Readmission to MedWard

Number of Ward readmission within 7 days per 100 discharges from discharging 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

QI domain

Safe

Reported as

Percent of total discharges from discharging hospital (Rate)

	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.

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)

Frequency

SAS definition

As per 2025-02-14 email from JM

   if (0 le diff le 7)   /* within one week included */
       and ( 
           tolocation in ('Home','HSC Lennox Bell') 
           OR   toloctype in ('hospice','PCH','ambulatory care')  
           OR   toregion in ('out-of-WPG','out-of-MB','out-of-CAN') 
           /* left the hospital and went home, long-term care facility, outside city and prov */

           or ( lagFromLoctype in ('ER','ambulatory care' )  
               /*  (came from ER or ambulatory care)
                    
               and ( lagPreInptLocation in ('NA / not applicable',' ')  
                   or lagInptRegion in ('out-of-WPG','out-of-MB','out-of-CAN') 
                   )
                   /* was (not an in-patient or in-patient from outside of Winnipeg before that)
              
               or lagFromHospital in ('Children'
                                         ,'Misericordia'
                                         ,'Manitoba Adolescent Treatment Center'
                                         ,'River Ridge Transition Care Environment'
                                         )
                                         /* or Children & Misericordia */
               )                    
                   
           or   lagFromLocation in ('Home' ) 
           /* next admit from Home */
            
           or  lagFromLoctype in ('PCH') 
           /* next admit from nursing home */
       )
   then readm7=1; 

   else readm7=0;  /* discharged to hospital ward,ICUs,OR,RR excluded*/

   if AMA=1 and readm7=1 then readm7=0;  /* AMA is excluded to readmission */
   if palliative=1  and readm7=1 then readm7=0;  /*palliative excluded */

   /* EMIP pts moving to another ward is not readmission */
   if Ward='EMIP' and (0 le diff le 7) and lagfromloctype in ('ER') then do; 
   readm7=0; end;

   /* Same Visit_Admit_DtTm is not readmission */
   if nextvisit=Visit_Admit_DtTm then do;
   readm7=0; end;

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

S:\MED\CCMED\S:\MED\CCMED\Julie\SAS_CFE\CFE_macros\medreadm.sas

Report Users

Medicine Directors and Site Managers
Medicine Standards Committee - Dr. Elizabeth Salamon