Readmission to MedWard: Difference between revisions

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{{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

| created_raw = Created

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==QI domain==

* Safe

* [[QualityDomain::Safe]]

==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==

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 ~~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===

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===

===SAS definition===

{{Collapsable| always=As per 2025-02-14 email from JM

|full=

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==

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===

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

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==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==

X:\Julie\SAS_CFE\CFE_macros\medreadm.sas

{{S:\MED\MED_CCMED}}Julie\SAS_CFE\CFE_macros\medreadm.sas

==Report Users==

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*Medicine Standards Committee - Dr. Elizabeth Salamon

[[Category: Data Use]]

== Related articles ==

[[Category: Reporting]]

[[Category: Statistical Analysis]]

[[Category:Data Use]]

[[Category:Reporting]]

[[Category:Statistical Analysis]]

[[Category:Multiple Encounter linking]]

@@ Line 1: / Line 1: @@
 {{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
 | created_raw = Created
@@ Line 9: / Line 9: @@
 ==QI domain==
-* Safe
+* [[QualityDomain::Safe]]
 ==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==
 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===
-% of all  ward patients discharged out of hospital
+% of all patients discharged from medicine ward to home/PCH, outside Winnipeg/Manitoba/Canada hospitals/facilities.
 ===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===
+===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==
-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===
 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==
-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==
-X:\Julie\SAS_CFE\CFE_macros\medreadm.sas
+{{S:\MED\MED_CCMED}}Julie\SAS_CFE\CFE_macros\medreadm.sas
 ==Report Users==
@@ Line 48: / Line 114: @@
 *Medicine Standards Committee - Dr. Elizabeth Salamon
-[[Category: Data Use]]
+== Related articles ==
-[[Category: Reporting]]
+{{Related Articles}}
-[[Category: Statistical Analysis]]
+[[Category:Data Use]]
+[[Category:Reporting]]
+[[Category:Statistical Analysis]]
 [[Category:Multiple Encounter linking]]