Readmission to MedWard: Difference between revisions

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* Left the ward or unit against medical advice ([[Dispo]] = [[AMA]])
* Left the ward or unit against medical advice ([[Dispo]] = [[AMA]])
* Palliative patients at admission
* Palliative patients at admission
{{DJ |
* Is this at admission to med, or to that record from which they were discharged, or possibly including at admission to ICU prior to med during this hospitalization? [[User:Ttenbergen|Ttenbergen]] 18:53, 2024 December 11 (CST)
** This would only be relevant for records from before [[PatientFollow Project]]. It is possible that we don't care about older records for indicators like this. If that is so, then can we include here what defines how long ago we can calculate something for? This is different from the start date of an indicator... [[User:Ttenbergen|Ttenbergen]] 18:53, 2024 December 11 (CST)
** Does this essentially mean you code that the pt has a palliative [[Admit Diagnosis]]? If so, could we just state it like that? I know that's slightly less easy to understand for someone who isn't used to our data, but I think details matter for this more than an easy read. [[User:Ttenbergen|Ttenbergen]] 18:53, 2024 December 11 (CST)
}}
** The coding for Palliative changed over time.
** The coding for Palliative changed over time.
*** Until Dec 31, 2018 Old coding - 904 and Tmp Project [[Comfort Care]]
*** Until Dec 31, 2018 Old coding - 904 and Tmp Project [[Comfort Care]]

Latest revision as of 18:53, 2024 December 11

Number of Ward readmission within 7 days per 100 discharges to 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


  • Cargo


  • SMW:
  • Categories
  • Default form:

QI domain

  • Safe

Reported as

  • Percent of total discharges to hospital (Rate)
  • 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 left against medical advice (AMA), palliative patients in the count of readmission.

Exclusions for readmissions are the following:

  • There is a planned admission like elective surgery
  • Left the ward or unit against medical advice (Dispo = AMA)
  • Palliative patients at admission
  • Is this at admission to med, or to that record from which they were discharged, or possibly including at admission to ICU prior to med during this hospitalization? Ttenbergen 18:53, 2024 December 11 (CST)
    • This would only be relevant for records from before PatientFollow Project. It is possible that we don't care about older records for indicators like this. If that is so, then can we include here what defines how long ago we can calculate something for? This is different from the start date of an indicator... Ttenbergen 18:53, 2024 December 11 (CST)
    • Does this essentially mean you code that the pt has a palliative Admit Diagnosis? If so, could we just state it like that? I know that's slightly less easy to understand for someone who isn't used to our data, but I think details matter for this more than an easy read. Ttenbergen 18:53, 2024 December 11 (CST)
  • SMW


  • Cargo


  • Categories
    • The coding for Palliative changed over time.
  • Does Palliative Service play into this as well? Its mentioned in the first line under the header. Do you have any re-used macro in SAS to define palliative status? If so, can we put that on the wiki to make it re-usable? Ttenbergen 18:37, 2024 December 11 (CST)
  • SMW


  • Cargo


  • Categories


  • "HSC IICU has no readmission"
    • what does that mean in the context of a medicine report? Ttenbergen 18:37, 2024 December 11 (CST)
  • SMW


  • Cargo


  • Categories

Frequency

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

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

Report Users

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