District Hospital Performance Assessment Western Cape Province 2008-2010
Rhulane Madale, Sizulu Moyo, Thokozani Mbatha, Catherine Ogunmefun, Rene English
District Hospital Performance Assessment
Western Cape Province 2008-2010
Rhulane Madale, Sizulu Moyo, Thokozani Mbatha, Catherine Ogunmefun, Rene English
Published by Health Systems Trust
34 Essex Terrace Tel: +27 (0)31 266 9090 Westville Fax: +27 (0)31 266 9199 3630 Email: [email protected] South Africa http://www.hst.org.za
Published: November 2011
Suggested citation:
Madale R, Moyo S, Mbatha T, Ogunmefun C, English R. District Hospital Performance Assessment: Western Cape Province 2008-1010. Health Systems Trust; Durban, 2012
The information contained in this publication may be freely distributed and reproduced, as long as the source is acknowledged, and it is used for non-commercial purposes.
Acknowledgements
We would like to thank the National Department of Health for providing the data for the report. We are also grateful to Candy Day for assistance with the data. We thank Dr Peter Barron for input and guidance in writing the final report.
Contents
INTRODUCTION ...... 1 BACKGROUND ...... 3 A WEST COAST DISTRICT - DC-1 ...... 5 1. Citrusdal Hospital ...... 5 i: Description ...... 5 ii: Input and process indicators ...... 5 iii: Outcome indicators ...... 7 iv: Impact indicators ...... 7 v: Conclusions ...... 8 2. Clanwilliam Hospital ...... 9 i: Description ...... 9 ii: Input and process indicators ...... 9 iii: Outcome indicators ...... 10 iv: Impact indicators ...... 11 v: Conclusions ...... 12 3. LAPA Munnik Hospital ...... 13 i: Description ...... 13 ii: Input and process indicators ...... 13 iii: Outcome indicators ...... 14 iv: Impact indicators ...... 15 v: Conclusions ...... 16 4. Radie Kotze Hospital ...... 17 i: Description ...... 17 ii: Input and process indicators ...... 17 iii: Outcome indicators ...... 18 iv: Impact indicators ...... 19 v: Conclusions ...... 20 5. Swartland Hospital ...... 21 i: Description ...... 21 ii: Input and process indicators ...... 21 iii: Outcome indicators ...... 22 iv: Impact indicators ...... 23 v: Conclusions ...... 24 6. Vredenburg Hospital...... 25 i: Description ...... 25 ii: Input and process indicators ...... 25 iii: Outcome indicators ...... 26 iv: Impact indicators ...... 27 v: Conclusions ...... 28 7. Vredendal Hospital ...... 29 i: Description ...... 29 ii: Input and process indicators ...... 29 iii: Outcome indicators ...... 30 iv: Impact indicators ...... 31
District Hospital Performance Assessment: Western Cape Province 2008-2010 ii v: Conclusions ...... 32 B CAPE WINELANDS DISTRICT - DC-2 ...... 33 1. Ceres Hospital ...... 33 i: Description ...... 33 ii: Input and process indicators ...... 33 iii: Outcome indicators ...... 35 iv: Impact indicators ...... 35 v: Conclusions ...... 36 2. Montagu Hospital ...... 37 i: Description ...... 37 ii: Input and process indicators ...... 37 iii: Outcome indicators ...... 38 iv: Impact indicators ...... 39 v: Conclusions ...... 40 3. Robertson Hospital ...... 41 i: Description ...... 41 ii: Input and process indicators ...... 41 iii: Outcome indicators ...... 42 iv: Impact indicators ...... 43 v: Conclusions ...... 44 4. Stellenbosch Hospital ...... 45 i: Description ...... 45 ii: Input and process indicators ...... 45 iii: Outcome indicators ...... 46 iv: Impact indicators ...... 47 v: Conclusions ...... 48 C OVERBERG DISTRICT - DC-3 ...... 49 1. Otto Du Plessis Hospital ...... 49 i: Description ...... 49 ii: Input and process indicators ...... 49 iii: Outcome indicators ...... 51 iv: Impact indicators ...... 51 v: Conclusions ...... 52 2. Hermanus Hospital ...... 53 i: Description ...... 53 ii: Input and process indicators ...... 53 iii: Outcome indicators ...... 54 iv: Impact indicators ...... 55 v: Conclusions ...... 56 3. Caledon Hospital ...... 57 i: Description ...... 57 ii: Input and process indicators ...... 57 iii: Outcome indicators ...... 58 iv: Impact indicators ...... 59 v: Conclusions ...... 60 4. Swellendam Hospital ...... 61 i: Description ...... 61
District Hospital Performance Assessment: Western Cape Province 2008-2010 iii ii: Input and process indicators ...... 61 iii: Outcome indicators ...... 62 iv: Impact indicators ...... 63 v: Conclusions ...... 64 D EDEN DISTRICT - DC-4 ...... 65 1. Knysna Hospital ...... 65 i: Description ...... 65 ii: Input and process indicators ...... 65 iii: Outcome indicators ...... 67 iv: Impact indicators ...... 67 v: Conclusions ...... 68 2. Ladismith Hospital ...... 69 i: Description ...... 69 ii: Input and process indicators ...... 69 iii: Outcome indicators ...... 70 iv: Impact indicators ...... 71 v: Conclusions ...... 72 3. Mossel Bay Hospital ...... 73 i: Description ...... 73 ii: Input and process indicators ...... 73 iii: Outcome indicators ...... 74 iv: Impact indicators ...... 75 v: Conclusions ...... 76 4. Oudtshoorn Hospital...... 77 i: Description ...... 77 ii: Input and process indicators ...... 77 iii: Outcome indicators ...... 78 iv: Impact indicators ...... 79 v: Conclusions ...... 80 5. Riversdale Hospital ...... 81 i: Description ...... 81 ii: Input and process indicators ...... 81 iii: Outcome indicators ...... 82 iv: Impact indicators ...... 83 v: Conclusions ...... 84 6. Uniondale Hospital ...... 85 i: Description ...... 85 ii: Input and process indicators ...... 85 iii: Outcome indicators ...... 86 iv: Impact indicators ...... 87 v: Conclusions ...... 88 E CENTRAL KAROO DISTRICT - DC-5 ...... 89 1. Beaufort West Hospital ...... 89 i: Description ...... 89 ii: Input and process indicators ...... 89 iii: Outcome indicators ...... 91 iv: Impact indicators ...... 91
District Hospital Performance Assessment: Western Cape Province 2008-2010 iv v: Conclusions ...... 92 2. Laingsburg Hospital...... 93 i: Description ...... 93 ii: Input and process indicators ...... 93 iii: Outcome indicators ...... 94 iv: Impact indicators ...... 95 v: Conclusions ...... 96 3. Murraysburg Hospital ...... 97 i: Description ...... 97 ii: Input and process indicators ...... 97 iii: Outcome indicators ...... 98 iv: Impact indicators ...... 99 v: Conclusions ...... 100 4. Prince Albert Hospital ...... 101 i: Description ...... 101 ii: Input and process indicators ...... 101 iii: Outcome indicators ...... 102 iv: Impact indicators ...... 103 v: Conclusions ...... 104 F CITY OF CAPE TOWN METROPOLITAN ...... 105 1. Eerste River Hospital ...... 105 i: Description ...... 105 ii: Input and process indicators ...... 105 iii: Outcome indicators ...... 107 iv: Impact indicators ...... 107 v: Conclusions ...... 108 2. Helderberg Hospital...... 109 i: Description ...... 109 ii: Input and process indicators ...... 109 iii: Outcome indicators ...... 110 iv: Impact indicators ...... 111 v: Conclusions ...... 112 3. False Bay Hospital ...... 113 i: Description ...... 113 ii: Input and process indicators ...... 113 iii: Outcome indicators ...... 114 iv: Impact indicators ...... 115 v: Conclusions ...... 116 4. GF Jooste Hospital ...... 117 i: Description ...... 117 ii: Input and process indicators ...... 117 iii: Outcome indicators ...... 118 iv: Impact indicators ...... 119 v: Conclusions ...... 119 5. Wesfleur Hospital ...... 120 i: Description ...... 120 ii: Input and process indicators ...... 120
District Hospital Performance Assessment: Western Cape Province 2008-2010 v iii: Outcome indicators ...... 121 iv: Impact indicators ...... 122 v: Conclusions ...... 123 6. Karl Bremer Hospital ...... 124 i: Description ...... 124 ii: Input and process indicators ...... 124 iii: Outcome indicators ...... 125 iv: Impact indicators ...... 126 v: Conclusions ...... 127 7. Khayelitsha Hospital ...... 128 i: Description ...... 128 ii: Input and process indicators ...... 128 iii: Outcome indicators ...... 129 iv: Impact indicators ...... 130 v: Conclusions ...... 131
District Hospital Performance Assessment: Western Cape Province 2008-2010 vi Introduction
Health system strengthening is a key objective in both the Negotiated Service Delivery Agreement and the Re-engineered Primary Health Care approach. Effective utilisation of routine data is crucial for improving the effectiveness of service delivery as well as for improvement of health information systems. There remains considerable scope for improved utilisation of routine data for quality improvement.
This report aims to provide health managers at all levels within the health services, with a useful screening tool for assessing District Hospital management performance. It provides managers with a snap shot of how a facility is performing in key areas of hospital management. It focuses on individual facilities and assesses seven key hospital performance indicators listed in Table 1. Data on these seven indicators is retrieved primarily from the DHIS. Individual facility data is compared to the national and provincial indicator average values. The hospitals are assessed over a period of three financial years: 2008/2009; 2009/2010 and 2010/2011. These are depicted as 2008, 2009 and 2010 respectively in the graphs and text in the report. The data presented should be viewed with an awareness of problems common to routine data, namely incorrect and missing data, as well as specific contextual factors.
The report should be considered in conjunction with a number of other published documents including; The Guidebook for District Hospital Managers- Health Systems Trust-2006, A District Hospital Service Package for South Africa – The South African National Department of Health – 2002 and the Negotiated Service Delivery Agreement.
District Hospital Performance Assessment: Western Cape Province 2008-2010 1 Table 1: Selected Hospital performance indicators: definitions and description
Indicator Definition Description Numerator Denominator Unit of reporting Average length How long on The average length Inpatients days Separations: - Day of stay average each of time inpatients + 1/2 Day Discharges + (ALOS) patient spends spend in hospital patients Deaths + in hospital Transfers out + Day patients
Cost per patient The average The average cost Total Total patient Rand day equivalent cost per patient per patient per day expenditure on day equivalent (CpPDE) day seen in a seen in a hospital health per hospital hospital
Usable bed The proportion The number of Total patient Total usable Percent utilisation rate of beds in patient days during days - (Inpatient bed days (%) (BUR) hospital that the reporting period, days + 1/2 Day were utilised or expressed as a patients) x 100 occupied percentage of the sum of the daily number of useable beds.
Caesarean The proportion The number of Caesarean All deliveries in Percent section rate deliveries in caesarean section section the facility (%) (CS rate) which a deliveries, deliveries caesarean expressed as a section is percentage of all performed deliveries
Facility crude The proportion The number of all Total inpatient Total inpatient Percent death rate of all inpatient inpatient deaths deaths separations- (%) (FCDR): separations that expressed as a Includes - are deaths. percentage of all inpatient inpatient transfers out, separations day patients, inpatient deaths and inpatient discharges.
Perinatal The number of The sum of still Still births and Total births in Perinatal mortality rate perinatal deaths births + those inpatient early facility deaths/ (PNMR) per 1000 births. babies dying within neonatal deaths 1000 births The perinatal 7 days of life per in facility period starts at 1000 births the beginning of foetal viability (28 weeks gestation or 1000g) and ends at the end of the 7th day after delivery
Still birth rate The number of The number of The number of The total Still births/ (SBR): still births per babies who are still births number of 1000 births 1000 births “born dead” per births 1000 births
District Hospital Performance Assessment: Western Cape Province 2008-2010 2 Background
Western Province is divided into five district municipalities, and one metropolitan district demarcated as shown in Figure 1. In 2010, the province had 33 District Hospitals serving a population of approximately 5 million people. Table 2 gives a list of District Hospitals in the province by district and sub-district location. The number of useable beds per facility is also listed in Table 2.
Figure 1: Map of the Western Cape Province depicting District boundaries
District Hospital Performance Assessment: Western Cape Province 2008-2010 3 Table 2: District hospitals in Western Cape Province: Location by District and local municipality
Number of District Sub-district (Code) Hospital Name beds
Citrusdal 34 Cederberg Clanwilliam 48 LAPA Munnik 12 West Coast DC 1 Bergrivier Radie Kotze 31
Swartland Swartland 85 Saldanha Bay Vredenburg 71 Matzikama Vredendal 76 Witzenberg Ceres 76
Cape Winelands DC 2 Montagu 49 Breede Valley Robertson 46 Stellenbosch Stellenbosch 90 Cape Agulhas Otto Du Plessis 30
Overberg DC 3 Overstrand Hermanus 47 Theewaterskloof Caledon 65 Swellendam Swellendam 51
Knysna Knysna 98 Kannaland Ladismith (Alan Blyth) 30 Mossel Bay Mossel Bay 90 Eden DC 4 Oudtshoorn Oudtshoorn 123 Langeberg Riversdale 50 DMA includes(Uniondale, Uniondale 14 Haarlem, Avontuur) Beaufort West Beaufort West 57 Laingsburg Laingsburg 20 Central Karoo DC 5 Murraysburg Murraysburg 14 Prince Albert Prince Albert 29 Eerste River 101 Cape Town Eastern Helderberg Hospital 120 Cape Town Southern False Bay 65 City of Cape Town Metro Klipfontein GF Jooste 283 Cape Town Northern Wesfleur 31 Tygerberg Karl Bremer 282 Khayelitsha Khayelitsha 90
District Hospital Performance Assessment: Western Cape Province 2008-2010 4 A West Coast District – DC-1
West Coast district had a population of approximately 341 876 people in 2010. It has 28 clinics, 19 mobile services, 7 district hospitals and 1 specialised hospital. 1. Citrusdal Hospital i: Description
Citrusdal district hospital has 34 beds and lies in the Cederberg sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased between 2008 and 2009 and then increased back to the 2008 level in 2010. It was lower than national and provincial averages throughout this period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 5 2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was higher than the national and provincial averages throughout the reporting period. The reasons for this should be ascertained.
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was relatively constant over the reporting period. It was lower than the provincial averages throughout this period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 6
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased and was in line with the national average in 2010. The reasons for the increase should be ascertained.
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR was very low and relatively constant between 2008 and 2010. It was significantly lower than the national and provincial averages throughout this period. The FCDR should be investigated for good practices.
District Hospital Performance Assessment: Western Cape Province 2008-2010 7 2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased significantly and was lower than national and provincial averages throughout the reporting period. The reasons for the decrease and the low values ascertained
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR decreased between 2008 and 2009 and then increased in 2010. It was significantly lower than the national and provincial averages throughout this period. These data should be confirmed, and the reasons for the low values ascertained.
v: Conclusions
The reasons for the increase in the CpPDE and the CS rate should be investigated. The reasons for the very low FCDR, SBR and the decrease in the PNMR should be investigated and possible best practices obtained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 8 2. Clanwilliam Hospital i: Description
Clanwilliam district hospital has 48 beds and lies in the Cederberg sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased slightly between 2008 and 2009 and then increased sharply in 2010. It was higher than the provincial average in 2010. The reasons for the increase should be ascertained.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE fluctuated slightly and was significantly lower than the national and provincial averages throughout the reporting period. The data should be reviewed to exclude data error and to ascertain the reasons for these very low values.
District Hospital Performance Assessment: Western Cape Province 2008-2010 9 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was relatively constant in 2008 and 2009 and increased sharply by more than 20% in 2010, to a level well above the national and provincial averages. The reasons for the increase should be ascertained.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant in 2008 and 2009 and increased sharply in 2010. It was lower than the national and provincial averages throughout the reporting period. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 10 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR was constant in 2008 and 2009 and increased slightly in 2010. It was lower than the national and provincial averages throughout the reporting period. The FCDR should be investigated for good practices.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR increased sharply (by more than 100%) between 2008 and 2010. It was closer to the provincial average in 2010. The reasons for the sharp increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 11
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also increased sharply (a 4-fold increase) between 2008 and 2010. It was lower than the national and provincial averages throughout the reporting period. The reasons for the increase should be ascertained.
v: Conclusions
The CpPDE data should be reviewed to exclude data error and to ascertain the reasons for the very low values observed. The FCDR should be investigated to determine why it is so low and any best practices that are identified should be shared. The reasons for the increase in the CS rate, the PNMR and the SBR should also be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 12 3. LAPA Munnik Hospital i: Description
LAPA Munnik district hospital has 12 beds and lies in the Bergrivier sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased between 2008 and 2009 and then increased in 2010. It was lower than the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was higher than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 13 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR increased over the reporting period. It was higher than the national and provincial averages in 2009 and 2010
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS was very low. It was relatively constant and significantly lower than the national and provincial averages throughout the reporting period. The data should be reviewed to exclude data error and to ascertain the reasons for these very low values.
District Hospital Performance Assessment: Western Cape Province 2008-2010 14 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased between 2008 and 2010 and was lower than the national and provincial averages in 2009 and 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased between 2008 and 2009 and then increased sharply in 2010. The reasons for the fluctuations and the increase in the rate in 2010 should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 15 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated sharply, decreasing drastically between 2008 and 2009 followed by a sharp increase in 2010. The reasons for the fluctuations and the high rates should be ascertained.
v: Conclusions
The reasons for the increasing CpPDE should be ascertained. The CS rate data should be reviewed to exclude data error and to ascertain the reasons for the very low values. The reasons for the fluctuating and high PNMR and SBR levels should also be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 16 4. Radie Kotze Hospital i: Description
Radie Kotze hospital has 24 beds and lies in the Bergrivier sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant at about 2 days and was lower the provincial and national averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE was very low and increased to R1198 in 2010. It was significantly lower than the national and provincial averages throughout this period. The data should be reviewed to exclude data error and to ascertain the reasons for the low values and the sharp increase in 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 17 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was relatively constant and lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased to 2.3% in 2009 and then decreased to a very low level of 0.3% in 2010. It was significantly lower than the national and provincial averages throughout the reporting period. The data should be reviewed to exclude data error and to ascertain the reasons for these very low values.
District Hospital Performance Assessment: Western Cape Province 2008-2010 18 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR increased slightly and was lower than the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated sharply, decreasing between 2008 and 2009 and then increasing to a high level in 2010. It was significantly higher than the national and provincial averages in 2010. The reasons for the fluctuations and the high rates should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 19 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased sharply and was significantly higher than the national and provincial averages in 2009 and 2010. The reasons for this increase should be ascertained.
v: Conclusions
The CpPDE and CS rate data should be reviewed to exclude data error and to ascertain the reasons for the very low values observed. The reasons for the fluctuating and high PNMR values, the low BUR and the sharp increase in the SBR should be ascertained. The combination of low CS rates and high PNMR and SBR values in 2010 are of concern.
District Hospital Performance Assessment: Western Cape Province 2008-2010 20 5. Swartland Hospital i: Description
Swartland district hospital has 85 beds and lies in the Swartland sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS fluctuated slightly decreasing to 2.7 days in 2009 and then increasing to 3.2 days in 2010. It was in line with the provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was in line with the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 21 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was constant between 2008 and 2009 and increased in 2010. It was lower than the provincial averages throughout the reporting period.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate decreased and was lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 22 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased between 2008 and 2010. It was in line with the provincial averages in 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of Life/1000 births
The PNMR and SBR values for the period 2008-2010 are identical, suggesting data error. These data should be reviewed to ascertain the correct values for each indicator for this hospital.
District Hospital Performance Assessment: Western Cape Province 2008-2010 23 3. Still birth rate (SBR): number of babies born dead/1000 births
The PNMR and SBR values for the period 2008 to 2010 are identical, suggesting data error. These data should be reviewed to ascertain the correct values for each indicator for this hospital
v: Conclusions
The PNMR and SBR values for the period 2008-2010 are identical, suggesting data error. These data should be reviewed to ascertain the correct values for each indicator for this hospital.
District Hospital Performance Assessment: Western Cape Province 2008-2010 24 6. Vredenburg Hospital i: Description
Vredenburg district hospital has 72 beds and lies in the Saldanha Bay sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased slightly and was lower than the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased sharply and was significantly higher than the national and provincial averages in 2010. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 25 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased by 30% over the reporting period. It was in line with the national average in 2010. The reasons for the decline should be ascertained.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS increased slightly between 2008 and 2009 and was unchanged in 2010. It was lower than the national and provincial averages throughout this period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 26 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR decreased slightly and was lower than the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of Life/1000 births
The PNMR decreased significantly (by 44%) between 2008 and 2010. It was well below the national and provincial averages in 2009 and 2010. The reasons for the decrease should be ascertained and possible best practices identified.
District Hospital Performance Assessment: Western Cape Province 2008-2010 27 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also decreased sharply between 2008 and 2010, and was significantly lower than the national and provincial averages in 2009 and 2010. The reasons for the decrease should be ascertained and possible best practices identified.
v: Conclusions
The reasons for the increase in the CpPDE and the decrease in the BUR, the PNMR and the SBR should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 28 7. Vredendal Hospital i: Description
Vredendal district hospital has 76 beds and lies in the Matzikama sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased slightly between 2008 and 2009 and then increased in 2010. It was lower than the national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 29 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR increased between 2008 and 2009 and then decreased slightly in 2010. It was closer to the provincial average in 2010.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant between 2008 and 2010. It was lower than the national and provincial averages throughout this period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 30 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased slightly in 2009 before increasing back to the 2008 level in 2010. It was significantly lower than the national averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated sharply, increasing between 2008 and 2009 and then decreasing to a low level in 2010. It was lower than the national and provincial averages in 2010. The reasons for the fluctuations should be ascertained. The 2010 rate is identical to that of the SBR: the data should be reviewed to ascertain the correct rate for each indicator in 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 31 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated sharply, increasing between 2008 and 2009 and the decreasing to a low level in 2010. It was lower than the national and provincial averages in 2010. The reasons for the fluctuations should be ascertained. The 2010 rate is identical to that of the PNMR: the data should be reviewed to ascertain the correct rate for each indicator in 2010.
v: Conclusions
The reasons for the low CpPDE, and the fluctuating and low PNMR and SBR low values (in 2010) should be ascertained. The PNMR and SBR values for 2010 should be confirmed as they are identical.
District Hospital Performance Assessment: Western Cape Province 2008-2010 32 B Cape Winelands District – DC-2
Cape Winelands district had a population of approximately 742 766 people in 2010. It has 44 clinics, 5 CHCs, 27 mobile services, 4 district hospitals, 2 regional hospitals and 1 specialised hospital. 1. Ceres Hospital i: Description
Ceres district hospital has 76 beds and lies in the Witzenberg sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased between 2008 and 2009 and was relatively unchanged in 2010. It was in line with the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 33
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased from R956 in 2008 to R1338 in 2010. It was lower than the national and provincial averages throughout this period.
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased from a very high level of 103% (in 2008) to 82.7% in 2010. It was higher than the national and provincial averages throughout this period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 34
iii: Outcome indicators
1. Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased slightly between 2008 and 2010. It was in line with the national averages throughout this period.
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased slightly in 2009 before increasing in 2010. It was higher than the provincial average in 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 35 2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR increased slightly Perinatal Mortality Rate 50.0 between 2008 and 2009 and 40.0 then decreased in 2010. It was 30.0 in line with the national average 20.0 in 2010. 10.0
0.0
2008 2009 2010 Deaths/1000 births Deaths/1000 SA average 31.0 32.0 32.8 WC average 25.9 25.7 24.4 Ceres 28.1 37.0 31.8
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased slightly in 2009 and then decreased in 2010. It was in line with the national and provincial averages in 2009 and 2010.
v: Conclusions
The stability of the indicators and their relationship to the provincial and national averages suggest a well-functioning hospital. The reasons for this should be investigated and good practices identified and shared.
District Hospital Performance Assessment: Western Cape Province 2008-2010 36 2. Montagu Hospital i: Description
Montagu district hospital has 49 beds and lies in the Langeberg sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased slightly between 2008 and 2010 and then increased in 2010. It was in line with the provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased over the reporting period but was lower than the national and provincial averages throughout.
District Hospital Performance Assessment: Western Cape Province 2008-2010 37 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased between 2008 and 2009 and then increased in 2010. It was lower than the provincial average throughout the reporting period.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased slightly between 2008 and 2009 and then decreased sharply in 2010. It was in line with the national average in 2010. The reasons for the sharp decrease should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 38 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased between 2008 and 2009 and then increased in 2010. It was lower than the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of Life/1000 births
The PNMR increased by nearly Perinatal Mortality Rate 50.0 100% between 2008 and 2010. 40.0 It was higher than the national 30.0 and provincial averages in 2010. 20.0 The reasons for this increase 10.0 should be ascertained. 0.0 2008 2009 2010 Deaths/1000 births Deaths/1000 SA average 31.0 32.0 32.8 WC average 25.9 25.7 24.4 Montagu 20.5 27.2 40.5
District Hospital Performance Assessment: Western Cape Province 2008-2010 39 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also sharply increased sharply over the reporting period (a 3-fold increase). It was higher than the national and provincial averages in 2010. The reasons for this increase should be ascertained.
v: Conclusions
The reasons for the sharp decrease in the CS rate, and the increase in the PNMR and the SBR should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 40 3. Robertson Hospital i: Description
Robertson district hospital has 46 beds and lies in the Langeberg sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased between 2008 and 2009 and then increased in 2010. It was in line with the provincial averages throughout this period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was higher than the national and provincial averages throughout the reporting period. The reasons for this should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 41 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased between 2008 and 2009 and was largely unchanged in 2010. It was in line with the provincial averages in 2009 and 2010.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased over the reporting period, reaching a rate of 18.8% in 2010 when it was in line with the national average.
District Hospital Performance Assessment: Western Cape Province 2008-2010 42 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased between 2008 and 2009 and then increased back to the 2008 level in 2010. It was lower than the national and provincial averages throughout this period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR more than doubled between 2008 and 2010. It was closer to the provincial average in 2010. The reasons for this increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 43 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also increased significantly (doubled) between 2008 and 2010. It was lower than the national and provincial averages throughout this period.
v: Conclusions
The reasons for the increasing CpPDE, CS rate, PNMR and SBR should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 44 4. Stellenbosch Hospital i: Description
Stellenbosch district hospital has 90 beds and lies in the Stellenbosch sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased between 2008 and 2009 and then increased in 2010. It was in line with the provincial averages throughout this period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was higher than the national and provicial averages in 2010. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 45 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR increased to 78.5% in 2009 and decreased to 73.8% in 2010. It was in line with the provincial averages in 2009 and 2010.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant over the reporting period. It was in line with the provincial average in 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 46 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased between 2008 and 2009 and then increased slightly in 2010. It was just above the provincial averages throughout this period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of Life/1000 births
The PNMR increased sharply between 2008 and 2009 and was relatively unchanged in 2010. It was lower than the national and provincial averages throughout this period. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 47 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also increased sharply between 2008 and 2009 and was relatively unchanged in 2010. It was lower than the national and provincial averages throughout this period. The reasons for the increase should be ascertained.
v: Conclusions
The reasons for the increase in the CpPDE, the PNMR and the SBR should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 48 C Overberg District – DC-3
Overberg district had a population of approximately 248 996 people in 2010. It has 23 clinics, 14 mobile services, and 4 district hospitals. There are no regional, provincial tertiary or specialised hospitals in the district.
1. Otto Du Plessis Hospital i: Description
Otto Du Plessis district hospital has 30 beds and lies in the Cape Agulhas sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS increased to 2.5 days in 2010. It was lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 49 2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the fluctuations and the high rates should be ascertained.
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was lower than the national and provincial averages 2010. The reasons for the fluctuations and the low rate in 2010 should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 50
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate decreased sharply between 2008 and 2009 and was relatively constant in 2010. It was in line with the national averages in 2009 and 2010.
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR decreased between 2008 and 2009 and was largely unchanged in 2010. It was lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 51 2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of Life/1000 births
The PNMR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was lower than the national and provincial averages throughout this period.
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was lower than the national and provincial averages throughout this period.
v: Conclusions
The reasons for the fluctuating CpPDE, BUR, PNMR and SBR values should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 52 2. Hermanus Hospital i: Description
Hermanus district hospital has 47 beds and lies in the Overstrand sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased slightly between 2008 and 2009 and then increased in 2010. It was in line with the provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 53 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased to 86.2% in 2010. It was higher than the national and provincial averages throughout this period.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant and higher than the national and provincial averages throughout the reporting. The reasons for the high rates should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 54 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR was relatively constant and lower than the national and provincial averages throughout the reporting period. The FCDR should be investigated for good practices.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased and was lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 55 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR decreased sharply between 2008 and 2009 and then increased slightly in 2010. It was lower than the national and provincial averages throughout the reporting period.
v: Conclusions
The reasons for the high CS rates and the decline in the PNMR and SBR should be ascertained. The FCDR should be investigated to determine why it is so low and any best practices identified should be shared.
District Hospital Performance Assessment: Western Cape Province 2008-2010 56 3. Caledon Hospital i: Description
Caledon district hospital has 65 beds and lies in the Theewaterskloof sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased between 2008 and 2009 and the increased slightly in 2010. It was in line with the provincial average in 2010.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was in line with the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 57 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased in 2009, and then increased again in 2010. It was in line with the national average in 2010.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant and lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 58 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR decreased slightly between 2008 and 2009 and was unchanged in 2010. It was lower than the national and provincial averages throughout the reporting period. The FCDR should be investigated for good practices.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated slightly increasing between 2008 and 2009 and then decreasing in 2010. It was lower than the national and provincial averages in 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 59 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated and decreased between 2008 and 2009 and then increased in 2010. It was in line with the provincial average in 2010.
v: Conclusions
The indicators suggest a well-functioning hospital. Any best practices that are identified should be shared.
District Hospital Performance Assessment: Western Cape Province 2008-2010 60 4. Swellendam Hospital i: Description
Swellendam district hospital 51 beds and lies in the Swellendam sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased between 2008 and 2009 and then increased slightly in 2010. It was lower than the national and provincial averages throughout this period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was well above the national and provincial averages throughout the reporting period. The reasons for this should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 61 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was relatively constant and lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate decreased slightly and was lower than the national and provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 62 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR decreased between 2008 and 2009 and was unchanged in 2010. It was lower than the national and provincial averages throughout the reporting period. The FCDR should be investigated for good practices.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR increased by 60% between 2008 and 2009 and was largely unchanged in 2010. It was lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 63 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased sharply (doubled) over the reporting period. It was in line with the provincial average in 2010.
v: Conclusions
The reasons for the high and increasing CpPDE, the low BUR, and the increase in the PNMR and SBR should be ascertained. The FCDR should be investigated to determine why it is so low and any best practices that are identified should be shared.
District Hospital Performance Assessment: Western Cape Province 2008-2010 64 D Eden District – DC-4
Eden district had an estimated population of 548 482 people in 2010. It has 42 clinics, 5 CHCs, 23 mobiles services, 64 district hospitals, 1 regional hospital and 1 specialised hospital. 1. Knysna Hospital i: Description
Knysna district hospital has 98 beds and lies in the Knysna sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS fluctuated decreasing between 2008 and 2009 and then increasing in 2010. It was in line with the provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 65 2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was lower than the national and provincial averages throughout the reporting period.
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased over the reporting period. It was lower than the provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 66
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased slightly and was lower than the provincial averages throughout the reporting period.
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR was relatively constant and lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 67 2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The perinatal mortality rate Perinatal Mortality Rate 50.0 increased between 2008 and 40.0 2009 and was constant in 2010. 30.0 It was lower than the national 20.0 and provincial averages 10.0 throughout this period. 0.0 2008 2009 2010 Deaths/1000 births Deaths/1000 SA average 31.0 32.0 32.8 WC average 25.9 25.7 24.4 Knysna 13.4 18.1 18.0
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased and was lower than the national and provincial averages throughout the reporting period.
v: Conclusions
The indicators generally indicate a well-functioning hospital. The reasons for the increase in the PNMR and the SBR should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 68 2. Ladismith Hospital i: Description
Ladismith district hospital has 30 beds and lies in the Kannaland sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was in line with the provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
CpPDE increased over the reporting period and was higher than the national and provincial averages in 2010. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 69 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR increased between 2008 and 2009 and the decreased in 2010. It was lower than the provincial in 2010.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant in 2008 and 2009 and increased in 2010. It was significantly lower than the national and provincial rates throughout the reporting period. The data should be reviewed to confirm these rates and the reasons for this ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 70 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR increased between 2008 and 2010 and was in line with the provincial average in 2010
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased over the Perinatal Mortality Rate 50.0 reporting period. It was in line 40.0 with the provincial average in 30.0 2010. 20.0
10.0 0.0
2008 2009 2010 Deaths/1000 births Deaths/1000 SA average 31.0 32.0 32.8 WC average 25.9 25.7 24.4 Ladismith 29.1 26.9 22.0
District Hospital Performance Assessment: Western Cape Province 2008-2010 71 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased by 79% between 2008 and 2010. It was closer to provincial average in 2010.
v: Conclusions
The reasons for the increase in the CpPDE and the SBR should be ascertained. The CS rate data should be reviewed to confirm and ascertain the reasons for the low rates observed.
District Hospital Performance Assessment: Western Cape Province 2008-2010 72 3. Mossel Bay Hospital i: Description
Mossel Bay district hospital has 90 beds and lies in the Mossel Bay sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased slightly between 2008 and 2009 and then increased back to the 2008 level in 2010. It was lower than the national and provincial averages throughout this period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 73 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was relatively constant and in line with the provincial averages throughout the reporting period.
iii: Outcome indicators
1. Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased between 2008 and 2010. It was in line with the provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 74 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased between 2008 and 2009 and increased in 2010. It was lower than the national and provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated slightly increasing between 2008 and 2009 and then decreased in 2010. It was lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 75 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated sharply, increasing between 2008 and 2009 and then decreased in 2010. It was lower than the national and provincial averages throughout the reporting period.
v: Conclusions
The reasons for the fluctuations in the PNMR and SBR should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 76 4. Oudtshoorn Hospital i: Description
Oudtshoorn district hospital has 123 beds and lies in the Oudtshoorn sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased slightly between 2008 and 2009 and then increased back to the 2008 level in 2010. It was in line with the provincial averages throughout this period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was lower than the national and provincial averages in 2009 and 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 77 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was relatively constant over the reporting period. It was in line with the provincial average throughout this period.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased between 2008 and 2009 and was largely unchanged in 2010. It was lower than the provincial averages throughout this period. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 78 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR decreased between 2008 and 2009 and then increased in 2010. It was in line with the provincial averages throughout this period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of Life/1000 births
The PNMR decreased sharply over the reporting period. It was in line with the provincial average in 2010. The reasons for the decrease should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 79 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also decreased sharply over the reporting period, and was in line with the provincial average in 2010. The reasons for the decrease should be ascertained.
v: Conclusions
The reasons for the increase in the CS rate and the sharp decrease in the PNMR and the SBR should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 80 5. Riversdale Hospital i: Description
Riversdale district hospital has 50 beds and lies in the Langeberg sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS fluctuated, decreasing between 2008 and 2009 and then increased in 2010. It was higher than the provincial average in 2010.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was higher than the national and provincial averages throughout the reporting period. The reasons for this should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 81 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased between 2008 and 2010. It was lower than the provincial averages throughout the reporting period.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
CS rate increased over the reporting period. It was lower than the national and provincial averages throughout this period. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 82 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was in line with the provincial averages in 2009 and 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR increased over the reporting period. It was significantly lower than the national and provincial averages throughout this period. The data should be reviewed to exclude data error and to ascertain the reasons for these very low values.
District Hospital Performance Assessment: Western Cape Province 2008-2010 83 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was significantly lower than the national and provincial averages throughout this period. The data should be reviewed to exclude data error and to ascertain the reasons for these very low values.
v: Conclusions
The reasons for the increase in the CpPDE and the CS rate should be ascertained. The PNMR and SBR data should be reviewed to exclude data error and to ascertain the reasons for the low rates observed.
District Hospital Performance Assessment: Western Cape Province 2008-2010 84 6. Uniondale Hospital i: Description
Uniondale district hospital has 14 beds and lies in the Garden route/Klein Karoo DMA sub- district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased and was lower than the national and averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased sharply and was significantly higher than the national and provincial averages in 2010. The reasons for this sharp increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 85 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR fluctuated, increasing between 2008 and 2009 and then decreased in 2010. It was lower than the national and provincial averages throughout this period. The reasons for the low BUR should be ascertained.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.
District Hospital Performance Assessment: Western Cape Province 2008-2010 86
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased slightly between 2008 and 2009 and then increased in 2010. It was in line with the provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
PNMR increased sharply (2.4 times) between 2008 and 2010. It was significantly higher than the national and provincial averages in 2010. The data should be reviewed to exclude data error and to ascertain the reasons for the sharp increase.
District Hospital Performance Assessment: Western Cape Province 2008-2010 87 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR fluctuated, decreasing between 2008 and 2009 before increasing in 2010. It was significantly higher than provincial and national and provincial averages in 2010. The reasons for the fluctuations and the high rates should be ascertained.
v: Conclusions
The reasons for this sharp increase in the CpPDE, and the low BUR should be ascertained. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re- classified as a CHC. The PNMR data should be reviewed to exclude data error and to ascertain the reasons for the sharp increase. The reasons for the fluctuating and the high SBR values should be ascertained. There are questions to be asked about the economics of running such a small hospital (14 beds) which is very expensive per patient day and which does not do basic operations like C Sections. The data suggest that this should be a CHC.
District Hospital Performance Assessment: Western Cape Province 2008-2010 88 E Central Karoo District – DC-5
Central Karoo district had an estimated population of 65 361 people in 2010. It has 8 clinics, 1 CHC, 8 mobiles services and 4 district hospitals. There are no regional, provincial tertiary or central hospitals in the district. 1. Beaufort West Hospital i: Description
Beaufort West hospital has 57 beds and lies in the Beaufort West sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased over the reporting period. It was equivalent to the provincial average in 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 89 2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased between 2008 and 2010. It was lower than the national and provincial averages in 2009 and 2010.
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR fluctuated, increasing to a very high level in 2009 (107.2%) and then decreasing in 2010. It was higher than the national and provincial averages throughout this period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 90
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant at about 30% throughout the reporting period. It was higher than the national and provincial averages. The reasons for this should be ascertained.
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased slightly and was constant in 2009 and 2010. It was in line with the provincial average in 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 91 2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased slightly in 2009 and then increased in 2010 to a level in line with the national average. The reasons for the increase should be ascertained.
3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR increased sharply between 2008 and 2010 to a level in line with the national average. The reasons for the increase should be ascertained.
v: Conclusions
The reasons for the high CS rate and the increase in the PNMR and the SBR should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 92 2. Laingsburg Hospital i: Description
Laingsburg district hospital has 20 beds and lies in the Laingsburg sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased between 2008 and 2009 and then increased back to the 2008 level in 2010. It was higher than the provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was lower than the national and provincial averages throughout the reporting period.
District Hospital Performance Assessment: Western Cape Province 2008-2010 93 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased steadily over the reporting period and was in line with the national averages but below the provincial averages throughout the reporting period.
iii: Outcome indicators
1. Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.
District Hospital Performance Assessment: Western Cape Province 2008-2010 94
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR was relatively constant in 2008 and 2009 and increased in 2010. It was close to the provincial in 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated dramatically, decreasing sharply between 2008 and 2009 followed by a sharp increase in 2010. The reasons for the fluctuations and the high rates should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 95 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR decreased sharply between 2008 and 2009 and then increased slightly in 2010. It was lower than the national and provincial averages in 2009 and 2010.The reasons for the sharp decline should be ascertained.
v: Conclusions
The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re- classified as a CHC. The reasons for the fluctuating and high PNMR, and the sharp decrease in the SBR should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 96 3. Murraysburg Hospital i: Description
Murraysburg district hospital has 14 beds and lies in the Murraysburg sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was relatively constant and lower than the national and provincial averages throughout the reporting period. The reasons for the low ALOS should be ascertained.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE was constant in 2008 and 2009 and increased sharply (by nearly 100%) in 2010 to a level higher than the national and provincial averages. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 97 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR fluctuated increasing between 2008 and 2009 and then decreasing to a very low rate of 35% in 2010. It was lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.
District Hospital Performance Assessment: Western Cape Province 2008-2010 98
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased slightly between 2008 and 2009 and then increased in 2010. It was in line with the provincial average in 2010.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of Life/1000 births
The PNMR fluctuated, increasing sharply between 2008 and 2009 followed by a sharp decrease in 2010 to a level lower than the national and provincial averages. The reasons for the fluctuations and the low rate in 2010 should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 99 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated, increasing sharply between 2008 and 2009 followed by a sharp decrease in 2010 to a level lower than the national and provincial averages. The reasons for the fluctuations and the low rate in 2010 should be ascertained.
v: Conclusions
The reasons for the increase in the CpPDE and the low ALOS and BUR should be ascertained. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The fluctuations and the sharp decline in the PNMR and SBR in 2010 should be investigated. There are questions to be asked about the economics of running such a small hospital (14 beds) which is very expensive per patient day and which does not do basic operations like C Sections. The data suggest that this should be a CHC.
District Hospital Performance Assessment: Western Cape Province 2008-2010 100 4. Prince Albert Hospital i: Description
Prince Albert district hospital has 29 beds and lies in the Prince Albert sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased between 2008 and 2009 and was largely unchanged in 2010. It was lower than the national and provincial averages in 2009 and 2010.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased sharply from a very low level of R693 in 2008 and was in line with the national and provincial averages in 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 101 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased reaching a rate of 51% in 2010, when it was lower than the national and provincial averages. The reasons for the low BUR should be ascertained.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.
District Hospital Performance Assessment: Western Cape Province 2008-2010 102
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR was constant in 2008 and 2009 and increased in 2010, when it was then in line with the provincial average.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR was constant in 2008 and 2009 and increased in 2010, when it was then higher than the national and provincial averages. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 103 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR was constant in 2008 and 2009. Data for 2010 were not available. This should be investigated.
v: Conclusions
The reasons for the sharp increases in the ALOS and the low BUR should be ascertained. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re- classified as a CHC. The reasons for the increase in the PNMR and the absence of SBR data for 2010 should also be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 104 F City of Cape Town – Metropolitan
The City of Cape Town Metropolitan district had an estimated population of 3 507 640 people in 2010. It has 115 clinics, 53 CHCs, 4 mobile services, 7 district 5 regional, 3 central and 7 specialised hospitals. There are no provincial tertiary hospitals in the district. 1. Eerste River Hospital i: Description
Eerste River district hospital has 101 beds and lies in the Cape Town Eastern sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
There were no ALOS data for 2009. The 2010 ALOS was similar to that in 2008. The reasons for the absence of data in 2009 should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 105 2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was higher than the national and provincial averages throughout the reporting period. The reasons for the high CpPDE should be ascertained.
3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR increased and was in line with the provincial average in 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 106
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased between 2008 and 2009 and increased slightly in 2010. It was higher than the provincial averages throughout the reporting period
District Hospital Performance Assessment: Western Cape Province 2008-2010 107 2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
Data on the PNMR were not available for the period 2008-2010. This requires urgent investigation.
3. Still birth rate (SBR): number of babies born dead/1000 births
Data on the SBR rate were not available for the period 2008-2010. This requires urgent investigation.
v: Conclusions
There is need to review data collection and recording at this hospital. The reasons for the absence of the ALOS for 2009, the absence of the CS rate data, the absence of the PNMR and SBR data should be investigated urgently. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The reasons for the high CpPDE should also be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 108 2. Helderberg Hospital i: Description
Helderberg district hospital has 120 beds and lies in the Cape Town Eastern sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased between 2008 and 2009 and then increased in 2010. It was lower than the national and provincial averages throughout this period
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased slightly between 2008 and 2010. It was lower than the national and provincial averages in 2010
District Hospital Performance Assessment: Western Cape Province 2008-2010 109 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR was very high in 2008 and 2009 and decreased to 91% in 2010. These very high BUR values should be confirmed and the reasons ascertained.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was relatively constant and higher than the national and provincial averages throughout the reporting period. The reasons for this should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 110 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased between 2008 and 2009 and then increased in 2010. It was lower than the national and provincial averages throughout this period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR decreased sharply between 2008 and 2009 and was relatively unchanged in 2010. It was in line with the provincial averages in 2009 and 2010. The reasons for the decrease should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 111 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also decreased sharply between 2008 and 2009 and was relatively unchanged in 2010. It was in line with the provincial average in 2010. The reasons for the decrease should be ascertained.
v: Conclusions
The BUR data should be reviewed to confirm the very high rates observed in 2008 and 2009. The reasons for the high CS rate and the sharp decrease in the PNMR and SBR (in 2009) should be ascertained
District Hospital Performance Assessment: Western Cape Province 2008-2010 112 3. False Bay Hospital i: Description
False Bay district hospital is situated in the Cape Town Southern sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS was constant at 1.9 days in 2008 and 2009 and increased to 2.5 days in 2010. It was lower than national and provincial averages throughout the reporting period.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE was relatively constant between 2008 and 2010. It was lower than the national and provincial averages in 2009 and 2010. The reasons for the stagnation of the CpPDE need investigation.
District Hospital Performance Assessment: Western Cape Province 2008-2010 113 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR increased between 2008 and 2010. It was lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was exceptionally low; less than 1% throughout the reporting period. The data should be reviewed to exclude data error and to ascertain the reasons for these very low and unlikely values.
District Hospital Performance Assessment: Western Cape Province 2008-2010 114 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR was relatively constant at about 2% and was lower than the national and provincial averages throughout the reporting period. The FCDR should be investigated for good practices.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was significantly lower than the national and provincial averages throughout the reporting period. The data should be reviewed and the reasons for these very low values ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 115 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was significantly lower than the national and provincial averages throughout the reporting period. The data should be reviewed and the reasons for these very low values ascertained.
v: Conclusions
The reasons for the low ALOS and the low BUR should be ascertained. The FCDR should be investigated to determine why it is so low and any best practices identified should be shared. The CS rate, PNMR and SBR data should be reviewed to exclude data error and to ascertain the reasons for the very low values observed.
District Hospital Performance Assessment: Western Cape Province 2008-2010 116 4. GF Jooste Hospital i: Description
GF Jooste district hospital has 283 beds and lies in the Klipfontein sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS increased between 2008 and 2009 and then decreased in 2010. It was in line with the national average in 2010.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was higher than the national and provincial averages throughout the reporting period. The reasons for this should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 117 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased between 2008 and 2009 and then increased in 2010. It was higher than the national and provincial averages throughout the reporting period.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation
District Hospital Performance Assessment: Western Cape Province 2008-2010 118
iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR increased between 2008 and 2009 and then decreased in 2010 to a level in line with the national average. The reason for the high FCDR should be ascertained.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
Data on the PNMR were not available for the period 2008-2010. This requires urgent investigation
3. Still birth rate (SBR): number of babies born dead/1000 births
Data on the SBR were not available for the period 2008-2010. This requires urgent investigation
v: Conclusions
There is need to review data collection and recording at this hospital. The reasons for the increasing CpPDE, the absence of CS rate data, and the absence of the PNMR and SBR data should be investigated urgently. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC.
District Hospital Performance Assessment: Western Cape Province 2008-2010 119 5. Wesfleur Hospital i: Description
Wesfleur district hospital has 31 beds and lies in the Cape Town Northern sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased slightly between 2008 and 2009 and then increased back to the 2008 level in 2010. It was lower than the national and provincial averages throughout this period. The reasons for the low ALOS should be ascertained.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased between 2008 and 2009 and then decreased to a very low value in 2010.The data should be reviewed to exclude data error and to ascertain the reasons for the very low value in 2010.
District Hospital Performance Assessment: Western Cape Province 2008-2010 120 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased and was close to the provincial averages in 2009 and 2010.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate was very low; less than 1% throughout the reporting period. These data should be reviewed to exclude data error.
District Hospital Performance Assessment: Western Cape Province 2008-2010 121 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR decreased between 2008 and 2009 and then increased in 2010. It was lower than the provincial and national averages throughout this period. The reasons for the low FCDR should be investigated.
Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of Life/1000 births
PNMR decreased significantly over the reporting period to unlikely values. It was lower than the national the provincial averages throughout the reporting period. The reasons for the decrease and the low rates should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 122 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR decreased significantly over the reporting period to unlikely values. It was lower than the national the provincial averages throughout the reporting period. The reasons for the decrease and the low rates should be ascertained.
v: Conclusions
The reasons for the low ALOS and FCDR should be ascertained. The CpPDE and CS rate data should be reviewed to exclude data error and to ascertain the reasons for the very low values observed. The reasons for the sharp decrease and the very low PNMR and SBR values should also be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 123 6. Karl Bremer Hospital i: Description
Karl Bremer district hospital has 282 beds and lies in the Tygerberg sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased slightly between 2008 and 2009 and then increased in 2010. It was in line with the provincial averages in 2009 and 2010.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
The CpPDE increased and was significantly higher than the provincial and national averages throughout the reporting period. The reasons for the high CpPDE should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 124 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR decreased from a very high rate in 2008. It was higher than the national and provincial averages throughout the reporting period.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS rate increased and was significantly higher than the national and provincial averages throughout the reporting period. The reasons for these high rates should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 125 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.
The FCDR was relatively constant and was generally in line with the provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
Perinatal Mortality Rate The PNMR decreased between 50.0 2008 and 2010, and was lower 40.0 than the national and provincial 30.0 averages throughout this period. 20.0
Deaths/ 1000 births 1000 Deaths/ 10.0 0.0 2008 2009 2010 SA average 31.0 32.1 32.8 Western Cape 25.9 25.7 24.4 Karl Bremer 18.0 17.2 15.1
District Hospital Performance Assessment: Western Cape Province 2008-2010 126 3. Still birth rate (SBR): number of babies born dead/1000 births
The SBR also decreased between 2008 and 2010, and was lower than the national and provincial averages throughout this period.
v: Conclusions
The reasons for the high CpPDE and the high CS rate should be ascertained. The declining PNMR and SBR should be investigated for best practices.
District Hospital Performance Assessment: Western Cape Province 2008-2010 127 7. Khayelitsha Hospital i: Description
Khayelitsha district hospital has 90 beds and lies in the Khayelitsha sub-district. ii: Input and process indicators
1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital
The ALOS decreased slightly between 2008 and 2009 and then increased back to the 2008 level in 2010. It was higher than the national and provincial averages throughout this period. The reasons for this should be ascertained.
2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital
There were no CpPDE for 2008. The CpPDE increased between 2009 and 2010 and was higher than the national and provincial averages during this period. The reasons for the increase should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 128 3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use
The BUR increased between 2008 and 2009 and was largely unchanged in 2010. It was generally in line with the provincial averages in 2009 and 2010.
iii: Outcome indicators
Caesarean section (CS) rate: proportion of deliveries for which a CS is performed
The CS fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was significantly higher than the national and provincial averages throughout this period. The reasons for the high rates should be ascertained.
District Hospital Performance Assessment: Western Cape Province 2008-2010 129 iv: Impact indicators
1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths
The FCDR decreased sharply between 2008 and 2009 and was relatively unchanged in 2010. It was higher than the provincial averages throughout the reporting period.
2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births
The PNMR and SBR values are identical, suggesting data error. These data should be reviewed to ascertain the correct rates for each indicator.
District Hospital Performance Assessment: Western Cape Province 2008-2010 130 3. Still birth rate (SBR): number of babies born dead/1000 births
The PNMR and SBR values are identical suggesting data error. These data should be reviewed to ascertain the correct rates for each indicator.
v: Conclusions
The reasons for the high ALOS, the high CS rates and the sharp increase in the CpPDE and the sharp decline in the FCDR should be ascertained. The PNMR and SBR data are identical suggesting data error. These data should be reviewed to ascertain the correct values for each indicator.
District Hospital Performance Assessment: Western Cape Province 2008-2010 131