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| {{Reporting Indicators | | {{Reporting Indicators |
| | description = '''[[LOS | LENGTH OF STAY]] in all medicine wards per [[Site and Location table | HOSPITAL]] ADMISSION''' | | |description='''[[LOS | Length of stay]] in all medicine wards per [[Site and Location table | HOSPITAL]] ADMISSION''' |
| | indicator_name = {{PAGENAME}} | | |indicator_start_date=2003-10-01 |
| | created_raw = Created
| | |indicator_name={{PAGENAME}} |
| | program = Medicine | | |program=Medicine |
| | indicator_start_date =
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| | indicator_end_date =
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| }} | | }} |
| Usually used in aggregate form as "per location" and/or "per timeframe", e.g. month/quarter/year x Ward/Unit x Hospital. | | Usually used in aggregate form as "per location" and/or "per reporting timeframe", e.g. month/quarter/year x Ward/Unit x Hospital. |
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| ==Significance== | | ==Significance== |
| Length of stay (LOS) is influenced by many factors, but safe and effective care should result in shorter [[:Category: Length of stay | length of stay]]. | | Length of stay (LOS) is influenced by many factors, but safe and effective care should result in shorter [[:Category: Length of stay | length of stay]]. |
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| ==Start Dates== | | ==Start Dates== |
| *Oct 2003 to Sept 2020 - each record is per ward stay. A hospital stay may have one or more individual ward stay or records. | | *Oct 2003 to Sept 2020 - each record is per ward stay. A hospital stay may have one or more individual ward stay (or records). |
| *Starting Oct 2020- each record is a continuous stay in any locations under Medicine service (or one Medicine episode) - see [[Definition of a Medicine Laptop Admission]]. If the patient is transferred to another service and comes back to Medicine service, this is a new record. A hospital stay may have one or more Medicine episodes. | | *Starting Oct 2020- each record is a continuous stay in any locations under Medicine service (or one Medicine episode) - see [[Definition of a Medicine Program Admission]]. If the patient is transferred to another service and comes back to Medicine service, this is a new record. A hospital stay may have one or more Medicine episodes. |
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| == Definition ==
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| Average LOS reported for each ward, for each ward or unit and for each hospital in the region (see [[Site and Location table]] for list.
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| ==Sampling Plan / Procedure== | | ==Sampling Plan / Procedure== |
| ===Inclusion Criteria=== | | ===Inclusion Criteria=== |
| All patients admitted to a medical ward. If a patient is admitted to a Medicine service, stayed in one or more Medicine [[Site and Location table | ward]]s or came from/went to ICU and then discharged from the [[Site and Location table | hospital]], the individual length of stays in each of the [[Site and Location table | wards]] will be summed up. The LOS is accounted to the first [[Site and Location table | ward]] the patient was admitted. Movements are monitored between wards and ICUs. See the COMMENT below for details on how to link the flow of movement of patient within the [[Site and Location table | hospital]]. | | All Medicine admissions - see [[Definition of a Medicine Program Admission]] |
| {{Discuss | who = Julie | question = Does this mean time spent in an ICU between wards is included in the LOS? If not, can we tweak the text so that is clearer? }}
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| ===Exclusion Criteria=== | | ===Exclusion Criteria=== |
| All ICU admissions (e.g. ward patients who went to ICU) while [[Bed holds|beds are put on hold]] in Medicine wards are excluded (because the admission and discharge dates in ICU are within the admission and discharge dates in Medicine [[Site and Location table | ward]]).
| | None |
| {{DJ |
| | ===Frequency=== |
| * Is this still a thing? This would now be three different profiles, right? What of pt went to surgical ward in between instead? [[User:Ttenbergen|Ttenbergen]] 16:33, 2021 May 5 (CDT)}}
| | * Reported the admission to the Medicine [[Service tmp entry|Service]] ends, ie when there is a [[Dispo DtTm]](Discharge Date) |
| | | * Monthly, quarterly, year based on discharged date of [[Dispo DtTm]] |
| ==== Required Variables (Definition of Terms/) ==== | |
| *'''Ward admit date/time''' – the date and time the patient is admitted to a [[Site and Location table | ward]]. | |
| *'''Ward discharge date/time''' – the date and time the patient was discharge to a [[Site and Location table | ward]].
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| *'''Ward ''' – the ward(s) the patient was(were) admitted in the [[Site and Location table | hospital]]. The first and last wards must be clearly specified.
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| *'''ICU ''' – the ICU(s) the patient was(were) admitted in the [[Site and Location table | hospital]]. The first and last ICUs must be clearly specified. | |
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| ==Definition and Derivation== | | ==Definition and Derivation== |
| * '''Individual LOS per ward''' = [[Dispo DtTm]] – | | * Calculate the LOS for each record - refer to [[LOS Per Record]] |
| {{discuss | who=Julie |question = is this [[Arrive DtTm]] or [[Accept DtTm]]? }}
| | * Per patient, identify the records having the same [[Visit Admit DtTm]]. This implies same hospital stay or hospitalization. |
| (expressed in days).
| | * Per patient per hospitalization, sum up all the [[LOS Per Record]] |
| * '''LOS per patient''' = sum of individual LOS in all the wards the patient stayed during a [[Site and Location table | hospital]] stay. | | ** It is possible that the same patient may have one or more hospitalization within the same reporting time frame. |
| * '''Ave LOS Per Ward''' = average LOS from all hospital stays over all admissions in each ward, where discharge date of the last service (ward/ICU) is between the beginning and the ending of the reporting time. The term of reference for the [[Site and Location table | ward]] is the first [[Site and Location table | ward]] the patient was admitted. | |
| * '''Ave LOS per ward or unit''' = average LOS from all [[Site and Location table | hospital]] stays over all admissions in each ward or unit, where discharge date of the last service (ward/ICU) is between the beginning and the ending of the reporting time.
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| * '''Ave LOS Per [[Site and Location table | Hospital]]''' = average LOS from all hospital stays over all admissions in each [[Site and Location table | Hospital]], where discharge date of the last service (ward/ICU) is between the beginning and the ending of the reporting time.
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| == Reported ==
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| * Reported: 1) by [[Site and Location table | ward]] of each [[Site and Location table | hospital]], 2) by [[CTU]]s/[[NTU]]s/[[MU]]s of each hospital, and 3) by hospital in the region. | |
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| ==Report Users==
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| {{Discuss | who = Julie | question =
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| [[p:Dr. Dan Roberts]]
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| You had this as "PRESCRIBED BY: "; which is not how you set it in [[Template:Reporting Indicators]]. Also, Dan is likely no longer the user of this, so it should probably be updated. If we use a title rather than a name it will be self updating. }}
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| == TARGET==
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| {{Discuss | who = Julie | question =
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| "None yet."
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| What does that mean in the context of "Target"? And how does "Target" fit in with the structure you described in [[Template:Reporting Indicators]]? }}
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| ==Comment==
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| {{Discuss |who=Julie | question = this still talks about TMSX... what is the new status of this field? }}
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| The Medicine [[MedTMS]] and Critical [[TMSX]] Databases were combined to determine if a Medicine patient was admitted from ICU and/or have been transferred to ICU during a [[Site and Location table | hospital]] stay. Patient’s stay to different services within the [[Site and Location table | hospital]] were linked and cumulative LOS only in the medicine wards was calculated.
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| Two approaches to link patient's admissions within a [[Site and Location table | hospital]] stay when a patient appeared more than once in the database, '''1)''' link the admissions if the patient is transferred to or came from an ICU/another ward/went to OR within the [[Site and Location table | hospital]], and do not link if otherwise. '''2)''' do not link the patient if the next admission is a new admission, and do link if otherwise. Both will produce the same results .
| | ==Data Source== |
| | * For dates refer to [[LOS Per Record]] |
| | * For hospitalization date - use [[Visit Admit DtTm]] |
| | * For patient identifier - use either [[Person ID]], [[Chart]], [[PHIN]] |
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| The second approach has been used and the criteria to determine a new admission are the following:
| | == Reported as== |
| # Patient who has first and only admission
| | * Mean, median, sum, minimum, maximum (in days) per site and/or time frame |
| # Patient who left the hospital against medical advice (AMA) ([[Med Var 6 - AMA | Med Var 6]]), from previous admission
| | * N is the number of patient's hospitalizations |
| # When patient is transferred to a different [[Site and Location table | hospital]], the admission for that [[Site and Location table | hospital]] ends and the patient becomes a new admission to the second hospital (except if the reason is further lab test and the stay in the second [[Site and Location table | hospital]] < 1 day because the [[Bed holds|bed is usually put on hold on the first hospital]])
| | * Counts and % of N based on LOS groups (<1,1-5,6-10,11-15-16-20,>20) for a given reporting time frame and/or site |
| # Patient with previous encounter and now admitted from ER, home/long term care facility, outside city or province
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| # Patient with previous encounter who was discharged home/long term care facility, outside city or province and now admitted from a service/unit within the hospital
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| # Patient who was previously discharged to OR/RR and now admitted from OR/RR for more than 7 days from previous discharge date
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| # Patient who was previously discharged to a ward (not a Medicine ward) and now admitted from OR/RR for more than 30 days from previous discharge date
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| # Patient previously discharged to a ward and now admitted from a [[Site and Location table | ward]] but the ward [[Site and Location table | locations]] are now the same
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| # None of the above but the gap in time between the two admissions is >90 days.
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| === Elements used in linking admissions === | | ==SAS Program== |
| # [[PHIN field | PHIN]], [[Last Name]], [[First Name]]
| | S:\MED\MED_CCMED\Julie\SAS_CFE\Med_reports\1_prepMed_startingJan2021_26Aug2021.sas S:\MED\MED_CCMED\Julie\SAS_CFE\Med_reports\3_CFE_MedReportPart1_startingJan2021_16aug2021.sas |
| # [[Site and Location table| Hospital/Site]]
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| # [[Site and Location table | Ward/ICU location]]
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| # [[Admit From & Discharged To | ‘Admit From’ location]]
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| # [[Admit From & Discharged To | ‘Discharge To’ location]]
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| # [[Admit date and time]]
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| # [[Discharge date and time]]
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| # [[Med Var 1 - Admit-from Ward | Med Var 1]], [[Med Var 2 - Discharge-to Ward | Med Var 2]], [[Med Var 6 - AMA | Med Var 6]]
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| == Related Articles == | | == Related Articles == |