Readmission to MedWard

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)

do you mean from hospital

• SMW

• Cargo

• Categories

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.

• 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 left against medical advice (AMA), palliative patients in the count of readmission.

• Left the ward or unit against medical advice (Dispo = AMA) from the prior ward admission the patient was discharged
• Patient has a palliative Admit Diagnosis on the second (next) ward admission
  • The coding for Palliative changed over time.
  • Beginning to Nov 2013 -use the code 90400 Palliative Service
  • Nov 11, 2013 to Aug 26, 2019 - use Tmp Project Comfort Care
  • starting Jan 1, 2019 - ICD10 dx Palliative care (Z51.5)

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