LOS Medicine per hospital admission

INDICATOR:	LENGTH OF STAY IN ALL MEDICINE WARDS PER HOSPITAL ADMISSION
SIGNIFICANCE:	Length of stay (LOS) is influenced by many factors, but safe and effective care should result in shorter length of stay.
DEFINITIONS:	Average LOS reported for each ward in the region.
SPECIFICATION:
Inclusion Criteria:	All ward admissions in the Medicine Database MedTMS. If a patient is admitted to a Medicine service, stayed in one or more Medicine wards and then discharged from the hospital, the individual length of stays in each of the wards will be summed up. The LOS is accounted to the first ward the patient was admitted.
Exclusion Criteria:	None
Required Variables (Definition of Terms/) :	Ward admit date/time – the date and time the patient is admitted to a ward.
	Ward discharge date/time – the date and time the patient was discharge to a ward.
Calculation Procedure:	Individual LOS per ward = Ward discharge date/time – Ward admit date/time (expressed in days).
	LOS per patient = sum of individual LOS in all the wards the patient stayed during a hospital stay.
	Mean LOS Per Ward = average LOS from admissions to a ward where discharge date of the last ward/service is between the beginning and the ending of the reporting time.
HOW REPORTED:	Reported: 1) by ward of each hospital. 2) by CTUs of each hospital in the region,
WHERE & WHEN REPORTED:	Quarterly and Fiscal Year Summary of Early Predictor of Adverse Outcome MOST Report.
PRESCRIBED BY:	Dr Dan Roberts
TARGET:	None yet.
COMMENT:	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 or another ward 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 ways to link the patients: 1) Link the patient’s stay if the patient is transferred to another ward, OR or an ICU within the hospital and the second encounter indicated that it is so, t____? 2) Do not link the patient if the next stay is a new admission. {{Discussion: Julie to check. Missing from word doc.--TOstryzniuk 20:55, 2 February 2010 (CST)
	Have used the second option – Criteria to determine a new admission:
	1. Patient who have 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 reason is lab test and stay in the second hospital <1 day because 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 that was discharged home/long term care facility, outside city or province and now admitted from unit within the hospital
	6. Patient who was previously discharged to OR/RR and now admitted from OR/RR for more than 7 days
	7. Patient who was previously discharged to a ward and now admitted from OR/RR (or vice versa) for more than 30 days
	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
	3.      Ward/ICU
	4.      ‘Admit From’ location
	5.      ‘Discharge To’ location
	6.      Admit date/time
	7.      Discharge date/time
	8.      Med Var 1, Med Var 2, Med Var 6]