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Republic of the Philippines

Department of Health
HEALTH FACILITIES AND SERVICES REGULATORY BUREAU
ANNEX - E
A.O. No. 2012-0012
ANNUAL HEALTH FACILITY STATISTICAL REPORT

YEAR 2017

Name of Hospital: DOMINGO CASANO


Street Address: REAL STREET 143
HOSPITAL
District / Province: EASTERN Region: REGION VIII (EASTERN
City / Municipality: DOLORES
SAMAR VISAYAS)
Contact Number: Fax Number:
Email Address: jayannlebrilla86@gmail.com

(PLEASE FILL OUT ALL ITEMS. PUT N/A IF NOT APPLICABLE.)

I. GENERAL INFORMATION

A. Classification

1. Service Capability

 Service capability: Capability of a hospital/other health facility to render administrative, clinical, ancillary
and other services

General:
[ ✔ ] Level 1 Hospital Specialty: (Specify)
[ ] Level 2 Hospital [ ] Treats a particular
[ ] Level 3 Hospital (Teaching/Training) disease
[ ] Treats a particular
[ ] Infirmary organ
[ ] Treats a particular
Trauma Capability: class of patients
[ ✔ ] Trauma Capable [ ] Others(Specify):
[ ] Trauma Receiving

2. Nature of Ownership

Government: Private:
[ ] National - DOH Retained/Renationalized [ ✔ ] Single
[ ] Local (Specify): Proprietorship/Partnership
[ ] Province /Corporation
[ ] City [ ] Religious
[ ] Municipality [ ] Civic Organization
[ ] Foundation
[ ] DILG - PNP [ ] Others(Specify):
[ ] DND - AFP
[ ] DOJ
[ ] State Universities and Colleges (SUCs) 
[ ] Others (Specify):
B. Quality Management

 Quality Management/Quality Assurance Program: Organized set of activities designed to demonstrate on-
going assessment of important aspects of patient care and services

[ ] ISO Certified (Specify ISO Certifying Body and area(s) of the hospital with
Validity Period:
Certification)

[ ] International Accreditation Validity Period:

Validity Period:
[ ✔ ] PhilHealth Accreditation
[ ✔ ] Basic Participation  Jan 01, 2017 -
[ ] Advanced Participation Dec 31, 2017

[ ] PCAHO Validity Period:

C. Bed Capacity/Occupancy

1. Authorized Bed Capacity: 50 beds


o Authorized bed: Approved number of beds issued by HFSRB/RO, the licensing offices of DOH
2. Implementing Beds: 100 beds
o Implementing beds: Actual beds used (based on hospital management decision)
3. Bed Occupancy Rate (BOR) Based on Authorized Beds: 98.52% beds

[Total Inpatient service days for the period]** x 100


[Total number of Authorized beds] x [Total days in the period (365 0r 366 for leap year) ]

o Bed Occupancy Rate: The percentage of inpatient beds occupied over a given period of time. It is a
measure of the intensity of hospital resources utilized by in-patients.(given period of time is January 1 to
December 31each year for the annual statistics)
o Inpatient Service days (Inpatient bed days): Unit of measure denoting the services received by one in-
patient in one 24 hour period.
o Total Inpatient Service days or Inpatient Bed days =[(Inpatients remaining at midnight + Total
admissions) - Total discharges/deaths) + (number of admissions and discharges on the same day)].

II. HOSPITAL OPERATIONS

A. Summary of Patients in the Hospital

For each category listed below, please report the total volume of services or procedures performed.

**Inpatient: A patient who stays in a health facility licensed to admit patients, while under treatment

Inpatient Care Number

Total number of inpatients 6,272

Total Newborn (In facility deliveries) 583

Total Discharges (Alive) 6,116

Total patients admitted and discharged on the same day 75

Total number of inpatient bed days (service days) 17,979


Total number of inpatients transferred TO THIS FACILITY from another facility for
8
inpatient care

Total number of inpatients transferred FROM THIS FACILITY to another facility for
63
inpatient care

Total number of patients remaining in the hospital as of midnight last day of previous
30
year

B. Discharges

Type of Accomodation Condition on Discharge

Total Non-Philhealth Philhealth Deaths


Lengt
h of
No. of Stay/
Type of Remar
Patien Total Total
Service HM OWW < ≥ ks
ts No. R/I T H A U Discharg
of Pa Service/Char Tot Pa Service/Char Tot O A 48 48 Tot es
Days y ity al y ity al hr hr al
Stay s s

28 2,53 2,75 3
Medicine 2,819 7,955 0 284 0 2,535 0 2 0 0 0 22 9 31 2,819
4 5 8 0

Obstetrics 582 1,319 37 0 37 0 545 545 0 0 575 7 0 0 0 0 0 0 582

Gynecology 50 112 8 0 8 0 42 42 0 0 50 0 0 0 0 0 0 0 50

24 2,58 2,78 2
Pediatrics 2,821 8,593 0 240 0 2,581 0 19 0 0 0 10 3 13 2,821
0 1 2 6

Surgery

Pedia 10 21 0 0 0 0 10 10 0 0 10 0 0 0 0 0 0 0 10

Adult 92 92 8 0 8 0 84 84 0 0 92 0 0 0 0 0 0 0 92

Other(s)

18,09 57 5,79 6,26 6


Total 6,374 0 577 0 5,797 0 21 0 0 0 32 12 44 6,374
2 7 7 7 3

Total
583 1,319 40 0 40 0 543 543 0 0 578 2 0 0 0 3 0 3 583
Newborn

Pathologic 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Non-
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pathologic

Well-Baby 583 1,319 40 0 40 0 543 543 0 0 578 2 0 0 0 3 0 3 583

*R/I - Recovered/Improved T - Transferred U - Unimproved

H - Home Against Medical Advice A - Absconded D - Died


1. Average Length of Stay (ALOS) of Admitted Patients

Total length of stay of discharged patients (including Deaths) in the period = 2 - 3 Day(s)
Total Discharges and Deaths for the same period

 Average length of stay: Average number of days each inpatient stays in the hospital for each episode of
care.
2. Ten Leading causes of Morbidity based on final discharge diagnosis
For each category listed below, please report the total number of cases for the top 10 illnesses/injury.

(Do not include deliveries)

Cause of Morbidity/Illness/Injury Number ICD-10 Code

1. Influenza and pneumonia 910 J10-J18

2. Chronic lower respiratory diseases 658 J40-J47

3. Intestinal infectious diseases 565 A00-A09

4. Other diseases of the urinary system 483 N30-N39

5. Diseases of esophagus, stomach and duodenum 475 K20-K31

6. Hypertensive diseases 270 I10-I15

7. Tuberculosis 79 A15-A19

8. Other diseases of upper respiratory tract 78 J30-J39

3.

Kindly accomplish the "Ten Leading Causes of Morbidity/Diseases Disaggregated as to Age and Sex" in the table below.

Age Distribution of Patients ICD


Cause of
-10
Morbidit 70
CO
y/Illness/I Und 5- 10 - 15 - 20 - 25 - 30 - 35 - 40 - 45 - 50 - 55 - 60 - 65 - & Sub
1-4 DE /
njury er 1 9 14 19 24 29 34 39 44 49 54 59 64 69 ove total T
TA
r ot
BU
al
Spell out. LA
Do not R
M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F LIS
abbreviat
e. T

1.
Influenza 1 1 4 4 9
4 3 4 5 2 2 1 2 1 1 2 2 1 1 1 2 1 2 1 1 2 1 2 2 2 2 4 4 J10-
and 0 0 9 9 5 5 1
6 2 8 5 8 8 6 4 1 1 0 1 1 4 1 1 2 3 4 6 2 4 4 3 4 7 2 7 J18
pneumoni 3 4 9 1 0
a

2. Chronic
3 3 6
lower 1 1 4 3 4 3 2 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 2 3 4 J40-
1 4 5
respirator 6 3 0 9 6 3 5 7 9 9 2 4 2 7 2 1 1 8 2 3 6 4 4 7 6 5 6 0 7 1 3 0 J47
7 1 8
y diseases

3.
2 2 5 A00
Intestinal 1 1 6 4 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1
9 9 7 8 9 8 7 6 -
infectious 3 2 6 6 0 8 4 9 5 9 8 8 6 9 7 2 2 3 9 9 8 3 3 4 1 5 4
9 6 5 A09
diseases

4. Other
diseases 1 3 4 N30
1 2 3 4 2 2 2 4 2 1 1 1 2 1 1 1 1 1 2
of the 3 7 6 8 9 6 7 7 5 7 5 6 6 7 0 8 -
8 4 8 4 0 8 3 3 0 2 5 9 0 2 0 0 2 2 1
urinary 7 6 3 N39
system
5.
Diseases
of 2 2 4 K20
1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 3
esophagus 5 7 8 2 5 7 -
4 6 6 3 5 0 0 6 4 5 4 1 8 7 6 7 6 2 6 3 3 9 5 4 4 5 5 9 2
, stomach 0 5 5 K31
and
duodenum

6.
1 2
Hypertens 1 2 1 1 2 1 2 1 2 1 4 9 I10-
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 4 6 8 8 9 7 7
ive 6 3 2 2 1 8 3 7 3 7 5 3 I15
7 0
diseases

7. A15
1 4 3 7
Tuberculo 0 0 0 0 0 0 1 1 2 1 2 1 2 2 1 1 2 2 3 5 4 3 2 1 5 3 7 2 6 4 6 -
0 7 2 9
sis A19

8. Other
diseases
1 4 3 7 J30-
of upper 0 1 7 6 5 7 3 2 3 1 1 2 3 2 2 2 2 1 2 1 2 1 2 1 1 1 1 0 1 2 2
1 0 8 8 J39
respirator
y tract

3. Total Number of Deliveries


For each category of delivery listed below, please report the total number of deliveries.

Deliveries Number

Total number of in-facility deliveries 574

Total number of live-birth vaginal deliveries (normal) 583

Total number of live-birth C-section deliveries (Caesarians) 8

Total number of other deliveries 0

4. Outpatient Visits, including Emergency Care, Testing and Other Services


For each category of visit of service listed below, please report the total number of patients receiving the care.

Outpatient visits Number

Number of outpatient visits, new patient 4,350

Number of outpatient visits, re-visit 2,191

Number of outpatient visits, adult


3,091
(Age 19 years old and above)

Number of outpatient visits, pediatric


3,790
( Age 0 to 18 yrs old; before 19th birthday)

Number of adult general medicine outpatient visits 2,916

Number of specialty (non-surgical) outpatient visits 0

Number of surgical outpatient visits 0

Number of antenatal care visits 0

Number of postnatal care visits 0


5. Ten Leading Causes of OPD Consultation

ICD-10
Ten Leading OPD Consultations Number
Code

1. Other bacterial diseases 2,876 A30-A49

2. Intestinal infectious diseases 1,825 A00-A09

3. Acute upper respiratory infections 1,090 J00-J06

4. Symptoms and signs involving the digestive system and abdomen 519 R10-R19

5. Symptoms and signs involving cognition, perception, emotional state


426 R40-R46
and behavior

6. Symptoms and signs involving the circulatory and respiratory systems 181 R00-R09

7. Episodic and paroxysmal disorders 168 G40-G47

6.
7. Ten Leading Causes of ER Consultation

ICD-10
Ten Leading ER Consultations Number
Code

1. Other bacterial diseases 700 A30-A49

2. Intestinal infectious diseases 439 A00-A09

3. Acute upper respiratory infections 276 J00-J06

4. Symptoms and signs involving the digestive system and abdomen 169 R10-R19

5. Symptoms and signs involving cognition, perception, emotional state


146 R40-R46
and behavior

6. Symptoms and signs involving the circulatory and respiratory systems 63 R00-R09

7. Persons encountering health services in other circumstances 58 Z70-Z76

8.
9. TESTING

Total number of medical imaging tests (all types including x-rays, ultrasound, CT
Number
scans, etc.)

X-Ray 2,788

Ultrasound 0

CT-Scan 0

MRI 0

Mammography 0

Angiography 0

Linear Accelerator 0

Dental X-Ray 0

Other 0

Total number of laboratory and diagnostic tests (all types, excluding medical
imaging)
Urinalysis 4,081

Fecalysis 1,232

Hematology 7,529

Clinical chemistry 1,329

Immunology/Serology/HIV 0

Microbiology (Smears/Culture & Sensitivity) 0

Surgical Pathology 0

Autopsy 0

Cytology 0

Blood Service Facilities

Number of Blood units Transfused 0

10. EMERGENCY VISITS

Emergency visits Number

Total number of emergency department visits 3,983

Total number of emergency department visits, adult 2,094

Total number of emergency department visits, pediatric 1,889

Total number of patients transported FROM THIS FACILITY’S


16
EMERGENCY DEPARTMENT to another facility for inpatient care

11.

C. Deaths

 For each category of death listed below, please report the total number of deaths.

Types of deaths Number

Total deaths 56

Total number of inpatient deaths

 Total deaths < 48 hours


16

 Total deaths ≥ 48 hours


40

Total number of emergency room deaths 5

Total number of cases declared 'dead on arrival' 21

Total number of stillbirths 2

Total number of neonatal deaths 3

Total number of maternal deaths 0


1. Gross Death Rate 10.19%

Gross Death Rate = Total Deaths (including newborn for a given period) x 100
Total Discharges and Deaths for the same period

2.

10.19% = 639 x 100 (User encoded)


6,272

3. Net Death Rate 9.96%

Net Death Rate = Total Deaths (including newborn for a given period) - death < 48 hours for the period x 100
Total Discharges (including deaths and newborn) - death < 48 hours for the period

4.

9.96% = 623 x 100 (User encoded)


6,256

5. Ten Leading Causes of Mortality/Deaths and Total Number of Mortality/Deaths.

(Do not include Cardio-respiratory arrest, put underlying cause instead)

Mortality/Deaths Number ICD-10 Code

1. Ischemic heart diseases 12 I20-I25

2. Influenza and pneumonia 10 J10-J18

3. Chronic lower respiratory diseases 6 J40-J47

4. Infections specific to the perinatal period 4 P35-P39

5. Cerebrovascular diseases 4 I60-I69

6. Metabolic disorders 2 E70-E90

7. Other forms of heart disease 2 I30-I52

8. Other bacterial diseases 2 A30-A49


Kindly accomplish the "Ten Leading Causes of Mortality/Deaths Disaggregated as to Age and Sex" in the table below.

(Do not include cardio-respiratory Arrest and maternal deaths)

Cause Age Distribution of Patients


of
Mortali 70 Su ICD-
Un 10 15 25 30 35 40 45 50 55 60 65
ty 1- 5- 20 & b 10
der - - - - - - - - - - -
(Under 4 9 -24 ove tot COD
1 14 19 29 34 39 44 49 54 59 64 69 T
lying) r al E/
ot
TAB
Spell al
ULA
out. Do R
not M F MF MF MF MF MF MF MF MF MF MF MF MF MF MF MF MF LIST
abbrevi
ate.

1.
Ischemi I20-
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 1 3 3 5 7 12
c heart I25
diseases

2.
Influen
J10-
za and 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 4 3 7 10
J18
pneumo
nia

3.
Chronic
lower J40-
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 3 1 5 1 6
respirat J47
ory
diseases

4.
Infectio
ns
P35-
specific 1 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 2 4
P39
to the
perinata
l period

5.
Cerebro
I60-
vascula 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 1 3 1 4
I69
r
diseases

6.
Metabo
E70-
lic 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 2
E90
disorder
s

7. Other
forms I30-
0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 2
of heart I52
disease

8. Other
bacteria A30-
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 2 2
l A49
diseases
D. Healthcare Associated Infections (HAI)

 HAI are infections that patients acquire as a result of healthcare interventions. For purposes of Licensing, the four
(4) major HAI would suffice.
 For All Hospitals (General and Specialty)

INFECTION RATE = Number of Healthcare Associated Infections x 100


Number of Discharges

a. Device Related Infections


1. Ventilator Acquired Pneumonia (VAP) = Number of Patients with VAP x 1000


Total Number of Ventilator Days

 (Not to be filled up by Level 1 with no ICU facilities)


2. Blood Stream Infection x


Number of Patients with BSI
(BSI) = 1000
Total Number of Central Line (peripheral lines not
included)

3. Urinary Tract Infection (UTI) = Number of Patients (with catheter) with UTI x 1000
Total Number of Catheter Days

b. Non-Device Related Infections


Surgical Site Infections (SSI) = Number of Surgical Site Infections(Clean Cases) x 100
Total number of Clean Procedures done

Percentage (%)
INFECTION RATE 0.00
Device Related Infections
Ventilator Acquired Pneumonia (VAP) 0.00
Blood Stream Infection (BSI) 0.00
Urinary Tract Infection (UTI) 0.00
Non-Device Related Infections
Surgical Site Infections (SSI) 0.00
E. Surgical Operations

1. Major Operation refers to surgical procedures requiring anesthesia/ spinal anesthesia to be performed in an
operating theatre. ( Refer to different cutting specialties.)
2. Minor Operation refers to surgical procedures requiring only local anesthesia/ no OR needed, example suturing.
(Refer to different cutting specialties)

10 Leading Major Operations (excluding Caesarian Sections) Number

3.

10 Leading Minor Operations Number


1 LACERATED WOUND 41
2 Incised wound 15
3 Punctured wound 15
4 CIRCUMCISION 6
5 Avulsed wound 5
6 Hacked wound 2
7 Stabbed wound 2
8 Gun shot wound 1

4.

III. STAFFING PATTERN (Total Staff Complement)

Total staff working Total staff working


full time (at least part time (at least Active
Special 40 hours/week) 20 hours/week) Rotati
ty Number Number ng or
Profession/Position/Design Number Number Visitin Outsourc Tot
Board of of
ation of of ed al
Certifi permane permane g/
ed contract contract Affilia
nt full nt part
ual full ual part te
time time
time staff time staff
staff staff

A. Medical

1. Consultants 0 0 0 0 0 0 0 0

1.1 Internal Medicine 0 0 0 0 0 1 1

a. Generalist 0 1 0 0 0 4 5

b. Cardiologist 0 0 0 0 0 0 0

c. Endocrinologist 0 0 0 0 0 0 0

d. Gastro-
0 0 0 0 0 0 0
Enterologist

e. Pulmonologist 0 0 0 0 0 0 0

f. Nephrologist 0 0 0 0 0 0 0

g. Neurologist 0 0 0 0 0 0 0

1.2. Obstetrics/
Gynecology (and sub- 0 0 1 0 0 0 0 1
specialty)
1.3. Pediatrics (and
0 0 0 0 0 1 1
sub-specialty)

1.4. Surgery (and sub-


0 0 0 0 0 0 0
specialty)

1.5. Anesthesiologist 0 0 0 0 0 0 0

1.6. Radiologist 0 1 0 0 0 1 0 2

1.7. Pathologist 0 0 1 0 0 0 0 1

2. Post-Graduate Fellows
(Indicate 0 0 0 0 0 0 0 0
specialty/subspecialty)

3. Residents 0 0 0 0 0 0 0 0

3.1. Internal Medicine 0 0 0 0

3.2. Obstetricts-
0 0 0 0
Gynecology

3.3. Pediatrics 0 0 0 0

3.4. Surgery 0 0 0 0

SUB-TOTAL: 0 2 2 0 0 7 0 11

B. Allied Medical

1. Nurses 0 21 11 0 0 0 0 32

2. Midwives 1 0 1

3. Nursing Aides 1 0 1

4. Nutritionist 1 0 1

5. Physical Therapist 0 0 0

6. Pharmacists 2 0 2

7. Medical Technologist 0 0 0

8. Laboratory Technician 3 0 3

9. X-Ray Technologist/X-
2 0 2
Ray Technician

10. Medical Equipment


1 0 1
Technician

11. Social Worker 1 0 1

12. Medical Records


Officer/ Hospital Health 1 0 1
Information Officer

SUB-TOTAL: 0 34 11 0 0 0 0 45

C. Non-Medical

1. Chief Administrative
0 1 0 0 0 0 0 1
Officer

2. Accountant 1 0 1

3. Budget officer 0 0 0

4. Cashier 1 0 1

5. Clerk 6 0 6
6. Engineer 0 1 1

7. Driver 1 0 1

9. General Support Staff 0 15 0 0 0 0 0 15

- Janitorial 14 0 0 0 0 0 14

- Maintenance 1 0 0 0 0 0 1

- Security 0 2 0 0 0 0 2

SUB-TOTAL: 0 40 3 0 0 0 0 43

GRAND TOTAL: 0 76 16 0 0 7 0 99

IV. EXPENSES

 Report all money spent by the facility on each category.

Amount in
Expenses
Pesos
Amount spent on personnel salaries and wages 4,080,000.00
Amount spent on benefits for employees (benefits are in addition to wages/salaries.
588,000.00
Benefits include for example: social security contributions, health insurance)
Allowances provided to employees at this facility (Allowances are in addition to
wages/salaries. Allowances include for example: clothing allowance, PERA, vehicle 60,000.00
maintenance allowance and hazard pay.)
TOTAL amount spent on all personnel including wages, salaries, benefits and
4,728,000.00
allowances for last year (PS)
Total amount spent on medicines 0.00
Total amount spent on medical supplies (i.e. syringe, gauze, etc.; exclude
2,000,000.00
pharmaceuticals)
Total amount spent on utilities 100,000.00
Total amount spent on non-medical services (For example: security, food service,
1,500,000.00
laundry, waste management)
TOTAL amount spent on maintenance and other operating expenditures
3,600,000.00
(MOOE)
Amount spent on infrastructure (i.e., new hospital wing, installation of ramps) 5,000,000.00
Amount spent on equipment (i.e. x-ray machine, CT scan) 1,500,000.00
TOTAL amount spent on capital outlay (CO) 6,500,000.00
GRAND TOTAL 14,828,000.00

V. REVENUES

 Please report the total revenue this facility collected last year. This includes all monetary resources acquired by this
facility from all sources including donations.

Amount in
Revenues
Pesos
Total amount of money received from the Department of Health 0.00
Total amount of money received from the local government 0.00
Total amount of money received from donor agencies (for example JICA, USAID, and
0.00
others)
Total amount of money received from private organizations (donations from
0.00
businesses, NGOs, etc.)
Total amount of money received from Phil Health 24,000,000.00
Total amount of money received from direct patient/out-of-pocket charges/fees 300,000.00
Total amount of money received from reimbursement from private insurance/HMOs 0.00
Total amount of money received from other sources (PAGCOR, PCSO, etc.) 0.00
GRAND TOTAL 24,300,000.00

 If donation is in kind, please put equivalent amount in peso

Report Prepared by:

Designation/Section/Department: / / Date:

Report Approved and Certified by : Date: _______


Chief of Hospital/Medical Director

© Copyright 2015 | Department of Health - HFSRB

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