Readmission Rate to ICU

Number of ICU readmission within 72 hours per 100 discharges to 1) ward only and 2) ward, home or elsewhere.

Indicators
Indicator:	Readmission Rate to ICU
Created/Raw:	Created
Program:	Critical Care
Start Date:
End Date:
Reports:	Critical Care Program Quality Indicator Report, HSC ICUs Data by Patient

• Cargo

• SMW:

• Categories

• Default form:

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

QI domain

• Safe

Reported as

• Definition1 : Percent of total discharges to ward
• Definition2 : Percent of total discharges to ward, home and elsewhere

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 ICU occupancy at the time of discharge. Readmission may reflect premature transfer out of ICU due to errors in clinical judgment or system constraints.

Sampling Plan / Procedure

Inclusion Criteria

We report these in two ways:

• Definition1: 100% of all ICU patients discharged to ward
• Definition2: 100% of all ICU patients discharged to ward, home or elsewhere

Exclusion Criteria

• Definition1 & 2 : Excluding patients with planned and scheduled surgery in the count of readmission.
• Definition2 : Excluding patients who left AMA or palliative in the count of readmission.
  • Elective surgery
    • Admit Type for APACHE II is 'Elect.Surg'
  • Palliative in this context means at least one of the following is present:
    • based on ICD10 Palliative care
    • tmp Comfort Care
  • AMA - see AMA

Frequency

Monthly, quarterly or yearly based on either admission dates or discharge dates

Definition and Derivation

Readmission means the patient left/discharged out of ICU to elsewhere and came back to ICU in the same or different facility from elsewhere. Readmission count is accounted to the unit discharging the patient the first time and not of the unit admitting the patient the second time.

• Definition1 : Number of ICU readmission within 72 hours per 100 discharges to any ward
• Definition2 : Number of ICU readmission within 72 hours per 100 discharges to any ward, home or elsewhere

Numerator

• Num1 = Number of ICU patients discharged to any ward and readmitted to any ICU within 72 hours coming from elsewhere
• Num2 = Number of ICU patients discharged to any ward, home or elsewhere and readmitted to any ICU within 72 hours coming from elsewhere

Denominator

• Denom1 =Total Number of discharges who went to any ward
• Denom2 =Total Number of discharges who went to any ward, home or elsewhere

Formula

Readmission Rate(%) = Num / Denom * 100

Example

• Time Reference: Discharge Dates from Jan 1, 2017 to March 31, 2017
• Total readmission within 72 hours of patients previously discharged to any ward= 5
• Total discharges who went to ward = 102
• Readmission Rate(%) = 5 / 102 * 100= 4.9 %

Data Sources

The following fields from L_Log table are being used

• Person_ID
• first ICU Service Start DtTm or Accept_DtTm field or Arrive DtTm field
• Dispo DtTm field
• Dispo field
• Admit Type for APACHE II
• the Project Comfort Care from L_TmpV2 table, diagnosis code Palliative Service from L_DXs table, ICD10 code Z51.5 Palliative care from L_ICD10 table

SAS Program

S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\ccreadm_starting1Oct2020.sas

Report Users

• Critical Care Directors and Site Managers
• Critical Care Quality Improvement Team (QIT)