LOS Medicine per hospital admission: Difference between revisions

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{{Reporting Indicators
{{Reporting Indicators
| description = '''[[:Category: Length of stay | LENGTH OF STAY]] in all medicine wards per [[Site and Location table | HOSPITAL]] ADMISSION'''
|description='''[[LOS | Length of stay]] in all medicine wards per [[Site and Location table | HOSPITAL]] ADMISSION'''
| indicator_name = {{PAGENAME}}
|indicator_start_date=2003-10-01
| created_raw = Created
|indicator_name={{PAGENAME}}
| program = Medicine
|program=Medicine
| indicator_start_date =
| indicator_end_date =
}}
}}
Usually used in aggregate form as "per location" and/or "per reporting timeframe", e.g. month/quarter/year x Ward/Unit x Hospital.


==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]].


== Definition ==
==Start Dates==
Average LOS reported for each ward, for each ward or unit and for each hospital in the region (see [[Site and Location table]] for list.
*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==
==Sampling Plan / Procedure==
===Inclusion Criteria===
===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]].
All Medicine admissions - see [[Definition of a Medicine Laptop Admission]]
{{Discuss | who = Julie | question = Does this mean time spent in an ICU between wards is included in the LOS? If not, can we tweak the text so that is clearer? }}
 
===Exclusion Criteria===
===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]]).
None
==== Required Variables  (Definition of Terms/) ====
===Frequency===
*'''Ward admit date/time''' – the date and time the patient is admitted to a [[Site and Location table | ward]].
* Reported the admission to the Medicine [[Service tmp entry|Service]] ends, ie when there is a [[Dispo DtTm]](Discharge Date)
*'''Ward discharge date/time''' – the date and time the patient was discharge to a [[Site and Location table | ward]].
* Monthly, quarterly, year based on discharged date of [[Dispo DtTm]]
*'''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.
*'''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.
 


==Definition and Derivation==
==Definition and Derivation==
* '''Individual LOS per ward''' = [[Dispo DtTm]] –
* Calculate the LOS for each record - refer to [[LOS Per Record]]
{{discuss | who=Julie |question = is this [[Arrive DtTm]] or [[Accept DtTm]]? }}
* Per patient, identify the records having the same [[Visit Admit DtTm]]. This implies same hospital stay or hospitalization.
(expressed in days).
* Per patient per hospitalization, sum up all the [[LOS Per Record]]
* '''LOS per patient''' = sum of individual LOS in all  the wards the patient stayed during a [[Site and Location table | hospital]] stay.
** It is possible that the same patient may have one or more hospitalization within the same reporting time frame.
* '''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.
* '''Ave LOS per ward or unit''' = average LOS from all [[Site and Location table | hospital]] stays over all admissions in each ward or unit, where discharge date of the last service (ward/ICU) is between the beginning and the ending of the reporting time.   
* '''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.
 
== 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.
* WHERE & WHEN  REPORTED:
| [[Quarterly report | Quarterly]] and [[Annual report]] in Fiscal Year for Summary of Early Predictor of Adverse Outcome ([[ALERT Scale]]) .
 
==Report Users==
{{Discuss | who = Julie | question =
[[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. }}
 
== TARGET==
{{Discuss | who = Julie | question =
"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]]?  }}
 
==Comment==
{{Discuss |who=Julie | question = this still talks about TMSX... what is the new status of this field? }}
 
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.  


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 .
==Data Source==
* For dates refer to [[LOS Per Record]]
* For hospitalization date - use [[Visit Admit DtTm]]
* For patient identifier - use either [[Person ID]], [[Chart]], [[PHIN]]


The second approach has been used and the criteria to determine a new admission are the following: 
== Reported as==
# Patient who has first and only admission
* Mean, median, sum, minimum, maximum (in days) per site and/or time frame
# Patient who left the hospital against medical advice (AMA) ([[Med Var 6 - AMA | Med Var 6]]), from previous admission
* N is the number of patient's hospitalizations
# 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]])
* Counts and % of N based on LOS groups (<1,1-5,6-10,11-15-16-20,>20) for a given reporting time frame and/or site
# Patient with previous encounter and now admitted from ER, home/long term care facility, outside city or province
# 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
# Patient who was previously discharged to OR/RR and now admitted from OR/RR  for more than 7 days from previous discharge date
# 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
# 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
# None of the above but the gap in time between the two admissions is >90 days.


=== Elements used in linking admissions ===
==SAS Program==
# [[PHIN field | PHIN]], [[Last Name]], [[First Name]]
S:\MED\MED_CCMED\Julie\SAS_CFE\Med_reports\1_prepMed_startingJan2021_26Aug2021.sas S:\MED\MED_CCMED\Julie\SAS_CFE\Med_reports\3_CFE_MedReportPart1_startingJan2021_16aug2021.sas
# [[Site and Location table| Hospital/Site]]
# [[Site and Location table | Ward/ICU location]]
# [[Admit From & Discharged To | ‘Admit From’ location]] 
# [[Admit From & Discharged To | ‘Discharge To’ location]]
# [[Admit date and time]]
# [[Discharge date and time]]
# [[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]]


== Related Articles ==
== Related Articles ==

Latest revision as of 11:28, 2021 December 22

Length of stay in all medicine wards per HOSPITAL ADMISSION

Indicators
Indicator: LOS Medicine per hospital admission
Created/Raw: not stated
Program: Medicine
Start Date: 2003-10-01
End Date:
Reports: Directors Quarterly and Annual Report (Medicine)


  • Cargo


  • SMW:
    • "not stated" is not in the list (Created, Raw) of allowed values for the "IndicatorCreatedRaw" property.
  • Categories
  • Default form:

Usually used in aggregate form as "per location" and/or "per reporting 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 the admission to the Medicine Service ends, ie when there is a Dispo DtTm(Discharge Date)
  • Monthly, quarterly, year based on discharged date of Dispo DtTm

Definition and Derivation

  • Calculate the LOS for each record - refer to 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 reporting time frame.

Data Source

Reported as

  • Mean, median, sum, minimum, maximum (in days) per site and/or time frame
  • N is the number of patient's hospitalizations
  • Counts and % of N based on LOS groups (<1,1-5,6-10,11-15-16-20,>20) for a given reporting time frame and/or site

SAS Program

S:\MED\MED_CCMED\Julie\SAS_CFE\Med_reports\1_prepMed_startingJan2021_26Aug2021.sas S:\MED\MED_CCMED\Julie\SAS_CFE\Med_reports\3_CFE_MedReportPart1_startingJan2021_16aug2021.sas

Related Articles

Related articles:
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