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 2019

Name of Hospital: Jezrell L. Fulgencio, MIT Street Address: 12

City / Municipality: District / Province: Region: REGION XII (SOCCSKSARGEN)
Contact Number: 639090003353 Fax Number:
Email Address: quijano1968@ymail.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
[ ✔ ] Level 2 Hospital
Specialty: (Specify)
[ ] Level 3 Hospital (Teaching/Training)
[ ] Treats a particular disease
[ ] Treats a particular organ
[ ] Infirmary
[ ] Treats a particular class of patients
[ ] Others(Specify):
Trauma Capability:
[ ✔ ] Trauma Capable
[ ] Trauma Receiving

2. Nature of Ownership

Government:
[ ] National - DOH Retained/Renationalized
Private:
[ ] Local (Specify):
[ ] Province [ ✔ ] Single Proprietorship/Partnership/Corporation
[ ] City [ ] Religious
[ ] Municipality [ ] Civic Organization
[ ] Foundation
[ ] DILG - PNP [ ] Others(Specify):
[ ] DND - AFP
[ ] DOJ 0
[ ] 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 Certification) Validity Period:

[ ] International Accreditation Validity Period:

[ ✔ ] PhilHealth Accreditation Validity Period:

[ ✔ ] Basic Participation Jan 01, 2019 - Dec 31, 2019
[ ] Advanced Participation

[ ] PCAHO Validity Period:

C. Bed Capacity/Occupancy

1. Authorized Bed Capacity: 54 beds

Authorized bed: Approved number of beds issued by HFSRB/RO, the licensing offices of DOH

2. Implementing Beds: 54 beds

Implementing beds: Actual beds used (based on hospital management decision)

3. Bed Occupancy Rate (BOR) Based on Authorized Beds: 73.33% 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) ]

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)
 Inpatient Service days (Inpatient bed days): Unit of measure denoting the services received by one in-patient in one 24 hour period.

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 4,922
Total Newborn (In facility deliveries) 118
Total Discharges (Alive) 4,741
Total patients admitted and discharged on the same day 39
Total number of inpatient bed days (service days) 14,453
Total number of inpatients transferred TO THIS FACILITY from another facility for inpatient care 7
Total number of inpatients transferred FROM THIS FACILITY to another facility for inpatient care 45
Total number of patients remaining in the hospital as of midnight last day of previous year 22

B. Discharges

Total Type of Accomodation Condition on Discharge

Length
of Non-Philhealth Philhealth Deaths
No. of Stay/
Type of Service Remarks
Patients Total Total
HMO OWWA R/I T H A U < ≥
No. of Discharges
Pay Service/Charity Total Pay Service/Charity Total 48 48 Total
Days
hrs hrs
Stay
Medicine 2,232 6,571 19 11 30 2,176 21 2,197 2 3 2,067 20 3 3 4 53 82 135 2,232
Obstetrics 93 254 1 2 3 85 1 86 2 2 83 2 2 2 1 3 0 3 93
Gynecology 71 197 2 2 4 62 1 63 2 2 61 2 1 2 2 2 1 3 71
Pediatrics 1,656 4,954 8 7 15 1,622 14 1,636 2 3 1,614 13 2 1 3 19 4 23 1,656
Surgery
Pedia 164 448 5 2 7 151 2 153 2 2 147 5 2 2 2 3 3 6 164
Adult 706 2,029 12 9 21 677 5 682 2 1 684 3 4 2 2 7 4 11 706
Other(s)
Total 4,922 14,453 47 33 80 4,773 44 4,817 12 13 4,656 45 14 12 14 87 94 181 4,922
Total Newborn 118 316 8 5 13 91 6 97 4 4 86 4 7 5 4 8 4 12 118
Pathologic 99 273 6 3 9 82 4 86 2 2 81 2 4 3 2 5 2 7 99
Non-Pathologic 19 43 2 2 4 9 2 11 2 2 5 2 3 2 2 3 2 5 19

*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 1,099 J10-J18
2. Chronic lower respiratory diseases 349 J40-J47
3. Arthropod-borne viral fevers and viral hemorrhagic fevers 311 A90-A99
4. Other disorders of the nervous system 242 G90-G99
5. Intestinal infectious diseases 187 A00-A09
6. Hypertensive diseases 120 I10-I15
7. Renal tubulo-interstitial diseases 101 N10-N16
8. Other diseases of the respiratory system 93 J95-J99
Kindly accomplish the "Ten Leading Causes of Morbidity/Diseases Disaggregated as to Age and Sex" in the table below.

Age Distribution of Patients

Cause of ICD-10
Morbidity/Illness/Injury Under 1-4 5-9
10 - 15 -
20 -24
25 - 30 - 35 - 40 - 45 - 50 - 55 - 60 - 65 - 70 & Sub
CODE /
1 14 19 29 34 39 44 49 54 59 64 69 over total Total
TABULAR
Spell out. Do not LIST
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
abbreviate.
1. Influenza and
93 71 175 176 71 72 20 22 8 7 6 4 8 8 11 4 8 5 6 7 7 13 15 14 15 17 29 17 26 28 53 83 551 548 1,099 J10-J18
pneumonia
2. Chronic lower
15 12 37 39 23 16 17 12 15 9 9 8 6 16 3 9 4 6 6 8 3 2 3 8 8 9 3 4 8 4 12 15 172 177 349 J40-J47
respiratory diseases
3. Arthropod-borne viral
fevers and viral 3 6 23 17 25 20 19 22 22 29 16 12 15 9 8 6 5 8 5 9 2 6 2 3 3 1 1 3 2 4 2 3 153 158 311 A90-A99
hemorrhagic fevers
4. Other disorders of the
7 3 15 19 27 22 17 15 14 15 10 4 10 4 6 11 6 3 3 3 5 3 2 5 1 1 1 1 1 2 1 5 126 116 242 G90-G99
nervous system
5. Intestinal infectious
7 14 31 31 13 8 1 1 4 3 2 5 3 4 1 2 5 5 4 3 2 4 2 2 1 1 3 1 2 7 7 8 88 99 187 A00-A09
diseases
6. Hypertensive diseases 0 1 1 1 0 0 0 0 0 0 0 2 1 3 3 2 5 12 6 9 2 8 4 6 3 15 3 6 2 6 4 15 34 86 120 I10-I15
7. Renal tubulo-
0 0 2 5 0 9 4 7 5 14 1 6 3 3 1 3 1 2 1 4 1 1 1 2 1 8 1 3 3 5 1 3 26 75 101 N10-N16
interstitial diseases
8. Other diseases of the
1 1 3 3 1 0 0 0 4 1 1 2 3 1 0 4 1 1 0 1 4 1 8 2 1 1 3 5 7 4 12 17 49 44 93 J95-J99
respiratory system

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 204
Total number of live-birth vaginal deliveries (normal) 54
Total number of live-birth C-section deliveries (Caesarians) 148
Total number of other deliveries 2

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 15
Number of outpatient visits, re-visit 4
Number of outpatient visits, adult
12
(Age 19 years old and above)
Number of outpatient visits, pediatric
7
( Age 0 to 18 yrs old; before 19th birthday)
Number of adult general medicine outpatient visits 11
Number of specialty (non-surgical) outpatient visits 1
Number of surgical outpatient visits 3
Number of antenatal care visits 2
Number of postnatal care visits 2

Ten Leading Causes of OPD Consultation

Ten Leading OPD Consultations Number ICD-10 Code

1. Episodic and paroxysmal disorders 3 G40-G47
2. Mental disorders due to known physiological conditions 2 F00-F09
3. Other disorders originating in the perinatal period 2 P90-P96
4. Disorders of other endocrine glands 1 E20-E36
5. Diseases of external ear 1 H60-H62
6. Intestinal infectious diseases 1 A00-A09
7. Nutritional anemias 1 D50-D53
8. Other disorders of the nervous system 1 G90-G99

Ten Leading Causes of ER Consultation

Ten Leading ER Consultations Number ICD-10 Code

1. Influenza and pneumonia 3 J10-J18
2. Other disorders originating in the perinatal period 3 P90-P96
3. Suppurative and necrotic conditions of the lower respiratory tract 2 J85-J86
 4. Systemic atrophies primarily affecting the central nervous system 1 G10-G13
5. Other diseases of the pleura 1 J90-J94
6. Hypertensive diseases 1 I10-I15
7. Noninfective enteritis and colitis 1 K50-K52
8. Tuberculosis 1 A15-A19
9. Helminthiases 1 B65-B83

TESTING

Total number of medical imaging tests (all types including x-rays, ultrasound, CT scans, etc.) Number
X-Ray 3,007
Ultrasound 131
CT-Scan 0
MRI 0
Mammography 0
Angiography 0
Linear Accelerator 0
Dental X-Ray 0
Others 0
Total number of laboratory and diagnostic tests (all types, excluding medical imaging)
Urinalysis 3,727
Fecalysis 776
Hematology 9,086
Clinical chemistry 4,634
Immunology/Serology/HIV 496
Microbiology (Smears/Culture & Sensitivity) 212
Surgical Pathology 0
Autopsy 0
Cytology 0
Blood Service Facilities
Number of Blood units Transfused 13

EMERGENCY VISITS

Emergency visits Number

Total number of emergency department visits 13
Total number of emergency department visits, adult 10
Total number of emergency department visits, pediatric 3
Total number of patients transported FROM THIS FACILITY’S EMERGENCY DEPARTMENT to another
2
facility for inpatient care

C. Deaths

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

Types of deaths Number

Total deaths 186
Total number of inpatient deaths 181
Total deaths < 48 hours 87
Total deaths ≥ 48 hours 94
Total number of emergency room deaths 3
Total number of cases declared 'dead on arrival' 2
Total number of stillbirths 2
Total number of neonatal deaths 12
Total number of maternal deaths 3

1. Gross Death Rate 3.83%

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

3.83% = 193 x 100 (System generated)

5,040
 2. Net Death Rate 1.98%

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

1.98% = 193 - 95 x 100 (System generated)

5,040 - 95

3. 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. Influenza and pneumonia 35 J10-J18
2. Other diseases of the respiratory system 21 J95-J99
3. Hypertensive diseases 14 I10-I15
4. Ischemic heart diseases 12 I20-I25
5. Cerebrovascular diseases 11 I60-I69
6. Arthropod-borne viral fevers and viral hemorrhagic fevers 7 A90-A99
7. Chronic lower respiratory diseases 6 J40-J47
8. Persons encountering health services in circumstances related to reproduction 5 Z30-Z39

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 of Age Distribution of Patients

ICD-10
Mortality Under 10 - 15 - 20 25 - 30 - 35 - 40 - 45 - 50 - 55 - 60 - 65 - 70 & Sub CODE /
1-4 5-9
(Underlying) 1 14 19 -24 29 34 39 44 49 54 59 64 69 over total Total TABULAR
Spell out. Do LIST
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
not abbreviate.
1. Influenza and
1 1 0 0 1 2 1 0 0 0 0 1 1 0 1 1 0 0 0 0 0 1 0 0 0 1 1 2 2 0 13 5 21 14 35 J10-J18
pneumonia
2. Other
diseases of the
0 0 1 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 3 2 4 7 9 12 21 J95-J99
respiratory
system
3. Hypertensive
0 0 0 0 0 0 1 1 0 0 0 0 0 2 0 0 0 0 0 1 1 0 0 1 2 0 0 1 0 1 2 1 6 8 14 I10-I15
diseases
4. Ischemic
0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 1 0 1 0 1 0 0 1 3 3 9 12 I20-I25
heart diseases
5.
Cerebrovascular 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 1 3 3 8 11 I60-I69
diseases
6. Arthropod-
borne viral
fevers and viral 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 2 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 6 1 7 A90-A99
hemorrhagic
fevers
7. Chronic
lower
0 0 1 1 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 2 3 3 6 J40-J47
respiratory
diseases
8. Persons
encountering
health services
in 2 3 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 3 5 Z30-Z39
circumstances
related to
reproduction

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 (BSI) = Number of Patients with BSI x 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 0.08
Device Related Infections
Ventilator Acquired Pneumonia (VAP) 333.33
Blood Stream Infection (BSI) 500.00
Urinary Tract Infection (UTI) 333.33
Non-Device Related Infections
Surgical Site Infections (SSI) 50.00

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

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands
1 48
and feet); 2.6 cm to 7.5 cm
2 Treatment of incomplete abortion, any trimester, completed surgically 37
3 Dilation and curettage 35
4 Excision, tumor or vascular malformation, hand or finger; subcutaneous 29
5 Excision of lesion of tendon sheath or capsule (e.g., cyst, mucous cyst, or ganglion), hand or finger 26
6 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm 26
7 Radical resection of tumor (e.g., malignant neoplasm), soft tissue of face or scalp 23
8 Enterolysis (freeing of intestinal adhesion) 21
9 Radical resection of tumor (e.g., malignant neoplasm), soft tissue of shoulder area 20
10 Excision of benign cyst or tumor of mandible; simple 18

10 Leading Minor Operations Number

1 Removal of subdeltoid (or intratendinous) calcareous deposits, open method 4
2 Excision of breast lesion identified by preoperative placement of radiological marker; single lesion 2
Partial excision of vertebral body, for intrinsic bony lesion, w/o decompression of spinal cord or nerve root(s), single
3 2
vertebral segment; cervical
4 Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent 2
5 Excision of chest wall tumor including ribs 1
6 Excision of bone (e.g., for osteomyelitis or bone abscess); mandible 1
7 Closed treatment of skull fracture w/o operation 1
8 Open treatment of mandibular condylar fracture 1
Partial excision of posterior vertebral component (e.g., spinous process, lamina or facet) for intrinsic bony lesion,
9 1
single vertebral segment; cervical
10 Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less 1

III. STAFFING PATTERN (Total Staff Complement)

Total staff working full time (at Total staff working part time (at
least 40 hours/week) least 20 hours/week) Active
Specialty
Rotating or
Profession/Position/Designation Board Number of Number of Number of Number of Outsourced
Visiting/
Certified permanent full contractual full permanent part contractual part Affiliate
time staff time staff time staff time staff
A. Medical
B. Allied Medical
1. Nurses 25 4
C. Non-Medical

IV. EXPENSES

Report all money spent by the facility on each category.

Expenses Amount in Pesos
Amount spent on personnel salaries and wages 95,002.00
Amount spent on benefits for employees (benefits are in addition to wages/salaries. Benefits include for example: social security
200,002.00
contributions, health insurance)
Allowances provided to employees at this facility (Allowances are in addition to wages/salaries. Allowances include for
100,002.00
example: clothing allowance, PERA, vehicle maintenance allowance and hazard pay.)
TOTAL amount spent on all personnel including wages, salaries, benefits and allowances for last year (PS) 395,006.00
Total amount spent on medicines 250,002.00
Total amount spent on medical supplies (i.e. syringe, gauze, etc.; exclude pharmaceuticals) 1,500,002.00
 Total amount spent on utilities 2,000,002.00
Total amount spent on non-medical services (For example: security, food service, laundry, waste management) 500,002.00
TOTAL amount spent on maintenance and other operating expenditures (MOOE) 4,250,008.00
Amount spent on infrastructure (i.e., new hospital wing, installation of ramps) 750,002.00
Amount spent on equipment (i.e. x-ray machine, CT scan) 150,002.00
TOTAL amount spent on capital outlay (CO) 900,004.00
GRAND TOTAL 5,545,018.00

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.

Revenues Amount in Pesos

Total amount of money received from the Department of Health 20,002.00
Total amount of money received from the local government 50,002.00
Total amount of money received from donor agencies (for example JICA, USAID, and others) 25,002.00
Total amount of money received from private organizations (donations from businesses, NGOs, etc.) 5,002.00
Total amount of money received from Phil Health 150,002.00
Total amount of money received from direct patient/out-of-pocket charges/fees 500,002.00
Total amount of money received from reimbursement from private insurance/HMOs 300,002.00
Total amount of money received from other sources (PAGCOR, PCSO, etc.) 20,002.00
GRAND TOTAL 1,070,016.00

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