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LOS Medicine per hospital admission: Difference between revisions

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| | INDICATOR:
| | INDICATOR:
|style="font-size:11pt;font-weight:bold" | [[:Category: Length of stay | LENGTH OF STAY]] IN ALL  MEDICINE WARDS PER [[Site and Location table | HOSPITAL]] ADMISSION
|| '''[[:Category: Length of stay | LENGTH OF STAY]] IN ALL  MEDICINE WARDS PER [[Site and Location table | HOSPITAL]] ADMISSION'''
 
|-
|-   valign="top"
|| 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]].
|-
 
|| DEFINITIONS:
|-   valign="top"
| Average LOS reported for each ward, for each [[CTU]]/[[NTU]]/[[MU]] and for each [[Site and Location table | hospital]] in the region.
| | DEFINITIONS:
|-
| Average LOS reported for each ward, for each [[CTU]]/[[NTU]]/[[MU]] and for each [[Site and Location table | hospital]] in the region.
|| SPECIFICATION:
 
|  
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|-
| | SPECIFICATION:
|| 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]].
 
|-
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|| Exclusion Criteria:
| | Inclusion 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]]).
| All ward admissions in the Medicine Database [[MedTMS]] and all Medicine ward patients who appeared in the Critical Care Database [[TMSX]]. 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. The Medicine and Critical Care databases are  combined to monitor any movements of Medicine patients. See the COMMENT below for details on how to link the flow of movement of patient within the [[Site and Location table | hospital]].
|-
 
| rowspan="4" | Required Variables  (Definition of Terms/) :
|-   valign="top"
| '''Ward admit date/time''' – the date and time the patient is admitted to a [[Site and Location table | ward]].
| | 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]]).
| '''Ward discharge date/time''' – the date and time the patient was discharge to a [[Site and Location table | ward]].
 
|-
|-   valign="top"
| '''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.
| rowspan="4" | Required Variables  (Definition of Terms/) :
|-
| '''Ward admit date/time''' – the date and time the patient is admitted to a [[Site and Location table | ward]].
| '''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.
 
|-
|-   valign="top"
| rowspan="5"| Calculation Procedure:
| '''Ward discharge date/time''' – the date and time the patient was discharge to a [[Site and Location table | ward]].
| '''Individual LOS per ward''' = [[Dispo DtTm]] – {{discussion}} is this [[Arrive DtTm]] or [[Accept DtTm]]?
 
(expressed in days).
|-   valign="top"
|-
| '''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.
| '''LOS per patient''' = sum of individual LOS in all  the wards the patient stayed during a [[Site and Location table | hospital]] stay.
 
|-
|-   valign="top"
| '''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.  
| '''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.
|-
 
| '''Ave LOS Per [[CTU]]/[[NTU]]/[[MU]]''' = average LOS from all [[Site and Location table | hospital]] stays over all admissions in each [[CTU]]/[[NTU]]/[[MU]], where discharge date of the last service (ward/ICU) is between the beginning and the ending of the reporting time.     
|-   valign="top"
|-
| rowspan="5" height="25" | Calculation Procedure:
| '''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.  
| '''Individual LOS per ward''' = Ward discharge date/time – Ward admit date/time (expressed in days).
 
|-   valign="top"
| '''LOS per patient''' = sum of individual LOS in all  the wards the patient stayed during a [[Site and Location table | hospital]] stay.
 
|-   valign="top"
| '''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.  
 
|-   valign="top"
| '''Ave LOS Per [[CTU]]/[[NTU]]/[[MU]]''' = average LOS from all [[Site and Location table | hospital]] stays over all admissions in each [[CTU]]/[[NTU]]/[[MU]], where discharge date of the last service (ward/ICU) is between the beginning and the ending of the reporting time.     
 
|-   valign="top"
| '''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.  
 
|-  
|-  
| | HOW REPORTED:
|| HOW REPORTED:
| 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.
| 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.
 
|-   
|-   
| | WHERE & WHEN  REPORTED:
|| WHERE & WHEN  REPORTED:
| [[Quarterly report | Quarterly]] and [[Annual report]] in Fiscal Year for Summary of Early Predictor of Adverse Outcome ([[MOST]]) .
| [[Quarterly report | Quarterly]] and [[Annual report]] in Fiscal Year for Summary of Early Predictor of Adverse Outcome ([[MOST]]) .
|-   
|-   
| | PRESCRIBED BY:
|| PRESCRIBED BY:
| [[p:Dr. Dan Roberts]]  
| [[p:Dr. Dan Roberts]]  
 
|-   
|-   
| | TARGET:
|| TARGET:
| None yet.
| None yet.
 
|-
|-   valign="top"
| rowspan="21" | COMMENT:
| rowspan="21" | COMMENT:
| 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.  
| 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.  
 
|-
|-   valign="top"
| 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 .  
| 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 .  
|-
 
|-   valign="top"
|style="background-color:#C0C0C0;font-weight:bold" | The second approach has been used and the criteria to determine a new admission are the following:   
|style="background-color:#C0C0C0;font-weight:bold" | The second approach has been used and the criteria to determine a new admission are the following:   
 
|-
|-   valign="top"
| 1. Patient who has first and only admission
| 1. Patient who has first and only admission
|-
 
| 2. Patient who left the hospital against medical advice (AMA) ([[Med Var 6 - AMA | Med Var 6]]), from previous admission
|-   valign="top"
|-
| 2. Patient who left the hospital against medical advice (AMA) ([[Med Var 6 - AMA | Med Var 6]]), from previous admission
| 3. 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]])
 
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| 4. Patient with previous encounter and now admitted from ER, home/long term care facility, outside city or province  
| 3. 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]])
|-
 
| 5. 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
|-   valign="top"
|-
| 4. Patient with previous encounter and now admitted from ER, home/long term care facility, outside city or province  
| 6. Patient who was previously discharged to OR/RR and now admitted from OR/RR  for more than 7 days from previous discharge date
 
|-  
|-   valign="top"
| 7. 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
| 5. 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
|-
 
| 8. 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  
|-   valign="top"
|-
| 6. Patient who was previously discharged to OR/RR and now admitted from OR/RR  for more than 7 days from previous discharge date
| 9. None of the above but the gap in time between the two admissions is >90 days.  
 
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|-   valign="top"
| 7. 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
 
|-   valign="top"
| 8. 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  
 
|-   valign="top"
| 9. None of the above but the gap in time between the two admissions is >90 days.  
 
|-   valign="top"
|style="background-color:#C0C0C0;font-weight:bold" | Elements used in linking admissions:
|style="background-color:#C0C0C0;font-weight:bold" | Elements used in linking admissions:
|-  
|-  
| valign="top" | 1. [[PHIN field | PHIN]], [[Last Name]], [[First Name]]
|| 1. [[PHIN field | PHIN]], [[Last Name]], [[First Name]]
 
|-  
|-  
| valign="top" | 2. [[Site and Location table| Hospital/Site]]
|| 2. [[Site and Location table| Hospital/Site]]
 
|-  
|-  
| valign="top" | 3. [[Site and Location table | Ward/ICU location]]
|| 3. [[Site and Location table | Ward/ICU location]]
 
|-  
|-  
| valign="top" | 4. [[Admit From & Discharged To | ‘Admit From’ location]]   
|| 4. [[Admit From & Discharged To | ‘Admit From’ location]]   
 
|-  
|-  
| valign="top" | 5.  [[Admit From & Discharged To | ‘Discharge To’ location]]
|| 5. [[Admit From & Discharged To | ‘Discharge To’ location]]
 
|-  
|-  
| valign="top" | 6.  [[Admit date and time]]
|| 6. [[Admit date and time]]
 
|-  
|-  
| valign="top" | 7.  [[Discharge date and time]]
|| 7. [[Discharge date and time]]
 
|-  
|-  
| valign="top" | 8.  [[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]]
|| 8. [[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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