Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694841600635.pdf (Malta)
L-ERBATAX-IL LEĠIŻLATURA P.L.

1031 Dokument imqiegħed fuq il-Mejda tal-Kamra tad-Deputati fis-Seduta Numru 69 tat-12 ta’ Diċembru 2022 mid-Deputat Prim Ministru u Ministru għas-Saħħa.

___________________________ Raymond Scicluna Skrivan tal-Kamra SPTAR MATER DEI – ANNUAL HOSPITAL ACTIVITY REPORT *4562.

L-ONOR.
L-ONOR.

CLAUDETTE BUTTIGIEG staqsiet lill-Deputat Prim Ministru u Ministru għas-Saħħa: Jista’ d-Deputat Prim Ministru u Ministru għas-Saħħa jpoġġi fuq il- Mejda tal-Kamra l-Annual Hospital Activity Report tal-Isptar Mater Dei mis-sena 2013 sas- sena 2021?

28/11/2022 ONOR.

CHRIS FEARNE: Ninforma lill-Onor.

Interpellant illi qed inpoġġi fuq il-Mejda tal- Kamra l-informazzjoni mitluba minnu.
Seduta Numru 69 12/12/2022 HHOOSSPPIITTAALL AACCTTIIVVIITTYY RREEPPOORRTT ANNUAL 2013 ACTIVITY IN/DAY PATIENTS, A&E, WARD ATTENDERS (DECEMBER ’12 TO NOVEMBER ’13) OUT-PATIENTS (JANUARY TO DECEMBER ’13) BED STATISTICS (JANUARY TO NOVEMBER ’13) Version 1.0 CCLLIINNIICCAALL PPEERRFFOORRMMAANNCCEE UUNNIITT Mater Dei Hospital Analysis and Compilation David Borg, Scientific Officer Reviewed by Dr Sandra Buttigieg, Consultant Public Health Dr Antonella Grima, Resident Specialist Clinical Performance Unit DOCUMENT INFORMATION Document reference CPU/HIA/OP/A&E13 Current version Date published 1.0 26 February 2014 Document owner Clinical Performance Unit, MDH Document type Monthly statistical report Personal data No personal data Data Provider: IM&T Directorate Disclaimer: Data for in/day patients, A&E, Ward Attenders for December 2013 not available due to launch of CPAS Data Requests: When requesting data from CPU, one has to follow the published Data Request Protocol and fill in the Data Request Form, which was issued as a KURA circular.
http://www.kura.gov.mt CONTENTS 1 INTRODUCTION .................................................................................................................... 3 1.1 Demography ................................................................................................................... 3 1.2 Method of Admissions according to Admitting Speciality ............................................. 5 1.3 Method of Admissions according to Admitting Ward .................................................... 6 2 WARD ATTENDERS ............................................................................................................... 9 3 OUT-PATIENT ACTIVITY (JANUARY TO DECEMBER 2013) ............................................................. 10 Introduction .................................................................................................................. 10 3.1 3.2 Clinic Activity according to Departments ..................................................................... 12 4 ACCIDENT & EMERGENCY ACTIVITY ........................................................................................ 18 4.1 Total Attendances ......................................................................................................... 18 4.2 Outcome of A&E Attendances ...................................................................................... 19 4.3 Referral Source and Priority Code ................................................................................ 23 5 HOSPITAL ACTIVITY REPORT (OLD PAS), BED STATISTICS .............................................................. 25 6 DEFINITIONS USED IN HOSPITAL ACTIVITY REPORT OF THE PATIENT ADMINISTRATION SYSTEM.
.............. 30 The accuracy of information in this document might be limited by factors beyond author’s control.

Most of these limitations are highlighted.

Users should always acknowledge the source and include highlighted limitations in all works based on information supplied in this document.

This document also contains data which is subject to interpretation.
Before using this data for making decisions or drawing conclusions, users are encouraged to contact the Clinical Performance Unit for advice.

Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 2 Clinical Performance Unit 1 INTRODUCTION 1.1 Demography There were 101957 admissions (+4% over 2012) (in-patients and day cases) registered on the ADT module of the old PAS from December ’12 to November ’13 (12 months) giving a daily admission rate of 280/day (2012: 268/day).
The table below shows the number of registered admissions to Mater Dei for the twelve months from December ’12 to November ’13.

October and May registered the highest number of admissions whilst the lowest number was recorded in December.

The numbers of registered admissions from 2005 – 2012 can be seen in the table overleaf.

These admissions exclude admissions of newborns to nurseries and admissions to Renal Unit.
Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 3 Clinical Performance Unit Note: Figures above exclude Nursery Admissions and Renal Unit Day Cases Of the total admissions to MDH from Dec ’12 to Nov ’13, 50 % were females and 49% were males.

The remaining <1% had no gender specified.

The age and gender distribution can be seen in the chart below.
Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 4 Clinical Performance Unit 1.2 Method of Admissions according to Admitting Speciality The method of admission according to the admitting consultants’ specialty was analysed to determine the total admissions.

The totals for the Department of Medicine as well as the overall total were analysed including and excluding Renal Unit admissions.
Admitting Speciality Medicine/Acute Medicine/Diabetes/Endo Medicine/GIT Medicine/Infectious diseases Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Total Dept of Medicine (INCLUDING Renal Unit) Total Dept of Medicine (EXCLUDING Renal Unit) Neurology Neurosurgery Total Dept of Neurosciences Surgery/Emergency Surgery/general Surgery/plastics Surgery/Vascular Urology ENT Paediatric Surgery Total Dept of Surgery Cardiac Surgery Cardiology Total Dept of Cardiac Services Accident & Emergency Dental Haematology Obs & Gynae Ophthalmology Orthopaedics Paediatrics Pain Relief Psychiatry Thalassaemia Registered Day Cases 156 13 2087 13 15583 192 70 18114 Registered Elective Admissions 289 Registered Emergency Admissions Total (INCLUDING Renal Unit) Total (EXCLUDING Renal Unit) 42397 26853 18969 17007 36681 36675 Other Total Dec'12 - Nov'13 3843 1623 3803 1106 20155 2442 2224 Total 2012 647 1972 4873 1305 19643 2944 2456 35196 33840 17680 17433 1073 355 1428 4714 9293 1474 969 6426 2053 1379 1174 387 1561 n/a % Difference +494 -18 -22 -15 +3 -17 -9 +4 +1 -9 -8 -9 n/a -18 +21 +14 +3 +7 +4 +15 -2 +4 +3 -24 +4 +6 -1 -6 -3 +6 +10 +9 -13 +4 +4 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 5 The graph below presents the number of admissions according to type from 2005 to 2013.
The admissions exclude admissions of newborns to nurseries and admissions to Renal Unit.

Clinical Performance Unit *includes only newborns admitted to specialized care unit from 2007 onwards 1.3 Method of Admissions according to Admitting Ward The method of admission for all admissions within the period 01/12/12 to 30/11/13 was analysed by using the raw case-based ADT-PAS data for this period.
The table overleaf gives a breakdown of the type of admission according to the ADMITTING ward and ward categories, which is based on the registered method of admission as flagged by ward staff.

IMPORTANT: This table does not take into account transfers-in to the wards and shows admissions according to the ADMITTING WARD and not according to the specialty under whose care the admission was, as already highlighted above.
Number of Transfers-in for every ward can be found in the Bed Statistics report at the end of this report.
Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 6 Admitting Ward (Excluding Transfers-In) Registered Day Cases Registered Elective Admissions Registered Emergency Admissions Other Total Dec'12 - Nov'13 Total 2012 % Difference Clinical Performance Unit Medical Wards MEDICAL WARD 1, MDH MEDICAL WARD 2, MDH MEDICAL WARD 3, MDH MEDICAL WARD 4, MDH MEDICAL WARD 5, MDH MEDICAL WARD 6, MDH MEDICAL WARD 7, MDH MED.

INVEST.

& TREAT.

UNIT,MDH INFECTIOUS DISEASES UNIT, MDH MED.

ADMISS.
ADMISS.

UNIT 1,MDH MED.

ADMISS.

UNIT 2,MDH MED.

ADMISS.

UNIT 3,MDH Total Medical Wards Neurosciences Wards NEURO-MEDICAL WARD, MDH NEURO-SURGICAL WARD, MDH Total Neurosciences Wards Holding Areas A&E AREA 2, MDH A&E PAEDIATRIC CORRIDOR, MDH DISCHARGE LOUNGE,MDH WAITING AREA, MDH Total Holding Areas Cardiac Services Wards CARDIAC CATH.

SUITE, MDH CARDIAC INT.

CARE UNIT, MDH CARDIAC MEDICAL WARD, MDH CARDIOTHOR.
SURGERY UNIT, MDH CORONARY CARE UNIT, MDH Total Cardiac Services Wards Surgery & Sub-Spec Wards SURGICAL WARD 1, MDH SURGICAL WARD 2, MDH SURGICAL WARD 3, MDH SURGICAL WARD 4, MDH SURGICAL WARD 5, MDH UROLOGY PRE-ADMISSION UNIT,MDH UROLOGY WARD 1, MDH UROLOGY WARD 2, MDH SURG.

ADMISSION UNIT, MDH E.N.T.
WARD, MDH FAIRYLAND, MDH PLASTIC SURGERY UNIT, MDH BURNS UNIT, MDH Total Surgery & Sub-Spec Wards Day Care Unit DAY CARE UNIT (ENDOSCOPY), MDH DAY CARE UNIT (SURGERY), MDH n/a 1352 7001 456 614 1070 3629 939 15 333 8466* 1683 24 986 873 816 4382 909 893 954 1090 1024 n/a 1623 846 1605 1872 2150 1132 n/a 14098 10501 9478 +11 +1 +20 +11 -19 -2 -35 +19 +5 +349 n/a -3 +50 +29 -9 +7 -11 -93 +347 +253 -47 -19 0 +42 +4 -1 +3 -43 -41 -40 -49 -34 n/a -7 +12 +92 +3 +3 +17 n/a -1 -7 +33 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 7 Cont… Admitting Ward (Excluding Transfers-In) Total Day Care Unit Obstetrics & Gynaecology Wards DELIVERY SUITE, MDH GYNAE WARD, MDH OBSTETRICS WARD 1, MDH OBSTETRICS WARD 2, MDH OBSTETRICS WARD 3, MDH Total Obs & Gynae Paediatric Wards DISNEYLAND, MDH RAINBOW WARD, MDH WONDERLAND, MDH NEONATAL/PAED.
INT.

CARE, MDH NURSERY 1 (OBST.

WARD 1), MDH NURSERY 3 (OBST.

WARD 3), MDH PAEDIATRICS DAY CARE, MDH Total Paediatric Wards Orthopaedic Wards ORTHOPAEDIC WARD 1, MDH ORTHOPAEDIC WARD 2, MDH ORTHOPAEDIC WARD 3, MDH Total Orthopaedic Wards Other Wards INTENSIVE THERAPY UNIT, MDH DAYCARE RECOVERY(INT.

CARE)MDH MAIN RECOVERY(INT.
CARE),MDH OBSERVATION WARD, MDH OPHTHALMIC WARD, MDH PSYCHIATRIC UNIT, MDH RENAL UNIT, MDH SLEEP LAB, MDH Total Registered Admissions Registered Day Cases 21484 Registered Elective Admissions 328 Registered Emergency Admissions Other 13 7 1 9 4 39 60 206 1834 1656 3696 6 7 13 14 3 7 Clinical Performance Unit Total Dec'12 - Nov'13 22307 Total 2012 % Difference 19979 + n/a 3260 3702 219 16499 51 98047 +1 +2 -1 +4 +1 +2 +12 +5 +24 +1 -4 +1 +17 +7 -13 +8 0 0 +8 -71 n/a +22 -15 +13 +6 -73 +4 36681 3910 *includes A&E Area 1, Area2/Paed Area Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 8 Clinical Performance Unit 2 WARD ATTENDERS Ward attenders are registered on a separate module from the ADT Module or the OP module, that is, the Ward Attender Module of the PAS.
A ‘ward attender’ is a patient coming for treatment to the ward and not using a bed to receive care.

However, ward attenders are often freely defined by the ward staff and can also mean an ‘out-patient visit’.

Consequently the numbers given vary according to how one categorises these patient attendances, the frequency of registration and the point at which this module was used at each ward.
Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, pre-op attendances, follow-up visits post discharge, iv antibiotics, etc.
The table below gives the ward distribution of ward attenders according to speciality: Speciality Accident & Emergency Cardiac Surgery Cardiology Dental Dermatology ENT Genetics Medicine/Acute Medicine/Diabetes/Endo Medicine/GIT Medicine/Infectious diseases Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obs & Gynae Ophthalmology Orthopaedics Paediatric Surgery Paediatrics Pain Relief Psychiatry Surgery/Emergency Surgery/general Surgery/plastics Total Dec '12 - Nov '13 379 6427 588 75 1 2409 5 342 385 528 711 1284 378 744 1155 298 8100 2361 3743 706 4065 3 253 1038 1450 3752 Total 2012 % Difference 281 6754 395 26 29 2440 4 293 537 613 496 938 701 1401 1483 397 7183 2517 3626 745 3594 3 224 5 1578 2798 +35 -5 +49 +188 -97 -1 +25 +17 -28 -14 +43 +37 -46 -47 -22 -25 +13 -6 +3 -5 +13 0 +13 n/a -8 +34 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 9 Clinical Performance Unit Cont Ward Attenders… Speciality Surgery/Vascular Haematology Thalassaemia Urology Grand Total Total Dec '12 - Nov '13 177 4588 1 1655 47596 Total 2012 % Difference 353 3600 1 1335 44350 -50 +27 0 +24 +7 3 OUT-PATIENT ACTIVITY (JANUARY TO DECEMBER 2013) 3.1 Introduction In 2013 there were a total of 585255 attendances (+7% over 2012) that were seen at the Out-Patient department.
The average daily attendances per clinic day was 1932 attendances for 303 clinic days (2012: 545702, 1825/day).

It should be mentioned that these attendances may also include multiple attendances to different clinics by the same patient on the same day eg.

MOP and ECG clinic attendance, SOP and Bleeding room, etc.

The graph overleaf shows the number of registered outpatient attendances to Mater Dei for 2013.
October and November registered the highest number of outpatient clinic attendances whilst the lowest number was recorded in December.

Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 10 Clinical Performance Unit The number of registered outpatient attendances from 2008 to 2013 is illustrated in the table below.

The total number of follow-ups and walk-ins increased over the years whilst the number of new cases remained relatively constant.
This is partly due to the increase in the number of clinics which started to use the Out-patient module to register their attendances eg: ECG clinics started to use the Out-patient module in 2009.

Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 11 3.2 Clinic Activity according to Departments Clinical Performance Unit The table below illustrates the type of attendance, department and clinic description for 2013.
Department and Clinic Description Anaesthesia/Pain Relief Pain Clinic Pain Relief Anaesthesia/Pain Relief Total Anaesthesia/Pre-op Pre-operative assessment clinic Anaesthesia/Pre-op Total Cardiac services 7 Day Holter Clinic (Cardiol-tech led) Blood Pressure (Cardiology) Cardiac cath Suite (Cardiology Clinic) Cardiac Rehabilitation Clinic (nurse-led) Cardiac Surgery Clinic Cardiology (Adult/Cong.
Heart Disease) Cardiology OP ECG Clinic (12 lead) Echocardiogram (Cardiology) Heart Failure Clinic (Nurse led) Holter ECG (Cardiologist) ICD Clinic (technician led) Interventional Cardiology Pacemaker Clinic (technician led) Pacemaker Wound Check Cl (nurse-led) Stress ECG (Cardiology) T.O.E.
Clinic (Cardiology) Cardiac services Total Chinese Medicine Chinese Medicine clinic Chinese Medicine Total Dental Child Dental Clinic Cleft Lip & Palate Clnic (Dental) Dental Clinic Dental Clinic (A&E) Dental Clinic (Consultants) Dental Clinic (Oral Hygiene) Dental Clinic (oral rehabilitation) Dental Clinic (Oral Surgery) Dental Clinic (Pre-op) Dental Clinic (Prosthetics) Dental Clinic (X-Ray) Registered New Cases Registered Follow- Ups Registered Walk-Ins Registered Investigations Total Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 12 Cont… Department and Clinic Description Dental Orthodontic Clinic Dental VCC Dental Total Dietician Dietetic Clinic Dietetic/Diabetes Clinic Dietician Total Genetics Genetics Clinic Genetics Total Haematology MOP Thalassaemia/Haematology MOP Haematology MOP Haematology (Nurse led) Haematology Total Infection Control Hep.
B Titre Clinic Infection Control Clinic Infection Control Screening Influenza Vaccine Clinic MRSA Screening Clinic Infection Control Total Medicine Acute Medicine Asthma Clinic Baromedicine Chest Clinic (Mantoux) CTD Clinic DBS follow-up Diabetes Awareness Sessions Diabetes Clinic Diabetes Clinic (Bleeding room) Diabetes Clinic (follow-ups) Diabetes Clinic (Juvenile) Diabetic Foot Clinic Diabetic Retinopathy Clinic Diabetic Retinopathy Clinic (Juvenile) Dietician Clinic Nephrology EAC Clinic (Early Arthritis) Endocrine & Medical Clinic Endocrine Clinic General Medicine Clinic Gestational Diabetes Clinic Infectious Diseases Joint Injection Clinic Lipid Clinic Medical & Respiratory OP Medical OP Medicine/Nephrology Clinical Performance Unit Registered New Cases 3309 44 18769 Registered Follow- Ups Registered Walk-Ins Registered Investigations Total Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 13 Clinical Performance Unit Cont… Department and Clinic Description MOP General & Inf.
Diseases MOP Liver Clinic MOP VCC Respiratory MOP/Gastroenterology MOP/Gastroenterology/Hepatic Nephrology Neuroendocrine Clinic Pulmonary Function Lab (Nurse led) Rheumatoid Podiatry Clinic Rheumatology Ankylosing Spondylitis Rheumatology Clinic Rheumatology Clinic (nurse led) Rheumatology Injection Clinic (Nurse led) Rheumatology Rapid Access Rheumatology/Bone Clinic Sleep Disorders Clinic Sleep Disorders Clinic (domiciliary) Sleep Disorders Clinic (inpts) Sleep OP Clinic SLH Chest Clinic Stress ECG (Medicine) Systemic Sclerosis Clinic TB/Cardiopulmonary Geriatrics Thyroid Clinic Wound Clinic Wound Clinic (Hyperbaric) Medicine Total Neurosciences EEG EMG Evoked Potentials Clinic (Neurology Team) MOP Neurology Movement Disorder Multiple Sclerosis Neuro EEG Monitoring Neurocognative Clinic Neuroepilepsy Clinic Neurology Botox Clinic Neurology VCC Neuromuscular Clinic Neuropsychiatric joint clinic Neurosurgical Clinic Neurovascular Clinic Paediatric Neurosurgery VCC Neurosciences Total Neurosciences/Psychiatry Neuropsychiatric joint clinic Neurosciences/Psychiatry Total Obs & Gynae Registered New Cases 556 40 12 646 321 223 8 580 56 11 548 125 97 119 1 138 268 10 222 183 1699 8 76 9 6 4 18325 Registered Follow- Ups Registered Walk-Ins Registered Investigations Total Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 14 Clinical Performance Unit Cont… Department and
 Clinic Description Antenatal Clinic Breastfeeding Clinic (Midwife led) Diabetic Pregnancy Clinic Gynae Bone Density Gynae Endocrine Clinic Gynae OP Obstetrics & Gynaecology Ultrasound Obs & Gynae Total Ophthalmology Ophthalmic Botox Clinic Strabismus Ophthalmic IVFA Ophthalmic Laser Ophthalmic Low Vision Clinic Ophthalmic OP Ophthalmic OP (Botox Clinic) Ophthalmic OP (Vitreoretinal) Ophthalmic OP A&E Referrals Ophthalmic Optometry Ophthalmic Optometry/Refraction Clinic Ophthalmic Orthoptics Ophthalmic Peripheral Visual Fields Ophthalmic Post-OP Clinic Ophthalmic Retina Ophthalmology Pre-operative assessment Ophthlamic (Cornea) Ophthalmology Total Orthopaedics Foot and Ankle Clinic OOP Fresh Trauma Clinic Orthopaedic FTC Orthopaedic OP Orthopaedic OP (General/Paediatrics) Orthopaedic Plaster Clinic Orthopaedic VCC Orthopaedic VCC Orthopaedic VCC (Shoulder) Orthopaedic VCC (Spinal) Orthopaedics Total Orthotics & Prosthetics Orthotics/Prosthetics Clinic (at SLH) Podology Paediatric Clinic Orthotics & Prosthetics Total Paediatrics Children's OP Children's OP (Cardiology/General) Children's OP (Endocrine) Children's OP (Endocrine/General) Children's OP (Neuro-paed) Children's OP (Neuro-paed/General) Registered New Cases 3837 0 14 4485 175 4893 8550 21954 Registered Follow- Ups Registered Walk-Ins Registered Investigations Total 2013 14281 7574 68 14149 602 18870 18602 74146 38 1198 2742 132 20867
Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 15 Clinical Performance Unit Cont… Department and Clinic Description Children's OP Nursery Community Paediatric Clinic COP (Bleeding Room) Diabetes Clinic Paediatrics Paediatric Diet Clinic Paediatric Echo (Paediatrics) Paediatric Gastroenterology Paediatric Infant Wheezer Clinic Paediatric Nephrology Clinic@PDC Paediatric Neuromuscular Joint Clinic@PDC Paediatric Rheumatology Clinic Paediatric VCC Neuromuscular Paediatric VCC Nutrition Paediatrics Development Clinic Paediatrics General & Inf Diseases Paediatrics Infectious Diseases Clinic Paediatrics Nephrology Paediatrics Respirarory Medicine Paediatrics VCC Cystic Fibrosis Paediatrics VCC Endocrine @PDCU Paediatrics VCC Nephrology Paediatrics VCC Oncology Paediatrics/NPICU F/U Paediatrics VCC Paediatrics Total Pathology ACC Phlebotomy Bleeding Room (OGTT) Phlebotomy Pathology Psychiatry Perinatal Mental Health Clinic Psychiatric OP Psychiatry ADHD Clinic Psychiatry Child Guidance Clinic Psychiatry Disability Clinic Pathology Total Screening Screening Clinic Screening Total Surgery Breast Clinic ENT Audiology (paed) ENT Dizziness Clinic ENT Hearing Loss Clinic ENT Oncology ENT OP ENT OP Oncology ENT Tinnitus Clinic ENT/Audiology Registered New Cases 2 62 43 2 185 1201 417 13 0 0 13 6 0 33 65 98 72 64 4 17 1 5 15 10 4702 Registered Follow- Ups Registered Walk-Ins Registered Investigations 0
Total Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 16 Cont… Department and Clinic Description ENT/Audiology (Audiometry) ENT/Audiology (Hearing Aids) Paediatric Surgery Paediatric Surgery VCC SOP SOP (Stoma Clinic) SOP Bariatric Clinic SOP Dermatology Referrals SOP Plastic SOP-Pre-op Urology Clinic Urology Clinic (Pre-ops) Urology Clinic VCC Urology Outreach Clinic Vascular Surgery Clinic Surgery Total Thalassaemia Thalassaemia Clinic Thalassaemia Phlebotomy Clinic Thalassaemia Total Tissue Viability Tissue Viability Clinic Tissue Viability Total TVU Review Clinic (Nurse Led) Total 2013 Total 2012 % Difference Clinical Performance Unit Registered New Cases 12 12 614 6 7416 39 6 183 613 14 2442 194 10 532 842 24344 Registered Follow- Ups 2873 1246 2021 38 15184 428 2 38 1500 496 11880 434 24 488 2044 50365 299 730 1029 562 761 199 188798 2E+05 10 142 239 381 8330 8412 82 311532 3E+05 1 Registered Walk-Ins Registered Investigations n/a n/a Total 2013 3085 1304 2641 45 23480 510 9 221 2121 510 14752 641 34 1059 2946 76798 607 1007 1614 9200 9496 296 585255 5E+05 7 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 17 Clinical Performance Unit 4 ACCIDENT & EMERGENCY ACTIVITY 4.1 Total Attendances The total number of attendances registered on the A&E module of the PAS from Dec’12 to Nov’13 was 115706 (+4% when compared to 2012) attendances giving an average of 317 daily attendances (2012: 111533, 305/day).
The graph below illustrates the total number of A&E attendances over the months.

On the other hand, the graph overleaf shows the number of A&E attendances along the years from 2008 – 2013.

Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 18 Clinical Performance Unit 4.2 Outcome of A&E Attendances Once a patient is registered at the reception area he/she is directed to the triage nurse where the urgency of the complaint is assessed.
This allows the prioritization of the presenting complaints into seven categories: Priority 1 : Highest (urgent) Priority 2 : Medium (semi-urgent) Priority 3 : Low (Delay acceptable) Priority 7 : A&E on call Paediatrics Priority 8: Gynae/Obstetrics Complaint Priority 9: ENT/Ophthalmology/Dental Complaint BB : Bypass triage NA : Not available Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 19 The complexity and severity as well as the type of the different presenting complaints influence the category of triage.
The table below represents the percentage of registered accident and emergency attendances according to the various priority codes.
Clinical Performance Unit Dec'12 to Nov'13 Priority Code Month 1 2 3 7 8 9 BB Unsp Total Dec'12 Jan'13 Feb'13 Mar'13 Apr'13 May'13 Jun'13 Jul'13 Aug'13 Sep'13 Oct'13 Nov' Total Dec'12- Nov'13 Total 2012 % Diff 32499 24702 19316 12154 4285 20102 1872 776 115706 32338 23477 18446 11302 4004 19784 1433 0 +5 +5 +8 +7 +2 +31 749 +4 111533 +4 Average daily A&E attendances 291 306 304 321 331 333 320 325 339 314 314 306 - - - Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 20 Clinical Performance Unit The tables below give the destination of the registered A&E attendances as recorded on the A&E module.
One should be aware that problems with bed shortages resulted in patients who were seen at the A&E department and requiring admission to wait in the A&E holding area until a suitable bed was identified into which they could be admitted.

From the total A&E registered admissions in 2012, 21% were admitted to hospital wards whilst the remaining 79% were discharged from hospital.
Discharge Destination from A&E - Admission to Hospital Wards Ward ADM. TO M1 ADM. TO M2 ADM. TO M3 ADM. TO M4 ADM. TO M5 ADM. TO M6 ADM. TO M7 ADM. TO MED.

ADMISSIONS UNIT 1 ADM. TO MED.

ADMISSIONS UNIT 3 ADM. TO MED.INVEST.&TREAT.UNIT ADM. TO DAY SURGERY UNIT ADM. TO INFECT.

DISEASES UNIT ADM. TO PAEDIATRIC DAY CARE Total Dept of Medicine Holding Areas ADM. TO AREA 2 / PAED AREA ADM. TO CARDIAC CATH.
SUITE ADM. TO CARDIAC INTENSIVE CARE ADM. TO CARDIAC MEDICAL WARD ADM. TO CARDIAC SURGICAL WARD ADM. TO CCU Total Dept of Cardiac Services ADM. TO NEURO-MEDICAL WARD ADM. TO NEUROSURGERY UNIT Total Dept of Neurosciences ADM. TO SURGICAL WARD 1 ADM. TO SURGICAL WARD 2 ADM. TO SURGICAL WARD 3 ADM. TO SURGICAL WARD 4 ADM. TO SURGICAL WARD 5 Total Dec'12 - Nov'13 Total 2012 % Diff n/a n/a n/a 5 250 413 43 4442 6870 50 11 862 337 654 1914 348 360 708 591 645 429 518 587 -1 -9 +4 -6 -7 -20 n/a n/a n/a 0 +93 -13 +9 +94 -51 -14 -45 +25 0 -18 +4 +21 -18 +1 -50 -61 -39 -64 -56 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 21 Cont… Discharge Destination from A&E - Admission to Hospital Wards Ward ADM. TO UROLOGY WARD 1 ADM. TO UROLOGY WARD 2 ADM. TO PLASTICS & BURNS UNIT ADM.TO SURGICAL ADM UNIT ADM. TO ENT WARD ADM. TO FAIRYLAND Total Dept of Surgery ADM. TO O1 ADM. TO O2 ADM. TO O3 Total Dept of Orthopaedics ADM. TO DISNEYLAND ADM. TO WONDERLAND ADM. TO PAED.
INTENSIVE CARE Total Dept of Paediatrics ADM. TO DELIVERY SUITE ADM. TO GYNAE WARD ADM. TO HYPERBARIC UNIT ADM. TO ITU ADM. TO OBSERVATION WARD ADM. TO OBSTETRICS WARD 1 ADM. TO OBSTETRICS WARD 2 ADM. TO OBSTETRICS WARD 3 ADM. TO OPHTHALMIC WARD ADM. TO PSYCHIATRIC UNIT ADM. TO RENAL UNIT TRANSF.
TO OPERATING THEATRE Overall Total Admitted * total includes holding areas and wards as on 2012 Total Dec'12 - Nov'13 562 346 26 2588 75 886 5742 509 64 527 1100 135 71 3 209 4 36 7 267 2489 1 11 2 8 3 8 58 24644 Clinical Performance Unit Total 2012 % Diff 670 358 n/a n/a 101 863 6295 665 115 612 1392 163 86 9 301 7 10 2 291 2993 2 31 1 1 1 2 19 27158* -16 -3 n/a n/a -26 +3 -9 -23 -44 -14 -21 -17 -17 -67 -31 -43 +260 +250 -8 -17 -50 -65 +100 +700 +200 +300 +205 -9 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 22 Clinical Performance Unit Discharge Destination from A&E - Discharged from the A&E Dept Discharge Destination DISCHARGE BY SYSTEM HOME, FTC FOLLOW UP HOME, GP FOLLOW UP HOME, HEALTH CENTRE FOLLOW UP HOME, MOP FOLLOW UP HOME, NO FOLLOW UP HOME, OOP FOLLOW UP HOME, OTHER OP FOLLOW UP HOME, SELF DISCHARGED HOME, SOP FOLLOW UP LEFT BEFORE BEING SEEN MATER DEI HOSPITAL MORTUARY MOUNT CARMEL HOSPITAL RETURN VISIT SEEN, REFUSED TREATMENT Overall Total Discharges Total Dec'12 - Nov'13 Total % Diff +14 +8 -25 -42 -71 +5 -65 -58 -22 -80 +11 0 -1 -25 -14 -33 +8 4.3 Referral Source and Priority Code The A&E case-based data was used to analyse the referral source according to the priority coding at triage.
The tables overleaf show the source of referral and priority code from Dec’12 – Nov’13.

It could be noted that the greatest number of attendances to the A&E in this period (70%) were self-referrals.

In fact self referrals form the highest percentage in all the priority codes.

On the other hand, GP referrals together with Health Centre referrals constitute 29% of all referrals to A&E (see table and pie chart).
Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 23 Dec’12 – Nov’13 Referral Source CCF/POLICE REFERRAL GOZO GENERAL HOSPITAL REFERRAL 1 90 29 2 57 7 3 28 7 7 3 1 GP REFERRAL 9147 8430 2957 1647 HEALTH CENTRE REFERRAL 1818 1373 1678 405 OTHER REFERRAL PRIVATE HOSPITAL REFERRAL 928 163 209 112 76 47 36 24 Clinical Performance Unit Priority Code 8 8 0 671 124 17 14 9 19 14 3720 945 30 29 BB Unsp ec 3 4 Total Dec’12- Nov’13 208 62 Total 2012 263 46 82 12 15 1 129 26783 25087 26 23 6 585 776 6381 1334 396 6955 1143 468 80542 77571 115706 111533 % Diff -21 +35 +7 -8 +17 -15 +4 +4 SELF REFERRAL Grand Total 20324 14514 14523 10038 3451 15345 1762 32499 24702 19316 12154 4285 20102 1872 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 24 Clinical Performance Unit 5 HOSPITAL ACTIVITY REPORT (OLD PAS), BED STATISTICS Period: January to November 2013 Ward Department of Medicine MEDICAL WARD 1, MDH MEDICAL WARD 2, MDH MEDICAL WARD 3, MDH MEDICAL WARD 4, MDH MEDICAL WARD 5, MDH MEDICAL WARD 6, MDH MEDICAL WARD 7, MDH*/// MEDICAL ADMISSIONS UNIT 1 MEDICAL ADMISSIONS UNIT 2* MEDICAL ADMISSIONS UNIT 3*/ EMERGENCY WARD AREA*/// EMERGENCY ADM. WARD 1*/ INFECTIOUS DISEASES MED.
INVEST.

& TREAT RENAL UNIT, MDH SLEEP LAB, MDH Total excl.

Renal Unit & Sleep Lab Department of Neurosciences NEURO-MEDICAL WARD, NEURO-SURGICAL WARD, Total Department of Cardiac Services CARDIAC MEDICAL WARD CORONARY CARE UNIT, CARDIAC INT.
CARE UN Bed Comp 24 24 24 24 24 24 19 22 17 23 16 18 21 11 35 1 291 23 18 41 32 15 6 Avail Bed Days 8016 8016 8016 8016 8019 8016 1214 7348 1213 1403 5480 6302 7014 3674 11690 334 81747 7682 6012 13694 10688 5010 2004 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 Occ.

Bed Days Vacant Bed Days Trans In Adms Trans Out Patients Treated Disch Patnts RIP No of Day.

%Bed Occ Average Lng of Stay Trnovr Int.
Trnovr Rate Clinical Performance Unit Ward CARDIOTHOR.
SURGERY CARDIAC CATH.

SUITE Total (excl.
cardiac Cath Suite) Department of Orthopaedics ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 Totals Department of Obstetrics & Gynaecology OBSTETRICS WARD 1 OBSTETRICS WARD 2 OBSTETRICS WARD 3 DELIVERY SUITE GYNAE WARD Totals (incl Delivery Suite) Department of Surgery SURGICAL WARD 1, MDH SURGICAL WARD 2, MDH SURGICAL WARD 3, MDH SURGICAL WARD 4, MDH SURGICAL WARD 5, MDH UROLOGY PRE-ADMISSIO UROLOGY WARD 1, MDH UROLOGY WARD 2, MDH EMERGENCY ADM. WARD 2*// SURGICAL ADMISSIONS UNIT*// FAIRYLAND PLASTIC SURGERY UNIT BURNS UNIT E.N.T.
WARD Totals Bed Comp 16 16 69 24 24 20 68 24 19 20 10 24 97 24 24 24 24 24 2 24 12 17 21 20 7 0 18 241 Avail Bed Days 5344 5344 Occ.
Bed Days 4920 60 23046 19858 Vacant Bed Days 424 5284 3188 Trans In 676 4 Adms 839 174 Trans Out 506 142 Patients Treated Disch 1058 36 2403 2883 2187 3312 Patnts RIP - No of Day.
4 1146 18 3 21 14 38 1 30 0 2 12 45 11 16 7 11 7 1 11 3 14 3 2 984 0 2 1072 %Bed Occ 92.1 1.1 86.2 90 77.3 86.8 84.6 79.8 74.2 85.9 60.2 87.1 79.7 95.1 95.6 96.1 100.5 95.8 1.5 95.1 92.5 87.6 89.3 63.1 72.8 39.4 89.4 90.9 Average Lng of Stay 3.1 0.3 3.5 7.9 4 6.4 5.7 2.4 2.4 2.3 0.4 4 1.8 5.9 5.4 6 6.7 5.3 NA 4 3.5 1.8 1.9 1.9 5.1 3.9 2.7 3.8 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 Trnovr Int.
0.3 29.7 0.6 0.9 1.2 1 1.0 0.6 0.8 0.4 0.3 0.6 0.5 0.3 0.2 0.2 0 0.2 3.2 0.2 0.3 0.3 0.2 1.1 1.9 6.1 0.3 0.4 Trnovr Rate 98.3 11.1 81.2 37.8 64.1 45.6 49.4 108.9 103.1 123 521.2 73.2 144.3 53.8 58.9 53.5 50.1 60.8 103.2 79.7 88 163.9 155.4 109.5 48 33.4 112.1 73.1 26 Ward Department of Paediatrics DISNEYLAND WONDERLAND, MDH RAINBOW WARD, MDH NEONATAL/PAED.

INT.

PAEDIATRICS DAY CARE NURSERY 1 (OBST.

WARD 1) NURSERY 3 (OBST.

WARD 3) Totals (excl.


Nurs.& Paed DC) Department of Ophthalmology OPHTHALMIC WARD Department of Anaesthesia (ITU) INTENSIVE THERAPY UN MAIN RECOVERY(INT.

CARE)** DAYCARE RECOVERY(INT.


CARE) Day Care Beds DAY CARE UNIT (ENDO) DAY CARE UNIT (SURG) Other Units PSYCHIATRIC UNIT OBSERVATION WARD EMERGENCY OBSERVATION WARD* Holding Areas A&E AREA 2, MDH*** A&E PAEDIATRIC CORRI DISCHARGE LOUNGE*~ WAITING AREA, MDH *~~ Bed Comp 18 11 7 19 12 30 24 55 10 20 0 0 14 30 15 16 11 0 0 0 0 Clinical Performance Unit Avail Bed Days 6012 3674 2338 6346 4008 10020 8016 18370 Occ.

Bed Days Vacant Bed Days Trans In Adms Trans Out Patients Treated Disch Patnts RIP No of Day.
%Bed Occ Average Lng of Stay Trnovr Int.
Trnovr Rate - -2619 25 40 89 -25 -40 - NA 0.2 3.0 12.5 1.4 1.1 0.9 0.4 NA 0.1 1.2 0 0 57 0 0 20.4 2.7 16.2 58.9 2.8 0.2 0.3 0 0 0 0 21.9 209.1 241.6 0 0 0 0 27 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 Clinical Performance Unit Ward Bed Comp Avail Bed Days Occ.
Bed Days Vacant Bed Days Trans In Adms Trans Out Patients Treated Disch Patnts RIP No of Day.

%Bed Occ Average Lng of Stay Trnovr Int.

Trnovr Rate Totals (inclds all beds & cots) presently in use 1015 341024 268810 72214 26227 56258 26227 54777 1396 38593 78.8 3.3 0.9 80.7 Totals adjusted for In-patient Beds presently in use (excl.
Day Care beds & Nursery cots) 868 291648 259509 37427 22388 50619 25659 49582 1396 38593 89.0 5.1 0.4 88.3 *Emergency Observation Ward renamed as Medical Admissions Unit 2 ** Used as overflow area for the Intensive Care Unit ***Area 2 was used as holding bays until an -in-patient bed was found *~Patients started being discharged through the Discharge Lounge in March 2011 *~~Waiting Area MDH was introduced in the month of July 2012 and is used for Pre-Op patients prior to trasfer to a Surgical Ward.
*/ Emergency Admissions Ward 1 was renamed Medical Admissions Unit 3 *// Emergency Admissions Ward 2 was renamed Surgical Admissions Unit */// Emergency Ward Area was renamed Medical Ward 7 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 28 0 0 81.9 89.9 15.1 2.4 3.3 0.3 19.8 139.2 Clinical Performance Unit 0 0 0 0 0.8 1.4 0 0 0 0 Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 29 Clinical Performance Unit 6 DEFINITIONS USED IN HOSPITAL ACTIVITY REPORT OF THE PATIENT ADMINISTRATION SYSTEM.
Occ.

Bed Days Bed Comp The occupied bed days or the number of bed-days used is the total amount of use that has been made of beds during the defined period, that is the sum of occupied daily bed counts.

The bed complement is the number of beds available.

This does not include extra beds put up on the ward when demand is greater than availability.

Avail.

Bed Days The available bed days is calculated by multiplying the average bed complement by the number of days in the period under study.
Vacant Bed Days The vacant bed days is the difference between the occupied bed days and the available bed days.

This figure will be a negative figure if the occupied bed days figure is greater than the available bed days figure only due to extra beds being occupied.

Trans In Adms Trans Out Transfers in is the number of patients transferred into the ward during the defined period of time.

Admissions is the number of direct admissions to the ward (excluding transfers) during the defined period.
Transfers out is the number of patients transferred out of the ward during the defined period of time.

Patients Treated Disch Patients treated and discharged is the number of all discharges (excludes deceased and transfers out) during the defined period.

Patnts RIP No.

of Day.

Patients RIP is the number of patients who have died during the defined period.

The Number of Daycases is the number of daycases that have been flagged as such on the source of admission in the PAS.
However if in a flagged daycase, the date of admission and the date of discharge are not equal, this report will not record the episode as a day case but will record it as an admission.

The average percentage bed occupancy is the percentage of % Bed Occupancy available bed-days that were actually used during the period, that is the number of bed-days used divided by the number of bed-days available multiplied by one hundred.

It may be thought as the mean percentage bed occupancy per day during the period.
Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 30 Average Lng of Stay Trnovr Int.

Clinical Performance Unit The average length of stay (LOS) is the mean time per patient (measured in days) that a hospital bed is occupied during the period.

It may be calculated by dividing the number of bed-days used by the number of disposals (that is the sum of discharges, transfers out and deaths) during the period.
The average turnover interval is the mean length of time (measured in days) that a hospital bed is left empty between successive patients.

It is calculated by subtracting the number of bed-days used (occupied bed days) from the number of bed days available (i.e.

vacant bed days), and then dividing by the disposals.

Note: If the vacant bed days figure is negative, the turnover interval is shown to be 0.
Trnovr rate The average turnover is the mean number of patients that have occupied any one bed during the period.

It is calculated by dividing the number of disposals by the average number of available beds.
Hospital Activity Report – In-Patients, Out-Patients, A&E– 2013 31 HHOOSSPPIITTAALL AACCTTIIVVIITTYY RREEPPOORRTT ANNUAL 2014 ACTIVITY DISCHARGES, WARD ATTENDERS, OUT-PATIENTS, A&E Version 1.1 March 2015 Hospital Activity Report DOCUMENT INFORMATION Document reference CPU/HIA/OP/A&E/14 Current version Date published 1.1 2nd March 2015 Document owner Clinical Performance Unit, MDH Document type Monthly statistical report Personal data No personal data Analysis and compilation Reviewed by David Borg, Principal Scientific Officer, RGN Prof Sandra Buttigieg, Consultant Public Health, Head CPU Dr Sandra Distefano, Consultant Public Health CONTENTS 1 INTRODUCTION ......................................................................................................................................... 3 2 IN-PATIENT ACTIVITY ................................................................................................................................. 4 2.1 Discharges data .......................................................................................................................... 4 2.2 Discharges 2014 .......................................................................................................................... 5 2.3 Discharges by Consultant Speciality ........................................................................................... 6 2.4 Discharges by Ward .................................................................................................................... 7 3 WARD ATTENDERS .................................................................................................................................... 9 3.1 Ward Attenders by Speciality ................................................................................................... 10 3.2 Ward Attenders by Ward ......................................................................................................... 11 4 OUT-PATIENT ACTIVITY ............................................................................................................................ 13 4.1 Introduction .............................................................................................................................. 13 4.2 Out-Patient Activity 2014 ......................................................................................................... 13 Clinic Activity according to Department and clinics grouped into the clinic description and 4.3 attendance type .................................................................................................................................. 14 ACCIDENT & EMERGENCY ACTIVITY ............................................................................................................ 21 5.1 A&E Attendances over the years .............................................................................................. 21 Total Attendances..................................................................................................................... 22 5.2 5.3 Type of Attendance .................................................................................................................. 22 5.4 Attendances by Priority Codes ................................................................................................. 23 5.5 Attendances according to the department where they were seen ......................................... 24 5.6 A&E Attendances according to ESI breakdown ........................................................................ 25 5 Disclaimer The accuracy of information in this document might be limited by factors beyond author’s control.
Most of these limitations are highlighted.

Users should always acknowledge the source and include highlighted limitations in all works based on information supplied in this document.

This document also contains data which is subject to interpretation.
Before using this data for making decisions or drawing conclusions, users are encouraged to contact the Clinical Performance Unit for advice This data reflects what has been registered in CPAS and may not reflect the actual numbers especially in the first quarter due to patient administrative system changeover.

Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 2 Hospital Activity Report 1 INTRODUCTION This report gives an overview of the activity on discharges, ward attenders, out-patient attendances and A&E attendances at Mater Dei Hospital in 2014.

The activity was collected from registrations of patients on CPAS.

The first chapter describes in-patient activity in the form of discharges data, by consultant speciality and by department/ward.
Statistics with regards to admissions have been omitted from this report due to inaccuracy in the data being registered.

The second chapter presents Ward Attenders data, by consultant speciality and by ward.

Ward attenders are patients coming for treatment to the wards and not using a bed to receive care.

The third chapter outlines out-patient attendances by clinic description.
Clinics have been grouped together to form the clinic description in this report (for example all medicine respiratory clinics grouped into Medicine & Respiratory OP).

Out-patient attendances are divided into New Cases, Follow-Ups, Walk-Ins and Any Cases.

Registration of out-patient attendances as Any Cases started in the beginning of 2014 with the introduction of CPAS.

The fourth and last chapter highlights the A&E attendances, primarily by referral source and ESI category.
Note: This report displays graphs with historic data and trends over the years.

It should be noted that comparisons with previous years should be interpreted with caution due to patient administrative system changeover at the end of 2013 which resulted into a change in the method of registration of patients.

Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 3 Hospital Activity Report 2 IN-PATIENT ACTIVITY 2.1 Discharges data Graph below shows the number of registered discharges from 2008-2014.

The discharges exclude the renal unit and nurseries.

Comparisons with previous years should be interpreted with caution due to patient administrative system changeover in the end of 2013 which resulted into a change in the method of registration of patients.
*2013 estimate due to system change over Source: 2008 - end of 2013 PAS, 2014 CPAS Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.

Version 1.1 4 2.2 Discharges 2014 Hospital Activity Report There were 88557 registered discharges (source: CPAS) in 2014 excluding Renal Unit and Nursery discharges.

The average daily discharge rate was of 243/day.

Discharges data was collected from CPAS by grouping the registered discharges events of the admitted patients.
Discharges events include: DECX ,DISC-CH HOME, DISC-COMM, DISC- DECX, DISC-ELD HOME, DISC-FTC, DISC-GGH, DISC-GOV HOME, DISC-HOME, DISC-IR-OP CTRE, DISC- MCH, DISC-MED INS AB, DISC-NON-RESID, DISC-ONC HOSP, DISC-POLICE CUS, DISC-PPP, DISC-PRIV HOME,DISC-PRIV HOS/C,DISC-REQ , DISC-RHKG, DISC-RHKG DH,DISC-RHKG MOP ,DISC-SVPR.

Source: CPAS Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 5 2.3 Discharges by Consultant Speciality Hospital Activity Report Speciality A&E Anaesthesia/Pain relief Cardiac surgery Cardiology Dental Dermatology ENT Genetics Haematology Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obstetrics & Gynae Ophthalmology Orthopaedics Paediatrics Psychiatry Sleep Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics Surgery/Urology Surgery/Vascular Total Source: CPAS Total excl.
Renal Unit & Nursery discharges Number of Discharges Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 6 2.4 Discharges by Ward Department Ward Medicine Medical Ward 1 Medical Ward 2 Medical Ward 3 Medical Ward 4 Medical Ward 5 Medical Ward 6 Medical Ward 7 Medical Admissions Unit 1 Medical Admissions Unit 1, EXT Medical Admissions Unit 2 Medical Admissions Unit 3 Medical Admissions Unit 4 Infectious Diseases Unit Renal Unit Sleep Lab Total (exc.

RU & SLP Lab) Haematology Medical Investigations & Treat.
Unit Neurosciences Neuromedical Ward Neurosurgical Ward Total Cardiology Cardiac Cath.Suite Coronary Care Unit Cardiac Medical Ward Total Cardiac Surgery Cardiac Intensive Care Unit Cardiac Surgical Ward Total Orthopaedics Orthopaedic Ward 1 Orthopaedic Ward 2 Orthopaedic Ward 3 Total Obs & Gynae Obstetrics Ward 1 Obstetrics Ward 2 Hospital Activity Report Number of Discharges Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 7 Department Ward Number of Discharges 2014 Hospital Activity Report Obstetrics Ward 3 Delivery Suite Gynae Ward Total Surgery Surgical Ward 1 Surgical Ward 2 Surgical Ward 3 Surgical Ward 4 Surgical Ward 5 Pre admission Unit Urology Urology 1 Urology 2 Burns Unit ENT Ward Plastic Surgery Unit Surgical Admissions Unit Fairyland Total Paediatrics Disneyland Rainbow Ward Wonderland Neonatal Paed Int Care Unit Nursery 1 Nursery 3 Paediatric Day Care Total Other A&E Paed Corridor Day Care Unit (Endo) Day Care Unit (Surg) Intensive Theraoy Unit* Observation Ward Ophthalmology Ward Psychiatric Unit Wait Lounge Discharge Lounge** Grand Total *patients deceased are directly discharged from ITU **patients are discharged from the wards prior to discharge from discharge lounge Source: CPAS Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 8 Hospital Activity Report 3 WARD ATTENDERS There were 42485 registered ward attenders in 2014 (source: CPAS).

A ward attender is a patient coming for treatment to the ward and not using a bed to receive care.

Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, iv antibiotics, review, etc.
Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed in the respective ward.

All admissions assigned to such ward attender beds were therefore extracted from the CPAS and analysed to compile the following tables.

Graph below shows the number of registered ward attenders from 2009-2014.
Comparisons with previous years should be interpreted with caution due to patient administrative system changeover in the end of 2013 which resulted into a change in the method of registration of patients.

*2013 estimate due to system change over Source: 2009 - end of 2013 PAS, 2014 CPAS Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 9 3.1 Ward Attenders by Speciality Speciality A&E Anaesthesia/Pain relief Cardiac surgery Cardiology Dental Dermatology ENT Genetics Haematology Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Nursing Team Obstetrics & Gynae Ophthalmology Orthopaedics Paediatrics Psychiatry Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics Surgery/Urology Surgery/Vascular Grand Total Source: CPAS Hospital Activity Report Number of Registered Ward Attenders Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 10 3.2 Ward Attenders by Department and Ward Department Ward Hospital Activity Report Number of Registered Ward Attenders 2014 Medicine MEDICAL WARD 1, MDH MEDICAL WARD 2, MDH MEDICAL WARD 3, MDH MEDICAL WARD 4, MDH MEDICAL WARD 5, MDH MEDICAL WARD 6, MDH MEDICAL WARD 7, MDH MED.

ADMISSION UNIT 1, MDH MED.

ADMISSION UNIT 2, MDH MED.

ADMISSION UNIT 3, MDH INFECTIOUS DISEASES UNIT, MDH Total Neurosciences NEURO-MEDICAL WARD, MDH NEURO-SURGICAL WARD, MDH Total Haematology/Medicine MED.

INVEST.
INVEST.

& TREAT.

UNIT,MDH Cardiology CARDIAC CATH.

SUITE, MDH CORONARY CARE UNIT, MDH CARDIAC MEDICAL WARD, MDH Total Cardiac Surgery CARDIOTHOR.

SURGERY UNIT, MDH CARDIAC INT.


CARE UNIT, MDH Total Orthopaedics ORTHOPAEDIC WARD 1, MDH ORTHOPAEDIC WARD 2, MDH ORTHOPAEDIC WARD 3, MDH Total Obs & Gynae OBSTETRICS WARD 1, MDH OBSTETRICS WARD 2, MDH OBSTETRICS WARD 3, MDH DELIVERY SUITE, MDH GYNAE WARD, MDH Total Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 11 Department Ward Hospital Activity Report Number of Registered Ward Attenders 2014 Surgery SURGICAL WARD 1, MDH SURGICAL WARD 2, MDH SURGICAL WARD 3, MDH SURGICAL WARD 4, MDH SURGICAL WARD 5, MDH PRE-ADMISSION UROLOGY, MDH UROLOGY WARD 1, MDH UROLOGY WARD 2, MDH BURNS UNIT, MDH E.N.T.

WARD, MDH PLASTIC SURGERY UNIT, MDH SURG.

ADMISSION UNIT, MDH FAIRYLAND, MDH Total Paediatrics DISNEYLAND, MDH RAINBOW WARD, MDH WONDERLAND, MDH NEONATAL/PAED.

INT.

CARE NURSERY 3 (OBST.


WARD 3), MDH PAEDIATRICS DAY CARE, MDH Total Other DAY CARE UNIT (ENDOSCOPY), MDH DAY CARE UNIT (SURGERY), MDH DISCHARGE LOUNGE,MDH INTENSIVE THERAPY UNIT, MDH OBSERVATION WARD, MDH OPHTHALMIC WARD, MDH PSYCHIATRIC UNIT, MDH MD Wait Grand Total Source: CPAS Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 12 Hospital Activity Report 4 OUT-PATIENT ACTIVITY 4.1 Introduction Comparisons with previous years for out-patients activity was not included in this report due to patient administrative system changeover in the end of 2013 which resulted into a change in the method of registration of patients.

This resulted in a disjuncture in data collection therefore historic data cannot be compared like with like.

Out-patient attendances are divided into New Cases, Follow-Ups, Walk-Ins and Any Cases.
Registration of out-patient attendances as Any Cases started in the beginning of 2014 with the introduction of CPAS and these cases cannot be redefined as new, follow-ups or walk-ins cases.

4.2 Out-Patient Activity 2014 There were 483788 registered out-patient attendances in 2014 (source: CPAS).

The average daily attendance per clinic day was 1596 attendances for 303 clinic days.
Registered attendance type in 2014 • 58580 New Cases • 185188 Follow-ups • 150727 Walk-ins • 88854 Any Cases Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 13 Hospital Activity Report 4.3 Clinic Activity according to Department and clinics grouped into the clinic description and attendance type Department & Clinics Description Anaesthesia/Pain Relief Pain Clinic Anaesthesia/Pre-op Pre-operative assessment clinic Cardiac Surgery Cardiac Surgery Clinic Cardiology 7 Day Holter Clinic (Cardiol-tech led) Adult Heart Disease Blood Pressure (Cardiology) Cardiac cath Suite (Cardiology Clinic) Cardiac Rehabilitation Clinic (nurse-led) Cardiocall Monitoring Clinic (Cardiology) Cardiology (Adult/Cong.
Heart Disease) Cardiology OP Cardiomyopathy Clinic ECG Clinic (12 lead) Echocardiogram (Cardiology)* Heart Failure Clinic (Nurse led) Holter ECG (Cardiologist) ICD Clinic (technician led) Pacemaker Clinic (technician led) Pacemaker Wound Check Cl (nurse-led) Stress ECG (Cardiology) Chinese Medicine Chinese Medicine clinic Dental Child Dental Clinic Cleft Lip & Palate Clnic (Dental) Dental Clinic Dental Clinic (A&E) Dental Clinic (Consultants) Dental Clinic (Oral Hygiene) Dental Clinic (oral rehabilitation) Dental Clinic (Oral Surgery) Dental Clinic (Pre-op) Dental Clinic (Prosthetics) Dental Clinic (Scaling and Polishing) Dental Clinic (X-Ray) Dental Orthodontic Clinic Registered New Case 859 859 676 676 2538 Registered Follow-Up Registered Walk-In Registered Any Case Grand Total Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 14 Department & Clinics Description Registered New Case Registered Follow-Up 612 269 343 26 26 780 780 549 149 305 95 1 1 3892 3892 Dental VCC Dietician Dietetic Clinic Dietetic/Diabetes Clinic Dietician Clinic Genetics Genetics Clinic Haematology MOP Thalassaemia/Haematology MOP Haematology Infection Control Hep.
B Titre Clinic Infection Control Clinic Infection Control Screening Influenza Vaccine Clinic MRSA Screening Clinic Needle Stick Injury Clinic Medicine 10028 33425 Ambulatory Sleep Studies Asthma Clinic Baromedicine Chest Clinic (Mantoux) CTD Clinic DBS follow-up Diabetes Awareness Sessions Diabetes Clinic Diabetes Clinic (Bleeding room) Diabetes Clinic (follow-ups) Diabetes Clinic (Juvenile) Diabetes Education Unit Diabetic Foot Clinic Diabetic Retinopathy Clinic Dietician Clinic Nephrology EAC Clinic (Early Arthritis) Endocrine & Medical Clinic Endocrine Clinic General Medicine Clinic Gestational Diabetes Clinic Infectious Diseases Joint Injection Clinic Lipid Clinic Medical & Respiratory OP Hospital Activity Report Registered Walk-In Registered Any Case 66 583 448 135 1189 1189 189 17 172 96 13 83 9977 297 154 163 4 68 5382 122 2 8 31 122 587 Grand Total Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 15 Hospital Activity Report Department & Clinics Description Medical OP Medicine/Nephrology MOP General & Inf.
Diseases MOP Liver Clinic MOP VCC Respiratory MOP/Gastroenterology MOP/Gastroenterology/Hepatic Nephrology Neuroendocrine Clinic Pulmonary Fibrosis Pulmonary Function Lab (Nurse led) Rheumatoid Podiatry Clinic Rheumatology Ankylosing Spondylitis Rheumatology Clinic Rheumatology Clinic (nurse led) Rheumatology Injection Clinic (Nurse led) Rheumatology Rapid Access Rheumatology/Bone Clinic Sleep Disorders Clinic Sleep Disorders Clinic (domiciliary) Sleep OP Clinic Sleep Pap Clinic SLH Chest Clinic Stress ECG (Medicine) Systemic Sclerosis Clinic TB/Cardiopulmonary Geriatrics Thyroid Clinic Transplant/Travel Wound Clinic Wound Clinic (Hyperbaric) Registered New Case 2654 387 648 679 294 206 27 2 44 183 1 2 39 12 Registered Follow-Up 7749 1703 616 8 1098 1298 1490 1 68 3 3553 418 1 151 7 1 2 2 1232 15 Neurosciences 1459 4732 EEG EMG Evoked Potentials Clinic (Neurology Team) MOP Neurology Movement Disorder Multiple Sclerosis Neuro EEG Monitoring Neurocognative Clinic Neuroepilepsy Clinic Neurology Botox Clinic 55 802 44 6 39 15 3 3173 107 111 51 135 Registered Walk-In Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 Grand Total 750** 2707 55 5586 153 114 6 92 157 53 Registered Any Case 268 75 76 3 209 251 128 458 1 1 685 1 125 115 153 14 75 1 276 123 4087 733 2679 620 40 16 Department & Clinics Description Registered New Case Registered Follow-Up Neurology VCC Neuromuscular Clinic Neurosurgical Clinic Neurovascular Clinic Paediatric Neurosurgery VCC Neurosciences/Psychiatry Neuropsychiatric joint clinic Obs & Gynae Antenatal Clinic Breastfeeding Clinic (Midwife led) CTG Clinic Diabetic Pregnancy Clinic Gynae Bone Density Gynae Endocrine Clinic Gynae OP Gynae OP Miscarriage Clinic Gynae Urodynamics Obstetrics & Gynaecology Ultrasound Outreach Midwifery Occupational Health Medical Pre Employment Medical Test Social Services Review Clinic Ophthalmology Ophthalmic Botox Clinic Strabismus Ophthalmic Glaucoma Ophthalmic IVFA Ophthalmic Laser Ophthalmic Low Vision Clinic Ophthalmic OP Ophthalmic OP (Botox Clinic) Ophthalmic OP (Vitreoretinal) Ophthalmic OP A&E Referrals Ophthalmic Optometry Ophthalmic Optometry/Refraction Clinic Ophthalmic Orthoptics Ophthalmic Peripheral Visual Fields Ophthalmic Post-OP Clinic Ophthalmic Retina Ophthalmic Special Ophthalmology VCC Ophthlamic (Cornea) Orthopaedics Hospital Activity Report Registered Walk-In Registered Any Case 14 1 43 43 837 2 7 826 2 4225 62 1 23 121 3 31 1 363 3362 181 60 17 3874 Grand Total Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 17 Department & Clinics Description Foot and Ankle Clinic OOP Foot Ankle Clinic OOP Fresh Trauma Clinic Orthopaedic FTC Orthopaedic OP Orthopaedic OP (General/Paediatrics) Orthopaedic Outreach Orthopaedic Plaster Clinic Orthopaedic VCC Orthopaedic VCC Orthopaedic VCC (Shoulder) Orthopaedic VCC (Spinal) Orthopaedics VCC (Hand Clinic) Orthotics & Prosthetics Orthotics/Prosthetics Clinic (at SLH) Paediatrics Children's OP Children's OP (Cardiology/General) Children's OP (Endocrine) Children's OP (Endocrine/General) Children's OP (Neuro-paed) Children's OP (Neuro-paed/General) Children's OP Nursery Community Paediatric Clinic COP (Bleeding Room) Diabetes Clinic Paediatrics Paediatric Diet Clinic Paediatric Gastroenterology Paediatric Infant Wheezer Clinic Paediatric Rheumatology Clinic Paediatric VCC Paediatrics Development Clinic Paediatrics General & Inf Diseases Paediatrics Infectious Diseases Clinic Paediatrics Nephrology Paediatrics Respirarory Medicine Paediatrics VCC Cystic Fibrosis Paediatrics VCC Endocrine Paediatrics VCC Nephrology Paediatrics VCC Oncology Paediatrics/NPICU F/U Podology Paediatric Clinic Registered New Case Registered Follow-Up Hospital Activity Report Registered Walk-In Registered Any Case 50 12 3187 33 4 556 1 25 4 2 1114 1114 973 3 79 1 68 84 8 40 55 60 74 186 111 26 15 160 Grand Total Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 18 Department & Clinics Description Registered New Case Registered Follow-Up Stress ECG (Paediatrics) Pathology ACC Phlebotomy Bleeding Room (OGTT) Phlebotomy Pathology Psychiatry Perinatal Mental Health Clinic Psychiatric OP Psychiatry ADHD Clinic Psychiatry Child Guidance Clinic Psychiatry Disability Clinic Surgery Breast Clinic ENT Audiology (paed) ENT Dizziness Clinic ENT Hearing Loss Clinic ENT Oncology ENT OP ENT OP Oncology ENT Tinnitus Clinic ENT/Audiology ENT/Audiology (Audiometry) ENT/Audiology (Hearing Aids) Paediatric Surgery Paediatric Surgery VCC Paediatrics Surgery VCC SOP SOP (Stoma Clinic) SOP Bariatric Clinic SOP Dermatology Referrals SOP Plastic Urology Clinic Urology Clinic (Pre-ops) Urology Outreach Clinic Vascular Surgery Clinic Thalassaemia Thalassaemia Clinic Thalassaemia Phlebotomy Clinic Tissue Viability Tissue Viability Clinic TVU Review Clinic (Nurse Led) Grand Total Hospital Activity Report Registered Walk-In Registered Any Case 4 11942 11942 249 249 3796 1 48 1 2 11 23 6 1767 328 6 17 18 1126 442 402 395 7 5202 4901 301 89293 Grand Total Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 19 Hospital Activity Report *cases not being inputted on CPAS but on other systems ** does not include EEGs for in-patients Source: CPAS Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 20 Hospital Activity Report 5 ACCIDENT & EMERGENCY ACTIVITY 5.1 A&E Attendances over the years Comparisons with previous years should be interpreted with caution due to patient administrative system changeover in the end of 2013 which resulted into a change in the method of registration of patients.

*2013 estimate due to system change over Source: 2009 - end of 2013 PAS, 2014 CPAS Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 21 Hospital Activity Report 5.2 Total Attendances Total number of attendances registered on CPAS in 2014 was 119941.

Average of 329 total daily attendances.

The maximum number of attendances registered this month amounted to 451 on Monday 7th April whilst the minimum number was on Tuesday 30th December with 248 attendances.
5.3 Type of Attendance • Self-Referral: • Doctor Referral: • Other: 86260 (72%) 30158 (25%) 3523 (3%) Source: CPAS Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.

Version 1.1 22 5.4 Attendances by Priority Codes Hospital Activity Report Source: CPAS ESI (Emergency Severity Index) Algorithm Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 23 5.5 Attendances according to the department where they were seen Hospital Activity Report Source: CPAS Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 24 Hospital Activity Report 5.6 A&E Attendances according to ESI breakdown ESI Category/Department No of A&E Registered Attendances A&E ESI-1 ESI-2 ESI-3 ESI-4 ESI-5 A&E TRIAGE SKIP Total Medical Paediatrics ESI-2-PAEDS ESI-3-PEADS ESI-4-PEADS ESI-5-PEADS Total Dental ESI-3-DENTAL ESI-4-DENTAL ESI-5-DENTAL Total ENT ESI-3-ENT ESI-4-ENT ESI-5-ENT Total Obstetrics & Gynaecology ESI-3-OBS ESI-4-OBS ESI-5-OBS Total Ophthalmology ESI-3-OPTH ESI-4-OPTH ESI-5-OPTH Total 1039 29589 23197 16633 5478 1046 76982 2168 4211 3354 1196 10929 66 1076 548 1690 673 3467 1069 5209 2027 1828 486 4341 558 7872 2970 11400 Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 25 ESI Category/Department Psychiatry ESI-3-PSCH ESI-4-PSCH ESI-5-PSCH Total Old Triage System (was still being used in beginning of 2014) Priority 1 : Highest (urgent) Priority 2 : Medium (semi-urgent) Priority 3 : Low (Delay acceptable) Priority 7 : A&E on call Paediatrics Priority 8: Gynae/Obstetrics Complaint Priority 9: ENT/Ophthalmology/Dental Complaint A&E TRIAGE A&E Triage Gozo Total Hospital Activity Report No of A&E Registered Attendances 42 57 67 166 2550 2072 1443 1056 386 1461 252 4 9224 Total A&E Attendances 119941 Hospital Activity Report –Discharges, Out-Patients, A&E Annual 2014.
Version 1.1 26 Hospital Activity Report 2015 ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS, A&E DOCUMENT INFORMATION Document reference CPU/HIA/OP/A&E/15 Current version Date published 1.0 1st April 2016 Document owner Clinical Performance Unit, MDH Document type Annual statistical report Personal data No personal data Analysis and compilation David Borg, Principal Scientific Officer, RN Prof Sandra Buttigieg, Consultant Public Health, Head CPU Dr Sandra Distefano, Consultant Public Health CONTENTS 1 2 INTRODUCTION .......................................................................................................................................... 3 IN-PATIENT ACTIVITY .................................................................................................................................. 4 2.1 Admissions data .......................................................................................................................... 4 2.2 Admissions (ADMIT) 2015 ........................................................................................................... 5 2.3 Admissions (ADMIT) according to hospital identification number/ID letter .............................. 6 2.4 Admissions (ADMIT) Vs Discharges (DISC) .................................................................................. 7 2.5 Admissions (ADMIT) by Consultant Speciality ............................................................................ 8 2.6 Admissions (ADMIT) by Department and Ward ......................................................................... 9 3 WARD ATTENDERS ................................................................................................................................... 12 3.1 Ward attenders 2015 ................................................................................................................ 12 3.2 Ward Attenders by Consultant Speciality ................................................................................. 13 3.3 Ward Attenders by Department and Ward .............................................................................. 14 4 OUT-PATIENT ACTIVITY............................................................................................................................. 16 4.1 Out-Patient 2015 ...................................................................................................................... 16 4.2 Clinic Activity according to department and clinics grouped into the clinic description and attendance type .................................................................................................................................. 17 ACCIDENT & EMERGENCY ACTIVITY............................................................................................................. 25 5.1 A&E Attendances data .............................................................................................................. 25 5.2 A&E Attendances 2015 ............................................................................................................. 26 5.3 Attendances by Priority Codes .................................................................................................. 27 5.4 Admissions (ADMIT) according to hospital identification number/ID letter ............................ 28 5.5 A&E Attendances according to attending department and ESI breakdown ............................ 29 5 Disclaimer The accuracy of information in this document might be limited by factors beyond author’s control.
Most of these limitations are highlighted.

Users should always acknowledge the source and include highlighted limitations in all works based on information supplied in this document.

This document also contains data which is subject to interpretation.
Before using this data for making decisions or drawing conclusions, users are encouraged to contact the Clinical Performance Unit for advice Hospital Activity Report 2015 Page 2 1 INTRODUCTION This report gives an overview on the activity at Mater Dei Hospital (MDH) which relates to admissions, discharges, ward attenders, out-patient attendances and A&E attendances in 2015.

The activity was collected from registrations of patients on CPAS, which is the patient administrative system at MDH.
The first chapter describes in-patient activity in the form of admissions and discharges data.

This is further divided into admissions by consultant speciality and by department/ward.

The second chapter presents Ward Attenders data, by consultant speciality and by department and ward.

Ward attenders are patients coming for treatment to the wards and not using a bed for a long time to receive care.

The third chapter outlines out-patient attendances by clinic description.
Clinics have been grouped together to form the clinic description in this report (for example all medicine respiratory clinics grouped into Medicine & Respiratory OP).

Out-patient attendances are divided into New Cases, Follow-Ups, Walk-Ins and Any Cases.

Registration of out-patient attendances as Any Cases started in the beginning of 2014 with the introduction of CPAS.

The fourth and last chapter highlights the A&E attendances, primarily by referral source, ESI category and attending department.
Note: This report displays graphs with historic data and trends over the years.

It should be noted that comparisons with previous years should be interpreted with caution due to patient administrative system changeover at the end of 2013.

Hospital Activity Report 2015 Page 3 2 IN-PATIENT ACTIVITY 2.1 Admissions data The graph below shows the number of registered admissions from 2008-2015.

The admissions in this graph exclude the renal unit and nurseries (new born) registrations.
*IT administrative system changeover Hospital Activity Report 2015 Page 4 2.2 Admissions (ADMIT) 2015 There were 90128 (+1% 2014) registered admissions in 2015 excluding Renal Unit and Nursery registrations.

The average daily admission rate was of 247/day.
Type of admission registrations:  Elective: 16686 (19%)  Emergency: 39552 (44%)  Day Case: 30026 (33%)  Other*: 3864 (4%) *includes delivery of new born The monthly number of registered admissions in 2015 and compared to 2014 can be seen in the chart below: Source: CPAS Hospital Activity Report 2015 Page 5 2.3 Admissions (ADMIT) according to hospital identification number/ID letter The table and chart below show the number of admissions according to hospital identification number and ID card letter, distributed as Maltese, Gozitan, Non-Maltese residents, new born and foreigners.
Hospital Identification /ID card letter Maltese (M,L,P) Gozitan (G,H) Non-Maltese Residents (A) New Born (C) Foreigners (F) Grand Total Number of admissions 2015 Elective Emergency Day Case Other Total Registered Admissions 2015 2% 3% 2% 5% Non-Maltese residents New Born Foreigners Gozitans Maltese 88% Hospital Activity Report 2015 Page 6 2.4 Admissions (ADMIT) Vs Discharges (DISC) The chart below depicts the average number of admissions and discharges per day according to day of week in 2015 (excluding renal unit and nurseries registrations).
Source: CPAS Hospital Activity Report 2015 Page 7 2.5 Admissions (ADMIT) by Consultant Speciality Admissions A&E Anaesthesia/Pain relief Cardiac surgery Cardiology Dental Dermatology ENT Genetics Haematology* Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obstetrics & Gynae Ophthalmology Orthopaedics Paediatrics Psychiatry Sleep Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics** Surgery/Urology Surgery/Vascular Other Total (exc.
RU & NUR) % Difference -22 -8 +7 -14 -8 +78 0 -2 -20 +5 +14 +11 +18 +7 +11 +4 +1 -4 0 -11 +4 -9 +14 +7 +2 -1 -14 +168 -2 +13 -100 +1 Source: CPAS *Haematology migrated to SAMOC in early September 2015 ** These admissions might include ward attenders which were inadvertently admitted into admission beds rather than ward attender beds, hence one cannot distinguish actual admissions from ward attenders (see ward attender section).
Hospital Activity Report 2015 Page 8 2.6 Admissions (ADMIT) by Department and Ward The table below illustrates the number of registered admissions to the respective department and ward.

The admissions listed in the table exclude transfers-in (clinic changes on CPAS).

Dept Cardiology Cardiothoracic Surgery Ward CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD Total CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT Total Haematology* MED.

INVEST.

& TREAT.
INVEST.

& TREAT.

UNIT Medicine INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 (until 7th Nov) MED.

ADMISSION UNIT 1 (from 7th Nov) MED.

ADMISSION UNIT 2 (until 6th Nov) MED.

ADMISSION UNIT 2 (from 6th Nov) MED.

ADMISSION UNIT 3 (now closed) MED.
ADMISSION UNIT 4 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 SLEEP LAB Total Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Total Number of Admissions Hospital Activity Report 2015 Page 9 Dept Ward Number of Admissions 2015 Obs & Gynae Orthopaedics Surgery Paediatrics Other DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2 OBSTETRICS WARD 3 Total ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 Total BURNS UNIT E.N.T.
WARD FAIRYLAND PRE-ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 Total DISNEYLAND NEONATAL/PAED.

INT.
CARE PAEDIATRICS DAY CARE RAINBOW WARD** WONDERLAND Total A&E AREA2 A&E PAEDIATRIC CORRIDOR DAY CARE UNIT (ENDOSCOPY) DAY CARE UNIT (SURGERY) DAY CARE RECOVERY DISCHARGE LOUNGE,MDH*** INTENSIVE THERAPY UNIT Hospital Activity Report 2015 Page 10 Dept Ward MEDICAL ADMISSIONS UNIT 1 EXT OBSERVATION WARD (now closed) OBSERVATION WARD 1 (from 29th Oct) OBSERVATION WARD 2 (from 29th Oct) OPHTHALMIC WARD PSYCHIATRIC UNIT MD Wait**** Grand Total Number of Admissions 2015 1455 1090 721 236 4349 407 112 90128 *Haematology migrated to SAMOC.
Activity at MITU now registeres ward attenders more than admissions **Migrated to SAMOC ***Patients are admitted to discharge lounge before leaving the hospital after being discharged from the wards ****Patients are admitted to MD WAIT prior to admission to respective ward Source: CPAS Hospital Activity Report 2015 Page 11 3 WARD ATTENDERS 3.1 Ward attenders 2015 There were 43791 (+3% 2014) registered ward attenders in 2015.
A ward attender is a patient coming for treatment to the ward and not using a bed to receive care.

Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.

Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.
All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed to compile the following tables.

The graph below shows the number of registered ward attenders from 2009-2015.
*IT system changeover Hospital Activity Report 2015 Page 12 3.2 Ward Attenders by Consultant Speciality Speciality A&E Anaesthesia/Pain relief Cardiac surgery Cardiology Dental Dermatology ENT Genetics Haematology* Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Investigations & Treatment** Neurology Neurosurgery Nursing Team Obstetrics & Gynae Ophthalmology Orthopaedics Paediatrics Psychiatry Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics Surgery/Urology Surgery/Vascular Other Grand Total n/a 1159 390 17 3654 1022 3622 5948 43 869 917 567 5866 2753 124 0 42485 % Difference -73 -64 +4 +365 +60 +288 -12 +500 -29 -36 -63 +4 -64 +264 -37 -47 n/a -9 +5 +47 +3 +77 +12 -11 -65 -40 -50 -19 -17 +9 +15 0 +3 *migrated to SAMOC **these ward attenders were registered as out-patient attendances and hence cannot be distributed according to the respective speciality.
This could reflect a decrease in ward attenders in other specialities.

Source: CPAS Hospital Activity Report 2015 Page 13 3.3 Ward Attenders by Department and Ward The table below illustrates the number of registered ward attenders to the respective department and ward in 2015.

Department Ward Number of Registered Ward Attenders 2015 Cardiology Cardiothoracic Surgery Medicine Neurosciences Obs & Gynae CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD Total CARDIAC INT.

CARE UNIT CARDIOTHOR.


SURGERY UNIT Total INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.
ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 RENAL UNIT Total NEURO-MEDICAL WARD NEURO-SURGICAL WARD Total DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2 OBSTETRICS WARD 3 Total Hospital Activity Report 2015 Page 14 Department Ward Orthopaedics Paediatrics Surgery Other Grand Total Source: CPAS ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 Total DISNEYLAND NEONATAL/PAED.
INT.

CARE NURSERY 1 (OBST.

WARD 1) NURSERY 3 (OBST.

WARD 3) PAEDIATRICS DAY CARE RAINBOW WARD WONDERLAND Total BURNS UNIT E.N.T.

WARD FAIRYLAND PRE-ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 Total DAY CARE UNIT (ENDOSCOPY) DAY CARE UNIT (SURGERY) DISCHARGE LOUNGE OBSERVATION WARD 1 OBSERVATION WARD 2 OPHTHALMIC WARD MED.

INVEST.

& TREAT.
INVEST.

& TREAT.

UNIT PSYCHIATRIC UNIT MD Wait Number of Registered Ward Attenders Hospital Activity Report 2015 Page 15 4 OUT-PATIENT ACTIVITY 4.1 Out-Patient 2015 There were 480214 (+9% 2014) registered out-patient attendances in 2015.

The average daily attendance per clinic day was 1595 attendances for 301 clinic days.
Registered attendances by type:  New Cases : 67623 (14%)  Follow-ups : 199630 (42%)  Walk-ins : 135034 (28%)  Any Cases : 77922 (16%) The graph below shows the number of out-patient attendances by month and type of attendance in 2015.
Hospital Activity Report 2015 Page 16 4.2 Clinic Activity according to department and clinics grouped into the clinic description and attendance type The table below illustrates the number of outpatient attendances by type of attendance and clinic description for every department at MDH whilst comparing the difference in the number of registered attendance between 2015 and 2014.

The clinics were grouped together to create the clinics report description to further ease analysis and interpretation of data.
For example all medicine respiratory clinics grouped into Medicine & Respiratory OP.
Department Anaesthesia/P ain Relief Anaesthesia/P ain Relief Total Anaesthesia/P re-op Anaesthesia/P re-op Total Cardiac Surgery Cardiac Surgery Total Cardiology Cardiology Total Clinics Report Description New- Case Follow- Up Walk- In Any- Case Pain Clinic 1568 1714 186 1568 1714 186 3 3 Total 2015 3471 Total 2014 % Diff - - 3471 3647 -5 Pre-operative assessment clinic 1433 453 1228 1397 4511 - - Cardiac Surgery Clinic Blood Pressure (Cardiology) Cardiac Rehabilitation Clinic (nurse-led) Cardiology (Adult/Cong.
Heart Disease) Cardiology OP Cardiomyopathy Clinic Heart Failure Clinic (Nurse led) Holter ECG (Cardiologist) ICD Clinic (technician led) Pacemaker Clinic (technician led) Pacemaker Wound Check Cl (nurse-led) Stress ECG (Cardiology) 1433 453 1228 1397 4511 3482 +30 - - - - 6 967 967 - - 27 27 44 977 13 11 1618 40 6263 163 1207 9 124 1118 - - 124 1118 1358 -18 776 820 777 +6 977 1507 -35 85 878 115 118 -3 9966 212 6699 74 +49 +186 - - -- 320 1319 1639 1263 90 57 1901 693 1467 700 636 +30 +30 -1 22 257 3669 3949 3789 +4 - 1174 95 10 466 586 561 672 1770 1836 -17 -4 1811 1 - - 3476 7635 3077 8415 22603 20446 +11 Hospital Activity Report 2015 Page 17 Department Chinese Medicine Chinese Medicine Total Dental Dental Total Dietician Dietician Total Genetics Genetics Total Infection Control Infection Control Total Clinics Report Description New- Case Follow- Up Walk- In Any- Case Chinese Medicine clinic 404 2466 131 - Total 2015 3001 Total 2014 % Diff - Child Dental Clinic Cleft Lip & Palate Clnic (Dental) Dental Clinic Dental Clinic (A&E) Dental Clinic (Consultants) Dental Clinic (Oral Hygiene) Dental Clinic (oral rehabilitation) Dental Clinic (Oral Surgery) Dental Clinic (Pre-op) Dental Clinic (Prosthetics) Dental Clinic (Scaling and Polishing) Dental Clinic (X-Ray) Dental Orthodontic Clinic Dental Teaching Dental VCC Dietetic Clinic Dietetic/Diabetes Clinic Dietician Clinic Dietician Renal Clinic Assisted Reporduction Clinic Genetics Genetics Clinic Hep.
B Titre Clinic Infection Control Clinic Infection Control Screening Influenza Vaccine Clinic MRSA Screening Clinic Needle Stick Injury Clinic - +3 +7 +3 404 2466 131 3001 2913 - - - - 52 2 8122 2 - 1681 1379 11677 210 71 4719 3 262 73 245 71 14220 13363 11701 13290 +22 +1 624 952 1671 2833 6080 6525 -7 - - 381 306 - - 1 592 28 - 10056 245 384 54 - 683 46 259 305 - - - - - - - - - 200 - - - 1 717 44 - 3595 94 219 49 - 362 41 323 364 - - - - - - - 768 5487 6255 7989 -22 369 691 1060 950 + -8 -30 -19 1406 2231 663 +237 435 8588 836 72 28074 - 283 64 85 432 - 1124 1124 1 - 37 - - - -18 +22 n/a -1 +4 -24 -23 -13 -18 - +17 +34 -75 -32 -8 +18 +7 -33 38 2267 2294 -1 Hospital Activity Report 2015 Page 18 Department Medicine Clinics Report Description Ambulatory Sleep Studies Asthma Clinic Baromedicine Coeliac Disease Clinic Congestive Heart Disorder Clinic COPD Clinic CTD Clinic Diabetes Clinic Diabetes Clinic (Bleeding room) Diabetes Clinic (follow- ups) Diabetes Clinic (Juvenile) Diabetes Education Unit Diabetic Foot Clinic Diabetic Retinopathy Clinic Dietician Clinic Nephrology EAC Clinic (Early Arthritis) Endocrine & Medical Clinic Endocrine Clinic Fibromyalgia Clinic General Medicine Clinic Gestational Diabetes Clinic IBD Clinic Infectious Diseases Joint Injection Clinic Lipid Clinic Medical & Respiratory OP Medical OP Medicine/Nephrology MOP General & Inf.
Diseases MOP Liver Clinic MOP VCC Respiratory MOP/Gastroenterology MOP/Gastroenterology/H epatic MOP/Gastroenterology/V CC Nephrology Neuroendocrine Clinic Pulmonary Fibrosis Hospital Activity Report 2015 New- Case - 317 - - Follow- Up - 2041 - 6 Walk- In 136 142 1128 - Any- Case 674 161 105 - Total 2015 810 2661 1233 6 Total 2014 357 2577 1350 0 - - 2 122 124 0 % Diff +127 +3 -9 - - - +17 -4 - 71 1303 110 4 3138 14 2 2026 - - - 141 - - - 120 688 341 - 283 - - 70 30 279 1237 2754 394 747 - - 752 306 - 373 - 25 133 814 1540 1932 - 759 1 2 - - 58 2241 3649 2065 1 - 1348 1318 672 - 1082 - 8 890 12 209 2169 7942 - 1651 803 - 1196 1439 - 1717 14 104 860 4 128 4 - 631 115 25 503 3555 171 228 89 - 470 168 - 477 94 10 26 - - - - 150 77 6467 0 66 6725 947 1601 -41 3472 3689 -6 104 - 5509 162 3141 9159 118 3520 8066 +37 -11 +14 - 35 - - - 64 - - 3 211 - 653 357 99 - - 10 - - 25 221 222 - 2067 2218 -7 36 120 125 110 3354 3434 1873 68 1493 1651 0 1313 4 29 8 1594 368 513 4562 14608 664 0 1130 243 574 4457 15158 645 -71 +9 -2 +13 - +14 -86 - +41 +51 -11 +2 -4 +3 2626 2657 -1 892 10 2418 780 85 2132 1913 1905 25 2788 330 139 0 2363 313 111 +14 -88 +13 0 - +18 +5 +25 Page 19 Department Medicine Total Neurosciences Clinics Report Description Pulmonary Function Lab (Nurse Led) Rheumatoid Podiatry Clinic Rheumatology Ankylosing Spondylitis Rheumatology Clinic Rheumatology Clinic (nurse led) Rheumatology Injection Clinic (Nurse led) Rheumatology Rapid Access Rheumatology/Bone Clinic Sleep Disorders Clinic Sleep OP Clinic Sleep Pap Clinic SLH Chest Clinic Stress ECG (Medicine) Systemic Sclerosis Clinic TB/Cardiopulmonary Geriatrics Thyroid Clinic Transplant/Travel Wound Clinic Wound Clinic (Hyperbaric) EEG EMG Evoked Potentials Clinic (Neurology Team) MOP Neurology Movement Disorder Multiple Sclerosis Neuro EEG Monitoring Neurocognative Clinic Neuroepilepsy Clinic Neurology VCC Neuromuscular Clinic Neurosurgical Clinic DBS follow-up Neurovascular Clinic New- Case Follow- Up 1 - 34 1 - - 306 3746 334 Walk- In 6491 64 - 512 569 Any-
 Case Total 2015 Total 2014 8 6501 5616 % Diff +16 516 580 512 +13 - 33 33 34 44 -23 4597 4446 936 860 - 148 698 846 878 -- 265 156 +70 - - - - - - - - - 34 - - 7 - - 262 2 - - 1835 -- - - - 20 - - - 236 127 - - - 10613 - 3 35190 - - 33345 20 - 10736 1308 1856 89884 1328 1859 86712 750 2707 68 1061 30 - 15 29 19 - 63 475 - 8 - 1 3209 142 134 - 20 124 - 168 1064 - 32 1221 6 4 5 11 1 3 107 35 3 - 937 - - - - - - - 1 - - 69 55 6428 178 138 15 54 154 1 234 1647 35 43 5586 153 114 6 92 157 22 199 1551 24 76 +3 +9 -4 -60 -75 +35 +50 -37 +22 -10 -2 +7 +3 +10 +29 +4 +77 -31 +25 +15 +16 +21 +150 -41 -2 -95 +18 +6 +46 -43 Neurosciences Total 1771 4893 1417 4102 12183 11492 +6 Hospital Activity Report 2015 Page 20 Department Neurosciences /Psychiatry Neurosciences /Psychiatry Total Obs & Gynae Obs & Gynae Total Ophthalmology Clinics Report Description Neuropsychiatric joint clinic Antenatal Clinic Assisted Reproduction Clinic Assisted Reproduction Clinic Counselling Breastfeeding Clinic (Midwife led) CTG Clinic Diabetic Pregnancy Clinic Gynae Endocrine Clinic Gynae OP Gynae OP Miscarriage Clinic Gynae Urodynamics Obstetrics & Gynaecology Ultrasound Outreach Midwifery Ophthalmic Botox Clinic Strabismus Ophthalmic Glaucoma Ophthalmic IVFA Ophthalmic Laser Ophthalmic Low Vision Clinic Ophthalmic OP Ophthalmic OP (Botox Clinic) Ophthalmic OP (Vitreoretinal) Ophthalmic OP A&E Referrals Ophthalmic Optometry/Refraction Clinic Ophthalmic Orthoptics Ophthalmic Peripheral Visual Fields Ophthalmic Post-OP Clinic Ophthalmic Retina Ophthalmic Special Hospital Activity Report 2015 % Diff - - - +56 n/a -2 -28 +10 +524 n/a -12 -12 +29 +27 -6 +14 -3 +5 New- Case Follow- Up Walk- In Any- Case Total 2015 Total 2014 113 22 54 198 - 113 22 54 198 190 +4 3422 6694 1603 - 11719 14327 -18 22 2168 121 2311 9 9 - - - - - - - 14 55 4841 - 28 28 12290 30 21 - - -
 - - 8906 1524 2 650 3518 127 209 1770 - 211 - - - - 2439 975 2033 - 14 149 15 57 2 1557 15591 1118 - 203 243 457 2 13 - - - 3059 1390 590 1 - - - - 1 3 - - - 9 69 1 - 1 0 0 1 8906 5720 1524 44 733 20650 181 209 56 45 1024 18720 29 3 1770 2002 53 - 1 75 67 76 2799 991 2165 2174 779 2315 139 141 124 18275 18824 274 262 714 821 -13 3059 1776 +72 1981 1787 +11 18599 - 18599 10985 +69 8362 37682 20477 126 66647 52911 +26 545 629 318 3451 4943 4466 +11 - - - - - 401 586 - 14 22 36 10 168 - - 214 182 423 622 224 189 360 811 63 -4 +18 -23 +256 Page 21 Department Ophthalmology Total Orthopaedics Orthopaedics Total Orthotics & Prosthetics Orthotics & Prosthetics Total Paediatrics Clinics Report Description Ophthlamic (Cornea) Ophthalmology VCC New- Case 626 - Follow- Up 3474 21 Walk- In 353 - Any- Case - - Total 2015 4453 21 Total 2014 2469 17 % Diff +80 +24 OOP Foot Ankle Clinic Orthopaedic FTC Orthopaedic OP Orthopaedic OP (General/Paediatrics) Orthopaedic Plaster Clinic Orthopaedic VCC Orthopaedic VCC (Shoulder) Orthopaedic VCC (Spinal) Orthopaedics VCC (Hand Clinic) Sport Injury Clinic Orthopaedic Outreach Orthotics/Prosthetics Clinic (at SLH) Orthotics/Prosthetics Clinic (Paediatrics) (at SLH) Children's OP Children's OP (Cardiology/General) Children's OP (Endocrine) Children's OP (Endocrine/General) Children's OP (Neuro- paed) Children's OP (Neuro- paed/General) Children's OP Nursery Community Paediatric Clinic COP (Bleeding Room) Diabetes Clinic Paediatrics Neonatal/NPICU F/U Paediatric Cardiology Paediatric Diet Clinic 3182 28199 5772 4181 41334 37313 +11 310 - 5002 759 476 11819 1108 156 5785 70 3983 445 2252 4615 23051 1008 4017 21989 +123 +15 +5 771 1526 954 - 79 19 39 - - - - 108 28 172 - - - 6194 5 2 11 - 12 - - - 23 - - 51 85 1588 3251 2920 6194 215 5458 228 49 222 51 97 1588 230 194 143 0 573 +11 +13 -6 -79 +14 -64 - +177 6220 14888 14227 6245 41585 36760 +13 - - - 2818 1630 439 486 3257 2116 - - - 907 4052 33 117 90 86 57 - 32 - - 8 - 114 473 374 188 226 178
 6 81 - 456 51 - 100 577 212 46 120 30 20 36 37 2 32 2778 22 9 47 5 - - 56 87 6 45 - - 162 - - 4448 3942 +13 925 0 - 5373 3942 +36 5582 6444 -13 838 521 298 865 500 348 -3 +4 -14 404 366 +10 359 14 190 283 +27 14 207 0 -8 2778 2149 +29 478 230 47 219 462 239 0 231 +3 -4 - -5 Page 22 Hospital Activity Report 2015 Department Paediatrics Total Psychiatry Psychiatry Total Surgery Clinics Report Description Paediatric Gastroenterology Paediatric Infant Wheezer Clinic Paediatric Rheumatology Clinic Paediatric-VCC-Nutrition Paediatrics-Development- Clinic Paediatrics-General-&- Inf-Diseases Paediatrics-Infectious- Diseases-Clinic Paediatrics-Nephrology Paediatrics-Respirarory- Medicine Paediatrics-VCC- Endocrine Paediatrics-VCC- Nephrology Paediatrics-VCC-Oncology CDAU Stress-ECG-(Paediatrics) Perinatal-Mental-Health- Clinic Psychiatric-OP Psychiatry-ADHD-Clinic Psychiatry-Child- Guidance-Clinic Psychiatry-Disability- Clinic New- Case Follow- Up Walk- In Any- Case Total 2015 Total 2014 % Diff 170 289 100 - 1 3 67 - - 25 52 142 221 101 117 116 - 6 - 17 - 361 - 122 23 32 - 96 - 6 2 - 50 36 38 48 60 2 1 - 15 19 46 27 76 - - - - 312 13 - 4 14 375 - 605 1130 -46 33 79 28 -55 -5 74 83 0 169 121 +40 399 358 +11 500 477 311 25 43 14 503 19 425 288 305 25 26 15 - 46 +18 +66 +2 0 +65 -7 - -59 2184 7406 4184 1389 15163 15004 +1 18 491 - - - 154 293 6510 - - - 5265 23 409 90 - 154 - - - 465 342 +36 12420 23 11495 106 409 1321 +8 -78 -69 90 316 -72 509 6664 6080 154 13407 13580 -1 ENT-Audiology-(paed) ENT-Dizziness-Clinic ENT-Hearing-Loss-Clinic ENT-OP ENT-OP-Oncology ENT-OP-Voice-Clinic ENT-Tinnitus-Clinic ENT/Audiology-(Hearing- Aids) Paediatric-Surgery- Paediatric-Surgery-VCC SOP 674 615 1235 2531 - - 86 226 675 436 6556 585 15 90 62 108 121 3371 23 - 15 - - - - - 4 - - - - +38 +24 +19 -9 +2 n/a -22 -89 -24 +85 0 Hospital Activity Report 2015
 Page 23 Clinics Report Description SOP-(Stoma-Clinic) SOP-Bariatric-Clinic SOP-Dermatology- Referrals SOP-Plastic Urology-Clinic Urology-Clinic-(Pre-ops) Urology-Clinic-VCC Urology-Male-Infertility- Clinic Urology-Outreach-Clinic Vascular-Surgery-Clinic Thalassaemia-Clinic Thalassaemia- Phlebotomy-Clinic Tissue-Viability-Clinic TVU-Outreach Department Surgery Total Thalassaemia Thalassaemia Total Tissue- Viability Tissue- Viability Total Grand Total New- Case - 105 286 552 1650 12 111 - 1122 16848 - Follow- Up 1 114 - 1733 12079 90 21 Walk- In 91 23 13 34 1466 10 - Any- Case 454 - - - - - - Total 2015 546 242 Total 2014 475 237 299 283 2319 15195 100 33 2126 15282 471 0 67 25 30 233 0 - 2590 43782 - 595 329 10470 192 1555 323 4425 504 2150 4364 75525 696 1583 3368 72955 590 989 1 990 643 % Diff +15 +2 +6 +9 -1 -79* - - +36 +30 +4 +18 +54 - - - - - - - - - - 1181 505 1686 1233 +37 1025 6037 7062 5814 +21 54 361 415 - n/a 1079 6398 7477 5814 +29 67623 199630 135034 77922 480214 442262 +9 *this clinic is probably using anaesthesia/pre-op instead to register patients.
Notes: 1) Haematology not included due to migration to SAMOC.

2) A number of cardiology clinics have been excluded from analysis since the activity is not being registered on CPAS but on cardiology system.

These include 7 Day Holter Clinic (Cardiol-tech led), Adult Heart Disease, Cardiac cath Suite (Cardiology Clinic), ECG Clinic (12 lead), Echocardiogram (cardiology).

3) Pathology activity for clinics ACC Phlebotomy, Bleeding Room (OGTT) and Phlebotomy Pathology have been excluded.
4) Sleep disorders clinic (domiciliary) has been excluded.

5) Gynae bone density clinic has been excluded due to the activity being registered on radiology system rather than CPAS Source:-CPAS Hospital Activity Report 2015 Page 24 5 ACCIDENT & EMERGENCY ACTIVITY 5.1 A&E Attendances data The graph below shows the number of registered A&E attendances from 2008-2015.
Number of Registered A&E Attendances 140000 s e c n a d n e t t A E & A f o r e b m u N 120000 100000 80000 60000 40000 20000 0 2008 2009 2010 2011 2012 2013 2014* 2015 Registered A&E Attendances 106907 101439 107102 110279 111533 115706 119941 128747 Registered A&E Attendances *IT system changeover Hospital Activity Report 2015 Page 25 5.2 A&E Attendances 2015 There were 128747 (+7% 2014) registered A&E admissions in 2015.

The average daily attendance rate was of 352/day (329/day 2014).
Type of A&E Attendance registration:  Self-referral:  Doctor referral:  Other: 94357 (73%) 30643 (24%) 3747 (3%) The monthly number of registered A&E attendances in 2015 and compared to 2014 can be seen in the chart below: A&E Attendances s e c n a d n e t t A f o r e b m u N 14000 12000 10000 8000 6000 4000 2000 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015 10210 9309 10476 10211 10816 10631 11554 12064 10848 10947 10793 10888 2014 9492 8573 9607 9859 10059 9991 10878 11275 9474 10026 9819 9808 Month Source:-CPAS Hospital Activity Report 2015 Page 26 5.3 Attendances by Priority Codes Attendances by ESI Category 2015 s e c n a d n e t t A f o r e b m u N 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 ESI-1 ESI-2 Total Registered Attendances 1143 38625 ESI-3 38740 ESI-4 38480 ESI-5 8501 Other 3258 ESI Category Source:-CPAS Total Registered Attendances Hospital Activity Report 2015 Page 27 5.4 A&E Attendances according to hospital identification number/ID letter The chart below shows the percentage of A&E attendances according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
Registered A&E Attendances 2015 7% 3% 8% 1% Non-Maltese Residents New Born Foreigners Gozitan Maltese 81% Source: CPAS Hospital Activity Report 2015 Page 28 5.5 A&E Attendances according to attending department and ESI breakdown The table below shows the number of A&E registrations grouped by the ESI severity index and the attending department.

The percentage difference between 2015 and 2014 can also be seen.
Department & ESI Category A&E ESI-1 ESI-2 ESI-3 ESI-4 ESI-5 A&E TRIAGE SKIP Total Medical Paediatrics ESI-2-PAEDS ESI-3-PEADS ESI-4-PEADS ESI-5-PEADS Total Dental ESI-3-DENTAL ESI-4-DENTAL ESI-5-DENTAL Total ENT ESI-3-ENT ESI-4-ENT ESI-5-ENT Total Obstetrics & Gynaecology ESI-3-OBS ESI-4-OBS ESI-5-OBS Total No of A&E Registered Attendances 2015 1143 36242 28228 18068 4432 3202 91315 2383 5509 3431 806 12129 67 1319 356 1742 1158 4370 678 6206 2738 2046 279 5063 2014 % Difference 1039 29589 23197 16633 5478 1046 76892 2168 4211 3354 1196 10929 66 1076 548 1690 673 3467 1069 5209 2027 1828 486 4341 +10 +23 +22 +9 -19 +206 +19 +10 +31 +2 -33 +11 +2 +23 -35 +3 +72 +26 -37 +19 +35 +12 -43 +17 Hospital Activity Report 2015 Page 29 Department & ESI Category No of A&E Registered Attendances Department & ESI Category No of A&E Registered Attendances Ophthalmology ESI-3-OPTH ESI-4-OPTH ESI-5-OPTH Total Psychiatry ESI-3-PSCH ESI-4-PSCH ESI-5-PSCH Total Other* 973 9177 1912 12062 77 59 38 174 56 558 7872 2970 11400 42 57 67 166 9224 Total A&E Attendances 128747 119941 +74 +17 -36 +6 +83 +4 -43 +5 -99 +7 *These may include attendances registered on the old triage system until the ESI severity index mechanism was fully rolled out.
Source: CPAS Hospital Activity Report 2015 Page 30 Hospital Activity Report 2016 A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS, Mater Dei Hospital ADMISSIONS, DAY CASES, OUT-PATIENTS, WARD ATTENDERS, Sir Anthony Mamo Oncology Centre Clinical Performance Unit Administration, Mater Dei Hospital DOCUMENT INFORMATION Version 1.0 Date published Document type June 2017 Annual statistical report Analysis and compilation David Borg Clinical Performance Unit Prof Sandra Buttigieg, Consultant Public Health, Head CPU Dr Sandra Distefano, Consultant Public Health David Borg, Principal Scientific Officer, RN Jane Agius, Assistant Principal CONTENTS 1 2 3 2.2 INTRODUCTION ......................................................................................................................................... 4 SECTION 1 MATER DEI HOSPITAL ACTIVITY ................................................................................................... 5 2.1 Accident & Emergency Activity .................................................................................................. 6 A&E Attendances 2016 ..................................................................................... 6 2.1.1 Source of Referral .............................................................................................. 7 2.1.2 A&E Attendances according to hospital identification number/ID letter ......... 8 2.1.3 A&E Attendances by ESI (Emergency Severity Index) Category ........................ 9 2.1.4 2.1.5 A&E Attendances according to attending department and ESI breakdown... 10 In-Patient Activity ..................................................................................................................... 13 Admissions (ADMIT) 2016 ............................................................................... 13 2.2.1 Admissions by Month ...................................................................................... 14 2.2.2 Demography .................................................................................................... 15 2.2.3 Admissions (ADMIT) Vs Discharges (DISC) ...................................................... 17 2.2.4 2.2.5 Method of Admission ...................................................................................... 18 2.2.6 Method of Admissions by Consultant Speciality ............................................. 19 2.2.7 of stay (days) and % bed occupancy ............................................................................. 20 2.3 Ward Attenders ........................................................................................................................ 22 2.3.1 Ward Attenders 2016 ...................................................................................... 22 2.3.2 Ward Attenders by Consultant Speciality ....................................................... 23 2.3.3 Ward Attenders by Department and Ward .................................................... 24 2.4 Out-Patient Activity .................................................................................................................. 26 2.4.1 Out-Patient Attendances 2016 ....................................................................... 26 2.4.2 Out patient attendances by month and type of attendance .......................... 27 2.4.3 description and attendance type .................................................................................. 28 SECTION 2 SAMOC ACTIVITY ................................................................................................................... 35 3.1 Admissions 2016 ....................................................................................................................... 36 Admissions by ward ........................................................................................ 36 3.2 Out-Patient Attendances 2016 ................................................................................................. 37 3.3 Ward Attenders 2016 ................................................................................................................ 38 Admissions by department and ward including transfers in, average length Clinic Activity according to department and clinics grouped into the clinic 3.1.1 Hospital Activity Report 2016 Page 3 Mater Dei Hospital 1 INTRODUCTION The Hospital Activity Report 2016 presents an overview on the activity at Mater Dei Hospital (MDH) and Sir Anthony Mamo Oncology Centre (SAMOC) for the year 2016.
It details information on A&E attendances, admissions, discharges, ward attenders and out-patient attendances.

The data contained in this report have been compiled from registrations on CPAS, which is the patient administrative system at MDH and SAMOC and the primary source of data for this report.

The first section includes activity at MDH, highlighting information on A&E attendances, in-patient activity in the form of admissions and ward attenders and out-patient attendances.
The second section encompasses the main activity at SAMOC, including admissions to the wards, ward attenders and out-patient attendences.

The year 2016 has seen an increase in the number of patients attending at Mater Dei Hospital in the different departments and specialities of care.

A&E attendances increased by +7% on the previous year, admissions including day cases, elective and emergency increased by +2%, ward attenders increased by +5% and outpatient attendances increased by +4%.
Apart from the numbers presented in this report, it is important to note that the activity surrounding patient care includes important services such as pathology tests, renal dialysis, diagnostic procedures, radiological procedures, screening procedures and surgical operative procedures/interventions amongst other services that all contribute to providing holistic care for the well being of the patient.
One cannot forget to mention the collaborative and organised input by the multidisciplinary health care team at Mater Dei Hospital and Sir Anthony Mamo Oncology Centre to achieve the best health outcomes for our patients.

Disclaimer The accuracy of information in this document might be limited by factors beyond author’s control.

This document contains data which is subject to interpretation.
Before using this data for making decisions or drawing conclusions, users are encouraged to contact the Clinical Performance Unit for advice.

Hospital Activity Report 2016 Page 4 Mater Dei Hospital 2 SECTION 1 Mater Dei Hospital (MDH) Activity A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS Hospital Activity Report 2016 Page 5 Mater Dei Hospital 2.1 Accident & Emergency Activity 2.1.1 A&E Attendances 2016 In 2016 there were 137852 (+7% 2015) registered A&E attendances at the A&E Dept, MDH.
The average daily attendance rate was of 377/day (352/day 2015).

The graph below shows the number of registered A&E attendances from 2008-2016.

Note: A&E Attendances are patients visiting the A&E department, with cases ranging from minor walk in injuries to life-threatening accidents.
Registered A&E Attendances s e c n a d n e t t A E & A f o r e b m u N 160000 140000 120000 100000 80000 60000 40000 20000 0 2008 2009 2010 2011 2012 2013 2014* 2015 2016 Registered A&E Attendances 106907 101439 107102 110279 111533 115706 119941 128747 137852 *IT system changeover Illustration 1: number of registered A&E attendances over the years Hospital Activity Report 2016 Page 6 Mater Dei Hospital The monthly number of registered A&E attendances in 2016 and compared to 2015 can be seen in the graph below: Registered A&E Attendances 2015/2016 s e c n a d n e t t A f o r e b m u N 13000 12500 12000 11500 11000 10500 10000 9500 9000 8500 8000 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016 11965 11044 11420 11253 11909 11282 11903 12333 10982 11596 11000 11165 2015 10210 9309 10476 10211 10816 10631 11554 12064 10848 10947 10793 10888 Month Illustration 2: number of A&E attendances in 2016 and 2015 by month 2.1.2 Source of Referral The majority of A&E attendances were self referrals (75%) whilst doctor referrals accounted to 23% of attendances.
Source of Referral:  Self-referral:  Doctor referral:  Other: 103391 (75%) 31285 (23%) 3176 (2%) Hospital Activity Report 2016 Page 7 Mater Dei Hospital 2.1.3 A&E Attendances according to hospital identification number/ID letter The chart below shows the percentage of A&E attendances according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of A&E attendances were Maltese with 79% of the total attendances whilst non Maltese residents and foreigners made up 16% (22 000) of the A&E attendances in 2016.
Registered A&E Attendances 2016 8% 4% 8% 1% Non-Maltese Residents New Born Foreigners Gozitan Maltese 79% Illustration 3: Registered A&E attendances by hospital identification number/ID letter Hospital Activity Report 2016 Page 8 Mater Dei Hospital 2.1.4 A&E Attendances by ESI (Emergency Severity Index) Category The graph below presents the number of A&E Attendances according to the Emergency Severity Index done at triage level.
This includes all the attending departments, including A&E, paediatrics, ophthalmic, ENT, obstetrics and gynaecology, dental and psychiatric.

The majority of A&E attendances were categorized into ESI 3 and 4 followed by ESI 2 and ESI 1.

Note: The Emergency Severity Index (ESI) is a five-level emergency department triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resources needed.
Attendances by ESI Category 2016 s e c n a d n e t t A f o r e b m u N 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 ESI-1 ESI-2 Registered A&E Attendances 1408 38996 Illustration 4: Registered A&E Attendances by ESI Category ESI-3 41218 ESI-4 41812 ESI-5 8470 Other 5948 ESI Category Hospital Activity Report 2016 Page 9 Mater Dei Hospital 2.1.5 A&E Attendances according to attending department and ESI breakdown The pie chart below shows the percentage activity of A&E attendances according to the speciality/department that they were seen after triage.
The A&E dept attended to 66% of the total cases after triage, followed by the paediatric A&E dept with 13% of cases and the ophthalmic department with 11% of attendances.

The rest of the cases were attended to by the ENT dept, OBG dept and Dental dept.
A&E Attendances 2016 Attending Dept 0% 13% 11% 4% 5% 1% 66% A&E Dental ENT OBG Ophth Paeds Psych Illustration 5: Registered A&E attendances by attending department Hospital Activity Report 2016 Page 10 Mater Dei Hospital The table below shows the number of A&E registrations grouped by the Emergency Severity Index and the attending speciality/department.

The percentage difference in activity between 2016 and 2015 can also be seen.
Department & ESI Category A&E A&E TRIAGE SKIP ESI-1 ESI-2 ESI-3 ESI-4 ESI-5 Total Dental A&E TRIAGE SKIP ESI-3-DENTAL ESI-4-DENTAL ESI-5-DENTAL Total ENT A&E TRIAGE SKIP ESI-3-ENT ESI-4-ENT ESI-5-ENT Total OBG A&E TRIAGE SKIP ESI-3-OBS ESI-4-OBS ESI-5-OBS Total Ophth A&E TRIAGE SKIP ESI-3-OPTH ESI-4-OPTH ESI-5-OPTH Total Number of A&E Attendances 2016 2015 % Difference +334 +23 -3 +4 +1 -8 +2 +67 -13 +3 0 +2 +332 -5 +7 -6 +5 +84 0 +22 -23 +10 +9 -32 +4 -6 +1 Hospital Activity Report 2016 Page 11 Mater Dei Hospital Cont… Department & ESI Category Paeds A&E TRIAGE SKIP ESI-2-PAEDS ESI-3-PEADS ESI-4-PEADS ESI-5-PEADS Total Psych A&E TRIAGE SKIP ESI-3-PSCH ESI-4-PSCH ESI-5-PSCH Total Other A&E TRIAGE SKIP Number of A&E Attendances 2016 Department & ESI Category 2015 Number of A&E Attendances % Difference 28 3955 7349 5450 1326 18108 4 42 25 46 117 202 4 2383 5509 3431 806 12133 0 77 59 38 174 2 n/a +66 +33 +59 +65 +49 n/a -45 -58 +21 -33 n/a +7 Total A&E Attendances 137852 128747 Hospital Activity Report 2016 Page 12 Mater Dei Hospital 2.2 In-Patient Activity 2.2.1 Admissions (ADMIT) 2016 In 2016 there were 92191 (+2% 2015) registered admissions (in-patients and day cases) excluding renal unit1 and nursery2 registrations at MDH.
The average daily admission rate was of 253/day (247/day 2015).

The graph below shows the number of registered admissions from 2008-2016.

Note: an admission is a patient entering the hospital for in-patient service and at which the patient begins an episode of care.
Number of Admissions Over the Years s n o i s s i m d A f o r e b m u N 100000 90000 80000 70000 60000 50000 40000 30000 20000 10000 0 2008 2009 2010 2011 2012 2013 2014* 2015 2016 No of Admissions 66742 68060 71331 75075 77983 80931 89449 90128 92191 Year *IT administrative system changeover Illustration 6: Number of admissions over the years 1 In the Renal Unit, there were 16 461 registered admission episodes/dialysis sessions.

2 In the Nurseries, there were 3538 registered admission episodes.
Hospital Activity Report 2016 Page 13 Mater Dei Hospital 2.2.2 Admissions by Month The monthly number of registered admissions in 2016 and compared to 2015 can be seen in the graph below.

The highest number of admissions was registered in October with 8215 admissions whilst the lowest number was recorded in August with 7115 admissions.
Registered Admissions 2016/2015 s n o i s s i m d A f o r e b m u N 8400 8200 8000 7800 7600 7400 7200 7000 6800 6600 6400 6200 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016 8077 7533 7377 7836 8174 7317 7723 7115 7504 8215 8175 7145 2015 8073 7225 7682 7506 7263 7375 7786 7664 7202 7626 7747 6979 Month Illustration 7: number of admissions by month 2016/2015 Hospital Activity Report 2016 Page 14 Mater Dei Hospital 2.2.3 Demography Admissions according to hospital identification number/ID letter The chart below shows the percentage of admissions according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of admissions were made up of Maltese with 87% of the total admissions whilst non Maltese residents and foreigners made up 9% of the admissions in 2016.
Admissions Origin 2016 2% 3% 2% 6% Non-Maltese residents New Born Foreigners Gozitans Maltese 87% Illustration 8: Percentage of admissions according to origin Hospital Activity Report 2016 Page 15 Mater Dei Hospital Admissions according to Age and Gender Out of the total admissions to MDH this year, 52% were females and 48% were male admissions.

The remaining <1% of admissions had no gender specified.

The age and gender distribution can be seen in the table below.
The highest increases in admission age groups from the previous year were noted in the 65-74 and 95+ age brackets.

This highlights the notion that the hospital and health care are catering more to the demands of an ageing population.
Age Group (yrs) <5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-94 95+ Unspec Grand Total Males 2156 1651 1903 2998 3377 4661 8054 10307 6572 1901 116 56 43752 Gender and Age Population Admissions Females Unspecified Total 2016 Total 2015 % Difference +2 -2 -2 +3 +5 -4 +4 +7 0 -1 +21 +21 +2 Hospital Activity Report 2016 Page 16 Mater Dei Hospital 2.2.4 Admissions (ADMIT) Vs Discharges (DISC) The illustration below depicts the average number of admissions and discharges per day according to day of week in 2016 (excluding renal unit and nursery registrations).
The highest average number of admissions was recorded on Mondays with 299 admissions and the lowest average number on Sundays with 159 admissions.

The same scenario was noticed with the average number of discharges, with Mondays recording the highest average number with 290 discharges and the lowest on Sundays with an average of 96 discharges.
Average Daily Admissions and Discharges 2016 s e g r a h c s i D & s n o i s s i m d A f o r e b m u N 350 300 250 200 150 100 50 0 Monday Tuesday Wednesda y Thursday Friday Saturday Sunday Admissions Discharges 299 290 278 289 273 271 278 275 249 268 229 263 159 96 Average number of admissions & discharges Illustration 9: average number of admissions and discharges by day of week (excluding renal unit and nursery activity) Hospital Activity Report 2016 Page 17 Mater Dei Hospital 2.2.5 Method of Admission The method of admission was analysed by using the type of admission inputted by ward staff and assumptions3 when type was not inputted correctly.
The below shows a breakdown of admissions by type.
Type of admission registrations in 2016 (and percentage difference on 2015):  Day Case4: 32462 (+8%)  Elective5: 15315 (-8%)  Emergency6: 40353 (+2%)  Other*: 4061 (+5%) *includes delivery of new born & obstetrics admissions Method of Admission 2016 4% 35% 44% 17% Day Case Elective Emergency Other* * includes delivery of new born & obstetrics admissions Illustration 10: method of admission 3 Assumptions were based on the nature of the diagnosis, the ward and the length of stay when available.
4 Day cases are admissions which do not require an overnight stay.

5 Elective are planned admissions.

6 Emergency are unplanned, often urgent admissions.

Hospital Activity Report 2016 Page 18 Mater Dei Hospital 2.2.6 Method of Admissions by Consultant Speciality The admissions for 2016 were analysed according to the method of admission and consultant speciality and presented in the table below.

The figures exclude the renal unit and nursery admissions.
Consultant Speciality Day Case Elective Emergency Other A&E Anaesthesia/Pain relief Cardiac surgery Cardiology Dental Dermatology ENT ENT/Audiology Genetics Haematology* Infection Control Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obstetrics & Gynae Oncology* Ophthalmology Orthopaedics Paediatrics Psychiatry Sleep Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics** Surgery/Urology Surgery/Vascular Grand Total *Admissions from SAMOC.
Haematology & Oncology migrated to SAMOC in early September 2015.

** These admissions might include ward attenders which were inadvertently admitted into admission beds rather than ward attender beds, hence one cannot distinguish actual admissions from ward attenders (see ward attender section).
11 1971 295 1135 438 28 144 2 45 4 - 28 26 3289 6 29 226 90 4 2 2694 - 5545 1719 558 25 - 3007 5719 5 1449 3573 395 32462 1453 5 179 2134 30 - 508 19 - 284 - 3840 2472 2160 1377 2875 2847 2369 1144 227 2031 3 156 2411 3252 153 - 2723 2345 766 127 1722 741 40353 11 18 423 195 84 - 1379 5 3 59 5 102 81 268 76 207 106 95 113 271 3580 3 731 1904 169 203 20 704 1192 437 499 1522 850 15315 3 - - 6 - - - - - - - 1 4 1 2 2 3 1 - - 4019 - - 1 8 2 - 3 2 2 1 - - 4061 Total 2015 826 1922 849 3503 484 16 2085 n/a 42 503 n/a 4114 2652 5338 1344 3417 3170 2637 1173 455 12369 n/a 6202 5620 4063 410 31 6162 9356 1318 1484 6724 1859 90128 Total % Difference +79 +4 +6 -1 +14 +75 -3 n/a +14 -31 n/a -3 -3 +7 +9 -9 0 -3 +8 +10 0 n/a +4 +7 -2 -7 -35 +4 -1 -8 +40 +1 +7 +2 Hospital Activity Report 2016 Page 19 Mater Dei Hospital 2.2.7 Admissions by department and ward including transfers in, average length of stay (days) and % bed occupancy The table below illustrates the number of registered admissions to the admitting wards grouped together by the corresponding department including transfers in, average length of stay and the percentage (%) bed occupancy for 2016.
The transfers in (clinic changes) to the wards were also included in this table to provide a more complete picture of the input of patients into the wards.

Transfers in/out occur when patients are transferred from one ward to another within MDH.

Dept Ward Cardiology Cardiothoracic Surgery Medicine CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.
ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 RENAL UNIT SLEEP LAB Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 Total Admissions 2016 1327 776 1266 Total Transfers In 2016 19 323 1453 Average of Length of Stay (days) % Bed Occupancy 10 64 85 48 75 68 85 82 74 92 93 93 91 91 93 94 94 95 2 3 90 80 48 73 73 Hospital Activity Report 2016 Page 20 Mater Dei Hospital Dept Ward Orthopaedics Surgery Paediatrics Other OBSTETRICS WARD 2 OBSTETRICS WARD 3 ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 BURNS UNIT E.N.T.
WARD FAIRYLAND PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DISNEYLAND NEONATAL/PAED.

INT.
CARE NURSERY 1 NURSERY 3 PAEDIATRICS DAY CARE * WONDERLAND A&E AREA2 A&E PAEDIATRIC CORRIDOR DAY CARE UNIT (ENDOSCOPY) ** DAY CARE UNIT (SURGERY) ** DISCHARGE LOUNGE *** INTENSIVE THERAPY UNIT OBSERVATION WARD 1 OBSERVATION WARD 2 OPHTHALMIC WARD PSYCHIATRIC UNIT MD WAIT**** Total Admissions 2016 1707 949 Total Transfers In 2016 467 1780 Average of Length of Stay (days) % Bed Occupancy *Beds at Paeds Day Care were being used to admit emergency medical cases in case of influx in admissions ** Beds at Day Care Unit Surgery and Endoscopy were being used to admit emergency medical cases in case of influx in admissions ***Patients are transferred to the discharge lounge before leaving the hospital after being discharged from the wards.
***Patients are admitted to MD WAIT prior to admission to respective ward.

Hospital Activity Report 2016 Page 21 Mater Dei Hospital 2.3 Ward Attenders 2.3.1 Ward Attenders 2016 In 2016 there were 45914 (+5% 2015) registered ward attenders in the wards at MDH.

The graph below shows the number of registered ward attenders from 2009-2016.

Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.
Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.

Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.

All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed to compile the following tables.
Registered Ward Attenders s r e d n e t t A d r a W f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 2009 2010 2011 2012 2013 2014* 2016 2016 Number of Ward Attenders 18935 25150 31500 44350 47596 42485 43789 45914 Year *IT system changeover Illustration 11: number of ward attenders over the years Hospital Activity Report 2016 Page 22 Mater Dei Hospital 2.3.2 Ward Attenders by Consultant Speciality The ward attenders for 2016 were analysed according to the consultant speciality and presented in the table below.
The percentage difference in the totals compared with 2015 can also be found.
Speciality A&E Cardiac surgery Cardiology Dental Dermatology ENT Genetics Haematology* Investigations & Treatment** Nursing Team Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obstetrics & Gynae Ophthalmology Orthopaedics Paediatrics Psychiatry Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics Surgery/Urology Surgery/Vascular Other Grand Total *migrated to SAMOC **these ward attenders were registered as out-patient attendances and hence cannot be distributed according to the respective speciality.
This could reflect a decrease in ward attenders in other specialities.
% Difference +393 +14 +1 +38 -16 -17 -23 -96 +176 +40 -29 -69 -32 +383 -1 -33 -28 -58 +18 +68 -73 -11 -7 +480 -23 -10 -22 -12 +13 +77 -60 +5 Total Total Hospital Activity Report 2016 Page 23 Mater Dei Hospital 2.3.3 Ward Attenders by Department and Ward The table below illustrates the number of registered ward attenders to the respective department and ward in 2016 compared with 2015.
Clinic Total 2016 Total 2015 % Difference Dept Cardiology Cardiothoracic Surgery Medicine CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.


ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 RENAL UNIT Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae Orthopaedics Paediatrics DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2 OBSTETRICS WARD 3 ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 DISNEYLAND NEONATAL/PAED.

INT.

CARE NURSERY 1 (OBST.
WARD 1) +17 -34 -53 -63 +15 +274 +40 +168 -92 -2 -37 +8 +30 +16 -29 -67 +400 n/a -10 -58 +20 +256 -91 0 +88 -41 -19 -18 +69 -66 -20 +200 Hospital Activity Report 2016 Page 24 Mater Dei Hospital Cont… Dept Surgery Other Grand Total *migrated to SAMOC Clinic NURSERY 3 (OBST.
WARD 3) PAEDIATRICS DAY CARE RAINBOW* WONDERLAND Total 2016 1 5165 0 32 Total 2015 7 3303 1719 52 % Difference -86 +56 n/a -38 BURNS UNIT E.N.T.

WARD FAIRYLAND PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DAY CARE UNIT (ENDOSCOPY) DAY CARE UNIT (SURGERY) DISCHARGE LOUNGE INTENSIVE THERAPY UNIT MED.

INVEST.

& TREAT.
UNIT,MDH OBSERVATION WARD 1 OBSERVATION WARD 2 OPHTHALMIC WARD PSYCHIATRIC UNIT MD Wait -88 -17 -51 +29 -2 -44 +29 -39 +81 -25 -13 +11 -5 -27 -82 n/a n/a +20 +643 +100 -75 +562 n/a +5 Hospital Activity Report 2016 Page 25 Mater Dei Hospital 2.4 Out-Patient Activity 2.4.1 Out-Patient Attendances 2016 In 2016 there were 497399 (+4% 2015) registered clinic attendances at the out-patient department.
The average daily attendance per clinic day was 1647 attendances for 302 clinic days (2015: 1595 for 301 clinic days).

Note: an outpatient attendance is a patient visiting the outpatients department for ambulatory care including consultations, diagnosis, observation, treatment and other care from support areas.
Registered attendances by type in 2016 (and percentage difference on 2015):  New Cases7: 81378 (+20%)  Follow-ups8: 203512 (+2%)  Walk-ins9: 130917 (-3%)  Any Cases10: 81592 (+5%) Out patient attendances by type 2016 26% 16% 17% 41% Any Follow Up New Case Walk In 7 New cases are new outpatient appointments which are planned and given a date and time beforehand.

In this case, the patient will not have had a previous outpatient appointment related to the case.
8 Follow up cases are outpatient appointments which are planned to provide continuing or further attention to a previous related appointment.

The appointment will be planned and given a date and time beforehand.

9 Walk ins are unplanned outpatient attendances.

The patient turns up for an outpatient visit without a planned date and time for appointment.

10 These are cases registered as any in the system to allow for flexibility when booking patients.

These cases could be new cases or follow ups.


Hospital Activity Report 2016 Page 26 Mater Dei Hospital 2.4.2 Out patient attendances by month and type of attendance The graph below shows the number of out-patient attendances by month and type of attendance in 2016.

November registered the highest amount of outpatient attendances with 46 000 attendances whilst the lowest number of attendances was recorded in December with 33 100 attendances.
Registered Out-Patient Attendances 2016 s e c n a d n e t t A f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 2016 Grand Total Any Follow-Up New-Case Walk-In Illustration 12: Number of registered outpatient attendances 2016 by month Hospital Activity Report 2016 Page 27 Mater Dei Hospital 2.4.3 Clinic Activity according to department and clinics grouped into the clinic description and attendance type The table below illustrates the number of outpatient attendances by type of attendance and clinic description for every department and clinic held at MDH.
The clinics were grouped together to create the clinics report description to further ease analysis and interpretation of data.

For example all medicine respiratory clinics grouped into Medicine & Respiratory OP.

Department & Clinics Report Description Anaesthesia/Pain Relief Pain Clinic Anaesthesia/Pre-op Pre-operative assessment clinic Cardiac Surgery Cardiac Surgery Clinic Cardiology Blood Pressure (Cardiology) Cardiac Lab Blood Inv Cardiac Rehabilitation Clinic (nurse-led) Cardiology (Adult/Cong.
Heart Disease) Cardiology Heart Valve Clinic Cardiology OP Cardiology OP TAVI Cardiology Rapid Access Clinic Cardiomyopathy Clinic Heart Failure Clinic (Nurse led) Holter ECG (Cardiologist) ICD Clinic (technician led) Pacemaker Clinic (technician led) Pacemaker Wound Check Cl (nurse-led) Stress ECG (Cardiology) Chinese Medicine Chinese Medicine clinic Dental Child Dental Clinic Cleft Lip & Palate Clnic (Dental) Dental Clinic Dental Clinic (A&E) Dental Clinic (Consultants) New Case Follow Up Walk In Any Total Hospital Activity Report 2016 Page 28 Mater Dei Hospital Cont… Department & Clinics Report Description Dental Clinic (Oral Hygiene) Dental Clinic (oral rehabilitation) Dental Clinic (Oral Surgery) Dental Clinic (Pre-op) Dental Clinic (Prosthetics) Dental Clinic (Scaling and Polishing) Dental Clinic (X-Ray) Dental Orthodontic Clinic Dental Teaching Dental VCC Dietician Dietetic Clinic Dietetic/Diabetes Clinic Dietetic/Endocrine Dietician Renal Clinic Nutrition Support Genetics Assisted Reproduction Clinic Genetics Genetics Clinic Infection Control Hep.
B Titre Clinic Infection Control Clinic Infection Control Screening Influenza Vaccine Clinic MRSA Screening Clinic Needle Stick Injury Clinic Medicine Ambulatory Sleep Studies Asthma Clinic Baromedicine Coeliac Disease Clinic Congestive Heart Disorder Clinic COPD Clinic CTD Clinic Diabetes Awareness Sessions Diabetes Clinic Diabetes Clinic (Bleeding room) Diabetes Clinic (follow-ups) Diabetes Clinic (Juvenile) Diabetes Clinic (new-cases) New Case Follow Up Walk In Any Total Hospital Activity Report 2016 Page 29 Mater Dei Hospital Cont… Department & Clinics Report Description Diabetes Education Unit Diabetes Point of Care Clinic Diabetic Foot Clinic Diabetic Retinopathy Clinic Dietician Clinic Nephrology EAC Clinic (Early Arthritis) Endocrine & Medical Clinic Endocrine Clinic Endocrinology Rapid Access Fibromyalgia Clinic General Medicine Clinic Gestational Diabetes Clinic Home Therapy Hyperbaric Unit IBC Clinic Infectious Diseases Infectious Diseases/General Medicine Joint Injection Clinic Lipid Clinic Medical & Respiratory OP MOP Medicine/Nephrology MOP General & Inf.
Diseases MOP Liver Clinic MOP VCC Respiratory MOP/Gastroenterology/Hepatic MOP/Gastroenterology MOP/Gastroenterology/VCC Nephrology Nephrology Transplant Clinic Neuroendocrine Clinic Pulmonary Fibrosis Pulmonary Function Lab (Nurse led) Rheumatoid Podiatry Clinic Rheumatology Ankylosing Spondylitis Rheumatology Clinic Rheumatology Clinic (nurse led) Rheumatology Rapid Access Rheumatology/Bone Clinic Sleep Disorders Clinic New Case Follow Up Walk In Any Total Hospital Activity Report 2016 Page 30 Mater Dei Hospital Cont… Department & Clinics Report Description Sleep OP Clinic Sleep Pap Clinic Stress ECG (Medicine) Systemic Sclerosis Clinic TB/Cardiopulmonary Geriatrics Thyroid Clinic Transplant/Travel Wound Clinic Wound Clinic (Hyperbaric) New Case Follow Up Walk In 33 2147 1 45 Neurosciences 1740 5029 DBS follow-up EEG EMG Evoked Potentials Clinic (Neurology Team) Neurology OP Movement Disorder Multiple Sclerosis Neuro EEG Monitoring Neurocognative Clinic Neuroepilepsy Clinic Neurology Botox Clinic Neurology Clinic Neurology VCC Neuromuscular Clinic Neurosurgical Clinic Neurovascular Clinic Neurosciences/Psychiatry Neuropsychiatric joint clinic Nutrition Nutrition Clinic Obs & Gynae Antenatal Clinic Assisted Reporduction Clinic Assisted Reporduction Clinic Counselling Assisted Reproduction Clinic Breastfeeding Clinic (Midwife led) CTG Clinic Diabetic Pregnancy Clinic Gynae Endocrine Clinic 18
122 20 142 751 188 1105 59 132 132 36440 6478 18 22 7 1 Any 399 54 298 209 4781 1430 2343 747 60 186 15 68 68 2 2 730 258 3 435 Total Hospital Activity Report 2016 Page 31 Mater Dei Hospital Cont… Department & Clinics Report Description Gynae Midwife Perinatal Mental Gynae OP Gynae OP Miscarriage Clinic Gynae Urodynamics Obstetrics & Gynaecology Ultrasound Outreach Midwifery Ophthalmology Ophthalmic Botox Clinic Strabismus Ophthalmic Glaucoma Ophthalmic IVFA Ophthalmic Laser Ophthalmic Low Vision Clinic Ophthalmic OP Ophthalmic OP (Botox Clinic) Ophthalmic OP (Vitreoretinal) Ophthalmic OP A&E Referrals Ophthalmic Optometry/Refraction Clinic Ophthalmic Orthoptics Ophthalmic Peripheral Visual Fields Ophthalmic Post-OP Clinic Ophthalmic Retina Ophthalmic Special Ophthalmology VCC Ophthlamic (Cornea) Orthopaedics OOP Foot Ankle Clinic Orthopaedic FTC Orthopaedic OP Orthopaedic OP (General/Paediatrics) Orthopaedic OP Shockwave Orthopaedic Outreach Orthopaedic Plaster Clinic Orthopaedic VCC Orthopaedic VCC (Shoulder) Orthopaedic VCC (Spinal) Orthopaedics VCC (Hand Clinic) Sport Injury Clinic Paediatrics Children's OP Children's OP (Cardiology/General) New Case Follow Up Walk In Any Total 2162
220 32 4660 45472 2740 5007 25808 2963 44 2162 5545 267 3 224 150 559 13766 5097 886 Hospital Activity Report 2016 Page 32 Mater Dei Hospital Cont… Department & Clinics Report Description Children's OP (Endocrine) Children's OP (Endocrine/General) Children's OP (Neuro-paed) Children's OP (Neuro-paed/General) Children's OP Nursery Community Paediatric Clinic COP (Bleeding Room) Diabetes Clinic Paediatrics Neonatal/NPICU F/U Paediatric Cardiology Paediatric Diet Clinic Paediatric Gastroenterology VCC Paediatric Infant Wheezer Clinic Paediatric Respiratory Medicine Paediatric Rheumatology Clinic Paediatric VCC Nutrition Paediatrics Development Clinic Paediatrics General & Inf Diseases Paediatrics Infectious Diseases Clinic Paediatrics Nephrology Paediatrics Respirarory Medicine Paediatrics VCC Endocrine Paediatrics VCC Nephrology Paediatrics/NPICU Paediatrics-Respiratory-Medicine Psychiatry Perinatal Mental Health Clinic Psychiatric OP Psychiatric OP Adult & Liaison Surgery Assessment Dialysis Breast Clinic ENT Audiology ENT Audiology (paed) ENT Dizziness Clinic ENT Hearing Loss Clinic ENT OP ENT OP Oncology ENT OP Voice Clinic ENT Tinnitus Clinic New Case Follow Up Walk In Any Total Hospital Activity Report 2016 Page 33 Mater Dei Hospital Cont… Department & Clinics Report Description ENT/Audiology (Audiometry) ENT/Audiology (Hearing Aids) Paediatric Surgery Paediatric Surgery VCC SOP SOP Stoma Clinic SOP Bariatric Clinic SOP Dermatology Referrals SOP Plastic Urology Clinic Urology Clinic VCC
 Urology Male Infertility Clinic Urology Outreach Clinic Vascular Surgery Clinic Thalassaemia Thalassaemia Clinic Thalassaemia Phlebotomy Clinic Tissue Viability Tissue Viability Clinic TVU Outreach Grand Total Notes: New Case Follow Up Walk In Any Total 1) Haematology not included due to migration to SAMOC.
2) A number of cardiology clinics have been excluded from analysis since the activity is not being registered on CPAS but on cardiology system.

These include 7 Day Holter Clinic (Cardiol-tech led), Adult Heart Disease, Cardiac cath Suite (Cardiology Clinic), ECG Clinic (12 lead), Echocardiogram (cardiology).

3) Pathology activity for clinics ACC Phlebotomy, Bleeding Room (OGTT) and Phlebotomy Pathology have been excluded.

4) Sleep disorders clinic (domiciliary) has been excluded.
5) Gynae bone density clinic has been excluded due to the activity being registered on radiology system rather than CPAS.

6) Clinics registered under MDH but are held at a different location have been excluded (orthotics & prosthetics, CDAU, occupational therapy).
Hospital Activity Report 2016 Page 34 Mater Dei Hospital 3 SECTION 2 Sir Anthony Mamo Oncology Centre (SAMOC) Activity ADMISSIONS, DAY CASES, WARD ATTENDERS, OUT-PATIENTS Hospital Activity Report 2016 Page 35 Mater Dei Hospital 3.1 Admissions 2016 In 2016 there were 19965 registered admissions (in-patients and day cases) at SAMOC.

The average daily admission rate was of 55/day.

The below shows a breakdown of admissions by type.


Type of admission registrations in 2016:  Day Case*:  Elective:  Emergency: 187  Other**: 630 15574 3574 *these include day cases registered as out patient attendances at the DCU SAMOC **all admissions should be inputted as either day cases, elective or emergency 3.1.1 Admissions by ward The table below illustrates the number of registered admissions to the admitting wards at SAMOC.
Ward OC DCU - Day Care Unit OC HAEMW- Haematology Ward OC PAU-Paediatric Adolescent Ward OC PCU- Palliative Care Unit OC RIU- Radioisotope unit OC WARD 1- Oncology Ward 1 OC WARD 2- Oncology Ward 2 Grand Total Total 2016 16045 315 217 395 62 1239 1692 19965 Hospital Activity Report 2016 Page 36 Mater Dei Hospital 3.2 Out-Patient Attendances 2016 In 2016 there were 46016 registered out-patient attendances at SAMOC out-patient department.
The table below illustrates the number of outpatient attendances by type of attendance for every department.
Department Haematology Oncology Palliative Pathology Physiotherapy Team Radiology Grand Total New Case 1143 1461 147 13600 Follow Up 8311 14836 956 100 1 16351 24204 Walk In 598 1970 29 27 42 429 3095 Any 250 29 404 158 1525 2366 Total 2016 10302 18296 1132 14131 201 1954 46016 Hospital Activity Report 2016 Page 37 Mater Dei Hospital 3.3 Ward Attenders 2016 In 2016 there were 3048 registered ward attenders at SAMOC.
Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.

Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.

Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.
All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed.

The table below illustrates the number of registered ward attenders to the respective wards in 2016.
Ward OC DCU - Day Care Unit OC HAEMW - HaematologyWard OC PAU - Paediatric Adoloscent Unit OC PCU - Palliative Care Unit OC RIU - Radioisotope Unit OC WARD 1 - Oncology Ward 1 OC WARD 2 - Oncology Ward 2 Grand Total Total 2016 654 37 1730 12 217 206 192 3048 Hospital Activity Report 2016 Page 38 Hospital Activity Report 2017 Annual A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS, Mater Dei Hospital ADMISSIONS, DAY CASES, OUT-PATIENTS, WARD ATTENDERS, Sir Anthony Mamo Oncology Centre Clinical Performance Unit Administration, Mater Dei Hospital DOCUMENT INFORMATION Version 1.0 (DRAFT) Date published Document type Annual statistical report Analysis and compilation David Borg Clinical Performance Unit Prof Sandra Buttigieg, Consultant Public Health, Head CPU Dr Sandra Distefano, Consultant Public Health David Borg, Principal Scientific Officer, RN Jane Agius, Assistant Principal Hospital Activity Report 2016 Page 3 Mater Dei Hospital CONTENTS 1 2 3 2.2 INTRODUCTION .......................................................................................................................................... 5 SECTION 1 ................................................................................................................................................ 6 2.1 Accident & Emergency Activity ................................................................................................... 7 A&E Attendances 2017 ..................................................................................... 7 2.1.1 Source of Referral .............................................................................................. 8 2.1.2 A&E Attendances according to hospital identification number/ID letter ......... 9 2.1.3 A&E Attendances by ESI (Emergency Severity Index) Category ...................... 10 2.1.4 A&E Attendances according to attending department and ESI breakdown... 11 2.1.5 In-Patient Activity ...................................................................................................................... 14 Admissions (ADMIT) 2017 ............................................................................... 14 2.2.1 Admissions by Month ...................................................................................... 15 2.2.2 Demography .................................................................................................... 16 2.2.3 2.2.4 Admissions (ADMIT) Vs Discharges (DISC) ...................................................... 18 2.2.5 Method of Admission ...................................................................................... 19 2.2.6 Method of Admissions by Consultant Speciality ............................................. 20 2.2.7 of stay (days) and % bed occupancy ............................................................................. 21 2.3 Ward Attenders ......................................................................................................................... 23 2.3.1 Ward Attenders 2017 ...................................................................................... 23 2.3.2 Ward Attenders by Consultant Speciality ....................................................... 24 2.3.3 Ward Attenders by Department and Ward .................................................... 25 2.4 Out-Patient Activity ................................................................................................................... 27 2.4.1 Out-Patient Attendances 2017 ....................................................................... 27 2.4.2 Out patient attendances by month and type of attendance .......................... 28 2.4.3 description and attendance type .................................................................................. 29 SECTION 2 .............................................................................................................................................. 36 3.1 Admissions 2017 ....................................................................................................................... 37 Admissions by ward ........................................................................................ 37 3.2 Out-Patient Attendances 2017 ................................................................................................. 38 3.3 Ward Attenders 2017 ................................................................................................................ 39 Admissions by department and ward including transfers in, average length Clinic Activity according to department and clinics grouped into the clinic 3.1.1 Hospital Activity Report, Annual 2017 Page 4 Mater Dei Hospital 1 INTRODUCTION The Hospital Activity Report 2017 presents an overview on the main activities at Mater Dei Hospital (MDH) and Sir Anthony Mamo Oncology Centre (SAMOC) for the year 2017.
It details information on A&E attendances, admissions, discharges, ward attenders and out-patient attendances.

The data contained in this report have been compiled from registrations on CPAS, which is the patient administrative system at MDH and SAMOC and the primary source of data for this report.

The first section includes activity at MDH, highlighting information on A&E attendances, in-patient activity in the form of admissions and ward attenders and out-patient attendances.
The second section encompasses the main activity at SAMOC, including admissions to the wards, ward attenders and out-patient attendences.

The year 2017 has seen an increase in the number of patients attending at Mater Dei Hospital in the different departments and specialities of care.

A&E attendances increased by +3% on the previous year whilst admissions (including day cases, elective and emergency) increased by +2%.

Outpatient attendances increased by +2%.


The exception was a decrease in ward attenders at -6%.

Apart from the numbers presented in this report, it is important to note that the activity surrounding patient care includes important services such as pathology tests, renal dialysis, diagnostic procedures, radiological procedures, screening procedures and surgical operative procedures/interventions amongst other services that all contribute to providing holistic care for the well being of the patient.
One cannot forget to mention the collaborative and organised input by the multidisciplinary health care team at Mater Dei Hospital and Sir Anthony Mamo Oncology Centre in achieving the best health outcomes for our patients.

Disclaimer The accuracy of information in this document might be limited by factors beyond author’s control.

This document contains data which is subject to interpretation.
Before using this data for making decisions or drawing conclusions, users are encouraged to contact the Clinical Performance Unit for advice.
Hospital Activity Report, Annual 2017 Page 5 Mater Dei Hospital 2 SECTION 1 Mater Dei Hospital (MDH) Activity A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS Hospital Activity Report, Annual 2017 Page 6 Mater Dei Hospital 2.1 Accident & Emergency Activity 2.1.1 A&E Attendances 2017 In 2017 there were 141758 (+3% 2016) registered A&E attendances at the A&E Dept, MDH.

The average daily attendance rate was of 388/day (377/day 2016).
The graph below shows the number of registered A&E attendances from 2008-2017.

Note: A&E Attendances are patients visiting the A&E department, with cases ranging from minor walk in injuries to life-threatening accidents.
A&E Attendances A&E Attendances s e c n a d n e t t A E & A f o r e b m u N 160000 140000 120000 100000 80000 60000 40000 20000 0 2008 2009 2010 2011 2012 2013 2014* 2015 2016 2017 A&E Attendances 106907 101439 107102 110279 111533 115706 119941 128747 137852 141758 *IT system changeover Illustration 1: number of registered A&E attendances over the years Hospital Activity Report, Annual 2017 Page 7 Mater Dei Hospital The monthly number of registered A&E attendances in 2017 and compared to 2016 can be seen in the graph below.
January and February registered a negative percentage change in the number of attendances (-2% and -5%) with the rest of the months registering an increase in attendances, in particular March (+8%), the summer months (June +5%, July +7%, August +5%) and December (+5%).

The highest number of A&E attendances was registered in August with 12925 attendances whilst the lowest number was recorded in February with 10480 attendances.
Registered A&E Attendances 2017 2016 s e c n a d n e t t A f o r e b m u N 14000 13000 12000 11000 10000 9000 8000 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2017 11706 10480 12342 11626 12182 11831 12695 12925 11296 11717 11287 11671 2016 11965 11044 11420 11253 11909 11282 11903 12333 10982 11596 11000 11165 Month Illustration 2: number of A&E attendances in 2017 and 2016 by month 2.1.2 Source of Referral The majority of A&E attendances were self referrals at 75% whilst doctor referrals accounted to 22% of attendances.
Source of Referral: • Self-referral: • Doctor referral: • Other: 106835 (75%) 30834 (22%) 4089 (3%) Hospital Activity Report, Annual 2017 Page 8 Mater Dei Hospital 2.1.3 A&E Attendances according to hospital identification number/ID letter The chart below shows the percentage of A&E attendances according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of A&E attendances were Maltese with 77% (108358) of the total attendances whilst non Maltese residents and foreigners made up 17% (24750) of the A&E attendances in 2017.
Registered A&E Attendances 2017 9% 5% 8% 1% Non-Maltese Residents New Born Foreigners Gozitan Maltese 77% Illustration 3: Registered A&E attendances by hospital identification number/ID letter Hospital Activity Report, Annual 2017 Page 9 Mater Dei Hospital 2.1.4 A&E Attendances by ESI (Emergency Severity Index) Category The graph below presents the number of A&E Attendances according to the Emergency Severity Index done at triage level.
This includes all the attending departments, including A&E, paediatrics, ophthalmic, ENT, obstetrics and gynaecology, dental and psychiatric.

The majority of A&E attendances were categorized into ESI 2, 3 and 4 followed by ESI 5 and ESI 1.

Note: The Emergency Severity Index (ESI) is a five-level emergency department triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resources needed.
Attendances by ESI Category Registered A&E Attendances 2017 s e c n a d n e t t A f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 ESI-1 Registered A&E Attendances 2017 1694 ESI-2 45385 ESI-3 44300 ESI-4 42216 ESI-5 7557 Other 606 ESI Category Illustration 4: Registered A&E Attendances by ESI Category Hospital Activity Report, Annual 2017 Page 10 Mater Dei Hospital 2.1.5 A&E Attendances according to attending department and ESI breakdown The pie chart below shows the percentage activity of A&E attendances according to the speciality/department that they were seen after triage.
The A&E dept attended to 65% of the total cases after triage, followed by the paediatric A&E dept with 15% of cases and the ophthalmic department with 10% of attendances.

The rest of the cases were attended to by the ENT, OBG, dental and psychiatric dept.
A&E Attendances 2017 Attending Dept 0% 15% 10% 4% 5% 1% A&E Dental ENT OBG Ophth Paeds Psych 65% Illustration 5: Registered A&E attendances by attending department Hospital Activity Report, Annual 2017 Page 11 Mater Dei Hospital The table below shows the number of A&E registrations grouped by the Emergency Severity Index and the attending speciality/department.

The difference in activity between 2017 and 2016 can also be seen.
Department & ESI Category A&E A&E TRIAGE SKIP ESI-1 ESI-2 ESI-3 ESI-4 ESI-5 Total Dental A&E TRIAGE SKIP ESI-3-DENTAL ESI-4-DENTAL ESI-5-DENTAL Total ENT A&E TRIAGE SKIP ESI-3-ENT ESI-4-ENT ESI-5-ENT Total OBG A&E TRIAGE SKIP ESI-3-OBS ESI-4-OBS ESI-5-OBS Total Ophth A&E TRIAGE SKIP ESI-3-OPTH ESI-4-OPTH ESI-5-OPTH Total Number of A&E Attendances 2017 2016 Difference -2367 +286 +4627 +1332 -2027 -799 +1052 -5 +10 -6 +81 +80 -103 +350 +180 -83 +344 -95 +38 +292 +16 +251 -2546 +407 +2096 +21 -22 Hospital Activity Report, Annual 2017 Page 12 Mater Dei Hospital Cont… Department & ESI Category Paeds A&E TRIAGE SKIP ESI-2-PAEDS ESI-3-PEADS ESI-4-PEADS ESI-5-PEADS Total Psych A&E TRIAGE SKIP ESI-3-PSCH ESI-4-PSCH ESI-5-PSCH Total Other A&E TRIAGE SKIP Number of A&E Attendances 2017 Department & ESI Category 2016 Number of A&E Attendances Difference 8 5717 8287 5302 1173 20487 0 49 42 50 141 0 28 3955 7349 5450 1326 18108 4 42 25 46 117 202 -20 +1762 +938 -148 -153 +2379 -4 +7 +17 +4 +24 n/a Total A&E Attendances 141758 137852 +3906 Hospital Activity Report, Annual 2017 Page 13 Mater Dei Hospital 2.2 In-Patient Activity 2.2.1 Admissions (ADMIT) 2017 In 2017 there were 93658 (+2% 2016) registered admissions (in-patients and day cases) excluding renal unit1 and nursery2 registrations at MDH.
The average daily admission rate was of 257/day (253/day 2016).

The graph below shows the number of registered admissions from 2008-2016.

Note: an admission is a patient entering the hospital for in-patient service and at which the patient begins an episode of care.
Number of Admissions Over the Years No of Admissions s n o i s s i m d A f o r e b m u N 100000 90000 80000 70000 60000 50000 40000 30000 20000 10000 0 2008 2009 2010 2011 2012 2013 2014* 2015 2016 2017 No of Admissions 66742 68060 71331 75075 77983 80931 89449 90128 91928 93658 Year *IT administrative system changeover Illustration 6: Number of admissions over the years 1 In the Renal Unit, there were 20384 registered admission episodes/dialysis sessions.
2 In the Nurseries, there were 3793 registered admission episodes.

Hospital Activity Report, Annual 2017 Page 14 Mater Dei Hospital 2.2.2 Admissions by Month The monthly number of registered admissions in 2017 and compared to 2016 can be seen in the graph below.
There was a slight decrease in the number of admission episodes in February (-1%), May (-3%), September (-3%) and October (-1%) with the rest of the months registering an increase in admission episodes, in particular March (+13%) and August (+12%).

The highest number of admission episodes was registered in January with 8472 admissions whilst the lowest number was recorded in June with 7271 admission episodes.
Registered Admissions 2017 2016 s n o i s s i m d A f o r e b m u N 9000 8500 8000 7500 7000 6500 6000 Jan Feb Mar Apr May Jun Jul 2017 8472 2016 8055 7415 7505 8341 7349 7526 7809 7918 8155 7271 7299 7722 7703 Month Illustration 7: number of admissions by month 2017/2016 Aug 7977 7095 Sep 7293 7486 Oct 8105 8193 Nov 8305 8152 Dec 7313 7127 Hospital Activity Report, Annual 2017 Page 15 Mater Dei Hospital 2.2.3 Demography Admissions according to hospital identification number/ID letter The chart below shows the percentage of admissions according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of admissions were made up of Maltese with 86% of the total admissions whilst non Maltese residents and foreigners made up 9% of the admissions in 2017.
Admissions Origin 2017 6% 3% 3% 2% Non-Maltese residents New Born Foreigners Gozitans Maltese 86% Illustration 8: Percentage of admissions according to origin Hospital Activity Report, Annual 2017 Page 16 Mater Dei Hospital Admissions according to Age and Gender Out of the total admissions to MDH this year, 52% were females and 48% were male admissions.

The remaining <1% of admissions had no gender specified.

The age and gender distribution can be seen in the table below.
The highest increases in admission age groups from the previous year were noted in the 65-74 and 85-94 age brackets.

This highlights the notion that the hospital and health care are catering more to the demands of an ageing population.
Age Group (yrs) <5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-94 95+ Unspec Grand Total Males 2358 1572 1768 3014 3431 4485 7961 10724 7070 2103 124 42 44652 Gender and Age Population Admissions Females Unspecified Total 2017 Total 2016 Difference +113 -72 -279 +134 +224 -75 -352 +746 +522 +776 +34 -41 +1730 Hospital Activity Report, Annual 2017 Page 17 Mater Dei Hospital 2.2.4 Admissions (ADMIT) Vs Discharges (DISC) The illustration below depicts the average number of admissions and discharges per day according to day of week in 2017 (excluding renal unit and nursery registrations).
The highest average number of admissions was recorded on Mondays with 295 admissions and the lowest average number on Sundays with 148 admissions.

With regards to the average number of discharges, Tuesdays registered the highest average number with 289 discharges and the lowest on Sundays with an average of 96 discharges.
Average Daily Admissions and Discharges 2017 Admissions Discharges s e g r a h c s i D & s n o i s s i m d A f o r e b m u N 350 300 250 200 150 100 50 0 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Admissions Discharges 295 285 294 289 293 271 283 275 255 268 236 263 148 96 Average number of admissions & discharges Illustration 9: average number of admissions and discharges by day of week (excluding renal unit and nursery activity) Hospital Activity Report, Annual 2017 Page 18 Mater Dei Hospital 2.2.5 Method of Admission The method of admission was analysed by using the type of admission as inputted by ward staff and assumptions3 when type was not inputted accordingly.
The below shows a breakdown of admissions by type.
Type of admission registrations in 2017 (and percentage difference on 2016): • Day Case4: 30673 (-5%) • Elective5: 15380 (+2%) • Emergency6: 42897 (+7%) • Other*: 4708 (+16%) *includes delivery of new born & obstetrics admissions Method of Admission 2017 5% 33% 46% 16% Day Case Elective Emergency Other* * includes delivery of new born & obstetrics admissions Illustration 10: method of admission 3 Assumptions were based on the nature of the diagnosis, the ward and the length of stay when available.
4 Day cases are admissions which do not require an overnight stay.

5 Elective are planned admissions.

6 Emergency are unplanned, often urgent admissions.

Hospital Activity Report, Annual 2017 Page 19 Mater Dei Hospital 2.2.6 Method of Admissions by Consultant Speciality The admissions for 2017 were analysed according to the method of admission and consultant speciality and presented in the table below.

The figures exclude the renal unit and nursery admissions.
Difference 0 0 0 33 6 200 Consultant Speciality Day Case Elective Emergency Other A&E Anaesthesia/Pain relief Cardiac surgery Cardiology Dental Dermatology ENT ENT/Audiology Genetics Haematology* Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obstetrics & Gynae Oncology* Ophthalmology Orthopaedics Other Paediatrics Psychiatry Sleep Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics** Surgery/Urology Surgery/Vascular Grand Total *Admissions from SAMOC.
Haematology & Oncology migrated to SAMOC in early September 2015.

**These admissions might include ward attenders which were inadvertently admitted into admission beds rather than ward attender beds, hence one cannot distinguish actual admissions from ward attenders (see ward attender section).
Total Total -1433 -33 -80 +470 -82 -10 +91 +11 -15 -87 +233 +573 +321 +140 +215 +470 +1159 -19 -24 -99 -1 -245 +304 +11 +216 +8 +3 -16 -206 +37 -412 +47 +188 +1730 Hospital Activity Report, Annual 2017 Page 20 Mater Dei Hospital 2.2.7 Admissions by department and ward including transfers in, average length of stay (days) and % bed occupancy The table below illustrates the number of registered admissions to the admitting wards grouped together by the corresponding department including transfers in, average length of stay and the percentage (%) bed occupancy for 2017.
The transfers in (clinic changes) to the wards were also included in this table to provide a more complete picture of the input of patients into the wards.

Transfers in/out occur when patients are transferred from one ward to another within MDH.

Dept Ward Cardiology Cardiothoracic Surgery Medicine CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.
ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 SLEEP LAB Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2 Total Admissions 2017 1431 797 1311 Total Transfers In 2017 60 371 1332 Average of Length of Stay (days) n/app - 8.2 - n/app 6.0 6.9 n/app 4.6 2.3 2.2 % Bed Occupancy n/app 71.6% 84.6% 62.2% 78.7% 71.6% 86.4% 85.2% 89.9% 95.6% 96.7% 95.7% 93.6% 92.8% 97.2% 69.3% 97.3% - n/app 89.7% 83.7% n/app 74.4 77.0% 69.8% Hospital Activity Report, Annual 2017 Page 21 Mater Dei Hospital Dept Ward Orthopaedics Surgery Paediatrics Other OBSTETRICS WARD 3 ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 BURNS UNIT DIABETIC FOOT WARD E.N.T.
WARD FAIRYLAND PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT 1 SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DISNEYLAND NEONATAL/PAED.

INT.
CARE WONDERLAND A&E PAEDIATRIC CORRIDOR DAY CARE UNIT (ENDOSCOPY) * DAY CARE UNIT (SURGERY) * DISCHARGE LOUNGE ** INTENSIVE THERAPY UNIT OBSERVATION WARD 1*** OBSERVATION WARD 1A**** OBSERVATION WARD 1B**** OBSERVATION WARD 2 OPHTHALMIC WARD PAEDIATRICS DAY CARE*~ MD WAIT*~~ Total Admissions 2017 964 Total Transfers In 2017 1743 Average of Length of Stay (days) - 3.0 1.8 n/app 4.6 2.3 5.5 5.3 11.4 7.3 5.7 4.2 3.6 2.5 18.0 2.3 n/app n/app n/app n/app 5.9 - 2.3 2.0 2.8 2.4 n/app n/app % Bed Occupancy 82.1% 94.3% 75.9% 94.7% 46.0% - 78.1% 59.7% n/app 70.8% 83.3% 87.6% 88.1% 92.2% 92.3% 90.0% 89.9% 88.8% 74.2% 90.2% 79.2% n/app n/app n/app n/app 80.8% - 85.9% 87.7% 84.5% 55.2% n/app n/app * Beds at Day Care Unit Surgery and Endoscopy were being used to admit emergency cases (mostly medical) in the case of influx in admissions **Patients are transferred to the discharge lounge before leaving the hospital after being discharged from the wards.
***until August 2017 ****from August 2017 *~Beds at Paeds Day Care were being used to admit emergency medical cases in case of influx in admissions *~~Patients are admitted to MD WAIT prior to admission to respective ward.

Hospital Activity Report, Annual 2017 Page 22 Mater Dei Hospital 2.3 Ward Attenders 2.3.1 Ward Attenders 2017 In 2017 there were 42910 (-6% 2016) registered ward attenders in the wards at MDH.

The graph below shows the number of registered ward attenders from 2009-2017.
Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.

Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.

Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.
All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed to compile the following tables.
Ward Attenders Number of Ward Attenders s r e d n e t t A d r a W f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 2009 2010 2011 2012 2013 2014* 2016 2016 2017 Number of Ward Attenders 18935 25150 31500 44350 47596 42485 43789 45827 42910 Year *IT system changeover Illustration 11: number of ward attenders over the years Hospital Activity Report, Annual 2017 Page 23 Mater Dei Hospital 2.3.2 Ward Attenders by Consultant Speciality The ward attenders for 2017 were analysed according to the consultant speciality and presented in the table below.
The difference in the totals compared with 2016 can also be found.
Difference Speciality A&E Anaesthesia/Pain Relief Cardiac surgery Cardiology Dental Dermatology ENT ENT/Audiology Genetics Haematology* Investigations & Treatment** Nursing Team Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obstetrics & Gynae Ophthalmology Orthopaedics Paediatrics Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics Surgery/Urology Surgery/Vascular Other Grand Total *migrated to SAMOC **these ward attenders were registered as out-patient attendances and hence cannot be distributed according to the respective speciality.
This could reflect a decrease in ward attenders in other specialities.
Total Total +9 +2 -354 +341 -20 -11 -438 +6 -2 +4 +1019 -21 -4 -21 +32 +66 +138 -50 -86 -37 +37 -1020 -229 -258 -484 -36 -49 -51 -1273 -277 152 -2 -2917 Hospital Activity Report, Annual 2017 Page 24 Mater Dei Hospital 2.3.3 Ward Attenders by Department and Ward The table below illustrates the number of registered ward attenders to the respective department and ward in 2017 compared with 2016.
Clinic Total 2017 Total 2016 Difference Dept Cardiology Cardiothoracic Surgery Medicine CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.


ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 RENAL UNIT Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae Orthopaedics Paediatrics DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2 OBSTETRICS WARD 3 ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 DISNEYLAND NEONATAL/PAED.

INT.
INT.

CARE NURSERY +361 -9 -27 +49 -404 +83 0 -10 -1 +8 +34 -49 +11 -28 -31 -4 -1 0 +163 -21 +32 -149 -17 -15 -774 -10 -28 -358 +137 -29 -38 -1 Hospital Activity Report, Annual 2017 Page 25 Mater Dei Hospital Cont… Dept Surgery Other Grand Total Clinic NURSERY 3 (OBST.
WARD 3) PAEDIATRICS DAY CARE WONDERLAND Total 2017 2 4711 17 Total 2016 1 5165 32 Difference +1 -454 -15 BURNS UNIT E.N.T.

WARD FAIRYLAND PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT 1 SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DAY CARE UNIT (ENDOSCOPY) DAY CARE UNIT (SURGERY) INTENSIVE THERAPY UNIT MED.

INVEST.

& TREAT.
UNIT,MDH OBSERVATION WARD 1 OBSERVATION WARD 1A OBSERVATION WARD 1B OBSERVATION WARD 2 OPHTHALMIC WARD +7 -452 -35 +130 -1328 -100 +4 +15 +116 +43 -3 -49 -365 -9 -1 0 +975 -103 +46 +3 -3 -213 -2917 Hospital Activity Report, Annual 2017 Page 26 Mater Dei Hospital 2.4 Out-Patient Activity 2.4.1 Out-Patient Attendances 2017 In 2016 there were 495816 (+2% 2016) registered clinic attendances at the out-patient department.
The average daily attendance per clinic day was 1641 attendances for 302 clinic days (2016: 1606 for 302 clinic days).

Note: an outpatient attendance is a patient visiting the outpatients department for ambulatory care including consultations, diagnosis, observation, treatment and other care from support areas.
Registered attendances by type in 2017 (and percentage difference on 2016): • New Cases7: 87108 (+8%) • Follow-ups8: 204371 (+4%) • Walk-ins9: 125692 (-1%) • Any Cases10: 78645 (-3%) Type of Attendance 2017 25% 18% 16% 41% Any Follow Up New Case Walk In 7 New cases are new outpatient appointments which are planned and given a date and time beforehand.

In this case, the patient will not have had a previous outpatient appointment related to the case.
8 Follow up cases are outpatient appointments which are planned to provide continuing or further attention to a previous related appointment.

The appointment will be planned and given a date and time beforehand.

9 Walk ins are unplanned outpatient attendances.

The patient turns up for an outpatient visit without a planned date and time for appointment.

10 These are cases registered as any in the system to allow for flexibility when booking patients.

These cases could be new cases or follow ups.


Hospital Activity Report, Annual 2017 Page 27 Mater Dei Hospital 2.4.2 Out patient attendances by month and type of attendance The graph below shows the number of out-patient attendances by month and type of attendance in 2017.

November registered the highest amount of outpatient attendances with 47 000 attendances whilst the lowest number of attendances was recorded in December with 32 500 attendances.
Registered Out-Patient Attendances 2017 Grand Total Any Follow-Up New-Case Walk-In s e c n a d n e t t A f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 2017 Illustration 12: Number of registered outpatient attendances 2017 by month Hospital Activity Report, Annual 2017 Page 28 Mater Dei Hospital 2.4.3 Clinic Activity according to department and clinics grouped into the clinic description and attendance type The table below illustrates the number of outpatient attendances by type of attendance and clinic description for every department and clinic held at MDH.
The clinics were grouped together to create the clinics report description to further ease analysis and interpretation of data.

For example all medicine respiratory clinics grouped into Medicine & Respiratory OP.
Department & Clinics Report Description New Case Follow Up Walk In Anaesthesia/Pain Relief Pain Clinic Pain Clinic Nurse Led Anaesthesia/Pre-op Pre-operative assessment clinic Cardiac Surgery Cardiac Surgery Clinic Cardiology Blood Pressure (Cardiology) Cardiac Lab Blood Inv Cardiac Rehabilitation Clinic (nurse-led) Cardiology (Adult/Cong.
Heart Disease) Cardiology Heart Valve Clinic Cardiology OP Cardiology OP TAVI Cardiology Rapid Access Clinic Cardiomyopathy Clinic Echocardiogram (Cardiology) Heart Failure Clinic (Nurse led) Holter ECG (Cardiologist) ICD Clinic (technician led) Pacemaker Clinic (technician led) Pacemaker Wound Check Cl (nurse-led) Stress ECG (Cardiology) Chinese Medicine Chinese Medicine clinic Dental Child Dental Clinic Cleft Lip & Palate Clnic (Dental) Dental Clinic Dental Clinic (A&E) Hospital Activity Report, Annual Total Any 1 0 1 2993 2993 48 48 6796 995 0 0 0 144 333 144 0 0 0 1671 312 2195 454 548 0 27986 192 63 6729 8 Page 29 Mater Dei Hospital Department & Clinics Report Description New Case Follow Up Walk In Dental Clinic (Consultants) Dental Clinic (Oral Hygiene) Dental Clinic (oral rehabilitation) Dental Clinic (Oral Surgery) Dental Clinic (Pre-op) Dental Clinic (Prosthetics) Dental Clinic (Scaling and Polishing) Dental Clinic (X-Ray) Dental Orthodontic Clinic Dental VCC Dietician Dietetic Clinic Dietetic/Diabetes Clinic Dietetic/Endocrine Dietician Renal Clinic Genetics Assisted Reproduction Clinic Genetics Genetics Clinic Infection Control Hep.
B Titre Clinic Infection Control Clinic Infection Control Screening MRSA Screening Clinic Needle Stick Injury Clinic Medicine Ambulatory Sleep Studies Asthma Clinic Baromedicine Coeliac Disease Clinic Congestive Heart Disorder Clinic COPD Clinic CTD Clinic DBS follow-up Diabetes Awareness Sessions Diabetes Clinic Diabetes Clinic (Bleeding room) Diabetes Clinic (follow-ups) Diabetes Clinic (Juvenile) Diabetes Education Clinic Diabetic Foot Clinic Diabetic Retinopathy Clinic Any Total Hospital Activity Report, Annual 2017 Page 30 Mater Dei Hospital Department & Clinics Report Description New Case Follow Up Walk In Any Dietician Clinic Nephrology Endocrine & Medical Clinic Endocrine Clinic Endocrinology Rapid Access Fibromyalgia Clinic General Medicine Clinic Gestational Diabetes Clinic Home Therapy Hyperbaric Unit IBC Clinic Infectious Diseases Infectious Diseases/General Medicine Joint Injection Clinic Lipid Clinic Medical & Respiratory OP Medicine Afternoon clinic Medicine/Nephrology MOP MOP General & Inf.
Diseases MOP Liver Clinic MOP VCC Respiratory Gastroenterology Hepatic Clinic Gastroenterology Clinic Nephrology Nephrology Transplant Clinic Neuroendocrine Clinic Pulmonary Fibrosis Pulmonary Function Lab (Nurse led) Rheumatoid Podiatry Clinic Rheumatology Ankylosing Spondylitis Rheumatology Clinic Rheumatology Clinic (nurse led) Rheumatology Lupus Clinic Rheumatology Rapid Access Sleep Disorders Clinic Sleep OP Clinic Sleep Pap Clinic Stress ECG (Medicine) Systemic Sclerosis Clinic TB/Cardiopulmonary Geriatrics Thyroid Clinic Total Hospital Activity Report, Annual 2017 Page 31 Mater Dei Hospital Department & Clinics Report Description New Case Follow Up Walk In Transplant/Travel Wound Clinic Wound Clinic (Hyperbaric) Neurosciences EEG EMG Evoked Potentials Clinic (Neurology Team) Movement Disorder Multiple Sclerosis Neuro EEG Monitoring Neurocognative Clinic Neuroepilepsy Clinic Neurology Botox Clinic Neurology Clinic Neurology OP Neurology VCC Neuromuscular Clinic Neurosurgical Clinic Neurovascular Clinic Paediatrics Neurosurgery VCC Neurosciences/Psychiatry Neuropsychiatric joint clinic Nutrition Nutrition Clinic Obs & Gynae Antenatal Clinic Assisted Reproduction Clinic Assisted Reproduction Clinic Counselling Breastfeeding Clinic (Midwife led) CTG Clinic Diabetic Pregnancy Clinic GOP Pre Op Gynae Endocrine Clinic Gynae Midwife Perinatal Mental Gynae OP Gynae OP
 Miscarriage Clinic Gynae Urodynamics Obstetrics & Gynaecology Ultrasound Outreach Midwifery Post menopausal bleeding clinic Any Total Hospital Activity Report, Annual 2017 Page 32 Mater Dei Hospital Department & Clinics Report Description New Case Follow Up Walk In Ophthalmology Ophthalmic Botox Clinic Strabismus Ophthalmic IVFA Ophthalmic Laser Ophthalmic Low Vision Clinic Ophthalmic OP Ophthalmic OP (Botox Clinic) Ophthalmic OP (Vitreoretinal) Ophthalmic OP A&E Referrals Ophthalmic Optometry/Refraction Clinic Ophthalmic Orthoptics Ophthalmic Peripheral Visual Fields Ophthalmic Post-OP Clinic Ophthalmic Retina Ophthalmic Special Ophthalmology VCC Ophthlamic (Cornea) Orthopaedics OOP Foot Ankle Clinic Orthopaedic FTC Orthopaedic OP Orthopaedic OP (General/Paediatrics) Orthopaedic OP Shockwave Orthopaedic Outreach Orthopaedic Plaster Clinic Orthopaedic VCC Orthopaedic VCC (foot & ankle) Orthopaedic VCC (Spinal) Orthopaedics VCC (Hand Clinic) Sport Injury Clinic Other Home Antibiotic Therapy Paediatrics Children's OP Children's OP (Cardiology/General) Children's OP (Endocrine) Children's OP (Endocrine/General) Children's OP (Neuro-paed) Children's OP (Neuro-paed/General) Children's OP Nursery 666
Any Total Hospital Activity Report, Annual 2017 Page 33 Mater Dei Hospital Community Paediatric Clinic 32 87 50 Department & Clinics Report Description New Case Follow Up Walk In COP (Bleeding Room) Diabetes Clinic Paediatrics Neonatal/NPICU F/U Paediatric Cardiology Paediatric Diet Clinic Paediatric Gastroenterology VCC Paediatric Respiratory Medicine Paediatric Review Clinic Paediatric Rheumatology Clinic Paediatric VCC Nutrition Paediatrics Development Clinic Paediatrics General & Inf Diseases Paediatrics Infectious Diseases Clinic Paediatrics Nephrology Paediatrics VCC Cystic Fibrosis Paediatrics VCC Endocrine Paediatrics VCC Nephrology Paediatrics/NPICU Stress ECG (Paediatrics) Podiatry Podiatry Clinic Surgery Assessment Dialysis Breast Clinic ENT Audiology ENT Audiology (paed) ENT Dizziness Clinic ENT Hearing Loss Clinic ENT OP ENT OP Oncology ENT OP Voice Clinic ENT Tinnitus Clinic ENT/Audiology ENT/Audiology (Audiometry) ENT/Audiology (Hearing Aids) Paediatric Surgery Paediatric Surgery VCC SOP SOP (Stoma Clinic) SOP Bariatric Clinic Any 0 0 179 0 0 45 0 0 90 7 0
61 3 2680 83 51 49 Any Total Hospital Activity Report, Annual 2017 Page 34 Mater Dei Hospital SOP Breast 0 279 7 Department & Clinics Report Description New Case Follow Up Walk In SOP Dermatology Referrals SOP Plastic SOP Urology Urology Clinic Urology Clinic VCC Urology Male Infertility Clinic Urology Outreach Clinic Vascular Surgery Clinic Thalassaemia Thalassaemia Clinic Thalassaemia Phlebotomy Clinic Tissue Viability Tissue Viability Clinic TVU Outreach Grand Total Notes: Any 0 0 0 0 0 0 1817 132 519 519 0 7198 6578 620 78645 286 Total 2017 322 2842 1180 15145 26 376 2414 4355 1568 752 816 8574 7888 686 495816 1) Haematology not included due to migration to SAMOC.
2) A number of cardiology clinics have been excluded from analysis since the activity is not being registered on CPAS but on cardiology system.

These include 7 Day Holter Clinic (Cardiol-tech led), Adult Heart Disease, Cardiac cath Suite (Cardiology Clinic), ECG Clinic (12 lead), Echocardiogram (cardiology).

3) Pathology activity for clinics ACC Phlebotomy, Bleeding Room (OGTT) and Phlebotomy Pathology have been excluded.

4) Sleep disorders clinic (domiciliary) has been excluded.
5) Gynae bone density clinic has been excluded due to the activity being registered on radiology system rather than CPAS.

6) Clinics registered under MDH but are held at a different location have been excluded (orthotics & prosthetics, CDAU, occupational therapy).
Hospital Activity Report, Annual 2017 Page 35 Mater Dei Hospital 3 SECTION 2 Sir Anthony Mamo Oncology Centre (SAMOC) Activity ADMISSIONS, DAY CASES, WARD ATTENDERS, OUT-PATIENTS Hospital Activity Report, Annual 2017 Page 36 Mater Dei Hospital 3.1 Admissions 2017 In 2017 there were 20430 (+2% 2016) registered admissions (in-patients and day cases) at SAMOC.

The average daily admission rate was of 56/day (55/day in 2016).

The below shows a breakdown of admissions by type.


Type of admission registrations in 2017: 16566 3453 • Day Case*: • Elective: • Emergency: 187 • Other**: 224 *these include day cases registered as out patient attendances at the DCU SAMOC **all admissions should be inputted as either day cases, elective or emergency 3.1.1 Admissions by ward The table below illustrates the number of registered admissions to the admitting wards at SAMOC.
Ward OC DCU - Day Care Unit OC HAEMW- Haematology Ward OC PAU-Paediatric Adolescent Ward OC PCU- Palliative Care Unit OC RIU- Radioisotope unit OC WARD 1- Oncology Ward 1 OC WARD 2- Oncology Ward 2 Grand Total Total 2017 16601 343 206 304 72 1322 1582 20430 Hospital Activity Report, Annual 2017 Page 37 Mater Dei Hospital 3.2 Out-Patient Attendances 2017 In 2017 there were 44010 (-4% 2016) registered out-patient attendances at SAMOC out- patient department.
The table below illustrates the number of outpatient attendances by type of attendance for every department.
Department Haematology Oncology Palliative Pathology Clinics Radiotherapy Clinics Physiotherapy Team New Case 1482 1453 151 Follow Up 6331 12195 488 Walk In 428 2314 27 11140 84 116 Any 579 668 0 26 Total 2017 8820 16630 666 11366 0 5 0 3 581 2349 2930 103 3487 3598 Hospital Activity Report, Annual 2017 Page 38 Mater Dei Hospital 3.3 Ward Attenders 2017 In 2017 there were 2733 (-10% 2016) registered ward attenders at SAMOC.
Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.

Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.

Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.
All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed.

The table below illustrates the number of registered ward attenders to the respective wards in 2016.
Ward OC DCU - Day Care Unit OC HAEMW – Haematology Ward OC PAU - Paediatric Adoloscent Unit OC PCU - Palliative Care Unit OC RIU - Radioisotope Unit OC WARD 1 - Oncology Ward 1 OC WARD 2 - Oncology Ward 2 Grand Total Total 2017 521 7 1454 1 221 323 206 2733 Hospital Activity Report, Annual 2017 Page 39 Hospital Activity Report 2018 Annual A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS, Mater Dei Hospital ADMISSIONS, DAY CASES, OUT-PATIENTS, WARD ATTENDERS, Sir Anthony Mamo Oncology Centre Clinical Performance Unit Mater Dei Hospital DOCUMENT INFORMATION Version Date published Document type 1.0 April 2019 Annual statistical report Analysis and compilation Clinical Performance Unit David Borg Prof Sandra Buttigieg, Consultant Public Health, Head CPU Dr Sandra Distefano, Consultant Public Health David Borg, Principal Scientific Officer, RN Jane Agius, Assistant Principal Email: cpu.mdh@gov.mt Hospital Activity Report 2018 Page 2 Mater Dei Hospital CONTENTS 1 2 3 2.2 INTRODUCTION ....................................................................................................................................... 4 SECTION 1 MATER DEI ACTIVITY ................................................................................................................ 5 2.1 Accident & Emergency Activity ................................................................................................ 6 A&E Attendances 2018 .................................................................................. 6 2.1.1 Source of Referral ........................................................................................... 7 2.1.2 A&E Attendances according to hospital identification number/ID letter ...... 8 2.1.3 A&E Attendances by ESI (Emergency Severity Index) Category ..................... 9 2.1.4 A&E Attendances according to attending department and ESI breakdown 10 2.1.5 In-Patient Activity ................................................................................................................... 13 Admissions (ADMIT) 2018 ............................................................................ 13 2.2.1 Admissions by Month ................................................................................... 14 2.2.2 Demography ................................................................................................. 15 2.2.3 2.2.4 Admissions (ADMIT) Vs Discharges (DISC) ................................................... 17 2.2.5 Method of Admission ................................................................................... 18 2.2.6 Method of Admissions by Consultant Speciality .......................................... 19 2.2.7 Admissions by department and ward including transfers in, average length of stay (days) and % bed occupancy .......................................................................... 20 2.3 Ward Attenders ...................................................................................................................... 22 2.3.1 Ward Attenders 2018 ................................................................................... 22 2.3.2 Ward Attenders by Consultant Speciality .................................................... 23 2.3.3 Ward Attenders by Department and Ward ................................................. 24 2.4 Out-Patient Activity ................................................................................................................ 26 2.4.1 Out-Patient Attendances 2018 .................................................................... 26 2.4.2 Out patient attendances by month and type of attendance ....................... 27 2.4.3 description and attendance type ............................................................................... 28 SECTION 2 SAMOC ACTIVITY ................................................................................................................. 35 3.1 Admissions 2018 .................................................................................................................... 36 Admissions by ward ..................................................................................... 36 3.2 Out-Patient Attendances 2018 .............................................................................................. 37 3.3 Ward Attenders 2018 ............................................................................................................. 38 Clinic Activity according to department and clinics grouped into the clinic 3.1.1 Hospital Activity Report, Annual 2018 Page 3 Mater Dei Hospital 1 INTRODUCTION The Hospital Activity Report presents an overview on the main activities at Mater Dei Hospital (MDH) and Sir Anthony Mamo Oncology Centre (SAMOC) for the year 2018.
It details information on A&E attendances, admissions, discharges, ward attenders and out-patient attendances.

The data contained in this report have been compiled from registrations on CPAS, which is the patient administrative system of use at MDH and SAMOC and the primary source of data for this report.

The first section includes activity at MDH, highlighting information on A&E attendances, in-patient activity in the form of admissions and ward attenders and out-patient attendances.
The second section encompasses the main activity at SAMOC, including admissions to the wards, ward attenders and out- patient attendances.

The year 2018 has seen an increase in the number of patients attending at Mater Dei Hospital in the various departments and specialities of care.

A&E attendances increased by +1% on the previous year, also reflected in a +1% increase in in-patient admissions (including day cases, elective and emergency).
Outpatient attendances increased by +3%, including attendances seen to by the outreach teams.

On the other hand, the year on year negative trend for ward attenders continued to be evident in 2018 with a -2% decrease.
Apart from the numbers presented in this report, it is important to note that the activity surrounding patient care includes important services such as pathology tests, renal dialysis, diagnostic procedures, radiological procedures, screening procedures and surgical operative procedures/interventions amongst other services which all contribute to provide holistic care for the well being of the patient.
One cannot forget to mention the collaborative and organised input by the multidisciplinary health care team at Mater Dei Hospital and Sir Anthony Mamo Oncology Centre in achieving the best health outcomes for our patients.

Disclaimer The accuracy of information in this document might be limited by factors beyond author’s control.

This document contains data which is subject to interpretation.
Before using this data for making decisions or drawing conclusions, users are encouraged to contact the Clinical Performance Unit for advice.
Hospital Activity Report, Annual 2018 Page 4 Mater Dei Hospital 2 SECTION 1 Mater Dei Hospital (MDH) Activity A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS Hospital Activity Report, Annual 2018 Page 5 Mater Dei Hospital 2.1 Accident & Emergency Activity 2.1.1 A&E Attendances 2018 In 2018 there were 142519 (+1% 2017) registered A&E attendances at the A&E Dept, MDH.

The average daily attendance rate was of 391/day (388/day 2017).
The graph below shows the number of registered A&E attendances from 2008-2018.

Note: A&E Attendances are patients visiting the A&E department, with cases ranging from minor walk ins to life-threating injuries.
A&E Attendances A&E Attendances s e c n a d n e t t A E & A f o r e b m u N 160000 140000 120000 100000 80000 60000 40000 20000 0 2008 2009 2010 2011 2012 2013 2014* 2015 2016 2017 2018 A&E Attendances 106907 101439 107102 110279 111533 115706 119941 128747 137852 141758 142519 *IT system changeover Illustration 1: number of registered A&E attendances over the years Hospital Activity Report, Annual 2018 Page 6 Mater Dei Hospital The monthly number of registered A&E attendances in 2018 and compared to 2017 can be seen in the graph below.
The summer months registered a negative percentage change (June -3%, July -1%, August -2%) and December (-3%), with the rest of the months registering an increase in attendances, in particular January (+5%) and February (+5%).

The highest number of A&E attendances was registered in August with 12681 attendances whilst the lowest number was recorded in February with 10976 attendances.
Registered A&E Attendances 2018 2017 s e c n a d n e t t A f o r e b m u N 14000 13000 12000 11000 10000 9000 8000 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2018 12248 10976 12356 11692 12066 11426 12570 12681 11683 12172 11356 11293 2017 11706 10480 12342 11626 12182 11831 12698 12925 11296 11718 11287 11671 Month Illustration 2: number of A&E attendances in 2018 and 2017 by month 2.1.2 Source of Referral The majority of A&E attendances were self referrals at 75% whilst doctor referrals accounted to 22% of attendances.
Source of Referral:  Self-referral:  Doctor referral:  Other: 106941 (75%) 31400 (22%) 4178 (3%) Hospital Activity Report, Annual 2018 Page 7 Mater Dei Hospital 2.1.3 A&E Attendances according to hospital identification number/ID letter The chart below shows the percentage of A&E attendances according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of A&E attendances were Maltese with 75% (16556) of the total attendances whilst non Maltese residents and foreigners made up 19% (26957) of the A&E attendances in 2018.
Registered A&E Attendances 2018 10% 5% 9% 1% Non-Maltese Residents New Born Foreigners Gozitan Maltese 75% Illustration 3: Registered A&E attendances by hospital identification number/ID letter Hospital Activity Report, Annual 2018 Page 8 Mater Dei Hospital 2.1.4 A&E Attendances by ESI (Emergency Severity Index) Category The graph below presents the number of A&E Attendances according to the Emergency Severity Index done at triage level.
This includes all the attending departments, including A&E, paediatrics, ophthalmic, ENT, obstetrics and gynaecology, dental and psychiatric.

The majority of A&E attendances were categorized into ESI 2, 3 and 4 followed by ESI 5 and ESI 1.

Note: The Emergency Severity Index (ESI) is a five-level emergency department triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resources needed.
Attendances by ESI Category Registered A&E Attendances 2018 s e c n a d n e t t A f o r e b m u N 60000 50000 40000 30000 20000 10000 Registered A&E Attendances 2018 1744 0 ESI-1 ESI-2 49233 ESI-3 42956 ESI-4 41051 ESI-5 7116 Other 419 ESI Category Illustration 4: Registered A&E Attendances by ESI Category Hospital Activity Report, Annual 2018 Page 9 Mater Dei Hospital 2.1.5 A&E Attendances according to attending department and ESI breakdown The pie chart below shows the percentage activity of A&E attendances according to the speciality/department that they were seen after triage.
The A&E department attended to 66% of the total cases after triage, followed by the paediatric A&E department with 14% of cases and the ophthalmic department with 10% of attendances.

The rest of the cases were attended to by the ENT, OBG, dental and psychiatric dept.
A&E Attendances 2018 Attending Dept 0% 14% 10% 4% 5% 1% A&E Dental ENT OBG Ophth Paeds Psych 66% Illustration 5: Registered A&E attendances by attending department Hospital Activity Report, Annual 2018 Page 10 Mater Dei Hospital The table below shows the number of A&E registrations grouped by the Emergency Severity Index and the attending speciality/department.

The difference in activity between 2018 and 2017 can also be seen.
Department & ESI Category A&E A&E TRIAGE SKIP ESI-1 ESI-2 ESI-3 ESI-4 ESI-5 Total Dental A&E TRIAGE SKIP ESI-3-DENTAL ESI-4-DENTAL ESI-5-DENTAL Total ENT A&E TRIAGE SKIP ESI-3-ENT ESI-4-ENT ESI-5-ENT Total OBG A&E TRIAGE SKIP ESI-3-OBS ESI-4-OBS ESI-5-OBS Total Ophth A&E TRIAGE SKIP ESI-3-OPTH ESI-4-OPTH ESI-5-OPTH Total Number of A&E Attendances 2018 2017 Difference -22 48 3124 -935 -450 122 1887 0 -14 -430 -203 -647 -10 -19 -74 -129 -232 -99 -214 262 -6 -57 -66 172 -453 -156 -503 Hospital Activity Report, Annual 2018 Page 11 Mater Dei Hospital Cont… Department & ESI Category Paeds A&E TRIAGE SKIP ESI-2-PAEDS ESI-3-PAEDS ESI-4-PAEDS ESI-5-PAEDS Total Psych A&E TRIAGE SKIP ESI-2-PSCH ESI-3-PSCH ESI-4-PSCH ESI-5-PSCH Total Number of A&E Attendances 2018 Department & ESI Category 2017 Number of A&E Attendances Difference 17 6418 8001 5308 1123 20867 1 9 17 16 31 74 8 5717 8287 5302 1173 20487 0 0 49 42 50 141 9 701 -286 6 -50 380 1 9 -32 -26 -19 -67 761 Total A&E Attendances 142519 141758 Hospital Activity Report, Annual 2018 Page 12 Mater Dei Hospital 2.2 In-Patient Activity 2.2.1 Admissions (ADMIT) 2018 In 2018 there were 94803 (+1% on 2017) registered admissions (in-patients and day cases) excluding renal unit1 and nursery2 registrations at MDH.
The average daily admission rate was of 259/day (257/day 2017).

The graph below shows the number of registered admissions from 2008-2018.

Note: an admission is a patient entering the hospital for in-patient service and at which the patient begins an episode of care.
Number of Admissions Over the Years s n o i s s i m d A f o r e b m u N 100000 90000 80000 70000 60000 50000 40000 30000 20000 10000 0 2008 2009 2010 2011 2012 2013 2014* 2015 2016 2017 2018 No of Admissions 66742 68060 71331 75075 77983 80931 89449 90128 91925 93658 94803 Year *IT administrative system changeover Illustration 6: Number of admissions over the years 1 In the Renal Unit, there were 22940 registered admission episodes/dialysis sessions.
2 In the Nurseries, there were 3840 registered admission episodes.

Hospital Activity Report, Annual 2018 Page 13 Mater Dei Hospital 2.2.2 Admissions by Month The monthly number of registered admissions in 2018 and compared to 2017 can be seen in the graph below.

There was a slight decrease in the number of admission episodes in March (- 3%), and August (-2%) with the rest of the months registering an increase in admission episodes, in particular February (+5%) April and May (+4%).
The highest number of admission episodes was registered in January with 8472 admissions whilst the lowest number was recorded in June with 7271 admission episodes.
Registered Admissions 2018 2017 s n o i s s i m d A f o r e b m u N 8600 8400 8200 8000 7800 7600 7400 7200 7000 6800 6600 Jan Feb Mar Apr May Jun Jul 2018 8452 2017 8472 7784 7415 8105 8341 7825 7526 8227 7918 7454 7271 7926 7722 Month Illustration 7: number of admissions by month 2018/2017 Aug 7811 7977 Sep 7346 7293 Oct 8272 8105 Nov 8275 8305 Dec 7326 7313 Hospital Activity Report, Annual 2018 Page 14 Mater Dei Hospital 2.2.3 Demography Admissions according to hospital identification number/ID letter The chart below shows the percentage of admissions according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of admissions were made up of Maltese with 85% (86% in 2017) of the total admissions whilst non Maltese residents and foreigners made up 10% (9% in 2017) of the admissions in 2018.
Admissions Origin 2018 3% 7% 3% 2% Non-Maltese residents New Born Foreigners Gozitans Maltese 85% Illustration 8: Percentage of admissions according to origin Hospital Activity Report, Annual 2018 Page 15 Mater Dei Hospital Admissions according to Age and Gender Out of the total admissions to MDH this year, 52% were females and 48% were male admissions.

The remaining <1% of admissions had no gender specified.

The age and gender distribution can be seen in the table below.
The 65-74 year age group registered the highest increase in the number of admission episodes from the previous year.

This highlights the notion that the hospital and health care are catering more to the demands of an ageing population.
Gender and Age Population Admissions Age Group (yrs) <5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-94 95+ Unspec Total Males 2467 1703 1878 2970 3627 4440 8012 11286 6894 2241 102 41 45661 Females 1833 1169 3079 7739 5706 4445 6357 8692 6648 3189 262 13 49132 Unspecified 0 0 0 4 1 2 0 1 0 0 0 2 10 Total 2018 4300 2872 4957 10713 9334 8887 14369 19979 13542 5430 364 56 94803 Total 2017 4100 2754 4942 10919 9186 9128 14223 19132 13534 5288 399 53 93658 Difference 200 118 15 -206 148 -241 146 847 8 142 -35 3 1145 Hospital Activity Report, Annual 2018 Page 16 Mater Dei Hospital 2.2.4 Admissions (ADMIT) Vs Discharges (DISC) The illustration below depicts the average number of admissions and discharges per day according to day of week in 2018 (excluding renal unit and nursery registrations).
The highest average number of admissions was recorded on Mondays with 299 (295 in 2017) admissions and the lowest average number on Sundays with 147 (148 in 2017) admissions.

With regards to the average number of discharges, Tuesdays registered the highest average number with 308 (289 in 2017) discharges and the lowest on Sundays with an average of 84 (96 in 2017) discharges.
Average Daily Admissions and Discharges 2018 Admissions Discharges s e g r a h c s i D & s n o i s s i m d A f o r e b m u N 350 300 250 200 150 100 50 0 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Admissions Discharges 299 302 292 308 294 290 292 294 262 274 231 256 147 84 Average number of admissions & discharges Illustration 9: average number of admissions and discharges by day of week (excluding renal unit and nursery activity) Hospital Activity Report, Annual 2018 Page 17 Mater Dei Hospital 2.2.5 Method of Admission The method of admission was analysed by using the type of admission as inputted by ward staff and assumptions3 when type was not inputted accordingly.
The figure below shows a breakdown of admissions by type.
Type of admission registrations in 2018 (and percentage difference on 2017):  Day Case4: 30711 (0%)  Elective5: 15590 (+1%)  Emergency6: 43574 (+2%)  Other*: 4928 (+5%) *includes delivery of new born & obstetrics admissions Method of Admission 2018 5% 32% 46% 17% Day Case Elective Emergency Other* * includes delivery of new born & obstetrics admissions Illustration 10: method of admission 3 Assumptions were based on the nature of the diagnosis, the ward and the length of stay when available.
4 Day cases are admissions which do not require an overnight stay.

5 Elective are planned admissions.

6 Emergency are unplanned, often urgent admissions.

Hospital Activity Report, Annual 2018 Page 18 Mater Dei Hospital 2.2.6 Method of Admissions by Consultant Speciality The admissions for 2018 were analysed according to the method of admission and consultant speciality and presented in the table below.

The figures exclude the renal unit and nursery admissions.
Consultant Speciality Day Case Elective Emergency Other Anaesthesia/Pain relief Baromedicine Cardiac surgery Cardiology Dental Dermatology ENT ENT/Audiology Genetics Haematology* Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obstetrics & Gynae Oncology* Ophthalmology Orthopaedics Other Paediatrics Psychiatry Sleep Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics** Surgery/Urology Surgery/Vascular Total Total Total Difference 109 3 33 -57 -62 3 107 19 -6 8 -81 366 27 -35 103 59 -110 -81 84 -250 1 587 -204 -11 45 190 1 -438 474 291 -13 62 -34 1145 *Admissions from SAMOC.
Haematology & Oncology migrated to SAMOC in early September 2015.

**These admissions might include ward attenders which were inadvertently admitted into admission beds rather than ward attender beds, hence one cannot distinguish actual admissions from ward attenders (see ward attender section).
Hospital Activity Report, Annual 2018 Page 19 Mater Dei Hospital 2.2.7 Admissions by department and ward including transfers in, average length of stay (days) and % bed occupancy The table below illustrates the number of registered admissions to the admitting wards grouped together by the corresponding department including transfers in, average length of stay and the percentage (%) bed occupancy for 2018.
The transfers in (clinic changes) to the wards were also included in this table to provide a more complete picture of the input of patients into the wards.

Transfers in/out occur when patients are transferred from one ward to another within MDH.

Dept Ward Cardiology Cardiothoracic Surgery Medicine CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.
ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 SLEEP LAB Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2 Total Admissions 2018 1385 796 1378 Total Transfers In 2018 4 387 1622 Average of Length of Stay (days) n/app n/app 6.9 7.2 n/app 3.7 2.3 2.3 % Bed Occupancy n/app 75.1% 84.9% 57.6% 82.6% 66.9% 87.9% 88.0% 92.1% 96.0% 96.1% 95.6% 93.8% 91.0% 96.7% 79.6% 95.8% 99.4% n/app 80.9% 87.8% n/app 73.9% 75.7% 73.7% Hospital Activity Report, Annual 2018 Page 20 Mater Dei Hospital Dept Ward Orthopaedics Surgery Paediatrics Other OBSTETRICS WARD 3 ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 BURNS UNIT DIABETIC FOOT WARD E.N.T.
WARD FAIRYLAND PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT 1 SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DISNEYLAND NEONATAL/PAED.

INT.
CARE WONDERLAND A&E PAEDIATRIC CORRIDOR DAY CARE UNIT (ENDOSCOPY) * DAY CARE UNIT (SURGERY) * DAY CARE UNIT RECOVERY* DISCHARGE LOUNGE ** INTENSIVE THERAPY UNIT OBSERVATION WARD 1A OBSERVATION WARD 1B OBSERVATION WARD 2 OPHTHALMIC WARD PAEDIATRICS DAY CARE* MD WAIT*** MITU Total Admissions 2018 858 Total Transfers In 2018 1802 Average of Length of Stay (days) n/app 4.2 3.0 5.2 5.0 7.6 6.3 5.2 4.0 3.8 2.3 17.0 2.4 n/app n/app n/app n/app n/app 8.8 3.4 2.2 3.7 2.6 n/app n/app n/app % Bed Occupancy 81.8% 91.1% 77.7% 92.8% 52.2% 78.4% 79.8% 67.4% n/app 76.5% 88.0% 88.9% 81.9% 84.5% 92.4% 91.3% 87.9% 91.3% 75.7% 95.5% 85.0% n/app n/app n/app n/app n/app 83.6% 88.9% 82.9% 89.7% 57.8% n/app n/app n/app * Beds at Day Care Unit Surgery, Endoscopy and Recovery, Paediatrics Day Care and MITU were being used at times to admit emergency cases (mostly medical) in the case of influx in admissions **Patients are transferred to the discharge lounge before leaving the hospital after being discharged from the wards.
***Patients are admitted to MD WAIT prior to admission to respective ward.

Hospital Activity Report, Annual 2018 Page 21 Mater Dei Hospital 2.3 Ward Attenders 2.3.1 Ward Attenders 2018 In 2018 there were 42037 (-2% 2017) registered ward attenders in the wards at MDH.

The graph below shows the number of registered ward attenders from 2009-2018.

Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.
Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.

Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.

All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed to compile the following tables.
Ward Attenders Number of Ward Attenders s r e d n e t t A d r a W f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 2009 2010 2011 2012 2013 2014* 2016 2016 2017 2018 Number of Ward Attenders 18935 25150 31500 44350 47596 42485 43789 45827 42910 42037 Year *IT system changeover Illustration 11: number of ward attenders over the years Hospital Activity Report, Annual 2018 Page 22 Mater Dei Hospital 2.3.2 Ward Attenders by Consultant Speciality The ward attenders for 2018 were analysed according to the consultant speciality and presented in the table below.
The difference in the totals compared with 2017 can also be found.
Speciality A&E Anaesthesia/Pain Relief Cardiac surgery Cardiology Dental Dermatology ENT ENT/Audiology Genetics Haematology* Investigations & Treatment** Nursing Team Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obstetrics & Gynae Ophthalmology Orthopaedics Paediatrics Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics*** Surgery/Urology Surgery/Vascular Other Grand Total Total Total Difference -87 0 565 -43 2 4 -93 8 24 131 771 72 -10 107 334 59 -330 80 159 75 -147 -131 -90 -336 185 56 145 52 -2109 38 -370 6 -873 *migrated to SAMOC **these ward attenders were registered as out-patient attendances and hence cannot be distributed according to the respective speciality.
This could reflect a decrease in ward attenders in other specialities.

***follow ups at plastics are not being registered as ward attenders but as outpatient attendances seen at the ward.

Hospital Activity Report, Annual 2018 Page 23 Mater Dei Hospital 2.3.3 Ward Attenders by Department and Ward The table below illustrates the number of registered ward attenders to the respective department and ward in 2018 compared with 2017.
Clinic Total 2018 Total 2017 Difference Dept Cardiology Cardiothoracic Surgery Medicine CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.


ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 RENAL UNIT Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae Orthopaedics Paediatrics DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2 OBSTETRICS WARD 3 ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 DISNEYLAND NEONATAL/PAED.

INT.
INT.

CARE NURSERY -55 -2 23 -2 566 9 -3 -28 -2 -7 -12 5 -189 -5 -25 -4 -4 -4 -157 23 -153 -10 8 0 -138 -10 11 -153 -202 -11 -3 0 Hospital Activity Report, Annual 2018 Page 24 Mater Dei Hospital Cont… Dept Surgery Other Grand Total Clinic NURSERY 3 (OBST.
WARD 3) PAEDIATRICS DAY CARE WONDERLAND RAINBOW Total 2018 2 5046 11 6 Total 2017 2 4711 17 0 Difference 0 335 -6 6 BURNS UNIT E.N.T.

WARD DIABETIC FOOT WARD FAIRYLAND PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT* SURG.

ADMISSION UNIT 1 SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DAY CARE UNIT (ENDOSCOPY) DAY CARE UNIT (SURGERY) INTENSIVE THERAPY UNIT MED.

INVEST.

& TREAT.
INVEST.

& TREAT.

UNIT,MDH OBSERVATION WARD 1A OBSERVATION WARD 1B OBSERVATION WARD 2 OPHTHALMIC WARD MD WAIT 24 344 8 358 2277 880 10 214 132 27 156 381 16 844 41 1 0 11220 39 1 3 120 3 42037** 67 430 0 319 2232 2974 19 207 146 411 169 109 45 831 73 2 2 9378 46 3 1 233 0 42910*** -43 -86 8 39 45 -2094 -9 7 -14 -384 -13 272 -29 13 -32 -1 -2 1842 -7 -2 2 -113 3 -873 *follow ups at plastics are not being registered as ward attenders but as outpatient attendances seen at the ward.
**excluding psychiatry speciality ***includes observation ward 1 which was open until August 2017 Hospital Activity Report, Annual 2018 Page 25 Mater Dei Hospital 2.4 Out-Patient Activity 2.4.1 Out-Patient Attendances 2018 In 2018 there were 512535 (+3% 2017) registered clinic attendances at the out-patient department (of which 22566 were registered at outreach clinics7).

The average daily attendance was of 1637 attendances (excluding outreach clinics, Sundays and public holidays).
Note: an outpatient attendance is a patient visiting the outpatients department for ambulatory care including consultations, diagnosis, observation, treatment and other care from support areas.
Registered attendances by type in 2018 (and percentage difference on 2017):  New Cases8: 93693 (+8%)  Follow-ups9: 217830 (+7%)  Walk-ins10: 132811 (+6%)  Any Cases11: 68201 (-13%) Type of Attendance 2018 26% 13% Any Follow Up New Case Walk In 18% 43% 7 Outreach clinics include the following: tissue viability outreach, urology outreach, midwifery outreach, orthopaedic outreach and home antibiotic/therapy.
8 New cases are new outpatient appointments which are planned and given a date and time beforehand.

In this case, the patient will not have had a previous outpatient appointment related to the case.

9 Follow up cases are outpatient appointments which are planned to provide continuing or further attention to a previous related appointment.

The appointment will be planned and given a date and time beforehand.

10 Walk ins are unplanned outpatient attendances.


The patient turns up for an outpatient visit without a planned date and time for appointment.

11 These are cases registered as any in the system to allow for flexibility when booking patients.

These cases could be new cases or follow ups.


Hospital Activity Report, Annual 2018 Page 26 Mater Dei Hospital 2.4.2 Out patient attendances by month and type of attendance The graph below shows the number of out-patient attendances by month and type of attendance in 2018.

October registered the highest number of outpatient attendances with 47 038 attendances followed by January with 46008 attendances.

The lowest number of attendances was recorded in December with 31862 attendances.
Registered Out-Patient Attendances 2018 s e c n a d n e t t A f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 2018 Grand Total Any Follow-Up New-Case Walk-In Illustration 12: Number of registered outpatient attendances 2018 by month Hospital Activity Report, Annual 2018 Page 27 Mater Dei Hospital 2.4.3 Clinic Activity according to department and clinics grouped into the clinic description and attendance type The table below illustrates the number of outpatient attendances by type of attendance and clinic description for every department and clinic held at MDH.
The clinics were grouped together to create the clinics report description to further ease analysis and interpretation of data.

For example all medicine respiratory clinics grouped into Medicine & Respiratory OP.
Department & Clinics Report Description Anaesthesia/Pain Relief Pain Clinic Anaesthesia/Pre-op Pre-operative assessment clinic Cardiac Surgery Cardiac Surgery Clinic Cardiology Blood Pressure (Cardiology) Cardiac Lab Blood Inv Cardiac Rehabilitation Clinic (nurse-led) Cardiology Heart Valve Clinic Cardiology OP Cardiology OP TAVI Cardiology OP Visit Clinic Cardiology Rapid Access Clinic Cardiomyopathy Clinic Adult Congenital Heart Disease Clinic Heart Failure Clinic (Nurse led) Holter ECG (Cardiologist) ICD Clinic (technician led) Pacemaker Clinic (technician led) Pacemaker Wound Check Cl (nurse-led) Stress ECG (Cardiology) Chinese Medicine Chinese Medicine clinic Dental Child Dental Clinic Cleft Lip & Palate Clnic (Dental) Dental Clinic Dental Clinic (A&E) Dental Clinic (Consultants) New Case Follow Up Any Walk In Total Hospital Activity Report, Annual 2018 Page 28 Mater Dei Hospital Department & Clinics Report Description Dental Clinic (Oral Hygiene) Dental Clinic (oral rehabilitation) Dental Clinic (Oral Surgery) Dental Clinic (Pre-op) Dental Clinic (Prosthetics) Dental Clinic (Scaling and Polishing) Dental Clinic (X-Ray) Dental Orthodontic Clinic Dental VCC Dietician Dietetic Clinic Dietetic/Diabetes Clinic Dietetic/Gastro Clinic Dietician Oncology Dietician Renal Clinic Genetics Assisted Reproduction Clinic Genetics Genetics Clinic Infection Control Hep.
B Titre Clinic Infection Control Clinic Infection Control Screening Influenza Vaccine Clinic MRSA Screening Clinic Needle Stick Injury Clinic Medicine Ambulatory Sleep Studies Asthma Clinic Baromedicine Coeliac Disease Clinic COPD Clinic CTD Clinic Diabetes Awareness Sessions Diabetes Clinic Diabetes Clinic (follow-ups) Diabetes Clinic (Juvenile) Diabetes Clinic (new-cases) Diabetes Education Clinic Diabetes Point of Care Clinic Diabetic Foot Clinic Diabetic Retinopathy Clinic New Case Follow Up Any Walk In Total Hospital Activity Report, Annual 2018 Page 29 Mater Dei Hospital Department & Clinics Report Description Endocrine & Medical Clinic Endocrinology Rapid Access Fibromyalgia Clinic Gestational Diabetes Clinic Home Therapy Hyperbaric Unit IBD Clinic Infectious Diseases Joint Injection Clinic Lipid Clinic Medical & Respiratory OP Medical OP Medicine/Nephrology MOP General & Inf.
Diseases MOP Liver Clinic MOP VCC Respiratory MOP/Gastroenterology MOP/Gastroenterology/Hepatic Nephrology Nephrology Transplant Clinic Neuroendocrine Clinic Pulmonary Fibrosis Pulmonary Function Lab (Nurse led) Rheumatology Ankylosing Spondylitis Rheumatology Clinic Rheumatology Clinic (nurse led) Rheumatology Lupus Clinic Rheumatology Rapid Access Sleep Disorders Clinic Sleep OP Clinic Sleep Pap Clinic Systemic Sclerosis Clinic TB/Cardiopulmonary Geriatrics Thyroid Clinic Transplant/Travel Wound Clinic Wound Clinic (Hyperbaric) Neurosciences EEG EMG Evoked Potentials Clinic (Neurology Team) New Case Follow Up Any Walk In Total Hospital Activity Report, Annual 2018 Page 30 Mater Dei Hospital Department & Clinics Report Description Movement Disorder Multiple Sclerosis Neuro EEG Monitoring Neurocognative Clinic Neuroepilepsy Clinic Neurology Botox Clinic Neurology Clinic Neuromuscular Clinic Neurosurgical Clinic Neurovascular Clinic Paediatric Neurosurgery VCC Neurosciences/Psychiatry Neuropsychiatric joint clinic Nutrition Nutrition Clinic Obs & Gynae Antenatal Clinic Assisted Reproduction Clinic Breastfeeding Clinic (Midwife led) Colposcopy Clinic CTG Clinic Diabetic Pregnancy Clinic Gynae Midwife Perinatal Mental Gynae OP Gynae OP Miscarriage Clinic Gynae OP Scans Gynae Urodynamics Minimal Invasive Clinic Outreach Midwifery Post Menopausal Bleeding
 Clinic Ophthalmology Ophthalmic Botox Clinic Strabismus Ophthalmic IVFA Ophthalmic Laser Ophthalmic Low Vision Clinic Ophthalmic OCT Ophthalmic OP Ophthalmic OP (Botox Clinic) Ophthalmic OP (Vitreoretinal) Ophthalmic OP A&E Referrals Ophthalmic Optometry/Refraction Clinic New Case Follow Up Any Walk In Total Hospital Activity Report, Annual 2018 Page 31 Mater Dei Hospital Department & Clinics Report Description Ophthalmic Orthoptics Ophthalmic Paediatric Ophthalmic Peripheral Visual Fields Ophthalmic Post-OP Clinic Ophthalmic Retina Ophthalmic Special Ophthalmology VCC Ophthalmic (Cornea) Orthopaedics OOP Foot Ankle Clinic Orthopaedic FTC Orthopaedic OP Orthopaedic OP (General/Paediatrics) Orthopaedic OP Shockwave Orthopaedic Outreach Orthopaedic Plaster Clinic Orthopaedic VCC Orthopaedic VCC (Spinal) Orthopaedics VCC (Hand Clinic) Sport Injury Clinic Other Home Antibiotic Therapy Paediatrics Children's OP Children's OP (Cardiology/General) Children's OP (Endocrine) Children's OP (Endocrine/General) Children's OP (Neuro-paed) Children's OP (Neuro-paed/General) Community Paediatric Clinic COP (Bleeding Room) Diabetes Clinic Paediatrics Neonatal/NPICU F/U Paediatric Development Clinic Paediatric Diet Clinic Paediatric Gastroenterology VCC Paediatric General & Inf Diseases Paediatric
 Infectious Diseases Clinic Paediatric Nephrology Paediatric NPICU Paediatric Respiratory Medicine New Case Follow Up Any Walk In Total Hospital Activity Report, Annual 2018 Page 32 Mater Dei Hospital Department & Clinics Report Description Paediatric Review Clinic Paediatric Rheumatology Clinic Paediatric VCC Endocrine Paediatric VCC Nephrology Paediatric VCC Nutrition Stress ECG (Paediatrics) Podiatry Diabetic Foot Clinic Diabetic Foot Ward Ulcers Podiatry Clinic Podology Clinic Surgery Assessment Dialysis Breast Clinic ENT Audiology ENT Audiology (Audiometry) ENT Audiology (Hearing Aids) ENT Audiology (paed) ENT Dizziness Clinic ENT Hearing Loss Clinic ENT Oncology ENT OP ENT Tinnitus Clinic Paediatric Surgery Paediatric Surgery VCC SOP SOP (Stoma Clinic) SOP Bariatric Clinic SOP Dermatology Referrals SOP Plastic Urology Clinic Urology Clinic VCC Urology Male Infertility Clinic Urology Outreach Clinic Vascular Surgery Clinic Thalassaemia MOP Thalassaemia/Haematology Thalassaemia Clinic Thalassaemia Phlebotomy Clinic New Case Follow Up 2
41 18089 0 289 8 1882 12645 20 230 0 2572 114 2 112 0 Any Walk In Total Hospital Activity Report, Annual 2018 Page 33 Mater Dei Hospital Department & Clinics Report Description Tissue Viability Tissue Viability Clinic TVU Outreach Total Outpatient Attendances 2018 New Case 0 0 0 93693 Follow Up 0 0 0 217830 Any Walk In 6622 6355 267 68201 1591 1549 42 132811 Total 2018 8213 7904 309 512535 Notes: 1) Haematology not included due to migration to SAMOC.
2) A number of cardiology clinics have been excluded from analysis since the activity is not being registered on CPAS but on cardiology system.

These include 7 Day Holter Clinic (Cardiol-tech led), Adult Heart Disease, Cardiac cath Suite (Cardiology Clinic), ECG Clinic (12 lead), Echocardiogram (cardiology).

3) Pathology activity for clinics ACC Phlebotomy, Bleeding Room (OGTT) and Phlebotomy Pathology have been excluded.

4) Sleep disorders clinic (domiciliary) has been excluded.
5) Gynae bone density clinic has been excluded due to the activity being registered on radiology system rather than CPAS.

6) Clinics registered under MDH but are held at a different location have been excluded (orthotics & prosthetics, CDAU, occupational therapy, social work).
Hospital Activity Report, Annual 2018 Page 34 Mater Dei Hospital 3 SECTION 2 Sir Anthony Mamo Oncology Centre (SAMOC) Activity ADMISSIONS, DAY CASES, WARD ATTENDERS, OUT-PATIENTS Hospital Activity Report, Annual 2018 Page 35 Mater Dei Hospital 3.1 Admissions 2018 In 2018 there were 19437 (-5% 2017) registered admissions (in-patients and day cases) at SAMOC.

The average daily admission rate was of 53/day (56/day in 2017).

The list below shows a breakdown of admissions by type.
Type of admission registrations in 2018 (and percentage difference on 2017):  Day Case*: 15434 (-7%)  Elective: 3716 (+8%)  Emergency: 163 (-13%)  Other**: 124 (-45%) *these include day cases registered as out patient attendances at the DCU SAMOC **all admissions should be inputted as either day cases, elective or emergency 3.1.1 Admissions by ward The table below illustrates the number of registered admissions to the admitting wards at SAMOC.
Ward OC DCU - Day Care Unit OC HAEMW- Haematology Ward OC PAU-Paediatric Adolescent Ward OC PCU- Palliative Care Unit OC RIU- Radioisotope unit OC WARD 1- Oncology Ward 1 OC WARD 2- Oncology Ward 2 Total Total 2018 15365 267 204 260 63 1371 1907 19437 Hospital Activity Report, Annual 2018 Page 36 Mater Dei Hospital 3.2 Out-Patient Attendances 2018 In 2018 there were 51105 (+16% 2017) registered out-patient attendances at SAMOC out- patient department.
The table below illustrates the number of outpatient attendances by type of attendance for every department.
Department Haematology Oncology Palliative Pathology Clinics Radiotherapy Clinics Physiotherapy Team Psychology Clinics Occupational Therapy Clinics New Case Follow Up 1879 1732 168 6362 12338 549 Any 774 1729 0 Walk In Total Hospital Activity Report, Annual 2018 Page 37 Mater Dei Hospital 3.3 Ward Attenders 2018 In 2018 there were 2678 (-2% 2017) registered ward attenders at SAMOC.
Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.

Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.

Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.
All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed.

The table below illustrates the number of registered ward attenders to the respective wards in 2018.
Ward OC DCU - Day Care Unit OC HAEMW – Haematology Ward OC PAU - Paediatric Adoloscent Unit OC PCU - Palliative Care Unit OC RIU - Radioisotope Unit OC WARD 1 - Oncology Ward 1 OC WARD 2 - Oncology Ward 2 Total Total 2018 130 11 1572 6 169 237 553 2678 Hospital Activity Report, Annual 2018 Page 38 Hospital Activity Report 2019 Annual A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS, Mater Dei Hospital ADMISSIONS, DAY CASES, OUT-PATIENTS, WARD ATTENDERS, Sir Anthony Mamo Oncology Centre Clinical Performance Unit Mater Dei Hospital DOCUMENT INFORMATION Version Date published Document type 1.0 August 2020 Annual statistical report Analysis and compilation Clinical Performance Unit David Borg, Chief Scientific Officer Prof Sandra Buttigieg, Consultant Public Health Dr Sandra Distefano, Consultant Public Health David Borg, Chief Scientific Officer, RN Jane Agius, Assistant Principal Email: cpu.mdh@gov.mt Hospital Activity Report 2019 Page 2 Mater Dei Hospital CONTENTS 1 2 3 2.2 INTRODUCTION ....................................................................................................................................... 4 SECTION 1 ............................................................................................................................................. 5 2.1 Accident & Emergency Activity ................................................................................................ 6 A&E Attendances 2019 .................................................................................. 6 2.1.1 Source of Referral ........................................................................................... 7 2.1.2 A&E Attendances according to hospital identification number/ID letter ...... 8 2.1.3 A&E Attendances by ESI (Emergency Severity Index) Category ..................... 9 2.1.4 A&E Attendances according to attending department and ESI breakdown 10 2.1.5 In-Patient Activity ................................................................................................................... 13 Admissions (ADMIT) 2019 ............................................................................ 13 2.2.1 Admissions by Month ................................................................................... 14 2.2.2 Demography ................................................................................................. 15 2.2.3 2.2.4 Admissions according to Age and Gender ................................................... 16 2.2.5 Method of Admission ................................................................................... 17 2.2.6 Method of Admissions by Consultant Speciality .......................................... 18 2.2.7 Admissions by department and ward including transfers in, average length of stay (days) and % bed occupancy .......................................................................... 19 2.3 Ward Attenders ...................................................................................................................... 21 2.3.1 Ward Attenders 2019 ................................................................................... 21 2.3.2 Ward Attenders by Consultant Speciality .................................................... 22 2.3.3 Ward Attenders by Department and Ward ................................................. 23 2.4 Out-Patient Activity ................................................................................................................ 25 2.4.1 Out-Patient Attendances 2019 .................................................................... 25 2.4.2 Out patient attendances by month and type of attendance ....................... 26 2.4.3 description and attendance type ............................................................................... 27 SECTION 2 ........................................................................................................................................... 34 3.1 Admissions 2019 .................................................................................................................... 35 Admissions by ward ..................................................................................... 35 3.2 Out-Patient Attendances 2019 .............................................................................................. 36 3.3 Ward Attenders 2019 ............................................................................................................. 37 Clinic Activity according to department and clinics grouped into the clinic 3.1.1 Hospital Activity Report, Annual 2019 Page 3 Mater Dei Hospital 1 INTRODUCTION The Hospital Activity Report presents an overview on the main activities at Mater Dei Hospital (MDH) and Sir Anthony Mamo Oncology Centre (SAMOC) for the year 2019.
It details information on A&E attendances, admissions, discharges, ward attenders and out-patient attendances.

The data contained in this report have been compiled from registrations on CPAS, which is the patient administrative system of use at MDH and SAMOC and the primary source of data for this report.

The first section includes activity at MDH, highlighting information on A&E attendances, in-patient activity in the form of admissions, ward attenders and out-patient attendances.
The second section encompasses the main activity at SAMOC, including admissions to the wards, ward attenders and out- patient attendances.

The year 2019 has seen an increase of 3% in the number of admission registrations at MDH (including day cases, elective and emergency).

On the other hand, the number of registered A&E attendances seem to level off when compared with the previous year with a slight decrease of 2%.
Outpatient attendances increased by 1% (including attendances seen by the outreach teams).

Also in 2019, the year on year negative trend for ward attenders continued to be evident with a 4% decrease.
Apart from the numbers presented in this report, it is important to note that the activity surrounding patient care includes important services such as pathology tests, renal dialysis, diagnostic procedures, radiological procedures, screening procedures and surgical operative procedures/interventions amongst other services which all contribute to provide holistic care for the well being of the patient.
One cannot forget to mention the collaborative and organised input by the multidisciplinary health care team at Mater Dei Hospital and Sir Anthony Mamo Oncology Centre in achieving the best health outcomes for our patients.

Disclaimer The accuracy of information in this document might be limited by factors beyond author’s control.

This document contains data which is subject to interpretation.
Before using this data for making decisions or drawing conclusions, users are encouraged to contact the Clinical Performance Unit for advice.
Hospital Activity Report, Annual 2019 Page 4 Mater Dei Hospital 2 SECTION 1 Mater Dei Hospital (MDH) Activity A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS Hospital Activity Report, Annual 2019 Page 5 Mater Dei Hospital 2.1 Accident & Emergency Activity 2.1.1 A&E Attendances 2019 In 2019 there were 140209 (-2% 2018) registered A&E attendances at the A&E Dept, MDH.

The average daily attendance rate was of 384/day (391/day 2018).
The graph below shows the number of registered A&E attendances from 2009-2019.

Note: A&E Attendances are patients visiting the A&E department, with cases ranging from minor walk ins to life-threating injuries.
A&E Attendances A&E Attendances s e c n a d n e t t A E & A f o r e b m u N 160000 140000 120000 100000 80000 60000 40000 20000 0 2009 2010 2011 2012 2013 2014* 2015 2016 2017 2018 2019 A&E Attendances 101439 107102 110279 111533 115706 119941 128747 137852 141758 142519 140209 *IT system changeover Illustration 1: number of registered A&E attendances over the years Hospital Activity Report, Annual 2019 Page 6 Mater Dei Hospital The monthly number of registered A&E attendances in 2019 and compared to 2018 can be seen in the graph below.
June registered an increase in attendances (+3%) with the rest of the months registering less attendances, in particular the month of January (-5%).

The highest number of A&E attendances were registered in July and August whilst the lowest numbers were recorded in February and November.
Registered A&E Attendances 2019 2018 s e c n a d n e t t A f o r e b m u N 13000 12500 12000 11500 11000 10500 10000 9500 9000 8500 8000 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2019 11591 10737 12063 11554 11650 11821 12551 12543 11610 11679 11162 11248 2018 12248 10976 12356 11692 12066 11426 12570 12681 11683 12172 11356 11293 Month Illustration 2: number of A&E attendances in 2019 and 2018 by month 2.1.2 Source of Referral The majority of A&E attendances were self referrals at 74% whilst doctor referrals accounted to 22% of attendances.
Source of Referral: • Self-referral: • Doctor referral: • Other: 104239 (74%) 31472 (22%) 4498 (4%) Hospital Activity Report, Annual 2019 Page 7 Mater Dei Hospital 2.1.3 A&E Attendances according to hospital identification number/ID letter The chart below shows the percentage of A&E attendances according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of A&E attendances were Maltese with 74% (103794) (75%, 106556 in 2018) of the total attendances whilst non Maltese residents and foreigners made up 27% (27742) (19%, 26957 in 2018) of the A&E attendances in 2019.
Registered A&E Attendances 2019 11% 5% 9% 1% Non-Maltese Residents New Born Foreigners Gozitan Maltese 74% Illustration 3: Registered A&E attendances by hospital identification number/ID letter Hospital Activity Report, Annual 2019 Page 8 Mater Dei Hospital 2.1.4 A&E Attendances by ESI (Emergency Severity Index) Category The graph below presents the number of A&E Attendances according to the Emergency Severity Index done at triage level.
This includes all the attending departments, including A&E, paediatrics, ophthalmic, ENT, obstetrics and gynaecology, dental and psychiatric.

The majority of A&E attendances were categorized into ESI 2, 3 and 4 followed by ESI 5 and ESI 1.

Note: The Emergency Severity Index (ESI) is a five-level emergency department triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resources needed.
Attendances by ESI Category Registered A&E Attendances 2019 s e c n a d n e t t A f o r e b m u N 60000 50000 40000 30000 20000 10000 Registered A&E Attendances 2019 2010 0 ESI-1 ESI-2 51718 ESI-3 42089 ESI-4 37512 ESI-5 6525 Other 355 ESI Category Illustration 4: Registered A&E Attendances by ESI Category Hospital Activity Report, Annual 2019 Page 9 Mater Dei Hospital 2.1.5 A&E Attendances according to attending department and ESI breakdown The illustration below shows the percentage activity of A&E attendances according to the speciality/department that they were seen after triage.
The A&E department attended to 67% of the total cases after triage, followed by the paediatric A&E department with 14% of cases and the ophthalmic department with 10% of attendances.

The rest of the cases were attended to by the ENT, OBG, dental and psychiatric dept.
A&E Attendances 2019 Attending Dept 0% 14% 10% 4% 5% 0% 67% A&E Dental ENT OBG Ophth Paeds Psych Illustration 5: Registered A&E attendances by attending department Hospital Activity Report, Annual 2019 Page 10 Mater Dei Hospital The table below shows the number of A&E registrations grouped by the Emergency Severity Index and the attending speciality/department.

The difference in activity between 2019 and 2018 can also be seen.
Department & ESI Category A&E A&E TRIAGE SKIP ESI-1 ESI-2 ESI-3 ESI-4 ESI-5 Total Dental A&E TRIAGE SKIP ESI-3-DENTAL ESI-4-DENTAL ESI-5-DENTAL Total ENT A&E TRIAGE SKIP ESI-3-ENT ESI-4-ENT ESI-5-ENT Total OBG A&E TRIAGE SKIP ESI-3-OBS ESI-4-OBS ESI-5-OBS Total Ophth A&E TRIAGE SKIP ESI-3-OPTH ESI-4-OPTH ESI-5-OPTH Total Number of A&E Attendances 2019 2018 Difference -76 267 2452 -1032 -1611 -325 -325 -1 -20 -372 -85 -478 -4 160 -98 22 80 -93 141 -150 23 -79 0 -61 -689 -5 -755 Hospital Activity Report, Annual 2019 Page 11 Mater Dei Hospital Cont… Department & ESI Category Paeds A&E TRIAGE SKIP ESI-2-PAEDS ESI-3-PAEDS ESI-4-PAEDS ESI-5-PAEDS Total Psych A&E TRIAGE SKIP ESI-2-PSCH ESI-3-PSCH ESI-4-PSCH ESI-5-PSCH Total Number of A&E Attendances 2019 2018 Difference 147 6442 7937 4685 914 20125 1 13 10 20 19 63 17 6418 8001 5308 1123 20867 1 9 17 16 31 74 130 24 -64 -623 -209 -742 0 4 -7 4 -12 -11 Total A&E Attendances 140209 142519 -2310 Hospital Activity Report, Annual 2019 Page 12 Mater Dei Hospital 2.2 In-Patient Activity 2.2.1 Admissions (ADMIT) 2019 In 2019 there were 97618 (+3% on 2019) registered admissions (in-patients and day cases) excluding renal unit1 and nursery2 registrations at MDH.
The average daily admission rate was of 267/day (259/day 2018).

The graph below shows the number of registered admissions from 2009-2019.

Note: an admission is a patient entering the hospital for in-patient service and at which the patient begins an episode of care.
Number of Admissions Over the Years s n o i s s i m d A f o r e b m u N 120000 100000 80000 60000 40000 20000 0 2009 2010 2011 2012 2013 2014* 2015 2016 2017 2018 2019 No of Admissions 68060 71331 75075 77983 80931 89449 90128 91925 93658 94803 97618 Year *IT administrative system changeover Illustration 6: Number of admissions over the years 1 In the Renal Unit, there were 22226 registered episodes/dialysis sessions (including on outpatient module) 2 In the Nurseries, there were 3741 registered admission episodes.
Hospital Activity Report, Annual 2019 Page 13 Mater Dei Hospital 2.2.2 Admissions by Month The monthly number of registered admissions in 2019 and compared to 2018 can be seen in the graph below.

There was a slight decrease in the number of admission episodes in February (-16), with the rest of the months registering an increase in admission episodes, in particular July (+595), September (+569) and October (+325).
The highest number of admission episodes was registered in January with 8659 admissions whilst the lowest number was recorded in December with 7573 admission episodes.
Registered Admissions 2019 2018 s n o i s s i m d A f o r e b m u N 9000 8500 8000 7500 7000 6500 Jan Feb Mar Apr May Jun Jul 2019 8659 2018 8452 7768 7784 8221 8105 8008 7825 8405 8227 7616 7454 8521 7926 Month Illustration 7: number of admissions by month 2019/2018 Aug 8014 7811 Sep 7915 7346 Oct 8597 8272 Nov 8321 8275 Dec 7573 7326 Hospital Activity Report, Annual 2019 Page 14 Mater Dei Hospital 2.2.3 Demography Admissions according to hospital identification number/ID letter The chart below shows the percentage of admissions according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of admissions were made up of Maltese with 84% (85% in 2018) of the total admissions whilst non Maltese residents and foreigners made up 10% (10% in 2018) of the admissions in 2019.
Admissions Origin 2019 7% 3% 3% 3% Non-Maltese residents New Born Foreigners Gozitans Maltese 84% Illustration 8: Percentage of admissions according to origin Hospital Activity Report, Annual 2019 Page 15 Mater Dei Hospital 2.2.4 Admissions according to Age and Gender Out of the total admissions to MDH this year, 51% were females and 49% were male admissions.

The remaining <1% of admissions had no gender specified.

The age and gender distribution can be seen in the table below.
The 75-84 year age group registered the highest increase in the number of admission episodes from the previous year.

This highlights the notion that the hospital and health care are catering more to the demands of an ageing population.
Age Group (yrs) <5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-94 95+ Unspec Total Males 2549 1623 2028 3107 3987 4416 8222 11710 7530 2461 146 69 47848 Gender and Age Population Admissions Females Unspecified Total Total 2018 4300 2872 4957 10713 9334 8887 14369 19979 13542 5430 364 56 94803 Difference 113 -119 38 54 269 151 49 669 922 558 51 60 2815 Hospital Activity Report, Annual 2019 Page 16 Mater Dei Hospital 2.2.5 Method of Admission The method of admission was analysed by using the type of admission as inputted by ward staff and assumptions3 when type was not inputted accordingly.
The figure below shows a breakdown of admissions by type.
Type of admission registrations in 2019 (and percentage difference on 2018): • Day Case4: 31610 (+3%) • Elective5: 15499 (-1%) • Emergency6: 45412 (+4%) • Other*: 5097 (+3%) *includes delivery of new born & obstetrics admissions Method of Admission 2019 5% 32% 47% 16% Day Case Elective Emergency Other* * includes delivery of new born & obstetrics admissions Illustration 10: method of admission 3 Assumptions were based on the nature of the diagnosis/complaint, the ward, the length of stay and other factors when available.
4 Day cases are planned admissions which do not require an overnight stay.

5 Elective are planned admissions.

6 Emergency are unplanned, often urgent admissions.

Hospital Activity Report, Annual 2019 Page 17 Mater Dei Hospital 2.2.6 Method of Admissions by Consultant Speciality The admissions for 2019 were analysed according to the method of admission and consultant speciality and presented in the table below.

The figures exclude the renal unit and nursery admissions.
Consultant Speciality Day Case Elective Emergency Other Anaesthesia/Pain relief Baromedicine Cardiac surgery Cardiology Dental Dermatology ENT ENT/Audiology Genetics Haematology* Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obstetrics & Gynae Oncology* Ophthalmology Orthopaedics Paediatrics Psychiatry Sleep Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics** Surgery/Urology Surgery/Vascular Total Total Total Difference (in Total) 9 0 -13 398 60 5 -25 18 -21 -9 86 204 131 401 -57 348 718 -4 107 -370 -2 223 -38 253 -14 24 145 -348 -236 245 392 185 2815 *Admissions from SAMOC.
Haematology & Oncology migrated to SAMOC in early September 2015.

**These admissions might include ward attenders which were inadvertently admitted into admission beds rather than ward attender beds, hence one cannot distinguish actual admissions from ward attenders (see ward attender section).
Hospital Activity Report, Annual 2019 Page 18 Mater Dei Hospital 2.2.7 Admissions by department and ward including transfers in, average length of stay (days) and % bed occupancy The table below illustrates the number of registered admissions to the admitting wards grouped together by the corresponding department including transfers in, average length of stay and the percentage (%) bed occupancy for 2019.
The transfers in (clinic changes) to the wards were also included in this table to provide a more complete picture of the input of patients into the wards.

Transfers in/out occur when patients are transferred from one ward to another within MDH.

Dept Ward Cardiology Cardiothoracic Surgery Medicine CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.
ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 SLEEP LAB Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2 Total Admissions 2019 1615 870 1417 Total Transfers In 2019 7 376 1731 Average of Length of Stay (days) n/app n/app 7.1 6.7 n/app 3.4 2.4 2.5 % Bed Occupancy n/app 79.6% 95.1% 56.0% 90.2% 79.5% 97.1% 93.3% 97.5% 100% 100% 100% 99.9% 98.7% 100% 100% 100% 95.8% n/app 93.2% 94.7% n/app 79.7% 78.2% 75.3% Hospital Activity Report, Annual 2019 Page 19 Mater Dei Hospital Dept Ward Orthopaedics Surgery Paediatrics Other OBSTETRICS WARD 3 ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 BURNS UNIT DIABETIC FOOT WARD E.N.T.
WARD FAIRYLAND PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT 1 SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DISNEYLAND NEONATAL/PAED.

INT.
CARE WONDERLAND A&E PAEDIATRIC CORRIDOR DAY CARE UNIT (ENDOSCOPY) * DAY CARE UNIT (SURGERY) * DAY CARE UNIT RECOVERY* DISCHARGE LOUNGE ** INTENSIVE THERAPY UNIT OBSERVATION WARD 1A OBSERVATION WARD 1B OBSERVATION WARD 2 OPHTHALMIC WARD PAEDIATRICS DAY CARE* MD WAIT*** MITU MAJOR INCIDENCE UNIT Total Admissions 2019 820 Total Transfers In 2019 1758 Average of Length of Stay (days) n/app 4.6 1.8 4.8 4.8 5.7 5.9 4.5 4.3 3.9 2.4 17.1 2.5 n/app n/app n/app n/app n/app 4.9 3.0 2.2 3.2 2.2 n/app n/app n/app 2.2 % Bed Occupancy 85.6 100% 84.9% 98.8% 48.9% 92.6% 82.5% 72.2% n/app 90.4% 93.5% 92.4% 95.4% 92.2% 99.3% 97.0% 98.6% 97.7% 87.8% 114.6% 93.7% n/app n/app n/app n/app n/app 85.7% 100% 98.5% 98.5% 66.2% n/app n/app n/app 63.4% * Beds at Day Care Unit Surgery, Endoscopy and Recovery, Paediatrics Day Care and MITU were being used at times to admit emergency cases (mostly medical) in the case of influx in admissions **Patients are transferred to the discharge lounge before leaving the hospital after being discharged from the wards.
***Patients are admitted to MD WAIT prior to admission to respective ward.

Hospital Activity Report, Annual 2019 Page 20 Mater Dei Hospital 2.3 Ward Attenders 2.3.1 Ward Attenders 2019 In 2019 there were 40276 (-4% 2018) registered ward attenders in the wards at MDH.

The graph below shows the number of registered ward attenders from 2009-2019.

Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.
Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.

Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.

All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed to compile the following tables.
Ward Attenders s r e d n e t t A d r a W f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 2009 2010 2011 2012 2013 2014* 2016 2016 2017 2018 2019 Number of Ward Attenders 18935 25150 31500 44350 47596 42485 43789 45827 42910 42037 40276 Year *IT system changeover Illustration 11: number of ward attenders over the years Hospital Activity Report, Annual 2019 Page 21 Mater Dei Hospital 2.3.2 Ward Attenders by Consultant Speciality The ward attenders for 2018 were analysed according to the consultant speciality and presented in the table below.
The difference in the totals compared with 2017 can also be found.
Speciality A&E Anaesthesia/Pain Relief Cardiac surgery Cardiology Dental Dermatology ENT ENT/Audiology Genetics Haematology* Investigations & Treatment** Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obstetrics & Gynae Ophthalmology Orthopaedics Paediatrics Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics*** Surgery/Urology Surgery/Vascular Other Grand Total Total Total Difference -43 -1 227 99 3 7 172 3 20 -148 1437 51 -103 -293 -118 257 -20 -163 140 44 -4333 -47 -36 636 114 -147 59 256 99 -17 84 -1761 *migrated to SAMOC **these ward attenders were registered as out-patient attendances and hence cannot be distributed according to the respective speciality.
This could reflect a decrease in ward attenders in other specialities.

***follow ups at plastics are not being registered as ward attenders but as outpatient attendances seen at the ward.

Hospital Activity Report, Annual 2019 Page 22 Mater Dei Hospital 2.3.3 Ward Attenders by Department and Ward The table below illustrates the number of registered ward attenders to the respective department and ward in 2019 compared with 2018.
Clinic Total 2019 Total 2018 Difference Dept Cardiology Cardiothoracic Surgery Medicine CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.


ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 RENAL UNIT Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae Orthopaedics Paediatrics DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2* OBSTETRICS WARD 3 ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 DISNEYLAND NEONATAL/PAED.

INT.
INT.

CARE NURSERY -4 -33 -62 297 -91 -2 -10 -2 -4 69 15 35 1 -21 -1 0 0 358 184 29 0 -10 1 -4342 -8 -61 252 -240 -6 2 1 Hospital Activity Report, Annual 2019 Page 23 Mater Dei Hospital Cont… Dept Surgery Other Grand Total Clinic NURSERY 3 (OBST.
WARD 3) PAEDIATRICS DAY CARE WONDERLAND RAINBOW Total 2019 0 5812 0 0 Total 2018 2 5046 11 6 Difference -2 766 -11 -6 BURNS UNIT E.N.T.

WARD DIABETIC FOOT WARD FAIRYLAND PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT 1 SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DAY CARE UNIT (ENDOSCOPY) DAY CARE UNIT (SURGERY) INTENSIVE THERAPY UNIT MED.

INVEST.

& TREAT.
UNIT,MDH OBSERVATION WARD 1A OBSERVATION WARD 1B OBSERVATION WARD 2 OPHTHALMIC WARD MD WAIT 40276** 11220 39 1 3 120 3 42037** -23 169 -7 49 52 274 -1 45 31 -13 40 -128 -15 72 -37 -1 0 366 -25 1 -3 -45 2 -1761 *WA decreased at the OBS2 due to treatment being administered at OP clinics not on the ward, for example administering of Anti D injections; **excluding psychiatric unit Hospital Activity Report, Annual 2019 Page 24 Mater Dei Hospital 2.4 Out-Patient Activity 2.4.1 Out-Patient Attendances 2019 In 2019 there were 518175 (+1% 2018) registered clinic attendances at the out-patient department (of which 20669 were registered at outreach clinics7).
The average daily attendance was of 1641 attendances (excluding outreach clinics, Sundays and public holidays).

Note: an out-patient attendance is a patient visiting the outpatients department for ambulatory care including consultations, diagnosis, observation, treatment and other care from support areas.
Registered attendances by type in 2019 (and percentage difference on 2018): • New Cases8: 97957 (+5%) • Follow-ups9: 233860 (+7%) • Walk-ins10: 134484 (+1%) • Any Cases11: 51874 (-24%) Type of Attendance 2019 10% 26% 19% Any Follow Up New Case Walk In 45% 7 Outreach clinics include the following: tissue viability outreach, urology outreach, midwifery outreach, orthopaedic outreach and home antibiotic/therapy.
8 New cases are new outpatient appointments which are planned and given a date and time beforehand.

In this case, the patient will not have had a previous outpatient appointment related to the case.

9 Follow up cases are outpatient appointments which are planned to provide continuing or further attention to a previous related appointment.

The appointment will be planned and given a date and time beforehand.

10 Walk ins are unplanned outpatient attendances.


The patient turns up for an outpatient visit without a planned date and time for appointment.

11 These are cases registered as any in the system to allow for flexibility when booking patients.

These cases could be new cases or follow ups.


Hospital Activity Report, Annual 2019 Page 25 Mater Dei Hospital 2.4.2 Out-patient attendances by month and type of attendance The graph below shows the number of out-patient attendances by month and type of attendance in 2019.

October registered the highest number of out-patient attendances with 48709 attendances followed by July with 47350 attendances.

The lowest number of attendances was recorded in December with 35157 attendances.
Registered Out-Patient Attendances 2019 s e c n a d n e t t A f o r e b m u N 60000 50000 40000 30000 20000 10000 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 2019 Grand Total Any Follow-Up New-Case Walk-In Illustration 12: Number of registered outpatient attendances 2019 by month Hospital Activity Report, Annual 2019 Page 26 Mater Dei Hospital 2.4.3 Clinic Activity according to department and clinics grouped into the clinic description and attendance type The table below illustrates the number of out-patient attendances by type of attendance and clinic description for every department and clinic held at MDH.
The clinics were grouped together to create the clinics report description to further ease analysis and interpretation of data.

For example all medicine respiratory clinics grouped into Medicine & Respiratory OP.
Department & Clinics Report Description Anaesthesia/Pain Relief Pain Clinic Anaesthesia/Pre-op Pre-operative assessment clinic Cardiac Surgery Cardiac Surgery Clinic Cardiology Adult Congenital Heart Disease Clinic Blood Pressure (Cardiology) Cardiac Lab Blood Inv Cardiac Rehabilitation Clinic (nurse-led) Cardiology (Adult/Cong.
Heart Disease) Cardiology Heart Valve Clinic Cardiology OP Cardiology OP TAVI Cardiology Rapid Access Clinic Congestive Heart Disorder Clinic Heart Failure Clinic (Nurse led) Holter ECG (Cardiologist) ICD Clinic (technician led) Pacemaker Clinic (technician led) Pacemaker Wound Check Cl (nurse-led) Stress ECG (Cardiology) Chinese Medicine Chinese Medicine clinic Dental Child Dental Clinic Cleft Lip & Palate Clnic (Dental) Dental Clinic Dental Clinic (A&E) Dental Clinic (Consultants) New Case Follow Up Any Walk In Grand Total Hospital Activity Report, Annual 2019 Page 27 Mater Dei Hospital Cont… Department & Clinics Report Description Dental Clinic (Oral Hygiene) Dental Clinic (oral rehabilitation) Dental Clinic (Oral Surgery) Dental Clinic (Pre-op) Dental Clinic (Prosthetics) Dental Clinic (Scaling and Polishing) Dental Orthodontic Clinic Dental VCC Maxillofacial surgery Dietician Dietetic Clinic Dietetic Diabetes Clinic Dietetic Gastro Clinic Dietician Bariatric Dietician Oncology Dietician Paediatric Dietician Renal Clinic Genetics Assisted Reproduction Clinic Genetics Genetics Clinic Genetics Paediatrics Infection Control Hep.
B Titre Clinic Infection Control Clinic Infection Control Screening Influenza Vaccine Clinic MRSA Screening Clinic Needle Stick Injury Clinic Medicine Ambulatory Sleep Studies Asthma Clinic Baromedicine Chest Clinic Coeliac Disease Clinic COPD Clinic CTD Clinic Diabetes Awareness Sessions Diabetes Clinic Diabetes Clinic (follow-ups) Diabetes Clinic (Juvenile) New Case Follow Up Any Walk In Grand Total Hospital Activity Report, Annual 2019 Page 28 Mater Dei Hospital Cont… Department & Clinics Report Description Diabetes Clinic (new-cases) Diabetes Education Clinic Diabetes Point of Care Clinic Diabetic Foot Clinic Diabetic Retinopathy Clinic Endocrine & Medical Clinic Endocrine Clinic Endocrinology Rapid Access Fibromyalgia Clinic General Medicine Clinic Gestational Diabetes Clinic Home Therapy* Hyperbaric Unit IBD Clinic Infectious Diseases Joint Injection Clinic Lipid Clinic Medical OP MOP/Nephrology MOP General & Inf.
Diseases MOP Liver Clinic MOP/Gastroenterology MOP/Gastroenterology/Hepatic MOP/Respiratory MOP/VCC Nephrology Transplant Clinic Neuroendocrine Clinic Pulmonary Fibrosis Pulmonary Function Lab (Nurse led) Rheumatology Ankylosing Spondylitis Rheumatology Clinic Rheumatology Clinic (nurse led) Rheumatology Rapid Access Sleep Disorders Clinic Sleep OP Clinic Sleep Pap Clinic Systemic Sclerosis Clinic Thyroid Clinic Transplant/Travel Wound Clinic New Case Follow Up Any Walk In Grand Total Hospital Activity Report, Annual 2019 Page 29 Mater Dei Hospital Cont… Department & Clinics Report Description Wound Clinic (Hyperbaric) Neurosciences EEG EMG Evoked Potentials Clinic (Neurology Team) Movement Disorder Multiple Sclerosis Neuro EEG Monitoring Neurocognative Clinic Neuroepilepsy Clinic Neurology Botox Clinic Neurology Migraine Neurology OP Neuromuscular Clinic Neurosurgical Clinic Neurovascular Clinic Paediatric Neurosurgery VCC Neurosciences/Psychiatry Neuropsychiatric joint clinic Nutrition Nutrition Clinic Obs & Gynae Antenatal Clinic Assisted Reproduction Clinic Breastfeeding Clinic (Midwife led) Colposcopy Clinic CTG Clinic Diabetic Pregnancy Clinic Gynae Midwife Perinatal Mental Gynae OP Gynae OP Miscarriage Clinic Gynae OP Scans Gynae Urodynamics Minimal Invasive Clinic Obstetrics & Gynaecology Ultrasound Outreach Midwifery Perinatal Mental Health Clinic Post Menopausal
 Bleeding Clinic Ophthalmology New Case Follow Up Any Walk In Grand Total Hospital Activity Report, Annual 2019 Page 30 Mater Dei Hospital Cont… Department & Clinics Report Description Ophthalmic Botox Clinic Strabismus Ophthalmic IVFA Ophthalmic Laser Ophthalmic Low Vision Clinic Ophthalmic OCT Ophthalmic OP Ophthalmic OP (Botox Clinic) Ophthalmic OP (Vitreoretinal) Ophthalmic OP A&E Referrals Ophthalmic Optometry/Refraction Clinic Ophthalmic Orthoptics Ophthalmic Paediatric Ophthalmic Peripheral Visual Fields Ophthalmic Post-OP Clinic Ophthalmic Retina Ophthalmic Special Ophthalmology VCC Ophthalmic (Cornea) Orthopaedics OOP Foot Ankle Clinic Orthopaedic FTC Orthopaedic OP Orthopaedic OP (General/Paediatrics) Orthopaedic OP Shockwave Orthopaedic Outreach Orthopaedic Plaster Clinic Orthopaedic VCC Orthopaedic VCC (Spinal) Orthopaedics VCC (Hand Clinic) Sport Injury Clinic Other Home Antibiotic Therapy* Paediatrics Children's OP Children's OP (Cardiology/General) Children's OP (Endocrine) Children's OP (Endocrine/General) Children's OP (Neuro-paed) Children's OP (Neuro-paed/General) Community Paediatric Clinic New Case Follow Up 163 1381 2653 6 2368 18752 291 396 0 1216 620 297 0 367 1202 0 29 1911 20401 2215 11 14819 1553
 0 0 1132 153 193 68 257 0 0 7619 4658 1 354 185 325 0 195 Any Walk In Grand Total Hospital Activity Report, Annual 2019 Page 31 Mater Dei Hospital Cont… Department & Clinics Report Description COP (Bleeding Room) Diabetes Clinic Paediatrics Neonatal/NPICU F/U Paediatric Cardiology Paediatric Development Clinic Paediatric Echo (Paediatrics) Paediatric General & Inf Diseases Paediatric Infectious Diseases Clinic Paediatric NPICU Paediatric Respiratory Medicine Paediatric Review Clinic Paediatric Speech Therapy Paediatric VCC Paediatric VCC Endocrine Paediatric VCC Gastroenterology Paediatric VCC Hepatology Paediatric VCC Nephrology Paediatrics Development Clinic Paediatrics Nephrology Stress ECG (Paediatrics) Podiatry Diabetic Foot Clinic Diabetic Foot Ward Ulcers Podology Clinic Surgery Assessment Dialysis Breast Clinic ENT Audiology ENT Audiology (Audiometry) ENT Audiology (Hearing Aids) ENT Audiology (paed) ENT Dizziness Clinic ENT Head Neck ENT Hearing Loss Clinic ENT Oncology ENT OP ENT OP Oncology ENT Tinnitus Clinic Paediatric Surgery Paediatric Surgery VCC New Case Follow Up Any Walk In Grand
1172 4187 93 133 78 1 7 37 5354 3 15 101 Grand Total Hospital Activity Report, Annual 2019 Page 32 Mater Dei Hospital Cont… Department & Clinics Report Description SOP SOP (Stoma Clinic) SOP Bariatric Clinic SOP Breast SOP Dermatology Referrals SOP Plastic SOP Upper GI clinic SOP Urology Urology Clinic VCC Urology Male Infertility Clinic Urology Outreach Clinic Vascular Stroke (Nurse led) Vascular Surgery Clinic Thalassaemia Thalassaemia Clinic Thalassaemia Phlebotomy Clinic Tissue Viability Tissue Viability Clinic TVU Outreach Grand Total New Case 6601 11 0 0 315 809 165 2494 10 92 0 0 1498 430 239 191 98 98 0 Follow Up 19225 120 291 28 0 2023 51 13986 11 177 0 0 2715 200 200 0 2644 2644 0 97957 233860 Any 0 452 0 0 0 0 0 0 0 0 1678 0 168 0 0 0 2746 2718 28 51874 Walk In 2859 78 32 2 21 2234 12 2245 1 17 754 30 237 336 143 193 1393 1367 26 134484 Grand Total 28685 661 323 30 336 5066 228 18725 22 286 2432 30 4618 966 582 384 6881 6827 54 518175 *home antibiotic therapy numbers to be verified since not all visits are being registered on OP module.
Notes: 1) Haematology not included due to migration to SAMOC.

2) A number of cardiology clinics have been excluded from analysis since the activity is not being registered on CPAS but on cardiology system.

These include 7 Day Holter Clinic (Cardiol-tech led), Adult Heart Disease, Cardiac cath Suite (Cardiology Clinic), ECG Clinic (12 lead), Echocardiogram (cardiology).

3) Pathology activity for clinics ACC Phlebotomy, Bleeding Room (OGTT) and Phlebotomy Pathology have been excluded.
4) Sleep disorders clinic (domiciliary) has been excluded.

5) Gynae bone density clinic has been excluded due to the activity being registered on radiology system rather than CPAS.

6) Clinics registered under MDH but are held at a different location have been excluded (orthotics & prosthetics, CDAU, occupational therapy, social work, SLH chest clinic).
Hospital Activity Report, Annual 2019 Page 33 Mater Dei Hospital 3 SECTION 2 Sir Anthony Mamo Oncology Centre (SAMOC) Activity ADMISSIONS, DAY CASES, WARD ATTENDERS, OUT-PATIENTS Hospital Activity Report, Annual 2019 Page 34 Mater Dei Hospital 3.1 Admissions 2019 In 2019 there were 4238 (+4% 2018) registered in-patient admissions at SAMOC and 29301* registered day cases at SAMOC Day Care Unit.

The list below shows a breakdown of admissions by type.
Type of admission registrations in 2019: • Day Case*: 29299 • Elective: 4050 • Emergency: 110 • Other**: 80 *these include day cases registered as out patient clinic attendances at the DCU SAMOC, and include same patients visiting more than one clinic in one day **all admissions should be inputted as either day cases, elective or emergency 3.1.1 Admissions by ward The table below illustrates the number of registered admissions to the admitting wards at SAMOC.
Ward OC DCU - Day Care Unit OC HAEMW- Haematology Ward OC PAU-Paediatric Adolescent Ward OC PCU- Palliative Care Unit OC RIU- Radioisotope unit OC WARD 1- Oncology Ward 1 OC WARD 2- Oncology Ward 2 Total Total 2019 29301 292 158 275 52 1625 1836 33539 Hospital Activity Report, Annual 2019 Page 35 Mater Dei Hospital 3.2 Out-Patient Attendances 2019 In 2019 there were 55375 (+8% 2018) registered out-patient attendances at SAMOC out- patient department.
The table below illustrates the number of outpatient attendances by type of attendance for every department.
Department Haematology Oncology Palliative Total Pathology Clinics New Case Follow Up 2106 2702 158 4966 7032 13321 593 20946 Any 343 1378 0 1721 Walk In Total 2018 391 3674 17 4082 9872 21075 768 31715 12706 83 1 2552 15342 Radiotherapy Clinics 1009 Physiotherapy Team Psychology Clinics Occupational Therapy Clinics 20 0 0 0 7 0 0 1225 884 3118 4612 30 4669 448 82 1 0 449 82 Hospital Activity Report, Annual 2019 Page 36 Mater Dei Hospital 3.3 Ward Attenders 2019 In 2019 there were 2220 (-17% 2018) registered ward attenders at SAMOC.
Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.

Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.

Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.
All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed.

The table below illustrates the number of registered ward attenders to the respective wards in 2019.
Ward OC DCU - Day Care Unit OC HAEMW – Haematology Ward OC PAU - Paediatric Adoloscent Unit OC PCU - Palliative Care Unit OC RIU - Radioisotope Unit OC WARD 1 - Oncology Ward 1 OC WARD 2 - Oncology Ward 2 Total Total 2019 85 27 1281 2 268 112 445 2220 Hospital Activity Report, Annual 2019 Page 37 Hospital Activity Report 2020 Annual A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS, Mater Dei Hospital ADMISSIONS, DAY CASES, OUT-PATIENTS, WARD ATTENDERS, Sir Anthony Mamo Oncology Centre May 2021 DOCUMENT INFORMATION Version Date published Document type 1.0 May 2021 Annual statistical report Analysis and compilation David Borg, Chief Scientific Officer, RN Department Clinical Performance Unit (CPU) Prof Sandra Buttigieg, Consultant Public Health Dr Sandra Distefano, Consultant Public Health David Borg, Chief Scientific Officer, RN Maria-Anna Spiteri, Manager II Research Jane Agius, Assistant Principal CPU Portal: https://health.intra.gov.mt/mdh/CPU/SitePages/Home2.aspx Email: cpu.mdh@gov.mt Tel: 2545 6996/4144 Location: CPU, Administration MDH CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 2 Hospital Activity Report 2020 CONTENTS 1 2 3 2.2 INTRODUCTION ....................................................................................................................................... 4 SECTION 1 MATER DEI HOSPITAL .............................................................................................................. 5 2.1 Accident & Emergency Activity ................................................................................................ 6 A&E Attendances 2020 .................................................................................. 6 2.1.1 Source of Referral ........................................................................................... 7 2.1.2 A&E Attendances according to hospital identification number/ID letter ...... 8 2.1.3 A&E Attendances by ESI (Emergency Severity Index) Category ..................... 9 2.1.4 2.1.5 A&E Attendances according to attending department and ESI breakdown 10 In-Patient Activity ................................................................................................................... 13 Admissions (ADMIT) 2020 ............................................................................ 13 2.2.1 Admissions by Month ................................................................................... 14 2.2.2 Demography ................................................................................................. 15 2.2.3 Admissions according to Age and Gender ................................................... 16 2.2.4 2.2.5 Method of Admission ................................................................................... 17 2.2.6 Method of Admissions by Consultant Speciality .......................................... 18 2.2.7 Admissions by department and ward including transfers in, average length of stay (days) and % bed occupancy .......................................................................... 19 Summary stats of COVID-19 admission episodes MDH 2020 ...................... 22 2.2.8 2.3 Ward Attenders ...................................................................................................................... 24 2.3.1 Ward Attenders 2020 ................................................................................... 24 2.3.2 Ward Attenders by Consultant Speciality .................................................... 25 2.3.3 Ward Attenders by Department and Ward ................................................. 26 2.4 Out-Patient Activity ................................................................................................................ 28 2.4.1 Out-Patient Attendances 2020 .................................................................... 28 2.4.2 Out-patient attendances by month and type of attendance ....................... 29 2.4.3 description and attendance type ............................................................................... 30 SECTION 2 SAMOC .............................................................................................................................. 37 3.1 Admissions 2020 .................................................................................................................... 38 Admissions by ward ..................................................................................... 38 3.2 Out-Patient Attendances 2020 .............................................................................................. 39 3.3 Ward Attenders 2020 ............................................................................................................. 40 Clinic Activity according to department and clinics grouped into the clinic 3.1.1 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 3 Hospital Activity Report 2020 1 INTRODUCTION Due to the COVID-19 pandemic, the activity for the year 2020 should be interpreted with caution especially when compared to the previous year 2019.
The COVID-19 preparedness planning at Mater Dei Hospital (MDH) necessitated structural changes, extraordinary management and clinical measures within the hospital, particularly at the intensive care unit, operating theatres, wards and other areas.

This resulted in the shifting of resources and activity to deal with the effects of the pandemic, including the treatment of COVID-19 patients admitted to the hospital and the relocation and training of staff to deliver the best possible care to these patients.
The Hospital Activity Report presents an overview on the main activities at Mater Dei Hospital (MDH) and Sir Anthony Mamo Oncology Centre (SAMOC) for the year 2020.

It details information on A&E attendances, admissions (emergency, elective and day cases), discharges, ward attenders and out- patient attendances.
The data contained in this report have been compiled from registrations on CPAS, which is the main patient administrative system of use at MDH and SAMOC and the primary source of data for this report.

The first section of this report includes activity at MDH, highlighting information on A&E attendances, in-patient activity in the form of admissions, ward attenders and out-patient attendances.
The second section encompasses the main activity at SAMOC, including admissions to the wards, ward attenders and out-patient attendances.
Apart from the numbers presented in this report, it is important to note that the activity surrounding patient care includes important services such as pathology tests, renal dialysis, diagnostic procedures, radiological procedures, screening procedures and surgical operative procedures/interventions amongst other services which all contribute to provide holistic care for the well being of the patient.
One cannot forget to mention the collaborative and organised input by the multidisciplinary health care team at Mater Dei Hospital and Sir Anthony Mamo Oncology Centre in achieving the best health outcomes for our patients.

Disclaimer The accuracy of information in this document might be limited by factors beyond author’s control.

This document contains data which is subject to interpretation.
Before using this data for making decisions or drawing conclusions, users are encouraged to contact the Clinical Performance Unit for advice.
CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 4 2 SECTION 1 Hospital Activity Report 2020 Mater Dei Hospital (MDH) Activity A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 5 2.1 Accident & Emergency Activity Hospital Activity Report 2020 2.1.1 A&E Attendances 2020 In 2020 there were 96382 (-31% 2019) registered A&E attendances at the A&E Dept, MDH.

The average daily attendance rate was of 263/day (384/day 2019).
The graph below shows the number of registered A&E attendances from 2010-2020.

Note: A&E Attendances are patients visiting the A&E department, with cases ranging from minor walk ins to life-threating injuries.
A&E Attendances A&E Attendances s e c n a d n e t t A E & A f o r e b m u N 160000 140000 120000 100000 80000 60000 40000 20000 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 A&E Attendances 107102 110279 111533 115706 119941 128747 137852 141758 142519 140209 96382 Illustration 1: number of registered A&E attendances over the years CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 6 Hospital Activity Report 2020 The monthly number of registered A&E attendances in 2020 and compared to 2019 can be seen in the graph below.
On the onset of the COVID-19 pandemic in March 2020 the attendances notably decreased, only rising slightly in the summer months of July and August 2020 and declining again from September to December 2020.
Registered A&E Attendances 2020 2019 s e c n a d n e t t A f o r e b m u N 13000 12000 11000 10000 9000 8000 7000 6000 5000 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2020 12264 10853 6609 5489 6823 8013 9172 8184 7620 7313 6905 7137 2019 11591 10737 12063 11554 11650 11821 12551 12543 11610 11679 11162 11248 Month Illustration 2: number of A&E attendances in 2020 and 2019 by month 2.1.2 Source of Referral The majority of A&E attendances were self referrals at 79% whilst doctor referrals accounted to 17% of attendances.
Source of Referral: • Self-referral: • Doctor referral: • Other: 76171 (79%) 16076 (17%) 4135 (4%) CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 7 Hospital Activity Report 2020 2.1.3 A&E Attendances according to hospital identification number/ID letter The chart below shows the percentage of A&E attendances according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of A&E attendances were Maltese with 76% (73731) (74%, 103794 in 2019) of the total attendances whilst non Maltese residents and foreigners made up 20% (19221) (27%, 27742 in 2019) of the A&E attendances in 2020.
Registered A&E Attendances 2020 13% 3% 7% 1% Non-Maltese Residents New Born Foreigners Gozitan Maltese 76% Illustration 3: Registered A&E attendances by hospital identification number/ID letter CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 8 2.1.4 A&E Attendances by ESI (Emergency Severity Index) Category Hospital Activity Report 2020 The graph below presents the number of A&E Attendances according to the Emergency Severity Index done at triage level.
This includes all the attending departments, including A&E, paediatrics, ophthalmic, ENT, obstetrics and gynaecology, dental and psychiatric.

The majority of A&E attendances were categorized into ESI 2, 3 and 4 followed by ESI 5 and ESI 1.

Note: The Emergency Severity Index (ESI) is a five-level emergency department triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resources needed.
Attendances by ESI Category Registered A&E Attendances 2020 s e c n a d n e t t A f o r e b m u N 40000 35000 30000 25000 20000 15000 10000 5000 Registered A&E Attendances 2020 1752 0 ESI-1 ESI-2 36774 ESI-3 30794 ESI-4 22954 ESI-5 3856 Other 252 ESI Category Illustration 4: Registered A&E Attendances by ESI Category CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 9 Hospital Activity Report 2020 2.1.5 A&E Attendances according to attending department and ESI breakdown The illustration below shows the percentage activity of A&E attendances according to the speciality/department that they were seen after triage.
The A&E department attended to 72% of the total cases after triage, followed by the paediatric A&E department with 10% of cases and the ophthalmic department with 9% of attendances.

The rest of the cases were attended to by the ENT, OBG, dental and psychiatric dept.
A&E Attendances 2020 Attending Dept 0% 10% 9% 4% 4% 1% A&E Dental ENT OBG Ophth Paeds Psych 72% Illustration 5: Registered A&E attendances by attending department CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 10 The table below shows the number of A&E registrations grouped by the Emergency Severity Index and the attending speciality/department.

The difference in activity between 2020 and 2019 can also be seen.
Hospital Activity Report 2020 Department & ESI Category A&E A&E TRIAGE SKIP ESI-1 ESI-2 ESI-3 ESI-4 ESI-5 Total A&E Dental A&E TRIAGE SKIP ESI-3-DENTAL ESI-4-DENTAL ESI-5-DENTAL Total Dental ENT A&E TRIAGE SKIP ESI-3-ENT ESI-4-ENT ESI-5-ENT Total ENT OBG A&E TRIAGE SKIP ESI-3-OBS ESI-4-OBS ESI-5-OBS Total OBG Number of A&E Attendances 2020 2019 Difference -259 -10879 -5687 -5431 -1318 -23528 2 42 43 49 136 -9 -771 -2162 -143 -3085 -23 -637 -995 -91 -1746 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 11 Cont… Department & ESI Category Ophth A&E TRIAGE SKIP ESI-3-OPTH ESI-4-OPTH ESI-5-OPTH Total Ophth Paeds A&E TRIAGE SKIP ESI-2-PAEDS ESI-3-PAEDS ESI-4-PAEDS ESI-5-PAEDS Total Paeds Psych A&E TRIAGE SKIP ESI-2-PSCH ESI-3-PSCH ESI-4-PSCH ESI-5-PSCH Total Psych 2020 15 848 6556 925 8344 2020 25 2388 4017 2657 483 9570 1 21 15 10 14 61 Hospital Activity Report 2020 Number of A&E Attendances 2019 Difference 30 1175 10531 1655 13391 2019 147 6442 7937 4685 914 20125 1 13 10 20 19 63 -15 -327 -3975 -730 -5047 Difference -122 -4054 -3920 -2028 -431 -10555 0 8 5 -10 -5 -2 Total A&E Attendances 96382 140209 -43827 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 12 Hospital Activity Report 2020 2.2 In-Patient Activity 2.2.1 Admissions (ADMIT) 2020 In 2020 there were 72581 (-25% on 2019) registered admissions (emergency, elective and day cases) excluding renal unit1 and nursery2 registrations at MDH.
The average daily admission rate was of 198/day (267/day 2019).

The graph below shows the number of registered admissions from 2010-2020.

Note: an admission is a patient entering the hospital for in-patient service and at which the patient begins an episode of care.
Number of Admissions Over the Years s n o i s s i m d A f o r e b m u N 120000 100000 80000 60000 40000 20000 0 2010 2011 2012 2013 2014* 2015 2016 2017 2018 2019 2020 No of Admissions 71331 75075 77983 80931 89449 90128 91925 93658 94803 97307 72581 Year *IT administrative system changeover Illustration 6: Number of admissions over the years 1 In the Renal Unit, there were 21483 registered episodes/dialysis sessions (including on outpatient module) 2 In the Nurseries, there were 3913 registered admission episodes.
CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 13 Hospital Activity Report 2020 2.2.2 Admissions by Month The monthly number of registered admissions in 2020 and compared to 2019 can be seen in the graph below.

There was a slight increase in the number of admission episodes in January (+0.2%) and February (+2%), with the rest of the months registering a decline in admission episodes, in particular March (-38%), April (-58%) and May (-49%).
The highest number of admission episodes was registered in January with 8652 admissions whilst the lowest number was recorded in April with 3340 admission episodes.
Registered Admissions 2020 2019 s n o i s s i m d A f o r e b m u N 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 Jan Feb Mar Apr May Jun Jul 2020 8652 2019 8632 7900 7750 5106 8197 3340 7980 4295 8383 5733 7592 7088 8491 Month Illustration 7: number of admissions by month 2020/2019 Aug 6533 7990 Sep 6255 7888 Oct 6235 8570 Nov 5808 8295 Dec 5636 7542 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 14 Hospital Activity Report 2020 2.2.3 Demography Admissions according to hospital identification number/ID letter The chart below shows the percentage of admissions according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of admissions were made up of Maltese with 85% (84% in 2019) of the total admissions whilst non Maltese residents and foreigners made up 12% (10% in 2019) of the admissions in 2020.
Admissions Origin 2020 8% 1% 3% 3% Non-Maltese residents New Born Foreigners Gozitans Maltese 85% Illustration 8: Percentage of admissions according to origin CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 15 2.2.4 Admissions according to Age and Gender Hospital Activity Report 2020 Out of the total admissions to MDH this year, 51% were females and 49% were male admissions.

The remaining <1% of admissions had no gender specified.
The age and gender distribution can be seen in the table below, together with the difference as compared to the previous year.
Age Group (yrs) <5 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-94 95+ Unspec Total Males 1310 865 1356 2289 2939 3455 6036 9072 6286 1920 121 91 35740 Gender and Age Population Admissions Females Unspecified Total 2020 Total 2019 Difference -2099 -1194 -1448 -2135 -2323 -2252 -4044 -5367 -2613 -1211 -67 27 -24726 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 16 Hospital Activity Report 2020 2.2.5 Method of Admission The method of admission was analysed by using the type of admission as inputted by ward staff and assumptions3 when type was not inputted accordingly.
The figure below shows a breakdown of admissions by type.
Type of admission registrations in 2020 (and percentage difference on 2019): • Day Case4: 20318 (-36%) • Elective5: 11499 (-26%) • Emergency6: 36503 (-20%) • Other*: 4261 (-16%) *includes delivery of new born & obstetrics admissions Method of Admission 2020 6% 50% 28% 16% Day Case Elective Emergency Other* * includes delivery of new born & obstetrics admissions Illustration 10: method of admission 3 Assumptions were based on the nature of the diagnosis/complaint, the ward, the length of stay and other factors when available.
4 Day cases are planned admissions which do not require an overnight stay.

5 Elective are planned admissions which require more than 1 night stay.

6 Emergency are unplanned, often urgent admissions.

CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 17 Hospital Activity Report 2020 2.2.6 Method of Admissions by Consultant Speciality The admissions for 2020 were analysed according to the method of admission and consultant speciality and presented in the table below.
The figures exclude the renal unit and nursery admissions.
Consultant Speciality Day Case Elective Emergency Other A&E Anaesthesia/Pain relief Cardiac surgery Cardiology Dental Dermatology ENT ENT/Audiology Genetics Geriatrics Haematology* Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Obstetrics & Gynae Oncology* Ophthalmology Orthopaedics Paediatrics Sleep Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics** Surgery/Urology Surgery/Vascular Total Total Total Difference 14 -878 -382 -851 -225 7 -1156 -35 -4 31 -6 -902 -97 -536 -789 -563 -1012 -899 -201 -99 -1765 -1 -2615 -1766 -1947 -9 -1676 -3268 -568 -420 -1471 -637 -24726 *Admissions from SAMOC.
Haematology & Oncology migrated to SAMOC in early September 2015.

**These admissions might include ward attenders which were inadvertently admitted into admission beds rather than ward attender beds, hence one cannot distinguish actual admissions from ward attenders (see ward attender section).
CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 18 Hospital Activity Report 2020 2.2.7 Admissions by department and ward including transfers in, average length of stay (days) and % bed occupancy Due to the COVID-19 pandemic in 2020, new wards were created such as the Intensive Care Units 2 & 6 and the Major Incidence Units 4 & 6 to accommodate COVID-19 patients.

In addition, certain wards at MDH underwent restructuring in the bed compliment and admissions criteria.
The criteria included wards being assigned as COVID-related MARPA (Management and Assessment of Respiratory Patients) wards and GMA (General Medicine Area) wards.

The table below illustrates the number of registered admissions (day case, elective and emergency) to the admitting wards grouped together by the corresponding department including transfers in, average length of stay and the percentage (%) bed occupancy for 2020.
The transfers in (clinic changes) to the wards were also included in this table to provide a more complete picture of the input of patients into the wards.

Transfers in/out occur when patients are transferred from one ward to another within MDH.

Average length of stay and percentage bed occupancies were calculated according to the bed compliment and available bed days for each ward, taking into consideration the changes that were implemented throughout the year.

Dept Ward Cardiology CARDIAC CATH.


SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD Total Admissions 2020 1325 1034 1013 Total Transfers In 2020 114 385 1677 Average of Length of Stay (days) n/app 2.5 3.2 Cardiothoracic Surgery Medicine CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.
ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 SLEEP LAB n/app % Bed Occupancy n/app 50.4 72.1 43.8 56.4 70.5 86.0 80.7 73.7 72.3 61.3 68.2 87.3 41.6 98.7 82.6 87.5 83.4 n/app CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 19 Dept Ward Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2 OBSTETRICS WARD 3 Orthopaedics ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 Surgery Paediatrics Other BURNS UNIT DIABETIC FOOT WARD E.N.T.
WARD FAIRYLAND (1-17th Mar) WONDERLAND (18th Mar onwards) PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT 1 SURG.

ADMISSION UNIT 2*~ SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DISNEYLAND NEONATAL/PAED.

INT.
CARE WONDERLAND (1-17th Mar) FAIRYLAND (18th Mar onwards) A&E PAEDIATRIC CORRIDOR DAY CARE UNIT (ENDOSCOPY) * DAY CARE UNIT (SURGERY) * DAY CARE UNIT RECOVERY* DISCHARGE LOUNGE ** INTENSIVE THERAPY UNIT 1 INTENSIVE THERAPY UNIT 2*~~ INTENSIVE THERAPY UNIT 6*~~ OBSERVATION WARD 1A (Jan-Mar) Hospital Activity Report 2020 Total Admissions 2020 1545 523 Total Transfers In 2020 291 389 Average of Length of Stay (days) n/app 2.5 2.0 1.2 2.0 9.9 2.9 9.4 6.3 6.8 3.2 n/app n/app n/app 3.6 0.9 2.7 4.4 4.6 5.9 5.0 3.8 4.1 2.5 2.5 16.6 n/app n/app n/app n/app n/app n/app n/app 3.1 6.6 7.0 3.3 % Bed Occupancy 63.9 83.7 n/app 51.9 66.7 36.2 75.3 88.5 58.5 86.0 53.4 83.2 56.7 n/app n/app n/app 43.5 61.9 98.8 76.1 86.2 84.9 87.5 78.7 83.8 81.4 61.1 94.4 n/app n/app n/app n/app n/app n/app n/app 48.9 10.4 39.7 75.5 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 20 Dept Ward OBSERVATION WARD 1B OBSERVATION WARD 2 (Jan-Apr) OPHTHALMIC WARD PAEDIATRICS DAY CARE* MD WAIT*** MITU MAJOR INCIDENCE UNIT 1 MAJOR INCIDENCE UNIT 4*’ MAJOR INCIDENCE UNIT 6*’’ Hospital Activity Report 2020 Total Admissions 2020 3145 346 4399 19 2650 73 826 82 37 Total Transfers In 2020 15 137 44 1 30 161 1558 1259 966 Average of Length of Stay (days) 1.0 5.0 0.6 n/app n/app n/app 2.3 3.8 3.5 % Bed Occupancy 82.9 100 90.9 n/app n/app n/app 51.3 64.3 33.9 * Beds at Day Care Unit Surgery, Endoscopy and Recovery, Paediatrics Day Care and MITU were being used at times to admit emergency cases (mostly medical) in the case of influx in admissions **Patients are transferred to the discharge lounge before leaving the hospital after being discharged from the wards.
***Patients are admitted to MD WAIT prior to admission to respective ward or undergoing procedure.

*~Previously Psychiatric Unit.


SAU 2 from April 2020 *~~ ITU 2 & 6 opened to accommodate COVID-19 patients in addition to ITU 1 *’ MIU 4 was opened in the library as escalation for COVID-19 *’’ MIU 6 was opened in the staff canteen as escalation for COVID-19 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 21 Hospital Activity Report 2020 2.2.8 Summary stats of COVID-19 admission episodes MDH 2020 In 2020 there were 1022 admission episodes with a discharge diagnosis of COVID-19 (ICD 10 code: U07.1) to MDH.
The graphs below show the number of COVID-19 admission episodes by month, age group and gender from the beginning of the pandemic in March 2020 to December 2020.

Note: The source of data for the number of admission episodes with discharge diagnosis COVID- 19 (ICD 10 code: U07.1) was the Hospital Activity Analysis database which derives its information from the Electronic Case Summary.
Admission Episodes COVID-19 MDH 2020 s n o i s s i m d A f o r e b m u N 350 300 250 200 150 100 50 0 Number of Admission Episodes Mar 58 Apr 42 May 14 Jun 3 Jul 4 Aug 66 Sep 114 Oct 203 Nov 291 Dec 227 Month 2020 Illustration 11: Number of admission episodes with discharge diagnosis COVID-19 (ICD10: U07.1) by month CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 22 Hospital Activity Report 2020 Admission Episodes COVID-19 MDH 2020 s n o i s s i m d A f o r e b m u N 300 250 200 150 100 50 0 Number of Admission Episodes 0-9 22 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99 17 43 67 77 110 179 251 202 54 Age Group Illustration 12: Number of admission episodes with discharge diagnosis COVID-19 (ICD10: U07.1) by age group Admission Episodes COVID-19 MDH 2020 425 597 Illustration 13: Number of admission episodes with discharge diagnosis COVID-19 (ICD10: U07.1) by gender Female Male CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 23 Hospital Activity Report 2020 2.3 Ward Attenders 2.3.1 Ward Attenders 2020 In 2020 there were 30040 (-25% 2019) registered ward attenders in the wards at MDH.
The graph below shows the number of registered ward attenders from 2010-2020.

Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.

Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.
Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.

All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed to compile the following tables.

Ward Attenders s r e d n e t t A d r a W f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 2010 2011 2012 2013 2014 * 2016 2016 2017 2018 2019 2020 No.
of Ward Attenders 25150 31500 44350 47596 42485 43789 45827 42910 42037 40276 30040 Year No.

of Ward Attenders *IT system changeover Illustration 14: number of ward attenders over the years CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 24 Hospital Activity Report 2020 2.3.2 Ward Attenders by Consultant Speciality The ward attenders for 2020 were analysed according to the consultant speciality and presented in the table below.

The difference in the totals compared with 2019 can also be found.
Speciality A&E Anaesthesia/Pain Relief Cardiac surgery Cardiology Dental Dermatology ENT ENT/Audiology Genetics Haematology* Investigations & Treatment** Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Nursing Team Obstetrics & Gynae Ophthalmology Orthopaedics Paediatrics Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics*** Surgery/Urology Surgery/Vascular Other Grand Total Total Total Difference -12 2 -4283 -3 -7 -19 -370 -7 11 -123 -1570 -54 -21 -201 -370 -540 -83 -107 -350 -57 247 -716 0 661 -1528 -18 -166 -72 238 -632 15 -176 -10236 *migrated to SAMOC **these ward attenders were registered as out-patient attendances and hence cannot be distributed according to the respective speciality.
This could reflect a decrease in ward attenders in other specialities.

***follow ups at plastics are not being registered as ward attenders but as outpatient attendances seen at the ward.

CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 25 Hospital Activity Report 2020 2.3.3 Ward Attenders by Department and Ward The table below illustrates the number of registered ward attenders to the respective department and ward in 2020 compared with 2019.
Clinic Total 2020 Total 2019 Difference Dept Cardiology Cardiothoracic Surgery Medicine CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.


ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 RENAL UNIT Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae Orthopaedics Paediatrics DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2* OBSTETRICS WARD 3 ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 DISNEYLAND NEONATAL/PAED.

INT.
INT.

CARE NURSERY 1 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL -7 -13 4 -4283 -384 -2 -3 2 -60 -121 -57 -258 41 -2 0 0 2 -390 -348 -39 30 -13 2 -735 -2 -10 815 -106 -10 -28 0 26 Hospital Activity Report 2020 Clinic NURSERY 3 (OBST.
WARD 3) PAEDIATRICS DAY CARE WONDERLAND (1-17th Mar) FAIRYLAND (18th Mar onwards) Total 2020 4 4414 0 4 Total 2019 0 5812 n/app n/app Difference 4 -1398 n/app n/app BURNS UNIT E.N.T.

WARD DIABETIC FOOT WARD FAIRYLAND (1-17th Mar) WONDERLAND (18th Mar onwards) PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.
ADMISSION UNIT 1 SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DAY CARE UNIT (ENDOSCOPY) DAY CARE UNIT (SURGERY) INTENSIVE THERAPY UNIT MED.

INVEST.

& TREAT.
UNIT,MDH OBSERVATION WARD 1A OBSERVATION WARD 1B OBSERVATION WARD 2 OPHTHALMIC WARD MD WAIT 64 158 0 53 11 1956 1319 15 147 367 32 63 107 2 646 9 1 6 10091 0 0 0 74 4 30040 1 513 1 n/app n/app 2329 1154 9 259 163 14 196 253 1 916 4 0 0 11586 14 2 0 75 5 40276 63 -355 -1 n/app n/app -373 165 6 -112 204 18 -133 -146 1 -270 5 1 6 -1495 -14 -2 0 -1 -1 -10236 Cont… Dept Surgery Other Grand Total *WA decreased at the OBS2 due to treatment being administered at OP clinics not on the ward, for example administering of Anti D injections; CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 27 Hospital Activity Report 2020 2.4 Out-Patient Activity 2.4.1 Out-Patient Attendances 2020 In 2020 there were 364761 (-30% on 2019) registered clinic attendances at the out-patient department (of which 19552 were registered at outreach clinics7).
The average daily attendance was of 1145 attendances (excluding outreach clinics, Sundays and public holidays).

Note: an out-patient attendance is a patient visiting the outpatients department for ambulatory care including consultations, diagnosis, observation, treatment, investigations and other care from support areas.
Registered attendances by type in 2020 (and percentage difference on 2019): • New Cases8: • Follow-ups9: • Walk-ins10: • Any Cases11: • Telephone Consultations12: 6308 (% n/app) 68816 (-30%) 166736 (-29%) 96406 (-28%) 26495 (-49%) Type of Attendance 2020 7% 26% 2% 19% Any Follow Up New Case Tel Cons Walk In 46% 7 Outreach clinics include the following: tissue viability outreach, urology outreach, midwifery outreach, orthopaedic outreach and home antibiotic/therapy.
8 New cases are new outpatient appointments which are planned and given a date and time beforehand.

In this case, the patient will not have had a previous outpatient appointment related to the case.

9 Follow up cases are outpatient appointments which are planned to provide continuing or further attention to a previous related appointment.

The appointment will be planned and given a date and time beforehand.

10 Walk ins are unplanned outpatient attendances.


The patient turns up for an outpatient visit without a planned date and time for appointment.

11 These are cases registered as any in the system to allow for flexibility when booking patients.

These cases could be new cases or follow ups.

12 Due to the COVID-19 pandemic, outpatient consultations were also carried out over the phone as telephone consultations on the advice of the consultant firm.
CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 28 2.4.2 Out-patient attendances by month and type of attendance Hospital Activity Report 2020 The graph below shows the number of out-patient attendances by month and type of attendance in 2020.

On the onset of the COVID-19 pandemic in March 2020 the attendances notably decreased, only rising slightly in the months of July and October 2020 whilst declining again in November and December 2020.
Registered Out-Patient Attendances 2020 s e c n a d n e t t A f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month 2020 Grand Total Any Follow Up New Case Tel Cons Walk In Illustration 15: Number of registered outpatient attendances 2020 by month CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 29 Hospital Activity Report 2020 2.4.3 Clinic Activity according to department and clinics grouped into the clinic description and attendance type The table below illustrates the number of out-patient attendances by type of attendance and clinic description for every department and clinic held at MDH.
The clinics were grouped together to create the clinics description to further ease analysis and interpretation of data.

For example, all medicine respiratory clinics grouped into Medicine/Respiratory.
Department & Clinics Description Anaesthesia/Pain Relief Pain Clinic Anaesthesia/Pre-op Pre-operative assessment clinic Cardiac Surgery Cardiac Surgery Clinic Cardiology Adult Congenital Heart Disease Clinic Blood Pressure (Cardiology) Cardiac Lab Blood Inv Cardiac Rehabilitation Clinic (nurse-led) Cardiology (Adult/Cong.
Heart Disease) Cardiology Heart Valve Clinic Cardiology OP Cardiology Rapid Access Clinic Heart Failure Clinic (Nurse led) Holter ECG (Cardiologist) ICD Clinic (technician led) Interventional Cardiology Pacemaker Clinic (technician led) Pacemaker Wound Check Cl (nurse-led) Stress ECG (Cardiology) T.O.E.
Clinic (Cardiology) Chinese Medicine Chinese Medicine clinic Dental Child Dental Clinic Cleft Lip & Palate Clnic (Dental) Dental Clinic Dental Clinic (A&E) New Case Follow Up Any Walk In Tel Cons Grand Total CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 30 Hospital Activity Report 2020 Department & Clinics Description Dental Clinic (Consultants) Dental Clinic (Oral Hygiene) Dental Clinic (oral rehabilitation) Dental Clinic (Oral Surgery) Dental Clinic (Pre-op) Dental Clinic (Prosthetics) Dental Clinic (Scaling and Polishing) Dental Clinic (X-Ray) Dental Orthodontic Clinic Dental VCC Maxillofacial surgery Dietician Dietetic Clinic Dietetic/Diabetes Clinic Dietetic/Gastro Clinic Dietician Bariatric Dietician Oncology Dietician Paediatric Dietician Renal Clinic Genetics Assisted Reproduction Clinic Genetics Genetics Clinic Genetics Paediatrics Infection Control Hep.
B Titre Clinic Infection Control Clinic Infection Control Screening Influenza Vaccine Clinic MRSA Screening Clinic Needle Stick Injury Clinic Medicine Ambulatory Sleep Studies Asthma Clinic Baromedicine Coeliac Disease Clinic COPD Clinic CTD Clinic Diabetes Awareness Sessions Diabetes Clinic Diabetes Clinic (Juvenile) New Case Follow Up Any Tel Cons Walk In Grand Total CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 31 Department & Clinics Description Diabetes Education Clinic Diabetes Point of Care Clinic Diabetic Foot Clinic Diabetic Retinopathy Clinic Endocrine & Medical Clinic Endocrinology Rapid Access Fibromyalgia Clinic Home Therapy Hyperbaric Unit IBD Clinic Infectious Diseases Joint Injection Clinic Lipid Clinic Medical OP Medicine/Nephrology Medicine/Respiratory MOP Liver Clinic MOP VCC Respiratory Neuroendocrine Clinic Neurology OP Nursing Procedures Pulmonary Fibrosis Pulmonary Function Lab (Nurse led) Rheumatology Ankylosing Spondylitis Rheumatology Clinic Rheumatology Clinic (nurse led) Rheumatology Rapid Access Sleep Disorders Clinic Sleep OP Clinic Sleep Pap Clinic Systemic Sclerosis Clinic Thyroid Clinic Transplant/Travel Wound Clinic Wound Clinic (Hyperbaric) Medicine/General & Inf.
Diseases Medicine/Gastroenterology Medicine/Gastroenterology/Hepatic Neurosciences Evoked Potentials Clinic (Neurology Team) Hospital Activity Report 2020 New Case Follow Up Any Walk In Tel Cons Grand Total CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 32 Department & Clinics Description Movement Disorder Multiple Sclerosis Neuro EEG Monitoring Neurocognitive Clinic Neuroepilepsy Clinic Neurology Botox Clinic Neurology Migraine Neurology OP Neuromuscular Clinic Neurosurgical Clinic Neurovascular Clinic Paediatric Neurosurgery VCC Neuro EMG Monitoring Neurosciences/Psychiatry Neuropsychiatric joint clinic Nutrition Nutrition Clinic Obstetrics & Gynaecology Antenatal Clinic Assisted Reproduction Clinic Breastfeeding Clinic (Midwife led) Colposcopy Clinic CTG Clinic Diabetic Pregnancy Clinic GOP Pre Op Gynae Midwife Perinatal Mental Gynae OP Gynae OP Miscarriage Clinic Gynae OP Scans Gynae Urodynamics Outreach Midwifery Perinatal Mental Health Clinic Post Menopausal Bleeding Clinic Ophthalmology Ophthalmic Botox Clinic Strabismus Ophthalmic IVFA Ophthalmic Laser Ophthalmic Low Vision Clinic Ophthalmic OCT Ophthalmic OP Hospital Activity Report 2020 New Case Follow Up 134 62 0
328 117 3140 0 0 142 0 0 2021 Follow Up Any 0 0 1083 0 0 0 0 0 0 0 1 0 2659 0 0 0 0 Walk In Tel Cons Grand Total CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 33 Department & Clinics Description Ophthalmic OP (Botox Clinic) Ophthalmic OP (Vitreoretinal) Ophthalmic OP A&E Referrals Ophthalmic Optometry/Refraction Clinic Ophthalmic Orthoptics Ophthalmic Paediatric Ophthalmic Peripheral Visual Fields Ophthalmic Post-OP Clinic Ophthalmic Retina Ophthalmic Special Ophthalmology VCC Ophthalmic (Cornea) Orthopaedics OOP Foot Ankle Clinic Orthopaedic FTC Orthopaedic OP Orthopaedic OP (General/Paediatrics) Orthopaedic OP Shockwave Orthopaedic Outreach Orthopaedic Plaster Clinic Orthopaedic VCC Sport Injury Clinic Other Home Antibiotic Therapy* Paediatrics Children's OP Children's OP (Cardiology/General) Children's OP (Neuro-paed) Community Paediatric Clinic COP (Bleeding Room) Neonatal/NPICU F/U Paediatric Development Clinic Paediatric General & Inf Diseases Paediatric Infectious Diseases Clinic Paediatric NPICU Paediatric Respiratory Medicine Paediatric Review Clinic Paediatric Speech Therapy Paediatric Surgery Paediatric VCC Hospital Activity Report 2020 New Case Follow Up Any 37 0 0 0 3446 12
13 121 208 0 236 18 0 268 16 Any 37 0 0 0 3446 12 91 0 0 192 0 0 Walk In Tel Cons Grand Total CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 34 Hospital Activity Report 2020 Department & Clinics Description Paediatric VCC Gastroenterology Children's OP (Diabetes/Endocrine) Podiatry Diabetic Foot Clinic Diabetic Foot Ward Ulcers Podology Clinic Surgery Assessment Dialysis Breast Clinic ENT Audiology ENT Audiology (Audiometry) ENT Audiology (Hearing Aids) ENT Audiology (paed) ENT Dizziness Clinic ENT Hearing Loss Clinic ENT Nurse Led ENT Oncology ENT OP ENT Tinnitus Clinic Paediatric Surgery SOP (General) SOP (Stoma Clinic) SOP Bariatric Clinic SOP Dermatology Referrals SOP Plastic SOP Upper GI clinic Urology Clinic Urology Incontinence Assessments Urology Male Infertility Clinic Urology Outreach Clinic Vascular Stroke (Nurse led) Vascular Surgery Clinic Paediatric Surgery Breast Clinic Thalassaemia MOP Thalassaemia/Haematology Thalassaemia Clinic Thalassaemia Phlebotomy Clinic Tissue Viability Tissue Viability Clinic New Case 0 151 483 281 166 36 Follow Up Any Tel Cons 0 0 0 0 0 0 Walk In 0
Grand Total CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 35 Hospital Activity Report 2020 Department & Clinics Description TVU Outreach Grand Total New Case 0 Follow Up 0 Any 20 Walk In 43 Tel Cons 0 Grand Total 63 68816 166736 26495 96406 6308 364761 *home antibiotic therapy numbers to be verified since not all visits are being registered on OP module.
Notes: 1) Haematology not included due to migration to SAMOC.

2) A number of cardiology clinics have been excluded from analysis since the activity is not being registered on CPAS but on cardiology system.

These include 7 Day Holter Clinic (Cardiol-tech led), Adult Heart Disease, Cardiac cath Suite (Cardiology Clinic), ECG Clinic (12 lead), Echocardiogram (cardiology).

3) Pathology activity for clinics ACC Phlebotomy, Bleeding Room (OGTT) and Phlebotomy Pathology have been excluded.
4) Sleep disorders clinic (domiciliary) has been excluded.

5) Gynae bone density clinic has been excluded due to the activity being registered on radiology system rather than CPAS.

6) Clinics registered under MDH but are held at a different location have been excluded (orthotics & prosthetics, CDAU, occupational therapy, social work, SLH chest clinic).
CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 36 3 SECTION 2 Hospital Activity Report 2020 Sir Anthony Mamo Oncology Centre (SAMOC) Activity ADMISSIONS, DAY CASES, WARD ATTENDERS, OUT-PATIENTS CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 37 3.1 Admissions 2020 Hospital Activity Report 2020 In 2020 there were 3753 (-11% on 2019) registered in-patient admissions at SAMOC and 20107 (-31% on 2019) registered day cases at SAMOC Day Care Unit*.

The list below shows a breakdown of admissions by type.
Type of admission registrations in 2020: 20121 2891 • Day Case*: • Elective: • Emergency: 69 • Other**: 59 *these include day cases registered as out patient clinic attendances at the DCU SAMOC, and include same patients visiting more than one clinic in one day **all admissions should be inputted as either day cases, elective or emergency 3.1.1 Admissions by ward The table below illustrates the number of registered admissions to the admitting wards at SAMOC.
Ward OC DCU - Day Care Unit OC HAEMW- Haematology Ward OC PAU-Paediatric Adolescent Ward OC PCU- Palliative Care Unit OC RIU- Radioisotope unit OC WARD 1- Oncology Ward 1 OC WARD 2- Oncology Ward 2 Total Total 2020 20107 166 72 204 42 1112 1437 23140 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 38 3.2 Out-Patient Attendances 2020 Hospital Activity Report 2020 In 2020 there were 54200 (-2% on 2019) registered out-patient attendances at SAMOC out- patient department.
The table below illustrates the number of outpatient attendances by type of attendance for every department.
Department Haematology Oncology Palliative Total New Case 1164 2613 40 Follow Up 3758 9752 184 Any 203 944 0 3817 13694 1147 Walk In 415 2299 127 2841 Tel Cons 4983 4519 1053 Total 2020 10523 20127 1404 10555 32054 Pathology Clinics 3580 11529 0 1242 Radiotherapy Clinics Physiotherapy Team Psychology Clinics Occupational Therapy Clinics 0 11 0 0 0 4 0 0 2001 3094 333 103 112 133 2 0 2 0 0 0 0 16353 2113 3242 335 103 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 39 3.3 Ward Attenders 2020 Hospital Activity Report 2020 In 2020 there were 1267 (-42% on 2019) registered ward attenders at SAMOC.
Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.

Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.

Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.
All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed.

The table below illustrates the number of registered ward attenders to the respective wards in 2020.
Ward OC DCU - Day Care Unit OC HAEMW – Haematology Ward OC PAU - Paediatric Adolescent Unit OC PCU - Palliative Care Unit OC RIU - Radioisotope Unit OC WARD 1 - Oncology Ward 1 OC WARD 2 - Oncology Ward 2 Total Total 2020 5 8 817 0 223 112 102 1267 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 40 Hospital Activity Report 2021 Annual A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS: Mater Dei Hospital ADMISSIONS, DAY CASES, OUT-PATIENTS, WARD ATTENDERS: Sir Anthony Mamo Oncology Centre April 2022 DOCUMENT INFORMATION Version Date published Document type 1.0 6th April 2022 Annual statistical report Analysis and compilation David Borg, Chief Scientific Officer, RN Department Clinical Performance Unit (CPU) Prof Sandra Buttigieg, Consultant Public Health Dr Sandra Distefano, Consultant Public Health David Borg, Chief Scientific Officer, RN Maria-Anna Spiteri, Manager II Research Jane Agius, Assistant Principal CPU Portal: https://health.intra.gov.mt/mdh/CPU/SitePages/Home2.aspx Email: cpu.mdh@gov.mt Tel: 2545 6996/4144 Location: CPU, Administration MDH CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 2 Hospital Activity Report 2021 CONTENTS 1 2 3 2.2 INTRODUCTION ....................................................................................................................................... 4 SECTION 1 ............................................................................................................................................. 5 2.1 Accident & Emergency Activity ................................................................................................ 6 A&E Attendances 2021 .................................................................................. 6 2.1.1 Source of Referral ........................................................................................... 7 2.1.2 A&E Attendances according to hospital identification number/ID letter ...... 8 2.1.3 A&E Attendances by ESI (Emergency Severity Index) Category ..................... 9 2.1.4 2.1.5 A&E Attendances according to attending department and ESI breakdown 10 In-Patient Activity ................................................................................................................... 13 Admissions (ADMIT) 2021 ............................................................................ 13 2.2.1 Admissions by Month ................................................................................... 14 2.2.2 Demography ................................................................................................. 15 2.2.3 Admissions according to Age and Gender ................................................... 16 2.2.4 2.2.5 Method of Admission ................................................................................... 17 2.2.6 Method of Admission by Consultant Speciality ............................................ 18 2.2.7 Admissions by department and ward including transfers in, average length of stay (days) and % bed occupancy .......................................................................... 19 2.3 Ward Attenders ...................................................................................................................... 22 2.3.1 Ward Attenders 2021 ................................................................................... 22 2.3.2 Ward Attenders by Consultant Speciality .................................................... 23 2.3.3 Ward Attenders by Department and Ward ................................................. 24 2.4 Out-Patient Activity ................................................................................................................ 26 2.4.1 Out-Patient Attendances 2021 .................................................................... 26 2.4.2 Out-patient attendances by month and type of attendance ....................... 27 2.4.3 description and attendance type ............................................................................... 28 SECTION 2 ........................................................................................................................................... 35 3.1 Admissions 2021 .................................................................................................................... 36 Admissions by ward ..................................................................................... 36 3.2 Out-Patient Attendances 2021 .............................................................................................. 37 3.3 Ward Attenders 2021 ............................................................................................................. 38 Clinic Activity according to department and clinics grouped into the clinic 3.1.1 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 3 Hospital Activity Report 2021 1 INTRODUCTION Due to the COVID-19 pandemic, which started in 2020 and continued into 2021, the activity for the year 2021 should be interpreted with caution given the measures that were introduced in response to the pandemic.
The COVID-19 preparedness planning at Mater Dei Hospital (MDH) necessitated structural changes, extraordinary management and clinical measures within the hospital, particularly at the intensive care unit, operating theatres, wards and other areas.

This resulted in the shifting of resources and activity to deal with the effects of the pandemic, including the treatment of COVID-19 patients admitted to the hospital and the relocation and training of staff.
The Hospital Activity Report presents an overview on the main activities at Mater Dei Hospital (MDH) and Sir Anthony Mamo Oncology Centre (SAMOC) for the year 2021.

It details information on A&E attendances, admissions (emergency, elective and day cases), discharges, ward attenders and out- patient attendances.
The data contained in this report have been compiled from registrations on CPAS, which is the main patient administrative system of use at MDH and SAMOC and the primary source of data for this report.

The first section of this report includes activity at MDH, highlighting information on A&E attendances, in-patient activity in the form of admissions, ward attenders and out-patient attendances.
The second section encompasses the main activity at SAMOC, including admissions to the wards, ward attenders and out-patient attendances.
Apart from the numbers presented in this report, it is important to note that the activity surrounding patient care includes important services such as pathology tests, renal dialysis, diagnostic procedures, radiological procedures, screening procedures and surgical operative procedures/interventions amongst other services which all contribute to provide holistic care for the well being of the patient.
One cannot forget to mention the collaborative and organised input by the multidisciplinary health care team at Mater Dei Hospital and Sir Anthony Mamo Oncology Centre in achieving the best health outcomes for our patients.

Disclaimer The accuracy of information in this document might be limited by factors beyond author’s control.

This document contains data which is subject to interpretation.
Before using this data for making decisions or drawing conclusions, users are encouraged to contact the Clinical Performance Unit for advice.
CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 4 2 SECTION 1 Hospital Activity Report 2021 Mater Dei Hospital (MDH) Activity A&E, ADMISSIONS, DISCHARGES, WARD ATTENDERS, OUT-PATIENTS CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 5 2.1 Accident & Emergency Activity Hospital Activity Report 2021 2.1.1 A&E Attendances 2021 In 2021 there were 115068 (+19% on 2020, -18% on 2019) registered A&E attendances at the A&E Dept, MDH.

The average daily attendance rate was of 315/day (263/day 2020, 384/day 2019).
The graph below shows the number of registered A&E attendances from 2011-2021.

Note: A&E Attendances are patients visiting the A&E department, with cases ranging from minor walk ins to life-threating injuries.
A&E Attendances s e c n a d n e t t A E & A f o r e b m u N 160000 140000 120000 100000 80000 60000 40000 20000 0 A&E Attendances 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 110279 111533 115706 119941 128747 137852 141758 142519 140209 96382 115068 Illustration 1: number of registered A&E attendances over the years CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 6 Hospital Activity Report 2021 The monthly number of registered A&E attendances in 2021 compared to 2020 and 2019 can be seen in the graph below.
In 2021, the number of attendances increased in April and reached a peak in the summer months of July and August.

The highest number of A&E attendances were registered in July and August whilst the lowest numbers were recorded in January, February and March.
Registered A&E Attendances 2021 2020 2019 s e c n a d n e t t A f o r e b m u N 13000 12000 11000 10000 9000 8000 7000 6000 5000 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Month Illustration 2: number of A&E attendances in 2021, 2020 and 2019 by month 2.1.2 Source of Referral The majority of A&E attendances were self referrals at 79% whilst doctor referrals accounted to 17% of attendances in 2021.
Source of Referral: • Self-referral: • Doctor referral: • Other: 91391 (79%) 19741 (17%) 3936 (4%) CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 7 Hospital Activity Report 2021 2.1.3 A&E Attendances according to hospital identification number/ID letter The chart below shows the percentage of A&E attendances according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of A&E attendances were Maltese with 76% (87366) (74%, 103794 in 2019) of the total attendances whilst non Maltese residents and foreigners made up 20% (23078) (27%, 27742 in 2019) of the A&E attendances in 2021.
Registered A&E Attendances 2021 14% 3% 6% 1% Non-Maltese Residents New Born Foreigners Gozitan Maltese 76% Illustration 3: Registered A&E attendances by hospital identification number/ID letter CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 8 2.1.4 A&E Attendances by ESI (Emergency Severity Index) Category Hospital Activity Report 2021 The graph below presents the number of A&E Attendances according to the Emergency Severity Index done at triage level.
This includes all the attending departments, including A&E, paediatrics, ophthalmic, ENT, obstetrics and gynaecology, dental and psychiatric.

The majority of A&E attendances were categorized into ESI 2, 3 and 4 followed by ESI 5 and ESI 1.

Note: The Emergency Severity Index (ESI) is a five-level emergency department triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resources needed.
Attendances by ESI Category 2021 s e c n a d n e t t A f o r e b m u N 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 Registered A&E Attendances 2021 ESI-1 ESI-2 ESI-3 ESI-4 1839 42258 37028 28545 ESI-5 4390 Other 1008 ESI Category Illustration 4: Registered A&E Attendances by ESI Category CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 9 Hospital Activity Report 2021 2.1.5 A&E Attendances according to attending department and ESI breakdown The illustration below shows the percentage activity of A&E attendances according to the speciality/department that they were seen after triage.
The A&E department attended to 72% of the total cases after triage, followed by the paediatric A&E department with 11% of cases and the ophthalmic department with 9% of attendances.

The rest of the cases were attended to by the ENT, OBG, dental and psychiatric dept.
A&E Attendances 2021 Attending Dept 0% 11% 9% 4% 3% 1% A&E Dental ENT OBG Ophth Paeds Psych 72% Illustration 5: Registered A&E attendances by attending department CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 10 The table below shows the number of A&E registrations grouped by the Emergency Severity Index and the attending speciality/department.

The difference in activity between 2021 and 2019 can also be seen.
Hospital Activity Report 2021 Department & ESI Category A&E A&E TRIAGE SKIP ESI-1 ESI-2 ESI-3 ESI-4 ESI-5 Total A&E Dental A&E TRIAGE SKIP ESI-3-DENTAL ESI-4-DENTAL ESI-5-DENTAL Total Dental ENT A&E TRIAGE SKIP ESI-3-ENT ESI-4-ENT ESI-5-ENT Total ENT OBG A&E TRIAGE SKIP ESI-3-OBS ESI-4-OBS ESI-5-OBS Total OBG Number of A&E Attendances 2021 2020 2019 Difference 2021 & -170 -5312 -1387 -3272 -911 -10244 -4 24 234 73 327 -11 -731 -2275 -243 -3260 -16 -660 -894 -111 -1681 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 11 Cont… Department & ESI Category Ophth A&E TRIAGE SKIP ESI-3-OPTH ESI-4-OPTH ESI-5-OPTH Total Ophth Paeds A&E TRIAGE SKIP ESI-2-PAEDS ESI-3-PAEDS ESI-4-PAEDS ESI-5-PAEDS Total Paeds Psych A&E TRIAGE SKIP ESI-2-PSCH ESI-3-PSCH ESI-4-PSCH ESI-5-PSCH Total Psych Hospital Activity Report 2021 Number of A&E Attendances 2021 2020 2019 Difference 2021 & -16 -84 -2533 -792 -3425 -128 -4352 -2248 -235 -151 -6898 0 7 25 8 0 40 Total A&E Attendances 115068 96382 140209 -25141 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 12 Hospital Activity Report 2021 2.2 In-Patient Activity 2.2.1 Admissions (ADMIT) 2021 In 2021 there were 84476 (+16% on 2020, -15% on 2019) registered admissions (emergency, elective and day cases) excluding renal unit1 and nursery2 registrations at MDH.
The average daily admission rate was of 231/day (198/day in 2020, 267/day in 2019).

The graph below shows the number of registered admissions from 2011-2021.

Note: an admission is a patient entering the hospital for in-patient service and at which the patient begins an episode of care.
Number of Admissions Over the Years s n o i s s i m d A f o r e b m u N 120000 100000 80000 60000 40000 20000 0 Number of Admissions 2011 2012 2013 2014* 2015 2016 2017 2018 2019 2020 2021 75075 77983 80931 89449 90128 91925 93658 94803 97307 72581 84476 Year *IT administrative system changeover Illustration 6: Number of admissions over the years 1 In the Renal Unit, there were 24259 HD sessions (source: Renal Unit) 2 In the Nurseries, there were 3831 registered admission episodes.
CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 13 Hospital Activity Report 2021 2.2.2 Admissions by Month The monthly number of registered admissions in 2021 and compared to 2020 and 2019 can be seen in the graph below.

When compared to 2019, all months in 2021 registered a decline in admission episodes, in particular January (-37%), February (-28%) and March (-36%).

As the year progressed, the decline in admission episodes was less evident, almost reaching at par level in October (-5%) and November (-3%).
The highest number of admission episodes in 2021 was registered in October with 8126 admissions whilst the lowest number was recorded in March with 6016 admission episodes.
Registered Admissions 2021 2020 2019 s n o i s s i m d A f o r e b m u N 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 Jan Feb Mar Apr May Jun Jul 2021 6305 2020 8652 2019 8632 6034 7900 7750 6016 5106 8197 6360 3340 7980 7070 4295 8383 7063 5733 7592 7520 7088 8491 Month Illustration 7: number of admissions by month 2021/2020/2019 Aug 7709 6533 7990 Sep 7181 6255 7888 Oct 8126 6235 8570 Nov 8089 5808 8295 Dec 7003 5636 7542 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 14 Hospital Activity Report 2021 2.2.3 Demography Admissions according to hospital identification number/ID letter The chart below shows the percentage of admissions according to hospital identification number and ID card letter, distributed as Maltese, Gozitans, Non-Maltese residents, new born and foreigners.
The majority of admissions were made up of Maltese with 85% (85% in 2020, 84% in 2019) of the total admissions whilst non Maltese residents and foreigners made up 11% (12% in 2020, 10% in 2019) of the admissions in 2021.
Admissions Origin 2021 9% 1% 2% 3% Non-Maltese residents New Born Foreigners Gozitans Maltese 85% Illustration 8: Percentage of admissions according to origin CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 15 2.2.4 Admissions according to Age and Gender Hospital Activity Report 2021 Out of the total admissions to MDH this year, 52% were females and 48% were male admissions.

The remaining <1% of admissions had no gender specified.
The age and gender distribution can be seen in the table below, together with the difference as compared to the previous years.
Age Group (yrs) 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ Unspec Total Gender and Age Population Admissions Males Females Unspec Total 2021 Total 2020 Total Difference 2021 & 2019 -2334 -849 -1382 -780 -1124 -2021 -2431 -620 -1148 -133 -9 -12831 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 16 Hospital Activity Report 2021 2.2.5 Method of Admission The method of admission was analysed by using the type of admission as inputted by ward staff and assumptions3 when type was not inputted accordingly.
The figure below shows a breakdown of admissions by type.
Type of admission registrations in 2021 (and percentage difference on 2020 and 2019): • Day Case4: 27796 (+24% on 2020, -12% on 2019) • Elective5: 11713 (+1% on 2020, -24% on 2019) • Emergency6: 40592 (+9% on 2020, -11% on 2019) • Other*: 4375 (+2% on 2020, -14% on 2019) *includes delivery of new born & obstetrics admissions Method of Admission 2021 5% 48% 33% 14% Day Case Elective Emergency Other* * includes delivery of new born & obstetrics admissions Illustration 10: method of admission 3 Assumptions were based on the nature of the diagnosis/complaint, the ward, the length of stay and other factors when available.
4 Day cases are planned admissions which do not require an overnight stay.

5 Elective are planned admissions which require more than 1 night stay.

6 Emergency are unplanned, often urgent admissions.

CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 17 Hospital Activity Report 2021 2.2.6 Method of Admission by Consultant Speciality The admission episodes for 2021 were analysed according to the method of admission and consultant speciality and compared to 2020 and 2019.

Excluding renal unit and nurseries.
Consultant Speciality A&E Anaesthesia/Pain relief Baromedicine Cardiac surgery Cardiology Dental Dermatology ENT ENT/Audiology Geriatrics Haematology Medicine/Acute Medicine/Diab & Endo Medicine/Geriatrics Medicine/GIT Medicine/Inf Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheum Neurology Neurosurgery Obstetrics & Gynae Oncology Ophthalmology Orthopaedics Paediatrics Psychiatry Radiology Sleep Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics Surgery/Urology Surgery/Vascular Grand Total Day Case Elective Emerge ncy Other Total Total Total Diff 2021 & 2019 23 -26 3 -264 -402 -271 7 -915 -28 33 42 -830 20 153 265 -439 -278 -461 -875 107 39 -777 3 -342 -873 -1567 16 12 0 -1013 -2383 -423 -273 -658 -450 -12831 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 18 Hospital Activity Report 2021 2.2.7 Admissions by department and ward including transfers in, average length of stay (days) and % bed occupancy Due to the onset of COVID-19 pandemic in 2020 and continuing in 2021, new wards were created such as the Intensive Care Units 2, 3 & 6 and the Major Incidence Units 3, 4 & 6 to accommodate COVID-19 patients.
In addition, certain wards at MDH underwent restructuring in the bed compliment and admissions criteria.

The criteria included wards being assigned as COVID-related MARPA (Management and Assessment of Respiratory Patients) wards and GMA (General Medicine Area) wards.
The table below illustrates the number of registered admissions (day case, elective and emergency) to the admitting wards grouped together by the corresponding department including transfers in, average length of stay and the percentage (%) bed occupancy for 2021.

The transfers in (clinic changes) to the wards were also included in this table to provide a more complete picture of the input of patients into the wards.

Transfers in/out occur when patients are transferred from one ward to another within MDH.
Average length of stay and percentage bed occupancies were calculated according to the bed compliment and available bed days for each ward, taking into consideration the changes that were implemented throughout the year.

Dept Ward Cardiology CARDIAC CATH.

SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD Total Admissions 2021 1663 725 1429 Total Transfers In 2021 19 368 1436 Average of Length of Stay (days) n/app 2.7 3.1 Cardiothoracic Surgery Medicine CARDIAC INT.

CARE UNIT CARDIOTHOR.


SURGERY UNIT DAY CARE UNIT MEDICAL (from Oct) INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.
ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD n/app 5.9 4.4 4.1 2.9 2.8 4.4 3.4 2.1 5.3 3.2 7.8 16.3 12.7 % Bed Occupancy n/app 55.5 76.6 54.1 79.3 n/app 71.9 85.1 79.9 78.5 74.5 73.9 77.3 72.2 88.7 76.7 73.4 93.2 89.9 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 19 Hospital Activity Report 2021 Total Admissions 2021 48 Total Transfers In 2021 0 Average of Length of Stay (days) n/app Dept Ward SLEEP LAB Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2 OBSTETRICS WARD 3 Orthopaedics ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 BURNS UNIT DIABETIC FOOT WARD E.N.T.
WARD FAIRYLAND (16th Oct onwards) WONDERLAND (1st Jan-16th Oct) PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT 1 SURG.

ADMISSION UNIT 2*~ SURGICAL HDU (from Nov) SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DISNEYLAND NEONATAL/PAED.

INT.
CARE WONDERLAND (16th Oct onwards) FAIRYLAND (1st Jan-16th Oct) Surgery Paediatrics Other DAY CARE UNIT (ENDOSCOPY) * DAY CARE UNIT (SURGERY) * DISCHARGE LOUNGE ** INTENSIVE THERAPY UNIT 1 INTENSIVE THERAPY UNIT 2*~~ 10705 9099 8 404 12 % Bed Occupancy n/app 72.8 83.5 n/app 68.8 71.8 34.0 78.1 89.8 75.2 92.2 36.2 88.7 60.4 n/app n/app n/app 56.4 80.1 61.0 63.5 78.4 89.2 85.3 89.3 80.1 82.7 86.7 66.8 85.0 n/app n/app n/app n/app n/app 72.1 n/app n/app 2.9 2.1 0.9 2.0 7.4 3.5 8.8 5.7 7.0 3.0 n/app n/app n/app 2.3 1.0 3.0 2.9 3.8 5.1 5.4 5.2 3.8 3.6 3.5 2.4 14.5 n/app n/app n/app n/app n/app 4.3 5.6 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 20 Dept Ward INTENSIVE THERAPY UNIT 3*~~ INTENSIVE THERAPY UNIT 6*~~ OBSERVATION WARD 1B OPHTHALMIC WARD MD WAIT*** MAJOR INCIDENCE UNIT 1 MAJOR INCIDENCE UNIT 3*’ MAJOR INCIDENCE UNIT 4*’ MAJOR INCIDENCE UNIT 6*’’ Hospital Activity Report 2021 Total Admissions 2021 3 35 2655 6528 2932 890 96 885 836 Total Transfers In 2021 20 73 21 2 25 1227 37 1181 1401 Average of Length of Stay (days) 8.3 6.2 1.5 n/app n/app 3.1 2.3 3.6 3.8 % Bed Occupancy n/app n/app 64.3 n/app n/app 61.4 n/app 73.6 64.5 * Beds at Day Care Unit Surgery, Endoscopy and Recovery were being used at times to admit emergency cases (mostly medical) in the case of influx in admissions **Patients are transferred to the discharge lounge before leaving the hospital after being discharged from the wards.
***Patients are admitted to MD WAIT prior to admission to respective ward or undergoing procedure.

*~Previously Psychiatric Unit.

SAU 2 from April 2020.

Ward also accommodated COVID-19 patients.
*~~ ITU 2, 3 & 6 opened to accommodate COVID-19 patients in addition to ITU 1 *’ MIU 3 was opened in the lecture rooms as escalation for COVID-19 *’’ MIU 4 was opened in the library as escalation for COVID-19 *’’’ MIU 6 was opened in the staff canteen as escalation for COVID-19 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 21 Hospital Activity Report 2021 2.3 Ward Attenders 2.3.1 Ward Attenders 2021 In 2021 there were 41866 (+28% on 2020, +4% on 2019) registered ward attenders in the wards at MDH.
The graph below shows the number of registered ward attenders from 2011-2021.

Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.

Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.
Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.

All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed to compile the following tables.
Ward Attenders s r e d n e t t A d r a W f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 2011 2012 2013 2014 2016 2016 2017 2018 2019 2020 2021 Number of Ward Attenders 31500 44350 47596 42485 43789 45827 42910 42037 40276 30040 41866 Year Number of Ward Attenders Illustration 14: number of ward attenders over the years CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 22 Hospital Activity Report 2021 2.3.2 Ward Attenders by Consultant Speciality The ward attenders for 2021 were analysed according to the consultant speciality and presented in the table below.
The difference in the totals compared with 2019 can also be found.
Speciality Total 2021 Total 2020 Total 2019 A&E Anaesthesia/Pain Relief Cardiac surgery Cardiology Dental Dermatology ENT ENT/Audiology Genetics Haematology* Investigations & Treatment** Medicine/Acute Medicine/Diab & Endo Medicine/GIT Medicine/Infectious Dis Medicine/Nephrology Medicine/Respiratory Medicine/Rheumatology Neurology Neurosurgery Nursing Team Obstetrics & Gynae Ophthalmology Orthopaedics Paediatrics Radiology Surgery/Emerg Surgery/General Surgery/Paediatrics Surgery/Plastics*** Surgery/Urology Surgery/Vascular Other Grand Total Difference 2021 & 2019 -4 91 -4084 124 -1 -6 -193 -10 -9 -126 -44 136 -15 -226 -183 -244 -84 -72 -328 558 855 -322 -43 4181 51 21 145 319 332 1147 -321 120 -176 1590 *migrated to SAMOC **these ward attenders were registered as out-patient attendances and hence cannot be distributed according to the respective speciality.
This could reflect a decrease in ward attenders in other specialities.

***plastics register WAs in outpatient clinic codes in addition to normal WAs.

CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 23 Hospital Activity Report 2021 2.3.3 Ward Attenders by Department and Ward The table below illustrates the number of registered ward attenders to the respective department and ward in 2021 compared with 2019.

Dept Clinic Total 2021 Total 2020 Total 2019 Cardiology CARDIAC CATH.
SUITE CORONARY CARE UNIT CARDIAC MEDICAL WARD Cardiothoracic Surgery Medicine CARDIAC INT.

CARE UNIT CARDIOTHOR.

SURGERY UNIT INFECTIOUS DISEASES UNIT MED.

ADMISSION UNIT 1 MED.

ADMISSION UNIT 2 MED.


ADMISSION UNIT 3 MEDICAL WARD 1 MEDICAL WARD 2 MEDICAL WARD 3 MEDICAL WARD 4 MEDICAL WARD 5 MEDICAL WARD 6 MEDICAL WARD 7 MEDICAL WARD 8 MEDICAL WARD 9 RENAL UNIT Neurosciences NEURO-MEDICAL WARD NEURO-SURGICAL WARD Obs & Gynae Orthopaedics DELIVERY SUITE GYNAE WARD OBSTETRICS WARD 1 OBSTETRICS WARD 2* OBSTETRICS WARD 3 ORTHOPAEDIC WARD 1 ORTHOPAEDIC WARD 2 ORTHOPAEDIC WARD 3 Paediatrics DISNEYLAND NEONATAL/PAED.

INT.
CARE NURSERY 1 & 2 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL Difference 2021 & 2019 3 -7 -13 4 -4283 -384 -2 -3 2 -60 -121 -57 -258 41 -2 0 0 2 -390 -348 -39 30 -13 2 -735 -2 -10 815 -106 -10 -28 0 24 Hospital Activity Report 2021 Cont… Dept Clinic Total 2021 Total 2020 Total 2019 NURSERY 3 (OBST.
WARD 3) PAEDIATRICS DAY CARE WONDERLAND (16th Oct onwards) FAIRYLAND (1st Jan-16th Oct) BURNS UNIT E.N.T.

WARD DIABETIC FOOT WARD FAIRYLAND (16th Oct onwards) WONDERLAND (1st Jan-16th Oct) PRE ADMISSION UROLOGY PLASTIC SURGERY UNIT SURG.

ADMISSION UNIT 1 SURGICAL WARD 1 SURGICAL WARD 2 SURGICAL WARD 3 SURGICAL WARD 4 SURGICAL WARD 5 UROLOGY WARD 1 UROLOGY WARD 2 DAY CARE UNIT (ENDOSCOPY) DAY CARE UNIT (SURGERY) INTENSIVE THERAPY UNIT MED.

INVEST.

& TREAT.
UNIT,MDH OBSERVATION WARD 1B OBSERVATION WARD 2 OPHTHALMIC WARD MD WAIT n/app n/app 1 513 1 n/app n/app 2329 1154 9 259 163 14 196 253 1 916 4 0 0 11586 2 0 75 5 40276 Surgery Other Grand Total Difference 2021 & 2019 4 -1398 n/app n/app 63 -355 -1 n/app n/app -373 165 6 -112 204 18 -133 -146 1 -270 5 1 6 -1495 -2 0 -1 -1 1590 *WA decreased at the OBS2 due to treatment being administered at OP clinics not on the ward, for example administering of Anti D injections; CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 25 Hospital Activity Report 2021 2.4 Out-Patient Activity 2.4.1 Out-Patient Attendances 2021 In 2021 there were 466799 (+28% on 2020, -10% on 2019) registered clinic attendances at the out-patient department (of which 20974 were registered at outreach clinics7).
The average daily attendance was of 1486 attendances (excluding outreach clinics, Sundays and public holidays).

Note: an out-patient attendance is a patient visiting the outpatients department for ambulatory care including consultations, diagnosis, observation, treatment, investigations and other care from support areas.
Registered attendances by type in 2021 (and percentage difference on 2020 & 2019): • New Cases8: • Follow-ups9: • Walk-ins10: • Any Cases11: • Telephone Consultations12: 16700 (+165% on 2020) 94631 (+38% on 2020, -3% on 2019) 211627 (+27% on 2020, -10% on 2019) 109678 (+14% on 2020, -18% on 2019) 34163 (+29% on 2020, -34% on 2019) Type of Attendance 2021 7% 24% 4% 20% Any Follow Up New Case Tel Cons Walk In 45% 7 Outreach clinics include the following: tissue viability outreach, urology outreach, midwifery outreach, orthopaedic outreach and home antibiotic/therapy.
8 New cases are new outpatient appointments which are planned and given a date and time beforehand.

In this case, the patient will not have had a previous outpatient appointment related to the case.

9 Follow up cases are outpatient appointments which are planned to provide continuing or further attention to a previous related appointment.

The appointment will be planned and given a date and time beforehand.

10 Walk ins are unplanned outpatient attendances.


The patient turns up for an outpatient visit without a planned date and time for appointment.

11 These are cases registered as any in the system to allow for flexibility when booking patients.

These cases could be new cases or follow ups.

12 Due to the COVID-19 pandemic, outpatient consultations were also carried out over the phone as telephone consultations on the advice of the consultant firm.
CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 26 2.4.2 Out-patient attendances by month and type of attendance Hospital Activity Report 2021 The graph below shows the number of out-patient attendances by month and type of attendance in 2021.

The highest number of outpatient attendances in 2021 was registered in November with 46886 admissions whilst the lowest number was recorded in December with 32204 admission episodes.
Registered Out-Patient Attendances 2021 s e c n a d n e t t A f o r e b m u N 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Grand Total 34617 35040 36796 39371 40889 38606 42447 39332 38307 42304 46886 32204 Any 2892 2463 2863 2910 3391 2539 3271 2411 2068 3386 3666 2303 Follow Up 15961 15202 15333 17086 17982 17690 19807 17930 18421 19566 21587 15062 New Case Tel Cons Walk In Month 2021 Grand Total Any Follow Up New Case Tel Cons Walk In Illustration 15: Number of registered outpatient attendances 2021 by month CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 27 Hospital Activity Report 2021 2.4.3 Clinic Activity according to department and clinics grouped into the clinic description and attendance type The table below illustrates the number of out-patient attendances by type of attendance and clinic description for every department and clinic held at MDH.
The clinics were grouped together to create the clinics description to further ease analysis and interpretation of data.

For example, all medicine respiratory clinics grouped into Medicine/Respiratory.
Department & Clinic Description Anaesthesia/Pain Relief Pain Clinic Anaesthesia/Pre-op Pre-operative assessment clinic Cardiac Surgery Cardiac Surgery Clinic Cardiology Adult Congenital Heart Disease Clinic Blood Pressure (Cardiology) Cardiac Lab Blood Inv Cardiac Rehabilitation Clinic (nurse-led) Cardiology Heart Valve Clinic Cardiology OP Cardiology Post Covid Cardiology Rapid Access Clinic Cardiology Sports Electrophysiology Heart Failure Clinic (Nurse led) Heart Intervention Clinic Heart Valve Clinic ICD Clinic (technician led) Inherited Cardiomyopathy Clinic Pacemaker Clinic (technician led) Pacemaker Wound Check Cl (nurse-led) T.O.E.
Clinic (Cardiology) Chinese Medicine Chinese Medicine clinic New Case 1402 1402 8349 8349 0 0 3431 73 229 0 66 21 2390 9 268 11 82 4 26 205 0 39 0 8 0 336 336 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL Follow Up Any Walk In Tel Cons 212 212 0 0 531 531 6176 6 0 0 223 0 5709 0 147 3 14 3 37 25 0 9 0 0 0 0 0 Grand Total 2021 4018 4018 8786 8786 809 809 22819 486 231 164 3005 56 14501 19 641 50 463 1596 83 465 133 140 648 15 123 2337 2337 28 Hospital Activity Report 2021 Department & Clinic Description New Case Follow Up Any Walk In Dental Child Dental Clinic Cleft Lip & Palate Clnic (Dental) Dental Clinic Dental Clinic (A&E) Dental Clinic (Consultants) Dental Clinic (Oral Hygiene) Dental Clinic (oral rehabilitation) Dental Clinic (Oral Surgery) Dental Clinic (Pre-op) Dental Clinic (Prosthetics) Dental Clinic (Scaling and Polishing) Dental Orthodontic Clinic Dental VCC Maxillofacial surgery Dietician Dietetic Clinic Dietetic/Diabetes Clinic Dietetic/Gastro Clinic Dietician Bariatric Dietician Medical Dietician Oncology Dietician Paediatric Dietician Renal Clinic Dietician Surgical Genetics Assisted Reproduction Clinic Genetics Genetics Clinic Genetics Paediatrics Infection Control Hep.
B Titre Clinic Infection Control Clinic Infection Control Screening Influenza Vaccine Clinic MRSA Screening Clinic Quarantine Medicine Ambulatory Sleep Studies Asthma Clinic Tel Cons CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL Grand Total Hospital Activity Report 2021 Department & Clinic Description Baromedicine Coeliac Disease Clinic COPD Clinic CTD Clinic Diabetes Clinic Diabetes Clinic (Juvenile) Diabetes Education Clinic Diabetes Point of Care Clinic Diabetic Foot Clinic Endocrinology Rapid Access Fibromyalgia Clinic Home Therapy Hyperbaric Unit IBD Clinic Infectious Diseases Joint Injection Clinic Lipid Clinic Medicine/Respiratory Medical OP Medicine/Gastroenterology/Hepatic Medicine/Gastroenterology Medicine/General & Inf.
Diseases Medicine/Liver Clinic Medicine/Nephrology Medicine/Respiratory Medicine/Respiratory/VCC Medicine/Endocrine Clinic Neuroendocrine Clinic Nursing Procedures Post Covid-19 Pulmonary Fibrosis Pulmonary Function Lab (Nurse led) Rheumatology Ankylosing Spondylitis Rheumatology Clinic Rheumatology Clinic (nurse led) Rheumatology Rapid Access Sleep Disorders Clinic Sleep OP Clinic Sleep Pap Clinic New Case Follow Up Any Walk In Tel Cons CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL Grand Total Hospital Activity Report 2021 Department & Clinic Description New Case Follow Up Any Walk In Tel Cons Stress ECG (Medicine) Systemic Sclerosis Clinic Thyroid Clinic Transplant/Travel Wound Clinic Wound Clinic (Hyperbaric) Neurosciences Evoked Potentials Clinic (Neuro Team) Movement Disorder Multiple Sclerosis Neuro EEG Monitoring Neuro EMG Monitoring Neurocognitive Clinic Neuroepilepsy Clinic Neurology Botox Clinic Neurology Migraine Neurology OP Neuromuscular Clinic Neurosurgical Clinic Neurovascular Clinic Neurosciences/Psychiatry Neuropsychiatric joint clinic Nutrition Nutrition Clinic Obs & Gynae Antenatal Clinic Assisted Reproduction Clinic Breastfeeding Clinic (Midwife led) Colposcopy Clinic CTG Clinic Diabetic Pregnancy Clinic Gynae OP Gynae OP Miscarriage Clinic Gynae OP Scans Heavy
 Menstrual Bleeding Clinic Outreach Midwifery Perinatal Mental Health Clinic Post Menopausal Bleeding Clinic CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL Grand Total Hospital Activity Report 2021 Department & Clinic Description Ophthalmology Ophthalmic Botox Clinic Strabismus Ophthalmic IVFA Ophthalmic Laser Ophthalmic Low Vision Clinic Ophthalmic OCT Ophthalmic OP Ophthalmic OP (Botox Clinic) Ophthalmic OP (Vitreoretinal) Ophthalmic OP A&E Referrals Ophthalmic Orthoptics Ophthalmic Paediatric Ophthalmic Peripheral Visual Fields Ophthalmic Post-OP Clinic Ophthalmic Retina Ophthalmic Special Ophthalmic (Cornea) Orthopaedics OOP Foot Ankle Clinic Orthopaedic FTC Orthopaedic OP Orthopaedic OP (General/Paediatrics) Orthopaedic OP Shockwave Orthopaedic Outreach Orthopaedic Plaster Clinic Orthopaedic Rx Room (nurse led) Orthopaedic VCC Orthopaedic VCC (Spinal) Orthopaedics VCC (Hand Clinic) PRP Injection Clinic Sport Injury Clinic Study Other Home Antibiotic Therapy Paediatrics Children's OP Children's OP (Cardiology/General) Children's OP (Neuro-paed) Community Paediatric Clinic New Case Follow Up Any Walk In Tel Cons 2221
CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL Grand Total Department & Clinic Description COP (Bleeding Room) Paediatric Development Clinic Paediatric Diabetes/Endocrine Paediatric Echo (Paediatrics) Paediatric General & Inf Diseases Paediatric NPICU Paediatric Respiratory Medicine Paediatric Review Clinic Paediatric Speech Therapy Paediatric VCC Physiotherapy Physiotherapy Team Podiatry Diabetic Foot Clinic Diabetic Foot Ward Ulcers Podology Clinic Radiology Neuro Vascular Radiology Clinic Surgery Assessment Dialysis Breast Clinic ENT Audiology ENT Audiology (Audiometry) ENT Audiology (Hearing Aids) ENT Audiology (paed) ENT Dizziness Clinic ENT Hearing Loss Clinic ENT Oncology ENT OP ENT Otology ENT Tinnitus Clinic Liver Clinic Paediatric Surgery SOP SOP (General) SOP (Stoma Clinic) SOP Bariatric Clinic SOP Dermatology Referrals CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL Hospital Activity Report 2021 New Case Follow Up Any Walk In 0
Tel Cons Grand Total Department & Clinic Description SOP Lower GI Clinic SOP Plastic SOP Upper GI clinic Urology Clinic Urology Incontinence Assessments Urology Male Infertility Clinic Urology Outreach Clinic Vascular Stroke (Nurse led) Vascular Surgery Clinic Thalassaemia MOP Thalassaemia/Haematology Thalassaemia Clinic Thalassaemia Phlebotomy Clinic Tissue Viability Tissue Viability Clinic TVU Outreach Grand Total Hospital Activity Report 2021 New Case Follow Up Any Walk In Tel Cons 0 0 6 1734 0 155 0 0 171 57 5 51 1 4 4 0 16700 Grand Total 2021 158 4200 302 18160 14 743 2683 7 4118 706 5 286 415 6312 6266 46 466799 *home antibiotic therapy numbers to be verified since not all visits are being registered on OP module.
Notes: 1) Haematology not included due to migration to SAMOC.

2) A number of cardiology clinics have been excluded from analysis since the activity is not being registered on CPAS but on cardiology system.

These include 7 Day Holter Clinic (Cardiol-tech led), Adult Heart Disease, Cardiac cath Suite (Cardiology Clinic), ECG Clinic (12 lead), Echocardiogram (cardiology).

3) Pathology activity for clinics ACC Phlebotomy, Bleeding Room (OGTT) and Phlebotomy Pathology have been excluded.
4) Sleep disorders clinic (domiciliary) has been excluded.

5) Gynae bone density clinic has been excluded due to the activity being registered on radiology system rather than CPAS.

6) Clinics registered under MDH but are held at a different location have been excluded (orthotics & prosthetics, CDAU, occupational therapy, social work, SLH chest clinic).
CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 34 3 SECTION 2 Hospital Activity Report 2021 Sir Anthony Mamo Oncology Centre (SAMOC) Activity ADMISSIONS, DAY CASES, WARD ATTENDERS, OUT-PATIENTS CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 35 3.1 Admissions 2021 Hospital Activity Report 2021 In 2021 there were 4340 (+16% on 2020, +2% on 2019) registered in-patient admissions at SAMOC and 23199 (+15% on 2020, -21% on 2019) registered day cases at SAMOC Day Care Unit*.
The list below shows a breakdown of admissions by type.
Type of admission registrations in 2021: 23241 4196 • Day Case*: • Elective: • Emergency: 52 • Other**: 50 *these include day cases registered as out patient clinic attendances at the DCU SAMOC, and include same patients visiting more than one clinic in one day **all admissions should be inputted as either day cases, elective or emergency 3.1.1 Admissions by ward The table below illustrates the number of registered admissions to the admitting wards at SAMOC.
Ward OC DCU - Day Care Unit OC HAEMW- Haematology Ward OC PAU-Paediatric Adolescent Ward OC PCU- Palliative Care Unit OC RIU- Radioisotope unit OC WARD 1- Oncology Ward 1 OC WARD 2- Oncology Ward 2 Total Total 2021 23199 319 152 286 54 1608 1921 27539 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 36 3.2 Out-Patient Attendances 2021 Hospital Activity Report 2021 In 2021 there were 60229 (+11% on 2020, +9% on 2019) registered out-patient attendances at SAMOC out-patient department.
The table below illustrates the number of outpatient attendances by type of attendance for every department.
Department Haematology Oncology Palliative Total New Case Follow Up 1585 3379 6 4970 4131 11986 147 16264 Any 79 1241 0 1320 1050 1830 139 3019 6209 2559 1629 10397 Walk In Tel Cons Total 2021 Pathology Clinics 104 15953 0 21 Radiotherapy Clinics Physiotherapy Team 0 20 0 5 2177 4639 Psychology Clinics 173 180 416 Occupational Therapy Clinics 0 0 255 Dietician Clinics 160 146 3 7 0 0 0 0 0 0 0 0 0 0 13054 20995 1921 35970 16078 2184 4664 769 255 309 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 37 3.3 Ward Attenders 2021 Hospital Activity Report 2021 In 2021 there were 1827 (+44% on 2020, -18% on 2019) registered ward attenders at SAMOC.
Note: A ward attender is a patient coming for treatment to the ward and not using a bed for a prolonged time to receive care.

Examples of ward attenders include patients coming for intravenous infusions such as Aredia, change of dressings and wound care, follow-up visits post discharge, IV antibiotics, review, etc.

Ward attenders are registered on CPAS following selection ‘ward attender’ in the ‘Admin Method’ section and are assigned a ward attender bed (W_ATT*) in the respective ward.
All admissions assigned to ward attender beds were therefore extracted from CPAS and analysed.

The table below illustrates the number of registered ward attenders to the respective wards in 2021.

Ward OC DCU - Day Care Unit OC HAEMW – Haematology Ward OC PAU - Paediatric Adolescent Unit OC PCU - Palliative Care Unit OC RIU - Radioisotope Unit OC WARD 1 - Oncology Ward 1 OC WARD 2 - Oncology Ward 2 Total Total 2021 0 18 1250 9 271 115 164 1827 CLINICAL PERFORMANCE UNIT, MATER DEI HOSPITAL 38