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{{Reporting Indicators
{{Reporting Indicators
| description = Number of ICU readmission within 72 hours per 100 discharges to ward.
|description=Number of ICU readmission within 72 hours per 100 discharges to 1) ward only and 2) ward, home or elsewhere.
| indicator_name = Readmission Rate to ICU
|created_raw=Created
| created_raw = Created 
|Program=Critical Care
| program = Critical Care
|DataDependencies=Palliative care; Palliative Service; Palliative patient; Comfort Care; AMA; Admit Type for APACHE II; Dispo; Dispo DtTm; Admit date and time; Person ID field
| indicator_start_date =  
|indicator_name=Readmission Rate to ICU
| indicator_end_date =  
|program=Critical Care
}}
}}
Used in aggregate form as "per location" and/or "per timeframe", e.g. by month/quarter/year x Ward/Unit x Hospital.


==QI domain==
==QI domain==
* Safe
* [[QualityDomain::Safe]]


==Reported as==
==Reported as==
Percent of total discharges to ward
* Definition1 : Percent of total discharges to ward
* Definition2 : Percent of total discharges to ward, home and elsewhere
 
==Significance==
==Significance==
Unplanned readmissions are associated with worse patient outcomes. Most factors associated with an increased risk of readmission are patient and admission-specific. System related risk factors include discharge at night and ICU occupancy at the time of discharge. Readmission may reflect premature transfer out of ICU due to errors in clinical judgment or system constraints.
Unplanned readmissions are associated with worse patient outcomes. Most factors associated with an increased risk of readmission are patient and admission-specific. System related risk factors include discharge at night and ICU occupancy at the time of discharge. Readmission may reflect premature transfer out of ICU due to errors in clinical judgment or system constraints.
==Sampling Plan / Procedure==
==Sampling Plan / Procedure==
===Inclusion Criteria===
===Inclusion Criteria===
100% of all ICU patients discharged to ward  
We report these in two ways:
* Definition1: 100% of all ICU patients [[Dispo|discharged to]] ward
* Definition2: 100% of all ICU patients [[Dispo|discharged to]] ward, home or elsewhere
 
===Exclusion Criteria===
===Exclusion Criteria===
* Definition1 & 2 : Excluding patients with planned and scheduled surgery in the count of readmission.
* Definition2 : Excluding patients who left [[AMA]] or [[palliative patient]]s in the count of readmission.
* Elective surgery
** [[Admit Type for APACHE II]] is 'Elect.Surg'
{{palliative patient}}
* AMA - see [[AMA]]


===Frequency===
===Frequency===
* Once the transfer ready has been written and the allowable 4.0 hours has elapsed, compute [[Transfer Delay]] or the total time it takes for ICU patient to leave the unit. 
Monthly, quarterly or yearly based on either admission dates or discharge dates
**If no time is indicated with the transfer ready date a proxy time of 10:00 am for day shift and midnight for night shift will be used for calculation purposes. 
**If more than one transfer ready has been written, use the transfer ready date & time closest to actual ICU transfer
* To be completed at time of discharge from ICU, compute the total days spent in ICU (refer as [[LOS]])
* To be calculated and reported on a monthly, quarterly or yearly basis based on either ICU Admission Dates or ICU Discharge Dates.
* For the Director reports, the discharge dates are used as the time of reference.


==Definition and Derivation==
==Definition and Derivation==
Avoidable days is defined as the total time from date/time of transfer ready (e.g. stable enough to transfer) to date/time transfer out of ICU (in hours) less 4.0 hours (and divided by 24 to give yield total avoidable days)
Readmission means the patient left/discharged out of ICU to '''elsewhere''' and came back to ICU in the same or different facility  from '''elsewhere'''. Readmission count is accounted to the unit discharging the patient the first time and not to the unit admitting the patient the second time.
 
* Definition1 : Number of ICU readmission within 72 hours per 100 discharges to any ward
 
* Definition2 : Number of ICU readmission within 72 hours per 100 discharges to any ward, home or elsewhere
===Numerator===
===Numerator===
Num = Total [[Transfer Delay]] in a given period
* Num1 = Number of ICU patients discharged to any ward  and readmitted to any ICU within 72 hours coming from elsewhere
* Num2 = Number of ICU patients discharged to any ward, home or elsewhere and readmitted to any ICU within 72 hours coming from elsewhere
===Denominator===
===Denominator===
Denom =Total Patient Days on the same period as the numerator
* Denom1 =Total Number of discharges who went to any ward
* Denom2 =Total Number of discharges who went to any ward, home or elsewhere
===Formula===
===Formula===
Avoidable Days (%) = Num / Denom * 100
Readmission Rate(%) = Num / Denom * 100
===Example===
===Example===
*Time Reference: Discharge Dates from Jan 1, 2017 to March 31, 2017
*Time Reference: [[Discharge Date]]s from Jan 1, 2017 to March 31, 2017
*Total Avoidable Days of all patients with transfer ready = 254.5
*Total readmission within 72 hours of patients previously discharged to any ward= 5
*Total LOS of all ICU discharges = 1175.3
*Total discharges who went to ward  = 102
*Avoidable Days (%)  = 254.5 / 1175.3 * 100= 21.7%
*Readmission Rate(%)  = 5 / 102 * 100= 4.9 %


==Data Sources==
==Data Sources==
*Per patient [[Transfer Delay]] is derived from [[Transfer Ready DtTm field]] and [[Dispo DtTm field]] of the Centralized_data.mdb.
See infobox in top left
*Per patient [[LOS]] is derived from [[Accept DtTm field]] or [[Arrive DtTm field]] and [[Dispo DtTm field]] of the Centralized_data.mdb.
 
==SAS Program==
==SAS Program==
X:\Julie\SAS_CFE\CFE_macros\datetimes.sas
S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\ccreadm_starting1Oct2020.sas
 
==Report Users==
==Report Users==
*Critical Care Directors and Site  Managers
*Critical Care Directors and Site  Managers
*Critical Care Quality Improvement Team (QIT)
*Critical Care Quality Improvement Team (QIT)
[[Category: Transfer Ready]]
 
[[Category: Admit/Discharge]]
== Related articles ==
[[Category: Length of stay]]
{{Related Articles}}
[[Category: Data Use]]
 
[[Category: Reporting]]
[[Category:Multiple Encounter linking]]
[[Category: Statistical Analysis]]
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