Readmission to MedWard: Difference between revisions

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{{Reporting Indicators
{{Reporting Indicators
| description = Number of Ward readmission within 7 days per 100 discharges to hospital.
| description = Number of Ward readmission within 7 days per 100 discharges from discharging hospital.
| indicator_name = Readmission Rate to Med ward
| indicator_name = Readmission Rate to Med ward
| created_raw = Created   
| created_raw = Created   
Line 9: Line 9:


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


==Reported as==
==Reported as==
Percent of total discharges to hospital
* Percent of total discharges from discharging hospital (Rate)
 
{{DJ |
* when we were setting up [[LAU collection readmission data]] we realized that we are not clear on what exactly is included in a [[Discharged to community]]. We should decide how to define that and whether it should apply here and/or for other reports.
* In a meeting with Dan, Julie and Tina we also realized we need to include the newer home with supports etc in the definition of where someone was discharged to, and we may want to base this on Visit_Admit_dttm instead and so consider re-admission to either CC or med. If I understand right, the current definition considers someone who is re-admitted to ED the next day but then spends a week in CC before coming to a medicine bed is not considered a re-admission to medicine. I think EMIPs are excluded in the same way.
}}
* List of individual patients for chart review
 
==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 ward occupancy at the time of discharge. Readmission may reflect premature transfer out of hospital 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 ward occupancy at the time of discharge. Readmission may reflect premature transfer out of hospital due to errors in clinical judgment or system constraints.
==Sampling Plan / Procedure==
==Sampling Plan / Procedure==
===Inclusion Criteria===
===Inclusion Criteria===
100% of all ward patients discharged out of hospital
100% of all patients discharged from medicine ward to home/PCH, outside Winnipeg/Manitoba/Canada hospitals/facilities.
 
===Exclusion Criteria===
===Exclusion Criteria===
Excluding patients who left against medical advice (AMA), palliative patients in the count of readmission.
Excluding patients who  
* Left the '''earlier''' ward or unit against medical advice ([[Dispo]] = [[AMA]])  
* Arrived on the '''later''' ward as [[Palliative patient]]:
::{{palliative patient}}


===Frequency===
===Frequency===
===SAS definition===
{{Collapsable| always=As per 2025-02-14 email from JM
|full=
&nbsp; <!-- fix formatting for first line -->
    if (0 le diff le 7)  /* within one week included */
        and (
            tolocation in ('Home','HSC Lennox Bell')
            OR  toloctype in ('hospice','PCH','ambulatory care') 
            OR  toregion in ('out-of-WPG','out-of-MB','out-of-CAN')
            /* left the hospital and went home, long-term care facility, outside city and prov */
            or ( lagFromLoctype in ('ER','ambulatory care' ) 
                /*  (came from ER or ambulatory care)
                   
                and ( lagPreInptLocation in ('NA / not applicable',' ') 
                    or lagInptRegion in ('out-of-WPG','out-of-MB','out-of-CAN')
                    )
                    /* was (not an in-patient or in-patient from outside of Winnipeg before that)
             
                or lagFromHospital in ('Children'
                                          ,'Misericordia'
                                          ,'Manitoba Adolescent Treatment Center'
                                          ,'River Ridge Transition Care Environment'
                                          )
                                          /* or Children & Misericordia */
                )                   
                   
            or  lagFromLocation in ('Home' )
            /* next admit from Home */
           
            or  lagFromLoctype in ('PCH')
            /* next admit from nursing home */
        )
    then readm7=1;
    else readm7=0;  /* discharged to hospital ward,ICUs,OR,RR excluded*/
    if AMA=1 and readm7=1 then readm7=0;  /* AMA is excluded to readmission */
    if palliative=1  and readm7=1 then readm7=0;  /*palliative excluded */
    /* EMIP pts moving to another ward is not readmission */
    if Ward='EMIP' and (0 le diff le 7) and lagfromloctype in ('ER') then do;
    readm7=0; end;
    /* Same Visit_Admit_DtTm is not readmission */
    if nextvisit=Visit_Admit_DtTm then do;
    readm7=0; end;
}}


==Definition and Derivation==
==Definition and Derivation==
Number of Med ward readmission within 7 days per 100 discharges to hospital
For medicine, a readmission is a patient where
* (current [[Admit DtTm | admit date/time]]) - (most recent [[Dispo DtTm | discharge date/time]] to the hospital) is within 7 days after their most recent discharge date time to the hospital
* is admitted from outside hospital
Readmission is attributed to the site or hospital from which the patient was discharged.
===Numerator===
Num = Number of ward readmission within 7 days after being discharged out


===Numerator===
Num = Number of ward re-admission  within 7 days after being discharged out
===Denominator===
===Denominator===
Denom =Total Number of discharges who left the hospital (e.g. went home/nursing home, outside city, province or country)
Denom =Total Number of discharges who left the hospital (e.g. went home/nursing home, outside city, province or country)
Line 39: Line 104:


==Data Sources==
==Data Sources==
The following fields from L_Log table - [[Accept_DtTm field]] or [[Arrive DtTm field]], [[Dispo DtTm field]], [[Dispo field]],  the Project [[Comfort Care]] from L_TmpV2 table and diagnosis code [[Palliative Service]] from L_DXs table are used.
The following fields:
[[Admit DtTm]], [[Dispo DtTm field]], [[Dispo field]],  the Project [[Comfort Care]] from L_TmpV2 table and diagnosis code [[Palliative Service]] from L_DXs table, ICD10 code Z51.5 [[Palliative care]] from L_ICD10 table are used. Julie has confirmed this setup 2022 April 21.


==SAS Program==
==SAS Program==
X:\Julie\SAS_CFE\CFE_macros\medreadm.sas
{{S:\MED\MED_CCMED}}Julie\SAS_CFE\CFE_macros\medreadm.sas


==Report Users==
==Report Users==
Medicine Directors and Site  Managers
*Medicine Directors and Site  Managers
*Medicine Standards Committee - Dr. Elizabeth Salamon


== Related articles ==
{{Related Articles}}


[[Category: Data Use]]
[[Category:Data Use]]
[[Category: Reporting]]
[[Category:Reporting]]
[[Category: Statistical Analysis]]
[[Category:Statistical Analysis]]
[[Category:Multiple Encounter linking]]
[[Category:Multiple Encounter linking]]

Latest revision as of 15:36, 24 November 2025

Number of Ward readmission within 7 days per 100 discharges from discharging hospital.

Indicators
Indicator: Readmission Rate to Med ward
Created/Raw: Created
Program: Medicine
Start Date:
End Date:
Reports: Directors Quarterly and Annual Report (Medicine), Mortality and readmission report
Data Dependencies(Reports/Indicators/Data Elements):


  • Cargo


  • Helper template:
  • Cargo


  • Categories

none

  • SMW:
  • Categories
  • Default form:

QI domain

  • Safe

Reported as

  • Percent of total discharges from discharging hospital (Rate)


  • when we were setting up LAU collection readmission data we realized that we are not clear on what exactly is included in a Discharged to community. We should decide how to define that and whether it should apply here and/or for other reports.
  • In a meeting with Dan, Julie and Tina we also realized we need to include the newer home with supports etc in the definition of where someone was discharged to, and we may want to base this on Visit_Admit_dttm instead and so consider re-admission to either CC or med. If I understand right, the current definition considers someone who is re-admitted to ED the next day but then spends a week in CC before coming to a medicine bed is not considered a re-admission to medicine. I think EMIPs are excluded in the same way.
  • SMW


  • Cargo


  • Categories
  • List of individual patients for chart review

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 ward occupancy at the time of discharge. Readmission may reflect premature transfer out of hospital due to errors in clinical judgment or system constraints.

Sampling Plan / Procedure

Inclusion Criteria

100% of all patients discharged from medicine ward to home/PCH, outside Winnipeg/Manitoba/Canada hospitals/facilities.

Exclusion Criteria

Excluding patients who

Frequency

SAS definition

As per 2025-02-14 email from JM   

  

   if (0 le diff le 7)   /* within one week included */
       and ( 
           tolocation in ('Home','HSC Lennox Bell') 
           OR   toloctype in ('hospice','PCH','ambulatory care')  
           OR   toregion in ('out-of-WPG','out-of-MB','out-of-CAN') 
           /* left the hospital and went home, long-term care facility, outside city and prov */

           or ( lagFromLoctype in ('ER','ambulatory care' )  
               /*  (came from ER or ambulatory care)
                    
               and ( lagPreInptLocation in ('NA / not applicable',' ')  
                   or lagInptRegion in ('out-of-WPG','out-of-MB','out-of-CAN') 
                   )
                   /* was (not an in-patient or in-patient from outside of Winnipeg before that)
              
               or lagFromHospital in ('Children'
                                         ,'Misericordia'
                                         ,'Manitoba Adolescent Treatment Center'
                                         ,'River Ridge Transition Care Environment'
                                         )
                                         /* or Children & Misericordia */
               )                    
                   
           or   lagFromLocation in ('Home' ) 
           /* next admit from Home */
            
           or  lagFromLoctype in ('PCH') 
           /* next admit from nursing home */
       )
   then readm7=1; 

   else readm7=0;  /* discharged to hospital ward,ICUs,OR,RR excluded*/

   if AMA=1 and readm7=1 then readm7=0;  /* AMA is excluded to readmission */
   if palliative=1  and readm7=1 then readm7=0;  /*palliative excluded */

   /* EMIP pts moving to another ward is not readmission */
   if Ward='EMIP' and (0 le diff le 7) and lagfromloctype in ('ER') then do; 
   readm7=0; end;

   /* Same Visit_Admit_DtTm is not readmission */
   if nextvisit=Visit_Admit_DtTm then do;
   readm7=0; end;

Definition and Derivation

For medicine, a readmission is a patient where

  • (current admit date/time) - (most recent discharge date/time to the hospital) is within 7 days after their most recent discharge date time to the hospital
  • is admitted from outside hospital

Readmission is attributed to the site or hospital from which the patient was discharged.

Numerator

Num = Number of ward readmission within 7 days after being discharged out

Denominator

Denom =Total Number of discharges who left the hospital (e.g. went home/nursing home, outside city, province or country)

Formula

Readmission Rate(%) = Num / Denom * 100

Example

  • Time Reference: Discharge Dates from Jan 1, 2017 to March 31, 2017
  • Total readmission within 7 days after discharge to hospital= 5
  • Total discharges who left the hospital= 102
  • Readmission Rate(%) = 5 / 102 * 100= 4.9 %

Data Sources

The following fields: Admit DtTm, Dispo DtTm field, Dispo field, the Project Comfort Care from L_TmpV2 table and diagnosis code Palliative Service from L_DXs table, ICD10 code Z51.5 Palliative care from L_ICD10 table are used. Julie has confirmed this setup 2022 April 21.

SAS Program

S:\MED\Med_CCMED\​S:\MED\Med_CCMED\Julie\SAS_CFE\CFE_macros\medreadm.sas

Report Users

  • Medicine Directors and Site Managers
  • Medicine Standards Committee - Dr. Elizabeth Salamon

Related articles

Related articles:
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