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INPATIENT BED UTILIZATION - DO NOT INCLUDE NORMAL NEWBORNS IN BED UTILIZATION DATA |
Line No. | Bed Classification and General Acute Care (GAC) Bed Designation | (1) Licensed Beds as of 12/31 | (2) Licensed Bed Days | (3) Hospital Discharges (including deaths) | (4) Intra-hospital Transfers from Critical Care | (5) Patient (Census) Days |
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| GAC Bed Designations | | | | | | 1. | Medical / Surgical (include GYN) | 153 | 55,961 | 11,524 | | 43,717 | 2. | Perinatal (exclude Newborn / GYN) | 27 | 9,767 | 2,206 | | 5,240 | 3. | Pediatric | 0 | 0 | 0 | | 0 | 4. | Intensive Care | 22 | 8,030 | 452 | 1,527 | 5,781 | 5. | Coronary Care | 10 | 3,650 | 276 | 878 | 3,000 | 6. | Acute Respiratory Care | 0 | 0 | 0 | 0 | 0 | 7. | Burn | 0 | 0 | 0 | 0 | 0 | 8. | Intensive Care Newborn Nursery | 11 | 4,015 | 209 | 306 | 2,681 | 9. | Rehabilitation Center | 0 | 0 | 0 | | 0 | 15. | Subtotal - GAC | 223 | 81,423 | 14,667 | | 60,419 | | 16. | Chemical Dependency Recovery Hospital | 0 | 0 | 0 | | 0 | 17. | Acute Psychiatric | 0 | 0 | 0 | | 0 | 18. | Skilled Nursing | 0 | 0 | 0 | | 0 | 19. | Intermediate Care | 0 | 0 | 0 | | 0 | 20. | Intermediate Care / Developmentally Disabled | 0 | 0 | 0 | | 0 | 25. | Total (Sum of Lines 15 thru 20) | 223 | 81,423 | 14,667 | | 60,419 |
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Chemical Dependency Recovery Services In Licensed GAC and Acute Psychiatric Beds* |
Line No. | Bed Classification | (1) Licensed Beds |
| (3) Hospital Discharges |
| (5) Patient (Census) Days |
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30. | GAC - Chemical Dep Recovery Services | 0 | | 0 | | 0 | 31. | Acute Psych - Chemical Dep Recovery Svcs | 0 | | 0 | | 0 |
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* The licensed services data for these CDRS are to be included in lines 1 through 25 above. |
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Newborn Nursery Information |
Line No. | | (1) Nursery Bassinets | | (3) *Nursery Infants | | (5) Nursery Days |
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35. | Newborn Nursery | 12 | | 1,871 | | 3,571 |
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* Nursery Infants are the "normal" newborn nursery equivalent to discharges from licensed beds. |
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Complete lines 43 through 70 only if your hospital has licensed Acute Psychiatric or PHF beds. Include Chemical Dependency Recovery Services provided in licensed Acute Psychiatric beds. |
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Acute Psychiatric Patients By Unit on December 31 |
Line No. | | (1) Number of Patients |
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43. | Locked | 0 | 44. | Open | 0 | 45. | Acute Psychiatric Total* | 0 |
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Acute Psychiatric Patients By Age Category on December 31 |
Line No. | | (1) Number of Patients |
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46. | 0 - 17 Years | 0 | 47. | 18 - 64 Years | 0 | 49. | 65 Years and Older | 0 | 50. | Acute Psychiatric Total* | 0 |
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Acute Psychiatric Patients By Primary Payer on December 31 |
Line No. | | (1) Number of Patients |
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51. | Medicare - Traditional | 0 | 52. | Medicare - Managed Care | 0 | 53. | Medi-Cal - Traditional | 0 | 54. | Medi-Cal - Managed Care | 0 | 55. | County Indigent Programs | 0 | 56. | Other Third Parties - Traditional | 0 | 57. | Other Third Parties - Managed Care | 0 | 58. | Short-Doyle (includes Short-Doyle Medi-Cal) | 0 | 59. | Other Indigent | 0 | 64. | Other Payers | 0 | 65. | Acute Psychiatric Total* | 0 |
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* Acute Psychiatric Total on lines 45, 50 and 65 must agree. |
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Short Doyle Contract Services |
Line No. | | (1) |
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70. | During the reporting period, did you provide any acute psychiatric care under a Short-Doyle contract? | No |
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Inpatient Hospice Program |
Line No. | | (1) |
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71. | Did your hospital offer an inpatient hospice program during the report period? | No |
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If 'yes' on line 71, what type of bed classification is used for this service? (Check all that apply.) |
Line No. | Bed Classification | (1) |
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72. | General Acute Care | No | 73. | Skilled Nursing (SN) | No | 74. | Intermediate Care (IC) | No |
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EMSA Trauma Center Designation on December 31 (Completed by OSHPD from EMSA data.) |
Line No. | (1) Designation | (2) Pediatric |
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1. | | |
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Licensed Emergency Department Level (Completed by OSHPD) |
Line No. | (1) January 1 | (2) December 31 |
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2. | Basic | Basic |
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Services Available on Premises (Check all that apply.) |
Line No. | Services Available | (1) 24 Hour | (2) On-Call |
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11. | Anesthesiologist | No | Yes | 12. | Laboratory Services | Yes | No | 13. | Operating Room | No | Yes | 14. | Pharmacist | Yes | No | 15. | Physician | Yes | No | 16. | Psychiatric ER | No | No | 17. | Radiology Services | Yes | No |
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Emergency Medical Service Visits By Type |
Line No. | EMS Visit Type* | CPT Codes | (1) Total
| (2) Admitted
|
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21. | Minor | 99281 | 268 | 10 | 22. | Low/Moderate | 99282 | 12,597 | 47 | 23. | Moderate | 99283 | 19,284 | 800 | 24. | Severe without threat | 99284 | 10,231 | 6,236 | 25. | Severe with threat | 99285 | 704 | 548 | 30. | Total EMS Visits | | 43,084 | 7,641 |
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* DO NOT INCLUDE patients who register but leave without being seen, employee physicals and scheduled Clinic-type visits. |
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Emergency Medical Treatment Stations on December 31 |
Line No. | | (1)
|
---|
35. | Enter the number of emergency medical treatment stations. | 21 |
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Treatment Stations - A specific place within the emergency department adequate to treat one patient at a time. Do not count holding or observation beds. |
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Non-Emergency (Clinic) Visits Seen in Emergency Department |
Line No. | | (1)
|
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40. | Enter the number of non-emergency (clinic) visits seen in EMS. | 0 |
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Emergency Registrations, But Patient Leaves Without Being Seen* |
Line No. | | (1)
|
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45. | Enter the number of EMS registrations that did NOT result in treatment. | 1,833 |
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* Include patients who arrived at ED, but did not register and left without being seen (if available) |
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Emergency Department Closure / Ambulance Diversion Hours |
Line No. | | (1) |
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50. | At any time during the year was the ED forced to divert ambulances to another facility? If 'yes', fill out lines 51 through 65 below. | Yes |
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Number of Ambulance Diversion Hours that occurred at Emergency Department |
Line No. | Month | (1) Hours
|
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51. | January | 61 | 52. | February | 48 | 53. | March | 36 | 54. | April | 100 | 55. | May | 18 | 56. | June | 2 | 57. | July | 21 | 58. | August | 9 | 59. | September | 27 | 60. | October | 40 | 61. | November | 34 | 62. | December | 37 | 65. | Total Hours | 433 |
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Surgical Services |
Line No. | Surgical Services | (1) Surgical Operations | (2) Operating Room Minutes |
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1. | Inpatient | 3,250 | 382,239 | 2. | Outpatient | 3,128 | 266,067 |
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Operating Rooms On December 31 |
Line No. | Operating Room Type | (1) Number |
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7. | Inpatient Only | 0 | 8. | Outpatient Only | 0 | 9. | Inpatient and Outpatient | 7 | 10. | Total Operating Rooms | 7 |
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Ambulatory Surgical Program |
Line No. | | (1) |
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15. | Did your hospital have an organized ambulatory surgical program? | No |
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Live Births |
Line No. | | (1) Number |
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20. | Total Live Births (Count multiple births separately)* | 1,982 | 21. | Live Births with Birth Weight Less Than 2500 grams (5 lbs. 8 oz.) | 124 | 22. | Live Births with Birth Weight Less Than 1500 grams (3 lbs. 5 oz). | 29 |
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* TOTAL LIVE BIRTHS on line 20 should approximate the number of Perinatal discharges shown in Section 3, line 2, column 3. Include LDR or LDRP births and C-Section deliveries. |
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Alternate Birthing (Outpatient) Center Information |
Line No. | | (1) |
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31. | Did your hospital have an approved alternate birthing (outpatient) program? | Yes | 32. | Was your alternate setting was approved as LDR | Yes | 33. | Was your alternate setting was approved as LDRP | No |
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Other Live Birth Data |
Line No. | | (1) Number |
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36. | How many of the live births reported on line 20 occurred in your alternative (outpatient) setting? Do not include C-Section deliveries. | 1,454 | 37. | How many of the live births reported on line 20 were C-Section deliveries? | 528 |
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Licensed Cardiology and Cardiovascular Surgery Services (Completed by OSHPD.) |
Line No.
| (1) Licensure |
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41. | Cardiovascular Surgery Services |
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Note: Complete lines 42 to 85 if licensed for Cardiovascular Surgery Services. Complete lines 55 to 85 if licensed for Cardiac Catheterization only. |
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Licensed Cardiovascular Operating Rooms |
Line No. | | (1) |
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42. | Number of operating rooms licensed to perform cardiovascular surgery on December 31. | 2 |
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Cardiovascular Surgical Operations (with and without the HEART/LUNG MACHINE*) |
Line No. | | (1) Cardio-Pulmonary Bypass USED* | (2) Cardio-Pulmonary Bypass NOT USED |
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43. | Pediatric | 0 | 0 | 44. | Adult | 345 | 1 | 45. | Total Cardiovascular Surgical Operations | 345 | 1 |
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* Also refered to as Extracorporeal Bypass or "on-the-pump" (heart/lung machine). |
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Coronary Artery Bypass Graft (CABG) Surgeries* |
Line No. | | (1)
|
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50. | Number of Coronary Artery Bypass Graft (CABG) surgeries performed. | 298 |
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* Subset of cardiovascular surgeries reported on line 45 above. |
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Cardiac Catheterization Lab Rooms |
Line No. | | (1)
|
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55. | Number of rooms equipped to perform cardiac catheterizations on December 31. | 2 |
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Cardiac Catheterization Visits |
Line No. | | (1) Diagnostic
| (2) Therapuetic
|
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56. | Pediatric - Inpatient | 0 | 0 | 57. | Pediatric - Outpatient | 0 | 0 | 58. | Adult - Inpatient | 1,070 | 1,636 | 59. | Adult - Outpatient | 1,803 | 0 | 60. | Total Cardiac Catheterization Visits | 2,873 | 1,636 |
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Distribution of Therapeutic Cardiac Catheterization Procedures |
Complete this table if Therapeutic Cardiac Catheterization Visits are reported in column 2, line 60. |
Line No. | | (1) Procedures
|
---|
71. | Permanent Pacemaker Implantation | 118 | 72. | Percutaneous Transluminal Coronary Angioplasty (PTCA) - WITH Stent | 19 | 73. | Percutaneous Transluminal Coronary Angioplasty (PTCA) - WITHOUT Stent | 859 | 74. | Atherectomy (PTCRA - rotablator, DCA, laser, other ablation, etc.) | 24 | 75. | Thrombolytic Agents (Intracoronary only) | 43 | 76. | Percutaneous Transluminal Balloon Valvulopasty (PTBV) | 0 | 84. | All Other (including Radiofrequency Catheter Ablation) | 573 | 85. | Total Therapeutic Cardiac Catheterization Procedures | 1,636 |
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NOTE: Do Not Include Any Of The Following As A Cardiac Catheterization: |
Angiography - Non-coronary, Automatic Implantable Cardiac Defibrillator (AICD), Defibrillation, Cardioversion, Intra-Aortic Balloon Pump, Percutaneous Transluminal Angioplasty - Non-cardiac, Pericardiocentesis, or Temporary Pacemaker Insertion. |
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Section 127285(3) of the Health and Safety Code requires each hospital to report "acquisitions of diagnostic or therapeutic equipment during the reporting period with a value in excess of five hundred thousand dollars ($500,000)." |
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Diagnostic and Therapeutic Equipment Acquired During The Report Period |
1. | Did your hospital acquire any diagnostic or therapeutic equipment that had a value in excess of $500,000? (If 'Yes', fill out lines 2 through 11, as necessary, below.) | No |
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Diagnostic and Therapeutic Equipment Detail |
Line No. | (1) Description of Equipment | (2) Value | (3) Date of Aquisition MM/DD/YYYY | (4) Means of Acquisition |
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2. | | | | | 3. | | | | | 4. | | | | | 5. | | | | | 6. | | | | | 7. | | | | | 8. | | | | | 9. | | | | | 10. | | | | | 11. | | | | |
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Building Projects Commenced During Report Period Costing Over $1,000,000 |
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Section 127285(4) of the Health and Safety Code requires each hospital to report the "commencement of projects during the reporting period that require a capital expenditure for the facility or clinic in excess of one million dollars ($1,000,000)." |
25. | Did your hospital commence any building projects during the report period which will require an aggregate capital expenditure exceeding $1,000,000? (If 'Yes', fill out lines 26 through 30, as necessary, below.) | No |
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Detail of Capital Expenditures |
Line No. | (1) Description of Project | (2) Projected Total Capital Expenditure | (3) OSHPD Project No. (if applicable) |
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26. | | | | 27. | | | | 28. | | | | 29. | | | | 30. | | | |
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