MATERIALS AND METHODOLOGY

After obtaining ethical committee approval, as enumerated in

introduction and keeping in view the aim and objectives, both prospective

and retrospective studies were carried out in the hospital with respect to

the bed utilization indices of the hospital as a whole, and certain

specialties in the hospital for their performance for an year , so as to

assess the changing pattern of work load through out the year. As the

study has been conducted in a corporate hospital bed utilization is also

studied under general wards , paying rooms (private rooms/semiprivate

rooms ) and critical care areas.

Study materials: Case sheets and the data obtained from

questionnaires which are filled by the doctors and patients/patient

attendants

Study Design: An observational ,retrospective and prospective study.

Study period: Study was conducted for a period of 12 months, i.e., from

January 2018 to December 2018.

Study area: Out patient departments, general wards, semi private ,private

wards and critical care areas of the hospital.

Study Population:

a.Records of the patients admitted during the study period i.e., from from
January 2018 to December 2018.

b.Doctors who are posted in the study areas.

c.Patients and attendants of the patients who got admitted during the
study period.

d.Hospital staff posted in the concerned areas.

Sample Size:

Medical records of all the patients who visited OPD during the study
period i.e., ………

As the study is focused on bed utilization indices, we have included the bed
compliment i.e., total number of hospital beds …… in the study.

For the enquiry conducted to explore the suggestions for better functioning
of the facilities is 200…, out of which 100… are doctors and 100… are
patients/patient attendants.
Technique?.

Inclusion criteria :

a.All the records of Out patients who visited the hospital in the
study period i.e., from 01.01.2018 to 31.12.2018

b.All the case sheets of the patients admitted in the medical and surgical
departments hospital during the study period in the following areas

Critical care areas

General wards
Semi private wards
Private wards
 c.Doctors who are in willing to give consent to participate the
study
d.Patients/attendants who are willing to give consent to participate
the study

Exclusion criteria :

a.Excluding the beds which do not come under the bed compliment i.e.,
Day care beds
Patient examination beds
OT recovery beds
………………
b.Doctors who are not willing to give the consent to participate in the
study.
c.Patients/ attendants who are not willing to give the consent to
participate in the study.

Methodology: An observational ,retrospective and prospective study done

Keeping in view the above objectives of the study, following methodology

has been adopted Data would be collected in the following format.

Primary Data:

1. Medical records of all Out patients

2. Medical record of all in patients

3. From the data obtained from questionnaires

4. Direct observation.

5. Informal discussions with the hospital staff

 Secondary data:

1. Published and unpublished literature in the form of

books and articles in the journals.

2. Reports and Governmental documents.

3. Previous research published by premier institutes.

Record Study:

a) Retrospective study

The primary source of data in this project has been the Medical Records

Department (MRD), where we went through the relevant records and

collected the data required, like the changing bed complement of the

hospital and general statistics of the hospital ( like the number of OPs,

number of admissions, number of discharges and deaths per month) for

the year 2018.

From the collected data the bed utilization indices were calculated by

applying appropriate formulas to assess the performance of the hospital

for the year.

The formulas used for calculating the indices are;

 Average Length of Stay (ALS):

 Summation of Daily Census
ALS = ------------------------------------
Discharges + Deaths

 Bed Occupancy Rate (BOR):

Average Daily census

BOR = ---------------------------- x 100
Bed Compliment

 Bed Turnover Interval (BTI):

(Bed compliment x Period) - (Summation of Daily Census)

BTR = -----------------------------------------------------------------------------
Discharges + deaths

 Bed Turnover Rate

Total number of Discharges and Deaths

BTR = --------------------------------------------------
Bed Complement

The work load on Out patient department was calculated by taking the

ratio of OP to IP patient's ratio in the year 2018.

The same procedure was followed for assessing the performance of

available super specialties of the hospital like Cardiology, Cardiothoracic

Surgery, Neurology, Neurosurgery, Nephrology , Urology , Surgical

Gastro Enterology , Liver Transplantation , Medical & Surgical

Oncology ,Medical Gastro Enterology and some broad specialties like

Orthopedics and General Medicine and Obstetrics and Gynaecology

departments through out the year as majority of the patients come to this

particular hospital for the above mentioned specialties

b) Prospective study

A Prospective study of the hospital bed utilization was done for a period

of one year by collecting the daily statistics. These were computed and

the hospital bed utilization indices were calculated so as to compare

month wise changing trends of work load and bed utilization.

Another aspect of the prospective study is the analysis of bed utilization

indices of few areas of the general wards, paying rooms and acute wards

taken as a sample for a period of 12 months from January 2018 to

December 2018, with a view to assess the demand for a bed in those areas.

The general wards chosen for the study are (VII A&B , C&E , VIII (B to I) ,

Pediatric GW). The acute wards selected are ICCUs (Intensive Cardiac

Care Units ) , SICU(Surgical Intensive Care Units ), KTU, AMCU,

ANCU ,CVU, BSU, CT-ICUs, ACU ,HDU ,PICU , NICU , PHDU , Burns

ICU . The paying rooms selected are IIA , IIIA , IV- A,B,C,D , V-A,B,C,D,

VI-B,D , VII A,C , VIII A wards .

In the study period , the daily average census, transfer-outs, discharges

and deaths were collected from these areas and from the data, the bed

utilization indices were calculated.

2. Opinion Survey (Interview Method):

As stated in the objectives we conducted an opinion survey of both

patients and doctors so as to identify the bottlenecks affecting the bed

utilization in our hospital. A questionnaire was designed to clearly elicit

the information required for the purpose of the study. Care has been taken

to see that the sample represents all the specialties in the hospital.

Exit interviews were conducted through formatted questionnaire of a

hundred Cases ( patients) belonging to different specialties, who have

cleared their bills and were ready to leave the hospital. They were asked

suggestions for improvement of bed utilization in the Hospital. The data

collected was analyzed.

A Structured questionnaire was developed to interview doctors working

in the institute and was distributed both to the residents and Consultants

belonging to different specialties. The sample consisted of residents who

are working for more than two months in the Hospital and to Consultants

who were working for more than 5 years in the Hospital. A total of

hundred doctors were interviewed through the questionnaire which

covered different aspects of bed utilization in Yashoda Hospital and the

bottlenecks affecting bed utilization. The doctors were asked suitable

suggestions for improvement. The data collected was analyzed for

doctor's opinions and suggestions.

(The reason for selecting such a sample size is because the statistical

analysis for interpreting the data has been mainly through computation of

the percentages for which it has been considered that the bare minimum

of subjects interviewed be hundred.)

Direct Observational Study:

The factors that are enumerated as the bottlenecks in affecting bed

utilization in the hospital are directly observed for a period of three

months to confirm the affects. Then the wards which are under the study

are also observed for the same period to see the work load and pressure of

beds in those areas.

Statistical analysis:………….

Limitations of the study:

1.Since the data collected is based on records, we faced problems like

incompleteness, inaccurate entries, omissions, double entries etc.

2.To Calculate bed utilization indices like BOR and BTI for the

specialties was difficult because there is no fixed allotment of beds to the

particular speciality and the patient admitted under the specialty can be in
a general or private room. He can also be in a Intensive care units . So

this could not be calculated.

3.The present study to identify the bottlenecks of bed utilization, being

based on interview method, caution must be exercised in interpreting data

since the interview method is usually associated with certain

disadvantages such as being influenced by the investigators, and

interviewee may suffer from faculty perception, faculty memory etc.

However attempts have been made to minimize these errors by

conducting interview in a friendly atmosphere and also by conducting an

observational study to confirm the bottlenecks identified in the

interviews.

4.Parameters like operational efficiency and cost analysis have been

deliberately kept out of the study as these parameters involve differences

of opinion regarding their measurements and also their interpretations.

5.A question that is often raised is "How successful is a given hospital?"

Hospital indices are required not only to measure the performance of the

hospital, but also to assess the health care needs, for allocation of scarce

resources and for monitoring and evaluation of different services and

departments in the hospital. Indices help to measure the extent to which

the objectives and targets of a hospital are being attained.