global Distributor for the Smart card technology.

• Upon inserting a smart card and entering a password, doctors at Hospitals now have immediate access to
patient files and other critical applications. Once the doctor has finished reviewing files, removes the smart card
and walks away, the ultra- thin client display automatically turns blank and is locked.
THANK YOU