COOFCAREST
The Burden of Violence-related Injuries and Road Traffic Crashes to the Health Care System of Jamaica COST OF CARE PROJECT DATA MAPPING FOR UHWI AND SIX OTHER HOSPITALS
An Analysis of the Epidemiology and Cost of Violence-related Injuries and Road Traffic Crashes to the Health Care System of Jamaica
JN FOUNDATION SQUAREMay 2017 LOGO (RGB)
Commissioned by:
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The JN Foundation The National Health Fund 32½ Duke Street, Kingston 25 Dominica Drive, Kingston 5
Prepared by: The Violence Prevention Alliance 13 Gibraltar Camp Way University of the West Indies Mona Campus BLUE (RGB) Kingston 7, Jamaica [email protected] R0 / G83 / B158
Notes: A minimum space, equivalent to the height of the JN element ‘n’, should be maintained around the logo when scaling. The white keyline around the logo should be maintained at all times. Tempo Heavy Condensed is the font used for the ‘FOUNDATION’ logotype. ACKNOWLEDGEMENTS: IV
BACKGROUND: 1
THE PROJECT: 3 • Project Aims • Project Objectives
METHODOLOGY: 4-9 • Hospital Data Collection Using the Jamaica Injury Surveillance System (JISS) of the Ministry of Health: 4 • Estimation of Associated Costs of VRIs and RTC Cases: 5 • Profile of Violence-Related Injuries (VRIs): 6-7 • Profile of Road Traffic Crashes (RTCs): 8-9
DATA MAPPING: 11-18 • Mapping of Violence-Related Injuries (VRIs): 11 • Spatial Analytical Results: 12-18
COST OF CARE FINDINGS: 19-25 • Cost of Care for VRIs and RTCs in 2014: 20 • Cost of Care of the Injuries to the Health Services and the Economy: 22 • Significance of the Study and Utilisation of the Findings: 24
PUBLICITY OF THE PROJECT: 26
CONTENTS REFERENCES: 27
APPENDICES: 29-38
SAMPLE FORMS: 39-56
COST OF CARE PROJECT | iii ACKNOWLEDGEMENTS
We gratefully acknowledge the contribution of:
FUNDING COLLECTION OF DATA JN Foundation and the National Health Fund • University Hospital of the West Indies – Ms. Annette Campbell, Acting Administrator, HRD LEAD INVESTIGATORS • Kingston Public Hospital – Dr. Hugh Wong, A&E Consultant; • Prof. Trevor McCartney, Medical Chief of Staff, Ms. Natalie Forbes, Data Collection and Research; University Hospital of the West Indies Ms. Denise Amore, Asst. Health Records Administrator; Ms. Kellion Nelson, Registered Nurse; Mr. Fitzroy Staples; • Dr. Elizabeth Ward, Chairperson, Ms. Andrea Martin, Health Records Violence Prevention Alliance • Bustamante Hospital for Children – • Dr. Deanna Ashley, Executive Director, Ms. Tamra Brown, Health Records Officer Violence Prevention Alliance • Spanish Town Hospital –Ms. Claudette Jackson; • Dr. Jason Toppin, Consultant Anaesthetist, Mr. Vincent Brett, Health Records; Nurse Paddis Campbell Bartley University Hospital of the West Indies. • May Pen Hospital – Dr. Bradley Edwards, Snr. Medical Officer; Mrs. Etle Ludford-Webley; Ms. Susanne Nelson, Health Records ADJUNCT INVESTIGATOR • St. Ann’s Bay Hospital – Ms. Kerry-Ann Cameron, Health Records; • Dr Parris Lyew-Ayee, Director, Nurse Carmen Johnson Mona GeoInformatics Institute • Cornwall Regional Hospital - Dr. Jeffery East, Consultant Surgeon; Ms. Irmadine Fletcher, Health Records Supervisor; DATA ANALYSIS, REPORT COMPILATION Mr. Julian Scarlett; Ms. Julian Jackson; Mr. Garfield Colquhaun, AND EDITING Health Records; Mr. Andre McNab • Ms. Kaodi McGaw, Research Associate, • Sir John Golding Rehabilitation Centre – Violence Prevention Alliance Ms. Andrea Christie, Actg. Director of Nursing Services
• Ms. Winsome Williams, • Mrs. Anna Marie Deans and Ms. Ann Witter Violence Prevention Alliance • Data editing and compilation of output tables - Miss Kristin Fox GRAPHIC DESIGN/PAGE LAYOUT • Ms. Heather Kong-Smith
iv | COST OF CARE PROJECT BACKGROUND
hroughout the developing world, injuries represent a tremendous Violence-related injuries and Tburden to health and social road traffic crashes are the 3rd services. The World Health Organization (WHO) in 2014 estimated that in these and 11th leading cause of premature nations, injuries account for about 5 millions death per year, 1.25 million due death in Jamaica respectively.” to road traffic crashes and 1.6 million due to homicides and deaths from sui- cide. Injuries are exceeding the deaths cancellation of approximately 30% of all of Jamaica (Jamaica Observer, 22nd due to HIV, malaria and tuberculosis elective surgical cases and about 40% January 2009). combined (Gosselin, 2009). Despite of all hospital goods and services at the this call from the WHO, the numbers of major tertiary government hospitals Given the tremendous burden that persons affected by these injuries has (Jamaica Gleaner, 5th January 2009). these injuries place on every aspect continued to increase to epidemic pro- While injuries associated with road traf- of Jamaican society, it is essential that portions. These injuries are particularly fic crashes are less than those associat- authorities in Jamaica urgently ad- devastating to societies as they dispro- ed with violence, they are nonetheless dress them and develop strategies to portionately affect younger age groups, significant; road traffic crashes (RTCs) decrease the numbers and the asso- and many of those who survive are left are ranked as the 11th leading cause of ciated social and economic effects. with lifelong disabilities and dysfunc- premature death in Jamaica (Institute Traditionally, the role of health care in tions. The WHO has repeatedly high- for Health Metrics & Evaluation, 2015) dealing with injuries associated with lighted the need for the development and present a significant economic and interpersonal violence and road traffic of strategies to reduce these injuries social burden. More than 10,000 people crashes has been the provision of acute (World Health Organization, 2013) and are injured annually in RTCs (Williams, management of injuries and rehabilita- emphasized the potential social and 2006). In addition to the direct cost tion of the survivors. Reduction in these economic benefits of this reduction. of treating patients with injuries, the injuries has largely been the domain of Like many of its counterparts in indirect costs are no less significant. The the police and justice systems. Howev- the developing world, Jamaica has loss of productivity, primarily in young er, a public health approach of preven- been tremendously burdened with people in some of the most productive tion utilizing basic epidemiological these injuries. Jamaica has consistently years, must also be considered. Similar- principles has been used effectively in maintained one of the highest rates of ly, the long-term care and rehabilitation many different settings (Mercy, 1993; murder and Violence-related injuries of those left with significant disability McIlvenny, 2006). Such an approach in the world (Wortley, 2006), with rates from limb amputations, paralysis and must be multi-sectoral involving both more than 41 per 100,000 population severe brain injury are significant. Ward government and non-governmental or- (JCF Stats, 2015). VRI ranked as the 3rd et al. (2009) conservatively estimate ganizations, involving aspects of health, leading cause of death according to that the indirect costs associated with education, security youth development, the Institute for Health Metrics and these injuries also exceed $J 2.6 billion housing and business development. Evaluation. Previous estimates have per year. The loss of investment in busi- placed the direct cost of Violence-re- ness and infrastructure is another major lated injuries at $J 2.1 billion (Ward et concern. Like much of the developing al. 2009). Emergency management of world these traumatic injuries represent Violence-related injuries results in the a significant barrier to the development
COST OF CARE PROJECT | 1 2 | COST OF CARE PROJECT THE PROJECT
he Cost of Care Project reviewed cases of VRIs and RTCs seen T during the period April to June 2014 at seven (7) major hospitals cover- ing all health regions of the island: • University Hospital of the West Indies (UHWI) • Kingston Public Hospital (KPH) • Bustamante Hospital for Children (BHC) • Spanish Town Hospital (STH) • May Pen Hospital (MPH) • St. Ann’s Bay Hospital (STABH) • Cornwall Regional Hospital (CRH)
Special emphasis was placed on mapping the location of injuries using the Jamaica Injury Surveillance System. The project looked at the direct and indirect costs of injuries to UHWI, KPH, COLLABORATING AGENCIES PROJECT AIMS BHC, STH, MPH, STABH and CRH with • The Violence Prevention Alliance – 1. To determine the epidemiology a special focus on the impact on the Data analysis and report of Violence-related injuries (VRIs) and Operating Theatres and Intensive Care generation. injuries associated with road traffic Units (ICU). • The Ministry of Health – Provision crashes (RTCs) in Jamaica. The project outlines the impact of in- of data for analysis, technical 2. To estimate the direct and indirect juries on the operation of the hospitals, support and policy relevance. costs of VRIs and injuries associated in terms of cancellations of operations • Mona GeoInformatics Institute – with RTCs in Jamaica (including cardiac and neurosurgery), Mapping of the locations of injuries PROJECT OBJECTIVES the demand on the supply of blood at street and community levels. 1. To determine the location of and the psychological impact on the • The JN Foundation and the occurrence of VRIs and injuries hospital staff. National Health Fund – Funding. associated with RTCs in Jamaica. The Lead Investigators were Profes- 2. To determine the demographics of sor Trevor McCartney, Medical Chief of Hospitals also contributed funding victims of VRIs and RTCs in Jamaica. Staff, University Hospital of the West to assist with payment of overtime and 3. To determine the circumstances Indies; Dr. Elizabeth Ward, Chairperson sessions with staff to assist with loca- associated with VRIs. and Dr. Deanna Ashley, Executive Direc- tion of records and data extraction. 4. To determine the mechanism of tor Violence Prevention Alliance; and Dr. Ethical approval was obtained from and severity of injury of victims of VRIs Jason Toppin, Consultant Anaesthetist, the University of West Indies Ethics and RTCs. University Hospital of the West Indies. Board and the Ministry of Health. 5. To determine the cost associated with VRIs and RTCs.
COST OF CARE PROJECT | 3 METHODOLOGY
Hospital Data Collection Using the Flowchart of JISS Jamaica Injury Surveillance System (JISS) of the Ministry of Health Patients in A&E Department
This Project utilized the pre-existing Jamaica Triage nurse or doctor injury surveillance system (JISS) (Ward 2002) that identifies and collects data on patients Registration by medical records presenting to government run accident and emergency departments across the island. This system was expanded to include the University Work INJURY Attempted Hospital of the West Indies. A computer based related suicide system was used and initial data collection was done at the time of registration of the patient Road Traffic Violence-related by the medical records department. Supple- Crashes mentary paper data forms were also used as • Circumstances a backup for this initial data. Data collected at • Victim perpetrator Unintentional this point was primarily demographic data and • Palce of occurence details related to the injury. • Method of Injury • Alcohol/Drug Use
4 | COST OF CARE PROJECT Specific information extracted included: 1. Age Estimation of Associated Costs of VRIs and RTC Cases 2. Gender 3. Geographical location of incident DIRECT MEDICAL COST tal treatment. Direct medical costs are those costs • Average medical costs during vis- For Violence-related Injuries (VRIs): directly incurred by the health system its to the accident and emergency 1. Nature of place where incident in the investigation and treatment of room. occurred (e.g. home, work or persons with traumatic injuries. As • Average percentage of traumatic public place). done in a previous Jamaican estima- injuries requiring medico-legal 2. Circumstances surrounding injury tion of cost of VRIs (Ward et al. 2009), investigation. (e.g. robbery, gang related). the model outlined by the WHO • Average costs of medico-legal 3. Relationship to Perpetrator(s), (Butchart et al., 2008) was used. This investigation. if known. was a modular approach based on • Average transportation costs 4. Mechanism of injury incidence data gathered through the incurred. (e.g. blunt object, stabbing, JISS over the course of the year. Injuries The Butchart (2008) report contains strangulation, gun). were classified using the most recent a more detailed description of the 5. Location of injury(s) on body. revision of the International Statistical method as established by the WHO. For Road Traffic Crashes (RTCs) Classification of Diseases and Related INDIRECT COST Health Problems (ICD-10) (WHO 2010). 1. Mode of transport being used Indirect costs include the calcula- (e.g. car, pedestrian, motorbike). The relevant codes included: tion of loss of productivity that result 2. Position within a vehicle (driver, • Transport related accidents from injuries, and varies from tempo- passenger, bystander). (V01-V99). rary loss of function to long-lasting or For each injured patient, • Interpersonal violence (X85-Y09). permanent loss due to death or dis- data collected included: • Self-directed violence (X60-X84). ability. This is a lot harder to measure than the direct medical costs. However, • Hospital admission status • Undetermined (Y10-Y34). it represents a significant proportion • Length of hospital stay For the calculation of cost, injuries of the burden to families and society • Cost of transportation were classified as follows: due to these injuries. Several different • Operations performed • Fatal: Injury caused death within methods have been used to estimate • Drugs provided 30 days. these costs. We utilized the human • Consultations by staff • Hospitalised: Injury did not cause capital based method outlined by the • Blood and blood products death within 30 days but required WHO (Butchart et al., 2008), which has administered hospital admission. been used widely and was used in • Investigations/examinations • A&E: Injury required a visit to an previous costing studies in Jamaica carried out emergency room without the and the Region (Ward et al., 2009). • Dressings and disposables used need for hospital admission. Utilizing average age of death or injury • No. of days convalescing from violence, the average retirement • No. of outpatient visits Detailed data on the direct medical age, the average days of inactivity for • Long-term disability resulting costs was gathered from the patient non-fatal injuries, the minimum wage from the injury. medical records over a three-month with an adjustment for unemployment Other Sources of Information period (April to June 2014) in the rate, a discount factor of 3% to dis- Information on both patients and hospitals involved. Specific information count future costs on the principle that injuries was supplemented and cross determined for these patients includ- people value income in the present checked with data was obtained from ed: more than they do an equivalent the Jamaica Constabulary Force (JCF) • Percentage of patients requiring amount in the future. and if applicable with the Registrar hospital admission. To illustrate the burden of VRI and General’s Department (data form is • Average duration of hospital stay. RTC injuries, two (2) case studies are included as Appendix 17). • Average cost per bed-day of hospi- outlined on following pages.
COST OF CARE PROJECT | 5 PROFILE OF VIOLENCE-RELATED INJURIES (VRIS)
In Emergency Room Patient details • Emergency Surgery to • 24-year-old male • IV line fix artery in his arm • No chronic illnesses • IV fluids VRI • Two elective • Employed • Blood investigations CASE STUDY surgeries postponed • Chop wounds to • Chest X-ray • Transfused 3 units of chest and arm • X-ray of upper limb blood and plasma • Taken to hospital by taxi • Chest Tube • Lost 3 litres of blood Estimated Costs (J$) 25,000.00 Transferred via Ambulance to another hospital for ICU care CT Scan • Admitted to ICU 100,000.00
• Required mechanical ventilation 150,000.00 Rushed to theatre for fasciotomies to upper limb 200,000.00 Returned to operating theatre for emergency upper limb amputation 180,000.00
Developed renal failure requiring dialysis 150,000.00
Multiple course of IV antibiotics 594,000
Transfusion of red cells and plasma 4,000,000.00
34 days in ICU 70,000.00
Chest X-rays 350,000.00
Blood tests 220,000.00
Physiotherapy 5,900,000.00 Direct in-hospital costs In-direct costs* J$3,600,000.00 Loss of income (assuming work until age 65 at minimum wage ($5,600/week) J$9,500,000.00 Total - Direct in-hospital and indirect costs
*The WHO manual recommends using a standard discount rate of 3% per year for loss of productivity to calculate the present value of a sum of money to be earned in the future. The present value of indirect costs is J$3,600,000 with a discount factor of 3%.
VRI FINDINGS In 7 study hospitals April to July 2014 1%: Died
Admitted CASE STUDY 1 Gender Distribution* 16% A total of 1,735 patients had VRIs and were treated Female at the study hospitals - 1,036 males (59.7%) and 699 females (40.3%) [Appendix Table 1]: 40% Male • Gender was not reported for 5 cases from KPH, 1 from STH and 1 from UHWI 83% Discharged 60% • For VRI seen the Male: Female ratio was 1.5:1 • A larger number of females were seen than in previous studies Admission status* 36% Injury cases outcome [Appendix Table 3] – of Age distribution* the total study population: The Age Group most • 16% of VRI were admitted to hospital affected by VRI was 26% the 18-29 year old, 22% • 83% were discharged home except for at Busta- • 1% of patients with VRIs died in hospital 15% mante Hospital for • Of the total number of admitted patients Children (BHC) age Kingston public hospital and Cornwall Region- group most affected al Hospital each admitted 24% of the total, was 6-10 year olds 1.5% followed my May Pen Hospital and Spanish [Appendix Table 2]. < 18 18-29 30-44 45 > Unknown Town Hospital with 19% and 16% respectively. Age groups in years
*Numbers were rounded to nearest whole number or decimal point 6 | COST OF CARE PROJECT VRI FINDINGS In 7 study hospitals April to July 2014
Circumstance Mechanism of Injury Type and Perpetrator Relationship [Appendix 5,6] leading to VRIs [Appendix Table 4]: Gun Stab wound Blunt Sexual Other Shot & laceration trauma assault • Overall involvement in a fight was the most common reason for a vis- % % % % % it to the hospital (69 %) 9 31 36 5 16 and these were the most • Of all gun- • Of all stab Of all blunt Of all sexual common cause of visit/ shot wounds, wounds, 58% injuries, 47% assaults, 52% were admission to hospital over 50% of were inflicted by were inflicted inflicted by an due to VRI. were inflicted an acquaintance by an acquain- acquaintance and • For children under by strangers and 14% were tance and 16% 31% by a stranger. 12 years the common inflicted by boy- by girlfriend/ Sexual assault was circumstances of the friend/girlfriend boyfriend or highest at BHC – VRIs were; sexual assault or common-law common-law 26.7% of cases seen (30%), a fight (27%) or husband/wife. husband/wife at that hospital child abuse (13%).
VRI Perpetrator by Gender [Appendix Table 6]: Anatomical site of injuries [Appendix Table 7]: In the majority of cases of violence against women seen at study hospitals: 51% injured by a friend/acquaintance 36% 21% 7% • Injuries to • Injuries to the • Injuries to lower injured by Boyfriend/Girlfriend the head and upper extrem- limb and vertebral % and husband/wife 6 face were the ities were the column, spine, commonest site second most internal organs of injury being common site or ribs/sternum injured by 11% parent/other relative % present in 36% of injury being fractures each 11 of all patients present in 21% accounted for 7% with VRIs. of patients. of total injuries.
Perpetrator Relationship [Appendix Table 6]: • In most cases the perpetrator of the injury was known to the victim. 45% 16% 15% 13% 1.2% Acquaintance Stranger Boyfriend/Girlfriend Parent/Other relative Self-inflicted
COST OF CARE PROJECT | 7 PROFILE OF ROAD TRAFFIC CRASHES (RTCS)
Patient details In Emergency Room • 24-year-old male • Unable to move limbs • No chronic illnesses • IV line and fluids RTC • Employed • Blood tests CASE STUDY • Hit by motorcar while riding motor cycle • Chest and Cervical • Not wearing a helmet Spine X-rays • Taken to hospital in a taxi Estimated Costs (J$)
Transferred via Ambulance for Neurosurgery/ICU 125,000.00 CT Scan: C-Spine, Chest and Abdomen • MRI C-spine 500,000.00 Operating Theatre for emergency spine surgery 500,000.00 Admitted and spent 33 days in ICU 4,000,000.00 Stay on Ward 265,000.00 Tracheotomy (Breathing Tube) and Feeding Tube 270,000.00 Transfusions 252,000.00 Physiotherapy 320,000.00 Repeat CT and X-rays 75,000.00 Direct in-hospital costs 5,562,500.00 On-going Medical Care 110,000.00 In-direct costs Loss of income (assuming work until age 65 at minimum wage ($5,600/week) J$3,600,000.00 TOTAL – DIRECT IN-HOSPITAL AND IN-DIRECT COSTS J$9,272,500.00
RTC FINDINGS In 7 study hospitals April to July 2014 CASE STUDY 2
1%: Unknown 32% 1%: Died Admitted 24% 22% 20% 19% 33% Female 66% Male 80% 2% Discharged
< 18 18-29 30-44 45 > Unknown Age groups in years Gender Distribution* Admission status* A total of 1,497 RECs were Age distribution* Overall 19% of RTC cases seen treated at the 7 study hospi- were admitted to hospital. In Like the patients affected by VRIs the most tals. The Male: Female ratio May Pen and Spanish Town the frequently affected age group was 18-29 of the injured cases was 2:1 admissions from RTC rose to years of age - 31.7% [Appendix Table 9]. [Appendix Table 8]. over 30 cases [Appendix Table Over 20% of all injuries occurred in patients 10]. Passengers and bystanders under the age of 45 years. were most commonly injured.
*Numbers were rounded to nearest whole number or decimal point
8 | COST OF CARE PROJECT RTC FINDINGS In 7 study hospitals April to July 2014
Most frequent mode of transport for cases involved in the RTC [Appendix Table 11] : • At KPH and MPH, motorbikes were the frequent mode of transport in RTC, 35% and 21% Cars Motorbikes Pedestrians Other motor vehicle respectively. • Among children seen at BHC cars (6%) were the most % % % % frequent mode of transport, 31 15 14 13 bicycles 24% while pedestri- ans accounted for 5%.
Appendix Table 12 shows the severity of injuries by the body part affected:
Head & Face Upper & Lower Vertebral Column, spiral Superficial Other motor Extremities internal organs & ribs Injury vehichle 34% 14% 10% 5% 1% 34% of all patients Upper and lower 10% experienced 5% were 1% eye and 50% of admitted extremities were injuries to vertebral superficial injuries patients had head affected in 14% of column, spiral inter- injury and facial injuries. RTC ** nal organs and ribs
Only 10 % RTC cases seen at hospital used safety gear, i.e., a seat belt or a helmet [Appendix Table 13].
Body parts receiving injuries by mode of transportation [Appendix Table 14):
Pedestrians Bicycles Motorbikes Cars Other motor vehichle 36% 39% 30% 33% 32% had lower 39% had 30% had head 33% had head • Other motor extremity injuries head injuries and facial injuries and facial injuries vehicles − 32% had head and facial injuries. Most travelled % % % % in a pick-up 29 22 23 15 van or jeeps had facial injuries had lower had lower had injuries to extremity extremity injuries vertebral column, injuries spine, internal 21% organs and ribs had upper extremity injuries
COST OF CARE PROJECT | 9 Kingston Public Hospital.
10 | COST OF CARE PROJECT DATA MAPPING
Mapping of Violence-related Injuries (VRIs) and Road Traffic Crashes (RTCs)
recise mapping of these events was done in collaboration with Pthe Mona GeoInformatics In- stitute (2006), which has previously produced several high fidelity maps for both VRIs and RTCs in Jamaica (2013). Knowledge of the spatial relationships of these events in conjunction with other social and structural data has allowed for the targeted investigation and interventions (Small Arms Survey, 2013). The superimposed mapping of what has been termed social assets, such as businesses, churches or parks, format. With the use of ArcGIS, each VRI and RTCs were not mapped as a precise has proven to be critical information in was mapped in-house according to its location could not be deciphered. The understanding the factors that result reported location. mapped data is therefore a subset of all specific patterns of violence. These Each mapped point was also linked the VRIs recorded at the hospitals. structural and functional characteristics to the corresponding hospital that han- of different locations often explain the dled that specific case. This allowed for existence of crash “hot spots”. the calculation of travel distances (by Data was collected To complement the crime data road) from the injury locations to the provided by the security forces, VRI from the seven (7) hospital, and for the determination of data was also collected, which serve to participating hospitals. the range of influence for each hospital independently capture those violent and implications on service delivery The geographic incidents that were not officially re- and intervention planning. This will also ported to the police. Several hospitals location of injury was allow for the calculation of ideal service islandwide use the Ministry of Health’s ranges for each hospital, given its re- mapped against the Jamaica Injury Surveillance System source environment and conditions. demographic and risk (JISS) to collect and store data about patients. Data was collected from the LIMITATIONS factor data for the VRIs seven (7) participating hospitals. The The data captured by hospital per- and RTCs seen at the geographic location of injury was sonnel was not comprehensive in some hospitals. mapped against the demographic and cases, as some standard data was miss- risk factor data for the VRIs and RTCs ing. This was especially detrimental in seen at the hospitals. instances where vague injury locations The data was provided in MS Excel were reported. As a result, some VRIs
COST OF CARE PROJECT | 11 SPATIAL ANALYTICAL RESULTS
For the period January to June 2014, a total of 8,419 injury cases were reported to the hospitals in this study, spread over 544 separate communities (out of a total of 829 unique communities identified by the Planning Institute of Jamaica). Where data was available, 1,392 were mapped for RTCs and 2,389 for VRIs.
OBSERVATIONS Many injuries occurred near hospitals, with a few outliers that travelled extreme distances for injury treatment at hospitals, which could be better carried out at other hospitals nearby to those locations. Spanish Town Hospital had the smallest distance travelled on average from 603 injury locations HOSPITAL RTCs VRIs Communities Mean Injury from 121 communities, with an average distance of Distance 11.5km. St Ann’s Bay Hospital patients travelled the Cornwall Regional 809 1,246 121 22.5 km furthest distance on average from the 300 injury May Pen 239 581 77 22.9 km locations from 67 communities, for an average of Spanish Town 226 377 121 11.5 km 37.8km. This pattern for the four (4) hospitals is illus- St Ann’s Bay 118 182 67 37.8 km trated below in Figure 2.
Figure 2: Map showing the distance ranges between injury locations and corresponding hospitals.
12 | COST OF CARE PROJECT n Spanish Town Hospital Relationships between communities and hospitals
The graphs show the relationships be- tween the differ- ent contributing communities n May Pen Hospital and the corre- sponding hospi- tals, illustrating the number of injuries for each commu- nity along with the distance to the hospital. Most injuries are occurring n Cornwall Regional Hospital in communities relatively near the hospitals, though there are a few at significant distances from the hospital to which they presented.
n St. Ann’s Bay Hospital
COST OF CARE PROJECT | 13 RESULTS: CORNWALL REGIONAL HOSPITAL
TOP 5 COMMUNITIES: Road Traffic Cases RTCs • Downtown Montego Bay • Bogue • Unity Hall • John’s Hall • Flankers
VRIs • Downtown Montego Bay • Mt. Salem • Flankers • Rose Heights • Albion
Furthest Communities: • Mt James, St Andrew • Friendship, St. Mary Violence-related injuries • Pt Maria, St Mary • Ocho Rios, St Ann • Mt Airy, Clarendon
14 | COST OF CARE PROJECT RESULTS: MAY PEN HOSPITAL
TOP 5 Road Traffic Cases COMMUNITIES: RTCs • May Pen • Four Paths • Osborne Store • Mineral Heights • Hayes
VRIs • May Pen • Four Paths • Sandy Bay • Palmers Cross • New Denbigh
Furthest Communities: • Mt Airy, Westmoreland • New Market, St Elizabeth • New Roads, Violence-related injuries Westmoreland • Bog, Westmoreland • Mocho, St. James
COST OF CARE PROJECT | 15 RESULTS: ST. ANN’S BAY HOSPITAL
TOP 5 COMMUNITIES: Road Traffic Cases RTCs • Ocho Rios • Golden Grove • Steer Town • Chester • Walkers Wood
VRIs • Ocho Rios • Browns Town • Exchange • Steer Town • Runaway Bay
Furthest Communities: • Windsor, Portland • York, St. Thomas • Petersfield, Violence-related injuries Westmoreland • Cave, Westmoreland • Bluefields, Westmoreland
16 | COST OF CARE PROJECT RESULTS: SPANISH TOWN HOSPITAL
TOP 5 Road Traffic Cases COMMUNITIES: RTCs • Old Harbour • Spanish Town • Hellshire • Kitson Town • Braeton
VRIs • Spanish Town • Old Harbour • Gregory Park • Central Village • Ensom
Furthest Communities: • Flower Hill, St. James • Rosemount, Violence-related injuries St. James, • Bog, Westmoreland, • Jones Pen, St. Thomas
COST OF CARE PROJECT | 17 Cornwall Regional Hospital
SPATIAL ANALYTICAL CONCLUSIONS pressures on specific hospitals with high demand and/ AND IMPLICATIONS or strained resources. Ultimately, devising interventions and prevention mechanisms in high-risk communities Injuries generally occurred within close proximity of may reduce demand on the hospitals themselves. The local hospitals. Distance from incident occurrence to large distances between injury occurrence and ultimate closest/ideal or actual hospital maybe very large, this has hospital admission alone is problematic to the effective- implications for the management of time sensitive issues ness of any treatment. This study did not factor in road as definitive treatment maybe be delayed significantly. condition nor mode of transport of the patient to the The deployment of resources to closer hospitals – hospital, the combination of which may exacerbate any increased capacities and equipment, etc. – may reduce given injury.
18 | COST OF CARE PROJECT - MAY 2017 Cost of Care Findings
Cost of Care of the Injuries to the Health Services Estimated Annual Direct Medical Costs FOR Violence-related INJURIES (VRI) AND ROAD TRAFFIC CRASHES (RTC) and the Economy FOR JAMAICAN HOSPITALS: JANUARY TO DECEMBER 2014
In 2014 hospitals across the island HOSPITALS Item Number COST (J$’000) saw over 25,000 cases of Violence-re- of Cases Mean Total lated injuries (VRI), 13,000 road traffic 7 STUDY HOSPITALS VRI 12,989 175 2,268,642 crashes (RTC) and 500 cases of attempt- RTC 6,737 115 774,755 ed suicide (AS). OTHERS VRI 11,646 116 1,350,084 In 2014, the direct medical cost of JAMAICAN HOSPITALS RTC 5,716 115 657,349 VRIs was J$3.6 billion and the indirect costs was J$5 billion making a total TOTAL ALL VRI 24,635 147 3,618,726 (direct and indirect) medical cost of VRIs JAMAICAN HOSPITAL RTC 12,708 113 1,432,104 as J$8.6 billion (see table above). For * Total cost rounded to nearest ‘000. Mean cost is rounded to nearest whole number. road traffic crashes the estimated direct medical cost was J$1.4 billion and the indirect productivity cost was J$1.8 bil- Estimated Cost of Injuries in Jamaica, 2014 (J$) lion making a total (direct and indirect) Injuries No. of Cases Direct Medical Costs indirect Costs Total medical cost of RTC J$3.2 billion dollars. VRI 25,000 3.6 billion 5.0 billion 8.6 billion For suicide and attempted suicide the RTC 13,000 1.4 billion 1.8 billion 3.2 billion direct medical cost was J$0.4 billion Suicide & and the productivity cost was J$0.4 bil- Attempted lion making a total direct and indirect Suicide 500 0.35 billion 0.4 billion 0.8 billion medical cost of AS of J$0.8 billion. TOTAL 5.4 billion* 7.2 billion 12.6 billion In 2014, the estimated total direct medical cost of injuries was J$5.35 bil- Figure round to nearest ‘000. Indirect cost include productivity losses, disability lion (VRI, RTC and AS) indirect medical * The direct medical cost of injuries excluding compensation of staff was J$4.6 billion costs were J$7.2 billion making a total cost, both direct and medical produc- tivity of J$12.6 billion. In 2014/15 the Ministry of Health juries, traffic and suicide represent 36% RTC was 19% of the total MOH goods budget minus compensation for sala- of the annual hospital budget (com- and services in 2014. ries was J$12.7 billion which included pensation for employees not included). • The total estimated Direct and a budget of J$5.4 billion for goods and The total bill, direct and indirect, of Indirect Costs accounted for 1.2% of the services. The J$4.6 billion estimated the estimated cost of injuries is J$12.6 national GDP in 2014. direct medical cost for violence, road billion, representing 1% of the GDP: These figures are estimated, as the traffic crashes and suicides is equal to • The total estimated direct costs for direct medical costs must be adjusted 85% of the goods and services in the VRI was 59% of the total MOH goods for ICU costs, severity of injury, disabili- hospital budget and the estimated di- and services in 2014. ty and the indirect productivity factor is rect medical cost of Violence-related in- • The total estimated direct costs for subject to a discounting factor.
COST OF CARE PROJECT | 19 COST OF CARE FINDINGS
Number of cases Direct Medical Cost Indirect Cost VRI 25,000 $3.6 billion $5 billion
RTC 13,000 $1.4 billion $1.8 billion
Note: Numbers represent cost of VRIs and RTCs to all 22 Jamaican hospitals for the year 2014
he University Hospital of the West Indies (UHWI) and The Violence Pre- Tvention Alliance (VPA), Jamaica, looked at trends in hospital injury data comparing cost of care in 2006 and 2014. This provided a profile of injured patient by age, gender, nature and location of injury occurrence for Violence-related Injuries (VRI) and Road Traffic Crashes (RTC) seen at the major hospitals across the island. During the period, April – June 2014, detailed data was collected from 1,797 cases of VRIs and 1,556 cases of RTCs seen at the University Hospital of the West Indies (UHWI), Kingston Public Hospital (KPH), Bustamante Hospital for Children (BHC), Spanish Town Hos- pital (STH), May Pen Hospital (MPH), St. Ann’s Bay Hospital (STABH) and Cornwall Regional Hospital (CRH). This data was used to estimate the costs for injuries seen in hospitals across the island in the calendar year 2014.
20 | COST OF CARE PROJECT TOTAL COST TO JAMAICA $8.6 billion Total Cost of VRIs $0.8 billion $12.6 Suicide and attempted $3.2 billion suicide BILLION Total Cost of RTCs PER ANNUM
Medical Cost of Injury by Cost Item for All Hospitals
Violence-related Injuries = $3.6 billion Road Traffic Crashes = $1.4 billion
44% Hospital Stay 13%
3% Exam/X-ray 6%
13% Dressing & Disposable 19%
8% Convalescence 15%
5% Outpatients 4%
1% Drugs 2%
2% Blood & IV 3%
3% ICU 6%
9% Operations 7%
12% Consultations 24%
COST OF CARE PROJECT | 21 Average costs per case Road Traffic Crashes, 2014 $113,000 Avg. cost of RTC was J$113,000.00
Average costs per case Impact on Operations Violence-related Injuries, 2014 $166,000 During the study period one-third of Avg. cost of pedestrian injury operating theatre times at KPH STH and $147,000 CRH were used for emergencies caused by VRIs or RTCs. Avg. cost of VRI per case The average cost per case in 2014 was calculated for each type of injury incurred by the patient. The average $116,000 medical cost for a Violence-related injury at the hospital was J$147,000. Avg. cost of bicycle rider injury $402,000 The highest cost burden was incurred for a gunshot wound case which, on Average cost of a gunshot wound average, costed J$402,000. The second most expensive type of injury was for a stab wound or laceration which cost an average of J$194,000. A blunt injury was moderately less costly at J$115,000 per $263,000 $194,000 case, on average. Avg. cost of motorcycle rider injury For RTCs, the average cost of this type Avg. cost of stab wound/laceration of injury was J$113,000. The cost of the average pedestrian injury was J$166,000 and for a bicycle rider injury, J$116,000. Most expensive of the road traffic crash costs was the average cost of a motorcy- $115,000 cle rider injury amounting to J$263,000. $94,000 The average cost for an injury in a car Avg. cost of of blunt injury Avg. cost of injury in a car was J$94,000.
22 | COST OF CARE PROJECT COST OF CARE FINDINGS Impact on Hospital Budget
Direct Cost of VRI 22% as a Percentage of 1% Cost of VRIs Cost of VRIs, Hospital Budget RTCs and Direct Medical Cost (excluding Suicides compensation) J$3.2 Billion 78% N= 24,635 Remaining 99% Hospital Budget Remaining GDP
Indirect and Direct Cost of VRI, RTC & Suicides as a Percentage of the GDP 8% Cost of Direct Medical Cost (excluding com- RTCs pensation) J$4.6 Billion Direct Cost of RTC N= 37,343 as a Percentage of Hospital Budget
Direct Medical Cost (excluding 92% compensation) J$1.1 Billion N= 12,708 Remaining Hospital Budget 36% Cost of VRIs, RTCs and Suicides 64% Remaining Hospital Budget 6% Cost of Direct Costs of Suicides N= 12,708 suicides as a Percentage of Hospital Budget Direct Medical Cost (excluding Direct Cost of RTC & VRI* compensation) J$1.1 Billion as a Percentage of the 94% N= 12,708 Hospital Budget Remaining Direct Medical Cost (excluding com- Hospital Budget pensation) J$4.6 Billion N= 37,343
COST OF CARE PROJECT | 23 COST OF CARE FINDINGS
Significance of the This initial evaluation of trends seen and effective system for the collection from the data generated has revealed of demographic and geographical data Study and Utilization several significant patterns of injuries. It of patients affected by injuries and the of the Findings ˙ has been able to identify geographical context of their injuries. The strategies, areas with higher numbers of VRIs and developed and tested during this study, injuries associated with RTCs within several represent a template for the creation of The Study has parishes and communities. A high pro- a system to collect relevant, high quality demonstrated the portion of women affected by VRIs has data on this population of patients. Such significant burden also been found. Looking more closely at data must be shared and utilized by the VRIs affecting women, the considerable groups in our society. Using such data can and impact that number of sexual assaults and cases of enhance the efficacy of many groups trying VRIs and RTCs intimate partner violence affecting women to decrease the effect of these injuries: the is clearly identified. Our understanding of JCF can better investigate patterns of VRIs have on individuals’ the patterns seen will continue to develop by detecting increases in violent crime lives, the hospital as the data is used by workers within each at a very early stage; preventative social services and the geographical region and specific communi- programmes can use this information to ty based factors producing these patterns build on pre-existing community resources economy. can be determined. such as schools or churches; the Ministry Most importantly the study reveals of Health can use it to develop an efficient the successful development of a feasible ambulance service.
24 | COST OF CARE PROJECT WHO data shows that 80% of Violence- borne largely by the health care service. While this cost can be, overwhelming related injuries and 90% of road traffic and intimidating it can also represent tremendous opportunities for financial crashes can be prevented. and social savings that can be made by effectively combating and implement- This study built on the pre-existing • Programmes targeting at risk indi- ing prevention programmes to address Jamaica Injury Surveillance System, viduals (Mercy 1993): Examples include these problems. which needs to be strengthened by conflict resolution, training in social increasing the type and amount of data skills and education. Financial and social collected and expanding to include • Changes in the physical environ- new hospitals. Further iterations will ment: Often referred to as Crime Pre- savings can be made lead to further gains in the capacity and vention through Environmental Design by effectively efficiency of the system. With continued (CPTED) (RCMP, 1998). support the collection, distribution and implementing • Adjustment of social/economic use of this type of data can become conditions (Mercy 1993): Examples prevention an integrated but evolving part of our include job creation programmes, healthcare information system. Such programmes to mentoring programmes and communi- a system allows the rapid detection of ty-based programmes. address these changes in both the quantity and distri- bution of such injuries in Jamaica and • Programmes and legislations problems. enhance our ability to develop strate- targeting wearing of safety gears have This must inform the amount of gies that are targeted geographically seen reduction in RTCs (Global Status financial and other resources that we and demographically to the areas with Report on Road Safety, 2015). Examples assign to combat this epidemic of the greatest need. Ongoing use will include legislation and enforcement of violence and road traffic trauma. WHO allow the most cost effective resource use of helmets and seatbelts. (2002) data shows that 80% of violence- utilization as we determine which strat- Programmes utilizing these princi- related injuries and 90% of road traffic egies work best to combat this problem ples have been developed and success- crashes can be prevented. World Health and which ones are ineffective. fully implemented in Jamaica. Commu- Organization (WHO) recommends that The data from this study allows for nity-based programmes of the Peace investing in the prevention of these an accurate and up-to-date profile of Management Initiative (PMI) have been injuries would make available health the victims of VRIs and RTCs in Jamaica. utilized effectively in high-risk commu- care resources to treat, cardiovascular, It also allows forthe identification of nities such as Mountain View, Dunkirk chronic non-communicable diseases personal and environmental factors and Rock Hall (VPA Jamaica, 2015; and cancers. Evidence exists as to which that may alter the risk of being a victim Small Arms Survey, 2011; New York programmes work and don’t work to of traumatic injury. Such data has been Times, 2013). Enactment of the seatbelt reduce the impact of violence and road used by the security forces, health, law, targeting of crash “hot spots” and traffic crashes on the Jamaican health social security and in road safety in the the ongoing work of the Road Safety services and on our society. investigation of crimes and RTCs. These Council, has seen significant reduction Currently these costs are hidden and data can also be used in the planning in road traffic fatalities. an effective focus on prevention needs and implementation of strategies and Accurate cost data will allow sever- to be properly resourced as a matter of policies to prevent VRIs and RTCs. al things to be done. In the on-going priority. harsh economic conditions in Jamaica, PREVENTION STRATEGIES Unless addressed, Jamaica will we can provide an estimated dollar continue to bear the tremendous social Many effective evidence based pre- value of the scope of the problem. and economic burden associated with vention strategies have been utilized in Those involved in combating this issue the treatment of these injuries. throughout the world. These include: can look at the large associated cost
COST OF CARE PROJECT | 25 PUBLICITY OF THE PROJECT
Presentations advocating for policy support:
• UWI Research Day, 2014
• Ministry of Health, National Health Research, 2014
• Ministry of Health, National Health Research, 2015
• Caribbean Public Health Association (CARPHA) Conference in Grenada 2015
• SALISES Youth Conference, 2015
• Caribbean Neuroscience Symposium, 2016
• Research findings Forum Courtleigh Business Centre.
• JN Foundation/ National Health Fund/ UHWI/VPA, October 2015
• Newspaper articles
26 | COST OF CARE PROJECT REFERENCES
Butchart, A. et al. (2008) Manual for estimating the economic costs of injuries due to interpersonal and self-directed violence. World Health Organization, Department of Health and Human Services, Centers for Disease Control and Prevention
Fletcher, P. et al (2003) Surgery in Jamaica Arch Surg 138(10) pp. 1150-1153 Available at http://archsurg.jamanetwork.com/article.aspx?arti- cleid=395719 Accessed 18 June 2013
Gosselin, R. et al (2009) Injuries: the neglected burden in developing countries Bulletin of the World Health Organization 87 pp 246 Available at http://www.who.int/bulletin/volumes/87/4/08-052290/en/ Accessed 15 December 2013
Jamaica Gleaner (2009) Jamaica’s crime burden-Bleeding health-care system. January 5 (online) Available at http://jamaica-gleaner.com/ gleaner/20090105/news/news3.html Accessed 15 May 2013
Jamaica Observer (2009) Crime affecting Caribbean development -- UNDP report. January 22 (online) Available at http://m.jamaicaobserver. com/mobile/news/Crime-affecting-Caribbean-development----UNDP-report Accessed 22 January 2014
McIlvenny, S. (2006) Road traffic Accidents-A Challenging Epidemic Sultan Qaboos University Medical Journal 6(1) pp 3-5 Available at http:// www.ncbi.nlm.nih.gov/pmc/articles/PMC3074911/ Accessed 8 January 2014
Mercy, J. et al (1993) Public health policy for preventing violence Health Affairs 12(4) pp 7-29 Available at http://content.healthaffairs.org/ content/12/4/7.full.pdf+html Accessed 2 January 2014
Mona Geoinformatics (2006) Human and Social Mapping (online) Available at http://www2.monagis.com/upload/HS.pdf Accessed 24 Janu- ary 2014
New York Times (2013) Jamaica fights to break grip of violent past. August 17. (Online) Available at http://www.nytimes.com/2013/08/18/ world/americas/jamaica-fights-to-break-grip-of-violent-past.html?_r=0 Accessed 20 January 2014
RCMP (1998) Creating safer communities: An introduction to Crime Prevention through Environmental Design (CPTED) for architects, planners and builders. (online) Available at http://www.rcmp-grc.gc.ca/pubs/ccaps-spcca/pdf/cpted-pcam-eng.pdf Accessed 25 January 2014
Small Arms Survey (2011) Violence Prevention Alliance Jamaica: Issue Brief: Peace Brokers-Understanding Good Practice in Violence Preven- tion and Reduction in Jamaica. October 1 pp. 1-12 Available at http://www.genevadeclaration.org/fileadmin/docs/Issue-Brief/PMIVPA_Issue- Briefoct2011.pdf Accessed 25 January 2014
Small Arms Survey (2013) Issue Brief: Geospatial Technologies and Crime. October 3 pp. 1-12 Available at http://www.smallarmssurvey.org/ fileadmin/docs/G-Issue-briefs/SAS-AV-IB3-Geospatial-tech-jamaica.pdf Accessed 25 January 2014
Ward, E. et al. (2002) Jamaica Injury Surveillance System. The establishment of a Jamaican all-injury surveillance system.Injury Control and Safety Promotion 9(4) pp 219-225 Available at http://www.tandfonline.com/doi/abs/10.1076/icsp.9.4.219.13677 Accessed 21 January 2014
Ward, E. et al. (2009) Results of an exercise to estimate the costs of interpersonal violence in Jamaica. West Indian Med J 58(5) pp. 446-451 Available at http://www.ncbi.nlm.nih.gov/pubmed/20441064 Accessed 15 May 2013
Williams, G. & Ward, E. (2006) Mortality and Morbidity from motor vehicle accidents in Jamaica. APHA 134th annual meeting (online) Available at https://apha.confex.com/apha/134am/techprogram/paper_129308.htm Accessed 19 June 2013
World Health Organization (2013) Violence and injury prevention (online) Available at http://www.who.int/violence_injury_prevention/en/ Accessed 15 December 2013
World Health Rankings (2012) Jamaica; Road Traffic Accidents (online) Available at http://www.worldlifeexpectancy.com/jamaica-road-traf- fic-accidents Accessed 9 June 2013
World Health Organization (2010) International statistical classification of diseases and related health problems, 10th revision. Geneva, Avail- able at http://apps.who.int/classifications/icd10/browse/2010/en#/XX Accessed 19 February 2014 http://www.who.int/roadsafety/decade_of_action/plan/en/ http://www.who.int/violence_injury_prevention/violence/global_campaign/actionplan/en/ http://www.who.int/violence_injury_prevention/violence/inspire/en/
Wortley, Scot et al (2006) “The Jamaican National Crime Victimization Survey” Report prepared for the Ministry of National Security, Govern- ment of Jamaica. Toronto Centre of criminology, University of Toronto
COST OF CARE PROJECT | 27 28 | COST OF CARE PROJECT APPENDICES
Appendix Table 1: VRIs – Gender Distribution by Hospital 7 Study Hospitals, April-June 2014
Appendix Table 2: VRIs – Age Distribution by 7 Study Hospitals, April-June 2014
Appendix Table 3: VRIs – Outcome of injury by 7 Study Hospitals, April-June 2014
Appendix Table 4: VRIs – Context/Circumstance of the Incident by 7 Study Hospitals, April-June 2014
Appendix Table 5: VRIs – Injury Type by 7 Study Hospitals, April-June 2014
Appendix Table 6: VRI by Injury Type and Perpetrator, 2014 Study of 7 Hospitals, April-June 2014
Appendix Table 7: VRIs by Injury Type by Body Part Affected, April-June 2014
Appendix Table 8: RTCs – Gender Distribution by 7 Study Hospitals, April-June 2014
Appendix Table 9: RTCs – Age Distribution by 7 Study Hospitals, April-June 2014
Appendix Table 10: RTCs – Outcome of Injury by 7 Study Hospitals, April-June 2014
Appendix Table 11: RTCs – Patient’s Road Traffic Mode of Travel in 7 Study Hospitals, April-June 2014
Appendix Table 12: RTC – Injury Severity by Body Parts Affected, April-June 2014
Appendix Table 13: RTC – Use of Safety Gear by Injury Severity and Injury Outcome
Appendix Table 14: RTCs – Injury Group Patient’s Road Traffic Mode by Body Parts Affected, April-June 2014
Appendix Table 15: Information and formulae used in economic costing calculations Violence-related Injuries (VRI)
Appendix Table 16: Information and formulae used in economic costing calculations Road Traffic Crashes (RTC)
Appendix 17: Questionnaire – Patients Treated for Violence-related Injuries
Appendix 18: Questionnaire – Patients Treated for Road Traffic Crash-related Injuries
COST OF CARE PROJECT | 29 APPENDICES
APPENDIX TABLE 1: VRIs – GENDER DISTRIBUTION BY HOSPITAL 7 STUDY HOSPITALS APPENDIX TABLE 1: VRIs – GENDER DISTRIBUTION BY HOSPITAL 7 STUDY HOSPITALS APRIL-JUNE 2014 APRIL-JUNE 2014
Gender of Victim
Name of Hospital Male Female Total BHC 15 50.0% 15 50.0% 30 100.0% CRH 451 59.0% 313 41.0% 764 100.0%
KPH 160 62.3% 97 37.7% 257 100.0%
MPH 176 57.1% 132 42.9% 308 100.0%
SAB 117 61.9% 72 38.1% 189 100.0%
STH 84 62.2% 51 37.8% 135 100.0%
UHWI 33 63.5% 19 36.5% 52 100.0%
TOTAL 1,036 59.7% 699 40.3% 1,735 100.0%
Note: Sex not reported for 5 from KPH, 1 fromNote: Sex not reported for 5 STH and 1 from UHWI For Violence-related from KPH, 1 from STH and 1 from UHWI Injuries (VRI) seen Male: Female ratio was 1.5:1
For Violence Related Injuries (VRI) seen Male: Female ratio was 1.5:1
APPENDIX TABLE 2: VRIs –APPENDIX TABLE 2: VRIs – AGE DISTRIBUTION BY 7 STUDY HOSPITALS AGE DISTRIBUTION BY 7 STUDY HOSPITALS APRIL-JUNE 2014 APRIL-JUNE 2014
Name of Hospital Age Group Total (Years) BHC CRH KPH MPH SAB STH UHWI
<18 years 30 100% 173 22.6% 32 12.2% 55 17.9% 50 26.55 35 25.75 5 9.4% 380 21.8%
18-29 years 0 0.0% 265 34.7% 117 44.7% 111 36.0% 54 28.6% 55 40.4% 18 34.0% 620 35.6% 1
30-44 years 0 0.0% 206 27.0% 68 26.0% 88 28.6% 49 25.9% 30 22.1% 13 24.5% 454 26.1%
45 years & 0 0.0% 120 15.7% 31 11.8% 53 17.2% 35 18.5% 15 11.0% 7 13.2% 261 15.0% over
Unknown 0 0.0% 0 0.0% 14 5.3% 1 .3% 1 .5% 1 .7% 10 18.9% 27 1.5% Not reported
Total 30 100.0% 764 100.0% 262 100.0% 308 100.0% 189 100.0% 136 100.0% 53 100.0% 1,742 100.0%
Age Group most affected by VRI 18Age Group most affected by VRI 18-29-29 year old except for at BHC age group most affected was 6 year old except for at BHC age group most affected was 6-10 year-10 year olds olds
30 | COST OF CARE PROJECT APPENDICES
APPENDIX TABLE 3: VRIAPPENDIX TABLE 3: VRIs – Admission Status BY 7 STUDY HOSPITALS s – OUTCOME OF INJURY BY 7 STUDY HOSPITALS APRIL-JUNE 2014 APRIL-JUNE 2014
Name of Injury Outcome Hospital Total Cases A&E Cases Seen and Hospitalized Died in Hospital Discharged
BHC 24 80.0% 6 20.0% 0 0.0% 30 100.0%
CRH 691 90.4% 66 8.6% 7 0.9% 764 100.0%
KPH 183 69.8% 67 25.6% 12 4.6% 262 100.0%
MPH 254 82.5% 54 17.5% 0 0.0% 308 100.0%
SAB 158 83.6% 31 16.4% 0 0.0% 189 100.0%
STH 93 68.4% 43 31.6% 0 0.0% 136 100.0%
UHWI 39 73.6% 11 20.8% 3 5.7% 53 100.0%
TOTAL 1,442 82.8% 278 16.0% 22 1.3% 1,742 100.0%
VRI Cases Status: Overall 16% of VRI cases seen were admitted to hospital of which 1.3% died – Spanish Town admitted 32% of VRI cases; KPH admit- ted 26 %; UHWI admitted 21% and MPH admitted 18% of their VRI cases.
VRI Cases Status: Overall 16% of VRI cases seen were admitted to hospital of which 1.3% died – Spanish Town admitted 32% of VRI cases; KPH admitted 26 %; UHWI admitted 21% and MPH admitted 18% of their VRI cases. APPENDIX TABLE 4: VRIs – CONTEXT/CIRCUMSTANCE OF THE INCIDENT BY 7 STUDY HOSPITALS APRIL-JUNE 2014 APPENDIX TABLE 4: VRIs – CONTEXT/CIRCUMSTANCE OF THE INCIDENT BY 7 STUDY HOSPITALS APRIL-JUNE 2014
Name of Hospital
Incident BHC CRH KPH MPH SAB STH UHWI Total Fight/Argument 8 26.7% 576 75.4% 173 66.0% 197 64.0% 131 69.3% 77 56.6% 34 64.2% 1,196 68.7%
Robbery/Burglary 0 0.0% 22 2.9% 21 8.0% 30 9.7% 12 6.3% 8 5.9% 4 7.5% 97 5.6%
Drug Related 0 0.0% 0 0.0% 1 0.4% 0 3 0.0% 0 0.0% 0 0.0% 0 0.0% 1 0.1%
Gang Related 0 0.0% 11 1.4% 10 3.8% 2 0.6% 5 2.6% 0 0.0% 1 1.9% 29 1.7%
Mob/Riot 0 0.0% 4 0.5% 1 0.4% 2 0.6% 2 1.1% 2 1.5% 0 0.0% 11 0.6%
Sexual Assault 9 30.0% 35 4.6% 1 0.4% 29 9.4% 9 4.8% 16 11.8% 1 1.9% 100 5.7%
Child Abuse 4 13.3% 6 0.8% 1 0.4% 4 1.3% 4 2.1% 2 1.5% 0 0.0% 21 1.2%
Police Shooting 0 0.0% 2 0.3% 2 0.8% 0 0.0% 0 0.0% 4 2.9% 0 0.0% 8 0.5%
Other/Missing/Not 9 30.0% 108 14.1% 52 19.8% 44 14.3% 26 13.8% 27 19.9% 13 24.5% 279 16.0% Reported Total 30 100.0% 764 100.0% 262 100.0% 308 100.0% 189 100.0% 136 100.0% 53 100.0% 1,742 100.0%
VRI Persons Involved in fights (69 %) were the most common cause of visit/admission to hospital due to VRI. For children under 12 tears seen at BHC sexual assault 30%, VRI Persons Involved in fights (69 %) were the most common cause of visit/admission to hospital due to VRI. For children under 12 tears seen at BHC sexual assault 30%, fights27% child abuse 13% fights27% child abuse 13% child abuse and child assault were the most common causes. child abuse and child assault were the most common causes.
COST OF CARE PROJECT | 31 APPENDICES
APPENDIX TABLE 5: VRIsAPPENDIX TABLE 5: VRIs – MECHANISM OF INJURY BY 7 STUDY HOSPITALS – MECHANISM OF INJURY BY HOSPITAL 7 STUDY HOSPITALS APRIL-JUNE 2014 APRIL-JUNE 2014
Name of Hospital
Mechanism of Total BHC CRH KPH MPH SAB STH UHWI Injury
Gunshot Wound 0 0.0% 55 7.2% 48 18.3% 29 9.4% 4 2.1% 14 10.3% 12 22.6% 162 9.3%
Stab Wound and 5 16.7% 223 29.2% 112 42.7% 75 24.4% 70 37.0% 46 33.8% 8 15.1% 539 30.9% Laceration
Blunt Trauma 4 13.3% 255 33.4% 82 31.3% 110 35.7% 98 51.9% 51 37.5% 30 56.6% 630 36.2-%
Sexual Assault 8 26.7% 34 4.5% 0 0.0% 25 8.1% 5 2.6% 15 11.0% 1 1.9% 88 5.1%
Other 13 43.3% 185 24.2% 15 5.7% 58 18.8% 8 4.2% 10 7.4% 0 0.0% 289 16.6%
Missing/Not 0 0.0% 12 1.6% 5 1.9% 11 3.6% 4 2.1% 0 0.0% 2 3.8% 34 2.0% Reported
TOTAL 30 100.0% 764 100.0% 262 100.0% 308 100.0% 189 100.0% 136 100.0% 53 100.0% 1,742 100.0%
VRI of the VRI seen 37% were due to blunt trauma,32%were stab woundsVRI of the VRI seen 37% were due to blunt trauma,32%were stab or lacerations,10% were gunshot wounds, 5% were sexual assault. wounds or lacerations,10% were gunshot wounds, 5% were sexual assault. KPH had the highest number of cases of stab wounds and UHWI the highest number of cases of blunt trauma. Sexual assault was highest at BHC KPH had the highest number of cases of stab wounds and UHWI the highest number of cases of blunt trauma. Sexual assault was highest at BHC.
APPENDIX TABLE 6: APPENDIX TABLE 6: INJURY BY MECHANISM AND PERPETRATOR RELATIONSHIP, 2014 INJURY BY MECHANISM AND PERPETRATOR RELATIONSHIP, 2014 STUDY OF 7 HOSPITALS APRIL-JUNESTUDY OF 7 HOSPITALS, APRIL-JUNE 2014 2014
PERPETRATOR Gun Shot Wound STAB BLUNT TRAUMA LACERATION SEXUAL ASSAULT OTHER TOTAL
5 Boyfriend/Girlfriend, 2 1.4% 38 13.6% 96 15.5% 35 14.3% 4 4.7% 70 24.8% 245 14.8% Common-law Husband/ Wife
Parent/Other Relative 1 0.7% 18 6.4% 100 16.2% 40 16.3% 8 9.3% 42 14.9% 209 12.6%
Acquaintance 14 9.7% 163 58.2% 289 46.8% 121 49.4% 45 52.3% 109 38.6% 741 44.8%
Stranger 74 51.0% 42 15.0% 61 9.9% 29 11.8% 27 31.4% 34 12.1% 267 16.1%
Self-Inflicted 1 0.7% 1 0.4% 1 0.2% 1 0.4% 0 15 5.3% 19 1.2%
Official legal 9 6.2% 3 1.1% 12 1.9% 0 0 2 0.7% 26 1.6%
Unknown 44 30.3% 15 5.4% 59 9.6% 19 7.8% 2 2.3% 10 3.5% 149 8.9% TOTAL 145 280 618 245 86 282 1,656 (9) (17) (37) (15) (5) (17) (100)
Data on body part affected was not available for 86 cases of VRIs.Data on body part affected was not available for 86 cases of VRIs. For VRI: For VRI:• Victim Perpetrator Relationship 45% of all types of VRI were done by an acquaintance; • • Victim P VRI –erpetrator Relationship 45% of all types of VRI were done by an acquaintance; Most of the gunshot wounds, 51%, involved a stranger/unknown perpetrator. • • VRI Stab– Most of the gunshot wounds, 51%, involved a stranger/unknown perpetrator. wound 58% involved an acquaintance with 14% boyfriend/girlfriend/common-law husband/wife. • • Stab wound 58% involved an acquaintance with 14% boyfriend/girlfriend/common Blunt injury 47% by acquaintance with 16% by girlfriend/boyfriend/common-law husband/wife-law husband/wife. and with other relative 16%. • • Blunt injury 47% by acquaintance with 16% by girlfriend/boyfriend/common Lacerations, 49% was inflicted by an acquaintance with 14% by girlfriend/boyfriend/common-law-law husband/wife and with other relative 16%. husband/wife, 16% by other relative. • • Lacerations, 49% was inflicted by an acquaintance with 14% by girlfriend/boyfriend/common Sexual assaults 52% involved an acquaintance and 31% involved a stranger. -law husband/wife, 16% by other relative. • Sexual assaults 52% involved an acquaintance and 31% involved a stranger.
32 | COST OF CARE PROJECT APPENDICES
APPENDIX TABLE 7: VRIs BY INJURY TYPE BY BODY PART AFFECTED APPENDIX TABLE 7: VRIs BY INJURY TYPE BY BODY PART AFFECTED, APRIL-JUNE 2014 APRIL-JUNE 2014
Injury Type Injury Group Gun Shot Wound Stab Wound and Blunt Trauma Sexual Assault Other/Not Reported Total Laceration
Head and facial injury (excluding 18 11.1% 148 27.5% 346 54.9% 0 0.0% 102 31.6% 614 35.2% eye injury) Eye injury 2 1.2% 8 1.5% 26 4.1% 0 0.0% 18 5.6% 54 3.1% Injuries to vertebral column, 46 28.4% 52 9.6% 23 3.7% 1 1.1% 6 1.9% 128 7.3% spine, internal organs and ribs/sternum fractures Upper extremity injury 29 17.9% 172 31.9% 109 17.3% 0 0.0% 55 17.0% 365 21.0% (excluding nerves) Lower extremity injury 35 21.6% 20 3.7% 43 6.8% 3 3.4% 15 4.6% 116 6.7% Superficial injury, including 18 11.1% 100 18.6% 20 3.2% 0 0.0% 9 2.8% 147 8.4% contusions and open wounds Burns 0 0.0% 0 0.0% 0 0.0% 0 0.0% 8 2.5% 8 0.5% Poisoning 0 0.0% 0 0.0% 0 0.0% 0 0.0% 2 0.6% 2 0.1% Other and unspecified injury 8 4.9% 26 4.8% 47 7.5% 56 63.6% 60 18.6% 197 11.3% Unknown/Not Reported 6 3.7% 13 2.4% 16 2.5% 28 31.8% 48 14.9% 111 6.4 TOTAL 162 100.0% 539 100.0% 630 100.0% 88 100.0% 323 100.0% 1,742 100.0%
For VRI – the body part involved – For GSW 28% vertebral column, spine internal organs; 22% lower extremity and 18% upper extremity. For stab wounds and lacerations For VRI – the body part involved – For GSW 28% vertebral column, spine internal organs; 22% lower extremity and 18% upper extremity. For stab wounds and lacerations 32% 32% involved upper extremities, 28% head and facial injuries. For blunt trauma 55% involved head and facial injuries; 17% involved upper extremities. involved upper extremities, 28% head and facial injuries. For blunt trauma 55% involved head and facial injuries; 17% involved upper extremities. Overall for all VRI 35% of cases involved head and facial injuries; 21% involved upper extremities; 7% involved the vertebral column; spiral, internal organs ribs/sternum Overall for all VRI 35% of cases involved head and facial injuries; 21% involved upper fractures extremities; 7% involved the vertebral column; spiral, internal organs ribs/sternum fractures.
APPENDIX TABLE 8: RTCs – GENDER DISTRIBUTION BY 7 STUDY HOSPITALS APPENDIX TABLE 8: RTCs – GENDER DISTRIBUTION BY 7 STUDY HOSPITALS APRIL-JUNE 2014 APRIL-JUNE 2014
Gender of Victim Name of 6 Missing/Not Reported Total Male Female Hospital
BHC 24 58.5% 17 41.5% 0 0.0% 41 100.0%
CRH 298 62.9% 176 37.1% 0 0.0% 474 100.0%
KPH 113 71.5% 44 27.8% 1 0.6% 158 100.0%
MPH 80 69.0% 35 30.2% 1 0.9% 116 100.0%
SAB 61 59.8% 39 38.2% 2 2.0% 102 100.0%
STH 41 60.3% 26 38.2% 1 1.5% 68 100.0%
UHWI 364 67.7% 163 30.3% 11 2.0% 538 100.0%
TOTAL 981 65.5% 500 33.4% 16 1.1% 1,497 100.0%
*16 cases missing gender *16 cases missing gender For RTC seen Male: Female ratio was 2 to 1
For RTC seen Male: Female ratio was 2 to 1
COST OF CARE PROJECT | 33
APPENDICES
APPENDIX TABLE 9: RTCs APPENDIX TABLE 9: RTCs – AGE DISTRIBUTION BY 7 STUDY HOSPITALS – AGE DISTRIBUTION BY HOSPITAL 7 STUDY HOSPITALS APRIL-JUNE 2014 APRIL-JUNE 2014
Age Group Name of Unknown Total Hospital <18 Years 18-29 Years 30-44 Years 45 Years and Over
BHC 41 100.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 41 100%
CRH 115 24.3% 155 32.7% 104 21.9% 100 21.1% 0 0.0% 474 100.0%
KPH 14 8.9% 60 38.0% 43 27.2% 38 24.1% 3 1.9% 158 100.0%
MPH 17 14.7% 43 37.1% 28 24.1% 25 21.6% 3 2.6% 116 100.0%
SAB 25 24.5% 35 34.3$ 29 28.4% 11 10.8% 2 2.0% 102 100.0%
STH 19 27.9% 15 22.1% 17 25.0% 13 19.1% 4 5.9% 68 100.0%
UHWI 92 17.1% 167 31.0% 141 26.2% 120 22.3% 18 3.3% 538 100.0%
TOTAL 323 21.6% 475 31.7% 362 24.2% 307 20.5% 30 2.0% 1,497 100.0%
The young productive age group of 18The young productive age group of 18-29-29 years were most affected by RTC in all study hospitals While 20% of RTC cases were in the 45 years and older years were most affected by RTC in all study hospitals While 20% of RTC cases were in the 45 years and older age group.age group
APPENDIX TABLE 10: RTCS – OUTCOME OF INJURY BY 7 STUDY HOSPITALS APPENDIX TABLE 10: RTCS – OUTCOME OF INJURED CASES IN 7 STUDY HOSPITALS, APRIL-JUNE 2014 APRIL-JUNE 2014
Outcome Name of Hospital 9 Total A&E Hospitalization Death
BHC 38 92.7% 3 7.3% 0 0.0% 41 100.0%
CRH 427 90.1% 41 8.6% 6 1.3% 474 100.0%
KPH 104 65.8% 41 25.9% 13 8.2% 158 100.0%
MPH 79 68.1% 36 31.0% 1 0.9% 116 100.0%
SAB 77 75.5% 25 24.5% 0 0.0% 102 100.0%
STH 43 63.2% 24 35.3% 1 1.5% 68 100.0%
UHWI 427 79.4% 110 20.4% 1 0.2% 538 100.0%
Total 1,195 79.8% 280 18.7% 22 1.5% 1,497 100.0%
Overall 19% of RTC cases seen were admitted to hospital. In May Pen and Spanish Town, the admissions from RTC rose to over 30%. Overall 19% of RTC cases seen were admitted to hospital. In May Pen and Spanish Town, the admissions from RTC rose to over 30%.
34 | COST OF CARE PROJECT APPENDICES
APPENDIXAPPENDIX TABLE 11: RTCs – PATIENT’S ROAD TRAFFIC MODE OF TRAVEL IN 7 STUDY HOSPITALS, APRIL-JUNE 2014 TABLE 11: RTCs – PATIENT’S ROAD TRAFFIC MODE OF TRAVEL IN HOSPITAL 7 STUDY HOSPITALS APRIL-JUNE 2014
Name of Hospital
Total BHC CRH KPH MPH SAB STH UHWI
Pedestrian 2 4.9% 102 21.5% 26 16.5% 17 14.7% 10 9.8% 13 19.1% 44 8.2% 214 14.3%
Taxi 0 0.0% 10 2.1% 2 1.3% 0 0.0% 4 3.9% 4 5.9% 29 5.4% 49 3.3%
Bicycle 10 24.4% 18 3.8% 8 5.1% 13 11.2% 6 5.9% 6 8.8% 22 4.1% 83 5.5%
Motorbike 3 7.3% 79 16.7% 40 25.3% 24 20.7% 8 7.8% 11 16.2% 55 10.2% 220 14.7%
Car 22 53.6% 157 33.1% 46 29.1% 44 37.9% 42 41.2% 27 39.7% 132 24.5% 470 31.4%
*Other Motor 4 9.8% 97 20.5% 26 16.5% 18 15.5% 30 29.4% 7 10.3% 16 3.0% 198 13.2% Vehicle Mode
Unknown/Not 0 0.0% 11 2.3% 10 6.2% 0 0.0% 2 2.0% 0 0.0% 240 44.6% 263 17.6% Reported
Total 41 100.0% 474 100.0% 158 100.0% 116 100.0% 102 100.0% 68 100.0% 538 100.0% 1,497 100.0%
*Other Motor Vehicle Mode – Pick-up, Truck, Heavy vehicle, Bus, Train At KPH and MPH motorbikes as the mode of transport in RTC rose to 35% and 21% *Other Motor Vehicle Mode Cars (31%) were the most frequent– Pick-up, Truck, Heavy vehicle, Bus, Train mode of transport for cases of RTC seen at hos- respectively. Among children seen at BHC cars (6% were the most frequent mode pitals. Other modes included motorbikes (15%); pedestrians (14%), other motor of transport, bicycles 24% while pedestrians accounted for 5%. vehicles (13%) Cars (31%) were the most frequent mode of transport for cases of RTC seen at hospitals. Other modes included motorbikes (15%); pedestrians (14%), other motor vehicles (13%) APPENDIX TABLE 12: RTC – INJURY SEVERITY BY BODY PARTS AFFECTED, APRIL-JUNE 2014 At KPH and MPH motorbikes as the mode of transport in RTC rose to 35% and 21% respectively APRIL-JUNE 2014 Among children seen at BHC cars (6% were the most frequent mode of transport, bicycles 24% while pedestrians accounted for 5%APPENDIX TABLE 12: RTC – INJURY SEVERITY BY BODY PARTS AFFECTED .
Injury Severity by Body Parts Affected
Injury Group Total A & E Hospitalisation Death
Head and facial injury (excluding eye 355 29.7% 141 50.4% 16 72.7% 512 34.2% injury) 13
Eye Injury 14 1.2% 4 1.4% 0 0.0% 18 1.2%
Injuries to vertebral column, spine, 110 9.2% 30 10.7% 5 22.7% 145 9.7% internal organs, and rib/sternum fractures
Upper extremity injury (excluding 181 15.1% 20 7.1% 0 0.0% 201 13.4% nerves)
Lower extremity injury 177 14.8% 38 13.6% 1 4.5% 216 14.4%
Superficial injury, including 65 5.4% 9 3.2% 0 0.0% 74 4.9% contusions and open wounds
Foreign body 4 0.3% 1 0.4% 0 0.0% 5 0.3%
Other and unspecified injury 237 19.8% 15 5.4% 0 0.0% 252 16.8%
Missing N/A 52 4.4% 22 7.9% 0 0.0% 74 4.9%
Total 1,195 100.0% 280 100.0% 22 100.0% 1,497 100.0%
For RTC – 34% of all patients and 50% of admitted patients had head and facial injuries. Upper and lower extremities were body part affected in 14% of RTC. For RTC – 34% of all While 10% experiencedpatients and 50% of admitted patients had head and facial injuries. Upper and lower extremities were body part affected in 1 injuries to vertebral column, spiral internal organs and ribs 5% were superficial injury and 1% eye injuries 4% of RTC. While 10% experienced injuries to vertebral column, spiral internal organs and ribs 5% were superficial injury and 1% eCOST OF CARE PROJECT | 35 ye injuries
11 APPENDICES
APPENDIAPPENDIX TABLE 13: RTC – USE OF SAFETY GEARS BY INJURY SEVERITY AND ADMISSION STATUS X TABLE 13: RTC – USE OF SAFETY GEARS BY INJURY SEVERITY AND INJURY OUTCOME APRIL-JUNE 2014
A&E Hospitalization Deaths Total
Used seat belt 128 10.7% 29 10.4% 2 9.1% 159 10.6%
Did not use safety gear 664 55.6% 132 47.1% 11 50.0% 807 53.9%
Not reported 403 33.7% 119 42.5% 9 40.9% 531 35.5%
TOTAL 1,195 100.0% 280 100.0% 22 100.0% 1,497 100.0%
Only 10 % RTC cases seen at hospital did use safety gear, i.e., a seat belt or a helmet.
Only 10 % RTC cases seen at hospital did use safety gear, i.e., a seat belt or a helmet. APPENDIX TABLE 14: RTCS – INJURY GROUP PATIENT’S ROAD TRAFFIC MODE BY BODYAPPENDIX TABLE 14: RTCS – INJURY GROUP PATIENT’S ROAD TRAFFIC MODE BY BODY PARTS AFFECTED, APRIL-JUNE 2014 PARTS AFFECTED APRIL-JUNE 2014
Patient Motor Vehicle Accident Mode
Injury Group Pedestrian Bicycle Motorbike Car Other Motor Missing/Not Total Vehicle Reported
Head and Facial Injury 62 29.0% 33 39.0% 65 29.5% 157 33.4% 84 36% 111 42.7% 512 34% (excluding eye injury) Eye Injury 0 0.0% 1 1.2% 1 .5% 2 .4% 2 0.8% 12 5.1% 18 1% Injuries to vertebral 7 3.3% 2 2.4% 11 5.0% 72 15.3% 25 10.6% 28 7.3% 145 10% column, spine, internal organs, and rib/sternum fractures Upper extremity injury 28 13.1% 18 21.7% 43 19.5% 1248 10.2% 31 13.1% 41 16.7% 209 14% (excluding nerves) Lower extremity injury 76 35.5% 7 8.4% 51 23.2% 32 6.8% 25 10.6% 25 9.0% 216 14% Superficial injury, 10 4.7% 3 3.6% 11 5.0% 22 4.7% 13 5.5% 15 6.4% 74 5% including contusions and open wounds Foreign body 0 0.0% 0 0.0% 2 .9% 1 .2% 1 0.4% 1 .4% 5 .3% Other and unspecified 24 11.2% 14 16.9% 31 14.1% 117 24.9% 48 20.3% 18 6.4% 252 17% injury Missing N/A 7 3.3% 5 6.0% 5 2.3% 19 4.0% 7 3.0% 23 6.0% 66 4.4% Total 214 100.0% 83 100.0% 220 100.0% 470 100.0% 236 100.0% 274 100.0% 1,497 100.0%
For RTC:For RTC: • Pedestrians – 36% had lower extremity injuries and 29% head and facial injuries. • In cars 33% had head and facial injuries while 15% had injuries to vertebral column, spine, • On bicycles 39% had head injuries and 22% lower extremity injuries. internal organs and ribs • • OnPedestrians motorbikes 30%– 36% had lower extremity injuries and 29% head and facial injuries. had head and facial injuries while 23% and 21% had lower and upper • Other motor vehicles, 32% had head and facial injuries – most travelled in a pick-up van or • extremityOn bicycles 39% had head injuries and 22% lower extremity injuries. injuries. jeeps • On motorbikes 30% had head and facial injuries while 23% and 21% had lower and upper extremity injuries. • In cars 33% had head and facial injuries while 15% had injuries to vertebral column, spine, internal organs and ribs • Other motor vehicles, 32% had head and facial injuries – most travelled in a pick36 | COST-up van or jeeps OF CARE PROJECT APPENDICES
APPENDAPPENDIX TABLE 15: INFORMATION AND FORMULAE USED IN ECONOMIC COSTING CALCULATIONSVIOLENCE IX TABLE 15: INFORMATION AND FORMULAE USED IN ECONOMIC COSTING CALCULATIONS- VIOLENCE-RELATED INJURIES (VRI) RELATED INJURIES (VRI)
Parameter Estimate Source/Formula Fatal incidence 1004 (11) Jamaica Constabulary Force = (reported deaths from self-directed and interpersonal violence) Hospitalised injury (12) Cases from 7 Type A & B government hospitals 4237* = (injured inpatient admissions) A&E injury (13) Data not shown Cases from A&E depts. at 7 Type A & B government hospitals 20,398 = (injured ED visits) Direct medical cost for Fatal Injury 24,635 = Fatal incidence x {(Avg. cost per medic-legal investigation = 300,000) x (percentage of fatal injuries that obtain medico-legal investigation 100%) + (Transport cost/ED visit) x (Percentage of fatal injuries that involve transport to ED) + (Percentage of fatal injuries that involve hospital admission) x (Avg. cost per bed day of hospital treatment) x (Avg. length of stay in hospital)} Hospitalised Injury = Hospitalised injury incidence x {(Transport cost/ED visit) x (Percentage of fatal injuries that involve transport to ED) + (Avg. cost per bed day of hospital treatment) x (Avg. length of stay in hospital) + (Avg. ED treatment cost) x (Percentage of Hospitalised injuries that include an ED visit)} A&E Injury = A&E injury incidence x {(Avg. treatment cost per ED visit) + (Transport cost/ED visit) Percentage of l violent injuries that involve hospital admission, 17 % fatal 4 % Avg. length of stay in hospital, 5 days fatal 7 days Hospitalised Avg. cost per bed day of hospital treatment, JA$42,560-12,713 Avg. treatment cost per ED visit, JA$2,500 Av ED transport cost, JA$1,450 Indirect productivity cost (see notes Fatal Injury = {I1 x 365 x P5 x D x (P1-P2)} below) Hospitalised= {I2 x P3 x P5} A&E= {I3 x P4 x P5} Avg. age at death from violent injury 36 years Police and hospital records (P1) Avg. age at retirement/at which a 65 years Formal National Retirement Age, 2006 person ceases to work (P2) The avg. number of days a victim of a 42 days Patient records Hospitalised injury is unable to resume her/his normal activities (at the hospital and recovering from home) (P3) The avg. number of days a victim of a 14 days Patient records A&E injury is unable to resume her/his normal activities (recovering from home and during out-patient visits) (P4) Avg. income loss per capital per day, JA$1,120 Derived from national wage rate derived from average income loss
which incorporate paid and unpaid work as described above (P5) *Avg = average ED = Emergency Department
• 17% of cases in the VRI study population were admitted. Data was extrapolated to the VRI cases seen at Jamaican Hospitals 2014. • 17% of cases in the VRI study population were admitted. Data was extrapolated to the VRI cases seen at Jamaican Hospitals 2014.
COST OF CARE PROJECT | 37
15 APPENDICES
APPENDIX TABLE 16:APPENDIX TABLE 16: INFORMATION AND FORMULAE USED IN ECONOMIC COSTING INFORMATION AND FORMULAE USED IN ECONOMIC COSTING CALCULAT IONS ROAD TRAFFIC CRASHES (RTC) CALCULATIONS ROAD TRAFFIC CRASHES (RTC)
Parameter Estimate Source/Formula Fatal incidence (11) 306 Jamaica Constabulary Force = (reported deaths from road traffic crashes) Hospitalised injury (12) 2,376* Cases from 21 Type A & B& C government hospitals = (injured inpatient admissions) A&E injury (13) 10,332 Data not Cases from A&E depts. at 21 Type A & B& C government hospitals shown = (injured ED visits) Direct medical cost for Fatal Injury 12,708 = Fatal incidence x {(Avg. cost per medic-legal investigation = 300,000) x (percentage of fatal injuries that obtain medico-legal investigation 50%) + (Transport cost/ED visit) x (Percentage of fatal injuries that involve transport to ED) + (Percentage of fatal injuries that involve hospital admission) x (Avg. cost per bed day of hospital treatment) x (Avg. length of stay in hospital)} Hospitalised Injury = Hospitalised injury incidence x {(Transport cost/ED visit) x (Percentage of fatal injuries that involve transport to ED) + (Avg. cost per bed day of hospital treatment) x (Avg. length of stay in hospital) + (Avg. ED treatment cost) x (Percentage of Hospitalised injuries that include an ED visit)} A&E Injury = A&E injury incidence x {(Avg. treatment cost per ED visit) + (Transport cost/ED visit) Percentage of road traffic injuries that involve hospital admission, _18.7% Fatal 30% Avg. length of stay in hospital, 9 days fatal 9 days Hospitalised Avg. cost per bed day of hospital treatment, JA$41,166 Avg. treatment cost per ED visit, JA$2,500 Av ED transport cost, J$1,450 Indirect productivity cost (see notes Fatal Injury = {I1 x 365 x P5 x D x (P1-P2)} below) Hospitalised= {I2 x P3 x P5} A&E= {I3 x P4 x P5} Avg. age at death from road traffic injury 39 years Police and hospital records (P1) 65 years Formal National Retirement Age, 2006 Avg. age at retirement /at which a person ceases to work (P2) The avg. number of days a victim of a 42 days Patient records Hospitalised injury is unable to resume her/his normal activities (at the hospital and recovering from home) (P3) The avg. number of days a victim of a 14 days Patient records A&E injury is unable to resume her/his normal activities (recovering from home and during out-patient visits) (P4) Avg. income loss per capital per day, JA$1,120 Derived from national wage rate derived from average income loss which incorporate paid and unpaid work as *Avg = average ED = Emergency Department described above (P5)
*18.7% of RTC cases in the study population were admitted. Data was extrapolated to RTC injured population seen at Jamaican Hospitals in 2014. *18.7% of RTC cases in the study population were admitted. Data was extrapolated to RTC injured population seen at Jamaican Hospitals in 2014. 38 | COST OF CARE PROJECT 16 COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
APPENDIX 17
Patient ID: |___|___|___|___|___|___|___|
WHO/MOH/UHWI HOSPITAL ESTIMATION OF THE COST OF INJURIES STUDY FOR PATIENTS TREATED FOR VIOLENCE-RELATED INJURIES
Name of Hospital ______
Name of Abstractor ______
Date of Abstraction (dd/mm/year) ______/ ______/ ______
Time taken for data abstraction (minutes) ______
Form Satisfactorily Completed [ ] (verified by) ______
BASIC DATA
INJURY SEVERITY
A&E |___|
Hospitalisation |___| Death |___|
1. Registration Number: |___|___|___|___|___|___|___|___||___|
2. Medical Record Number: |___|___|___|___|___|___|___|___||___|
3. Date Seen at A&E |___|___|___|___|___|___|___|___|(dd/mm/year)
4. Date of Admission |___|___|___|___|___|___|___|___|(dd/mm/year)
5. Was patient referred from another hospital/institution 1. Yes |___| 0. No |___| Name of Hospital/Institution ______
6. Reason for referral ______
COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
7. Length of stay (days) at previous institution ______8. Date of Discharge: |___|___|___|___|___|___|___|___|(dd/mm/year)
9. Length of stay (days): ______
10. Admission group: 1. Grievous Bodily Harm (GBH) |___| 2. Trauma (T) |___| 3. Emergency (EM) |___| 4. Elective (El) |___|
PATIENT PROFILE
11. Gender: Male |___| Female |___|
12. Age (years) at last birthday: ______
13. Date of Birth: |___|___|___|___|___|___|___|___|(dd/mm/year)
14. Address ______
15. Education level: (Patient interview) 1. Primary/All Age |___| 2. Secondary |___| 3. Tertiary |___| 4. Unknown |___|
16. Literacy (check whether patient completes confidentiality form to evaluate this category) 1. Literate |___| 2. Illiterate |___| 3. Unknown |___|
17. Marital status: (Admission Face-Sheet) 1. Common-law |___| 2. Married |___| 3. Widowed/Divorced |___| 4. Single |___| 5. Other |___| (Specify) ______
18. Number of Dependents: ______
19. Occupation: (Admission Face Sheet)______
COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
INJURY SPECIFICATION
20. Intentionality: (JISS) 1. Interpersonal |___| 2. Self-Directed |___| 3. Collective |___| 4. Unintentional |___| 5. Undetermined |___|
21. Injury type: (JISS) 1. Gunshot wound |___| 2. Stab Wound |___| 3. Blunt Trauma |___| 4. Laceration |___| 5. Other |___| (Specify) ______
22. Context/Circumstance of the incident: (JISS) 1. Fight/argument |___| 2. Robbery/burglary |___| 3. Drug-related |___| 4. Gang-related |___| 5. Mob/riot |___| 6. Sexual assault |___| 7. Child abuse |___| 8. Police shooting |___| 9. Other |___| (Specify)______
23. Who inflicted the injury/Perpetrator(JISS)? 1. Girlfriend/boyfriend |___| 2. Husband/wife |___| 3. Parent |___| 4. Other relative |___| 5. Friend |___| 6. Acquaintance |___| 7. Stranger |___| 8. Official/legal |___| 9. Self-inflicted |___| 10. Unknown |___| 11. Other |___|
(Specify) ______
24. Place where the incident occurred: (JISS) 1. Home |___| 2. School/Institution |___| 3. Street/Public |___| 4. Industrial/Commercial |___| COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
5. Sport/Recreational/Cultural |___| 6. Farm/Country |___| 7. Other (including ‘At someone else’s home’) |___|
(Specify)______
25. Mechanism/Method: (JISS) 1. Blunt object |___| 2. Push/shove |___| 3. Stabbing |___| 4. Gunshots |___| 5. Sexual assault |___| 6. Choking |___| 7. Chemical burn |___| 8. Thermal burn |___| 9. Other |___|
(Specify) ______
26. Injury group: (Note: Superficial injuries to the chest and abdomen should be coded under No.6 while Chest/Abdominal injuries affecting internal organs should be coded as No. 3) 1. Head and facial injury (excluding eye injury) |___| 2. Eye injury |___| 3. Injuries to vertebral column, spine, internal organs, and rib/sternum fractures |___| 4. Upper extremity injury (excluding nerves) |___| 5. Lower extremity injury |___| 6. Superficial injury, including contusions and open wounds |___| 7. Burns |___| 8. Poisoning |___| 9. Foreign body |___| 10. Other and unspecified injury |___| (Specify)______
CARE PROVIDED
(CP1) Registration Number: |___|___|___|___|___|___|___|___||___|
(CP2) Medical Record Number: |___|___|___|___|___|___|___|___||___|
(CP3a) Did the patient require ambulance/taxi service? 1. Yes |___| 0. No |___| (CP3b) Type of Transport: (Interview with Patient) 1. Ambulance |___| 2. Taxi |___| 3. Police |___| 4. Other |___|
(Specify) ______Admission notes: COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
(CP4a) Name of Ward: ______
(CP4b) Special Care Unit: ______
(CP4c) Admission details: ______
______
______
______
______
______
______
______
______
______
______
What operations, if any, were/are to be carried out on the patient for treating this injury?
Operation(s) Time Taken for Operation (Hours)
(CP5.1) ______(CP5.1a) ______(CP5.2) ______(CP5.2a) ______(CP5.3) ______(CP5.3a) ______(CP5.4) ______(CP5.4a) ______(CP5.5) ______(CP5.5a) ______(CP5.6) ______(CP5.6a) ______(CP5.7) ______(CP5.7a) ______
(CP6) Direct transfer from Casualty to Theatre? 1. Yes |___| 0. No |___|
(CP7) Case in theatre? 1. Grievous Bodily Harm (GBH) |___| 2. Trauma (T) |___| 3. Emergency (Em) |___| 4. Elective (El) |___|
(CP8) What drugs will the patient be taking for treating this injury during and after his/her stay in the hospital? COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
Type of drug Strength Frequency Duration 1. (CP8.1)Adrenaline |__| ______2. (CP8.2)Alloferine |__| ______3. (CP8.3)Amikacin |__| ______4. (CP8.4)Amoxil |__| ______5. (CP8.5)Atropine |__| ______6. (CP8.6)Augmentin |__| ______7. (CP8.7)Bactroban |__| ______8. (CP8.8)Cataflam |__| ______9. (CP8.9)Ceftrioxime |__| ______10. (CP8.10)Chloramphenicol |__| ______11. (CP8.11)Cleocin |__| ______12. (CP8.12)Cloxacillin |__| ______13. (CP8.13)Crys Pen |__| ______14. (CP8.14)Cyanocobalamin inj. |__| ______15. (CP8.15)Dexamethasone |__| ______16. (CP8.16)Digoxin |__| ______17. (CP8.17)Dopamine |__| ______18. (CP8.18)Eloquine |__| ______19. (CP8.19)Ferrous Sulphate |__| ______20. (CP8.20)Flagyl |__| ______21. (CP8.21)Flamazine |__| ______22. (CP8.22)Fortum |__| ______23. (CP8.23)Gentamycin |__| ______24. (CP8.24)Gravol |__| ______25. (CP8.25)Ketamine |__| ______26. (CP8.26)Melazalol |__| ______27. (CP8.27)Metronidazole |__| ______28. (CP8.28)Mevillin |__| ______29. (CP8.29)Meropenem Inj. |__| ______30. (CP8.30)Morphine |__| ______31. (CP8.31)Neostigmine |__| ______32. (CP8.32)Ospexin |__| ______33. (CP8.33)Panadol |__| ______34. (CP8.34)Pethidine |__| ______35. (CP8.35)Ranitidine |__| ______36. (CP8.36)Rocephin |__| ______37. (CP8.37)Tet tox |__| ______38. (CP8.38)Voltaren |__| ______39. (CP8.39)Zantac |__| ______40. (CP8.40)Other |__| ______
(CP8.40.1)______
(CP8.40.2)______
(CP8.40.3)______
(CP8.40.4)______
(CP8.40.5)______
COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
(CP8.40.6)______
(CP8.40.7)______
(CP9) What physicians/other staff (e.g. physiotherapist) were consulted during the stay?
Physician/Other Staff Number of consultations (CP9.1)______(CP9.1a)______(CP9.2)______(CP9.2a)______(CP9.3)______(CP9.3a)______(CP9.4)______(CP9.4a)______(CP9.5)______(CP9.5a)______(CP9.6)______(CP9.6a)______
(CP7.7a)Total number of consultations: ______(CP10) Blood: a. (CP10a) Number of units cross-matched ______b. (CP10b) Number of units administered ______
(CP11.1) IV: 1. Yes |___| 0. No |___|
Type No. Branula (Y/N) No. Days
(CP11a.1) ______(CP11a.2) ______(CP11a.3) ______(CP11a.4) ______(CP11a.5) ______
(CP11.2) Nutritional Support: Yes |___| No |___|
(CP11.2a) Enteral |___| (CP11.2b) Parenteral |___| Type No. No. Days (CP11b.1) ______(CP11b.2) ______(CP11b.3) ______(CP11b.4) ______(CP11b.5) ______
(CP12) What exams were carried out on the patient? (lab report at back of docket, doctor’s notes, nurse’s notes) Number 1. (CP12.1) Cardiac enzymes |___| ______2. (CP12.2) Complete Blood Count (CBC) |___| ______3. (CP12.3) Contrast X-ray |___| ______4. (CP12.4) CT-Scan |___| ______COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
5. (CP12.5) Echocardiogram |___| ______6. (CP12.6) Liver Function test (LFT) |___| ______7. (CP12.7) MRI |___| ______8. (CP12.8) PT/PTT |___| ______9. (CP12.9) Random Blood Sugar (RBS) |___| ______10. (CP12.10) Ultrasound |___| ______11. (CP12.11) Urea and electrolytes (U&E) |___| ______12. (CP12.12) X-Ray(s) |___| (CP12.12.1) Type ______(CP12.12.2)Type ______(CP12.12.3)Type ______13. (CP12.13) Other |___| (CP12.13.1)______(CP12.13.1)______(CP12.13.1)______(CP12.13.1)______
(CP12.14b) Total number of exams ______
(CP13) Did the patient require dressings? (see Nurse’s notes, Nurse’s theatre records) 1. Yes |___| 0. No |___| Type Quantity (CP13.1) ______(CP13.2) ______(CP13.3) ______(CP13.4) ______(CP13.5) ______
(CP14) Did the patient require disposables? 1. Yes |___| 0. No |___|
Type Quantity (CP14.1) ______(CP14.2) ______(CP14.3) ______(CP14.4) ______(CP14.5) ______
(CP15) Estimated number of days the patient will be convalescing (i.e. not be able to work) after leaving the facility: ______
(CP16) Estimated number of outpatient visits the patient will undertake after leaving the facility: ______(See appointments on Discharge Summary. In addition follow-up with patients for two-months post-discharge to ascertain this information)
(CP17) Will the injury result in any long-term disability? 1. Yes |___| 0. No |___| If yes, what type? 1. (CP17.1) Amputation |___| 2. (CP17.2)Spinal Cord Injury |___| 3. (CP17.3)Traumatic brain injury |___| COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
4. (CP17.4)Colostomy |___| 5. (CP17.5)Other |___| (CP17.5a) (specify) ______(CP18) Other observations: ______
COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
APPENDIX 18
Patient ID: |___|___|___|___|___|___|___|
WHO/MOH/UHWI HOSPITAL ESTIMATION OF THE COST OF INJURIES STUDY FOR PATIENTS TREATED FOR ROAD TRAFFIC CRASH-RELATED INJURIES
Name of Hospital ______
Name of Abstractor ______
Date of Abstraction (dd/mm/year) ______/ ______/ ______
Time taken for data abstraction (minutes) ______
Form Satisfactorily Completed [] (verified by) ______
BASIC DATA
INJURY SEVERITY
A&E |___|
Hospitalisation |___|
Death |___|
1. Registration Number: |___|___|___|___|___|___|___|___||___|
2. Medical Record Number: |___|___|___|___|___|___|___|___||___|
3. Date Seen at A&E |___|___|___|___|___|___|___|___|(dd/mm/year)
4. Date of Admission |___|___|___|___|___|___|___|___|(dd/mm/year)
5. Geographic location of Injury - Address (Road, Community, Parish)______
6. Was patient referred from another hospital/institution 1. Yes |___| 0. No |___|
Name of Hospital/Institution ______7. Reason for referral ______
8. Length of stay (days) at previous institution ______COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
9. Date of Discharge: |___|___|___|___|___|___|___|___|(dd/mm/year)
10. Length of stay (days): ______
11. Admission group: 1. Grievous Bodily Harm (GBH) |___| 2. Trauma (T) |___| 3. Emergency (EM) |___| 4. Elective (El) |___|
PATIENT PROFILE
12. Gender: Male |___| Female |___|
13. Age (years) at last birthday: ______
14. Date of Birth: |___|___|___|___|___|___|___|___|(dd/mm/year)
15. Address ______
16. Education level: (Patient interview) 1. Primary/All Age |___| 2. Secondary |___| 3. Tertiary |___| 4. Unknown |___|
17. Literacy (Check whether patient completes confidentiality form to evaluate this category) 1. Literate |___| 2. Illiterate |___| 3. Unknown |___|
18. Marital status: (Admission Face-Sheet) 1. Common-law |___| 2. Married |___| 3. Widowed/Divorced |___| 4. Single |___| 5. Other |___| (Specify) ______
19. Number of Dependents: ______
20. Occupation: (Admission Face Sheet)______
COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
INJURY SPECIFICATION
21. Intentionality: (JISS) 1. Interpersonal |___| 2. Self-Directed |___| 3. Collective |___| 4. Unintentional |___| 5. Undetermined |___|
22. Injury type: (JISS) 1. Gunshot wound |___| 2. Stab Wound |___| 3. Blunt Trauma |___| 4. Laceration |___| 5. Other |___| (Specify) ______
23. Patient’s motor vehicle accident mode: (JISS) 1. Pedestrian |___| 2. Bicycle |___| 3. Motorbike |___| 4. Car |___| 5. Pick-up/Van/Jeep |___| 6. Truck/Heavy vehicle |___| 7. Bus |___| 8. Train |___| 9. Other motor vehicle |___| 10. Boat/ship |___| 11. Aircraft |___| 12. Taxi |___| 13. Other |___| (Specify) ______
24. Motor vehicle user/position: (JISS) 1. Driver/operator |___| 2. Passenger (vehicle/truck cab) |___| 3. Passenger (on vehicle back) |___| 4. Bystander |___| 5. Unspecified |___|
25. Motor vehicle counterpart: (JISS) 1. Pedestrian |___| 2. Bicycle |___| 3. Motorbike |___| 4. Car |___| 5. Pick-up/Van/Jeep |___| 6. Truck/Heavy vehicle |___| 7. Bus |___| 8. Train |___| 9. Other motor vehicle |___| COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
10. Boat/ship |___| 11. Aircraft |___| 12. Taxi |___| 13. Other |___|
(Specify) ______
26. Use of safety gears (seatbelt/helmet): (JISS) 1. Yes |___| 2. No |___|
27. Injury group: (Note: Superficial injuries to the chest and abdomen should be coded under No.6 while Chest/Abdominal injuries affecting internal organs should be coded as No. 3) 1. Head and facial injury (excluding eye injury) |___| 2. Eye injury |___| 3. Injuries to vertebral column, spine, internal organs, and rib/sternum fractures |___| 4. Upper extremity injury (excluding nerves) |___| 5. Lower extremity injury |___| 6. Superficial injury, including contusions and open wounds |___| 7. Burns |___| 8. Poisoning |___| 9. Foreign body |___| 10. Other and unspecified injury |___| (Specify) ______
CARE PROVIDED
(CP1) Registration Number: |___|___|___|___|___|___|___|___||___|
(CP2) Medical Record Number: |___|___|___|___|___|___|___|___||___|
(CP3a) Did the patient require ambulance/taxi service? 1. Yes |___| 0. No |___|
(CP3b) Type of Transport: (Interview with Patient) 1. Ambulance |___| 2. Taxi |___| 3. Police |___| 4. Other |___| (Specify) ______
Admission notes:
(CP4a) Name of Ward: ______
(CP4b) Special Care Unit: ______
(CP4c) Admission details: ______1. IV fluids (YES)|___| (NO)|___| COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
2. N/G Tube (YES)|___| (NO)|___|
3. Urethral Catheter (YES)|___| (NO)|___|
4. Dressings (YES)|___| (NO)|___|
5. Antibiotics (YES)|___| (NO)|___|
6. Investigations: Blood (YES)|___| (NO)|___|
Imaging (YES)|___| (NO)|___|
Other (YES)|___| (NO)|___|
7. Surgery (YES)|___| (NO)|___|
(CP5) What operations, if any, were/are to be carried out on the patient for treating this injury?
Operation(s) Time Taken for Operation (Hours)
(CP5.1) ______(CP5.1a) ______
(CP5.2) ______(CP5.2a) ______
(CP5.3) ______(CP5.3a) ______
(CP5.4) ______(CP5.4a) ______
(CP5.5) ______(CP5.5a) ______
(CP5.6) ______(CP5.6a) ______
(CP5.7) ______(CP5.7a) ______
(CP6) Direct transfer from Casualty to Theatre? 1. Yes |___| 0. No |___|
(CP7) Case in theatre?
1. Grievous Bodily Harm (GBH) |___| 2. Trauma (T) |___| 3. Emergency (Em) |___| 4. Elective (El) |___|
(CP8) What drugs will the patient be taking for treating this injury during and after his/her stay in the hospital?
Type of drug Strength Frequency Duration
1. (CP8.1)Adrenaline |__| ______2. (CP8.2)Alloferine |__| ______3. (CP8.3)Amikacin |__| ______4. (CP8.4)Amoxil |__| ______5. (CP8.5)Atropine |__| ______6. (CP8.6)Augmentin |__| ______7. (CP8.7)Bactroban |__| ______COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
8. (CP8.8)Cataflam |__| ______9. (CP8.9)Ceftrioxime |__| ______10. (CP8.10)Chloramphenicol |__| ______11. (CP8.11)Cleocin |__| ______12. (CP8.12)Cloxacillin |__| ______13. (CP8.13)Crys Pen |__| ______14. (CP8.14)Cyanocobalamin inj. |__| ______15. (CP8.15)Dexamethasone |__| ______16. (CP8.16)Digoxin |__| ______17. (CP8.17)Dopamine |__| ______18. (CP8.18)Eloquine |__| ______19. (CP8.19)Ferrous Sulphate |__| ______20. (CP8.20)Flagyl |__| ______21. (CP8.21)Flamazine |__| ______22. (CP8.22)Fortum |__| ______23. (CP8.23)Gentamycin |__| ______24. (CP8.24)Gravol |__| ______25. (CP8.25)Ketamine |__| ______26. (CP8.26)Melazalol |__| ______27. (CP8.27)Metronidazole |__| ______28. (CP8.28)Mevillin |__| ______29. (CP8.29)Meropenem Inj. |__| ______30. (CP8.30)Morphine |__| ______31. (CP8.31)Neostigmine |__| ______32. (CP8.32)Ospexin |__| ______33. (CP8.33)Panadol |__| ______34. (CP8.34)Pethidine |__| ______35. (CP8.35)Ranitidine |__| ______36. (CP8.36)Rocephin |__| ______37. (CP8.37)Tet tox |__| ______38. (CP8.38)Voltaren |__| ______39. (CP8.39)Zantac |__| ______40. (CP8.40)Other |__| ______(CP8.40.1)______(CP8.40.2)______(CP8.40.3)______(CP8.40.4)______(CP8.40.5)______(CP8.40.6)______(CP8.40.7)______
(CP9) What physicians/other staff (e.g. physiotherapist) were consulted during the stay?
Consultation (Medical, Paramedical) Number of consultations
(CP9.1)______(CP9.1a)______(CP9.2)______(CP9.2a)______(CP9.3)______(CP9.3a)______(CP9.4)______(CP9.4a)______(CP9.5)______(CP9.5a)______(CP9.6)______(CP9.6a)______
(CP9.7a)Total number of consultations: ______COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
(CP10) Blood: a. (CP10a) Number of units cross-matched ______b. (CP10b) Number of units administered ______
(CP11.1) IV: 1. Yes |___| 0. No |___|
Type No. Branula (Y/N) No. Days (CP11a.1) ______(CP11a.2) ______(CP11a.3) ______(CP11a.4) ______(CP11a.5) ______
(CP11.2) Nutritional Support: Yes |___| No |___| (CP11.2a) Enteral |___| (CP11.2b) Parenteral |___|
Type No. No. Days (CP11b.1) ______(CP11b.2) ______(CP11b.3) ______(CP11b.4) ______(CP11b.5) ______
(CP12) What exams were carried out on the patient? (lab report at back of docket, doctor’s notes, nurse’snotes)
Number 1. (CP12.1) Cardiac enzymes |___| ______2. (CP12.2) Complete Blood Count (CBC) |___| ______3. (CP12.3) Contrast X-ray |___| ______4. (CP12.4) CT-Scan |___| ______5. (CP12.5) Echocardiogram |___| ______6. (CP12.6) Liver Function test (LFT) |___| ______7. (CP12.7) MRI |___| ______8. (CP12.8) PT/PTT |___| ______9. (CP12.9) Random Blood Sugar (RBS) |___| ______10. (CP12.10) Ultrasound |___| ______11. (CP12.11) Urea and electrolytes (U&E) |___| ______12. (CP12.12) X-Ray(s) |___| (CP12.12.1)Type ______(CP12.12.2)Type ______(CP12.12.3)Type ______
13. (CP12.13) Other |___|
(CP12.13.1)______(CP12.13.1)______(CP12.13.1)______(CP12.13.1)______
(CP12.14b) Total number of exams ______
COST OF CARE PROJECT Data Mapping for UHWI and Six Other Hospitals
(CP13) Did the patient require dressings? (see Nurse’s notes, Nurse’s theatre records) 1. Yes |___| 0. No |___| Type Quantity (CP13.1) ______(CP13.2) ______(CP13.3) ______(CP13.4) ______(CP13.5) ______
(CP14) Did the patient require disposables? 1. Yes |___| 0. No |___|
Type Quantity (CP14.1) ______(CP14.2) ______(CP14.3) ______(CP14.4) ______(CP14.5) ______
(CP15) Estimated number of days the patient will be convalescing (i.e. not be able to work) after leaving the facility: ______
(CP16) Estimated number of outpatient visits the patient will undertake after leaving the facility: ______(See appointments on Discharge Summary. In addition follow-up with patients for two-months post-discharge to ascertain this information)
(CP17) Will the injury result in any long-term disability? 1. Yes |___| 0. No |___| If yes, what type? 1. (CP17.1) Amputation |___| 2. (CP17.2)Spinal Cord Injury |___| 3. (CP17.3)Traumatic brain injury |___| 4. (CP17.4)Colostomy |___| 5. (CP17.5)Other |___| (CP17.5a) (specify) ______
(CP18) Other observations: