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, for each CTU/NTU/MU and for each hospital in the region.
SPECIFICATION:
Inclusion Criteria:	All ward admissions in the Medicine Database MedTMS and all Medicine ward patients who appeared in the Critical Care Database TMSX. If a patient is admitted to a Medicine service, stayed in one or more Medicine wards or came from/went to ICU 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. The Medicine and Critical Care databases are combined to monitor any movements of Medicine patients. See the COMMENT below for details on how to link the flow of movement of patient within the hospital.
Exclusion Criteria:	All ICU admissions (e.g. ward patients who went to ICU) while 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 ward).
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.
	Ward – the ward(s) the patient was(were) admitted in the hospital. The first and last wards must be clearly specified.
	ICU – the ICU(s) the patient was(were) admitted in the hospital. The first and last ICUs must be clearly specified.
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.
	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 ward is the first ward the patient was admitted.
	Ave LOS Per CTU/NTU/MU = average LOS from all hospital stays over all admissions in each CTU/NTU/MU, where discharge date of the last service (ward/ICU) is between the beginning and the ending of the reporting time.
	Ave LOS Per Hospital = average LOS from all hospital stays over all admissions in each Hospital, where discharge date of the last service (ward/ICU) is between the beginning and the ending of the reporting time.
HOW REPORTED:	Reported: 1) by ward of each hospital, 2) by CTUs/NTUs/MUs of each hospital, and 3) by hospital in the region.
WHERE & WHEN REPORTED:	Quarterly and Annual report in Fiscal Year for Summary of Early Predictor of Adverse Outcome (MOST) .
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 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 approaches to link patient's admissions within a 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 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 .
	The second approach has been used and the criteria to determine a new admission are the following:
	1. Patient who has 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 the reason is further lab test and the stay in the second hospital < 1 day because the 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 who was discharged home/long term care facility, outside city or province and now admitted from a service/unit within the hospital
	6. Patient who was previously discharged to OR/RR and now admitted from OR/RR for more than 7 days from previous discharge date
	7. 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
	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/Site
	3.  Ward/ICU location
	4.  ‘Admit From’ location
	5.   ‘Discharge To’ location
	6.  Admit date and time
	7.  Discharge date and time
	8.   Med Var 1, Med Var 2, Med Var 6