LOS Medicine per hospital admission

LENGTH OF STAY in all medicine wards per HOSPITAL ADMISSION

Indicators
Indicator:	LOS Medicine per hospital admission
Created/Raw:	Created
Program:	Medicine
Start Date:
End Date:
Reports:	Directors Quarterly and Annual Report (Medicine)

• Cargo

• SMW:

• Categories

• Default form:

Usually used in aggregate form as "per location" and/or "per timeframe", e.g. month/quarter/year x Ward/Unit x Hospital.

Significance

Length of stay (LOS) is influenced by many factors, but safe and effective care should result in shorter length of stay.

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.
• 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.

Sampling Plan / Procedure

Inclusion Criteria

All Medicine admissions - see Definition of a Medicine Laptop Admission

Exclusion Criteria

None

Frequency

Reported when patient had been discharged out of Medicine. Monthly, quarterly, year based on discharged date of Dispo DtTm

Definition and Derivation

• Calculate the LOS - see LOS Per Record
• Per patient, identify the records having the same Visit Admit DtTm. This implies same hospital stay or hospitalization.
• Per patient per hospitalization, sum up all the LOS Per Record
  • It is possible that the same patient may have one or more hospitalization within the same time frame.

Data Source

• For dates refer to LOS Per Record
• For hospitalization date - use Visit Admit DtTm
• For patient identifier - either Person ID, Chart, PHIN

Reported

• Reported: 1) by ward of each hospital, 2) by CTUs/NTUs/MUs of each hospital, and 3) by hospital in the region.

Report Users

p:Dr. Dan Roberts 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.

• SMW

• Cargo

• Categories

TARGET

"None yet." What does that mean in the context of "Target"? And how does "Target" fit in with the structure you described in Template:Reporting Indicators?

• SMW

• Cargo

• Categories

Comment

this still talks about TMSX... what is the new status of this field?

• SMW

• Cargo

• Categories

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 hospital stay. Patient’s stay to different services within the hospital were linked and cumulative LOS only in the medicine wards was calculated.

Two approaches to link patient's admissions within a 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 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 .

The second approach has been used and the criteria to determine a new admission are the following:

1. Patient who has first and only admission
2. Patient who left the hospital against medical advice (AMA) ( Med Var 6), from previous admission
3. When patient is transferred to a different hospital, the admission for that 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 hospital < 1 day because the bed is usually put on hold on the first hospital)
4. Patient with previous encounter and now admitted from ER, home/long term care facility, outside city or province
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
6. Patient who was previously discharged to OR/RR and now admitted from OR/RR for more than 7 days from previous discharge date
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
8. Patient previously discharged to a ward and now admitted from a ward but the ward locations are now the same
9. None of the above but the gap in time between the two admissions is >90 days.

Elements used in linking admissions

1. PHIN, Last Name, First Name
2. Hospital/Site
3. Ward/ICU location
4. ‘Admit From’ location
5. ‘Discharge To’ location
6. Admit date and time
7. Discharge date and time
8. Med Var 1, Med Var 2, Med Var 6