kempsey hospital - bureau of health informationkempsey number of 30-day returns to acute care this...

July 2009 – June 2012

Returns to acute care and mortality for five clinical conditions2

Condition This period

July 2000 – June 2003 July 2003 – June 2006 July 2006 – June 2009 July 2009 – June 2012

Average length of stay (days)3

Space for chart

Pneumonia

Hip fracture surgery

Kempsey Hospital

Time series

Acute myocardial

infarction (AMI)

Ischaemic stroke

Congestive heart

failure (CHF)

0

5

10

15

20

25

30

Length

of

sta

y

Acute myocardial infarction

Ischaemic stroke Congestive heart failure Pneumonia Hip fracture surgery

Range across NSW hospitals NSW This hospital

Higher than expected No different than expected Lower than expected Not reported

This profile reports risk-standardised readmission ratios (RSRRs) and risk-standardised mortality ratios (RSMRs). The

ratios take into account differences across hospitals in terms of case mix and volumes of patients, and results are

reported as either: higher than expected; no different than expected; or lower than expected. The performance dashboard

below summarises ratio results for five conditions over a 12 year period together with length of stay information for July

2009 – June 2012. Subsequent pages provide information to support interpretation of the RSRR. Readmissions are

defined as returns to acute care1 and results describe the age profile and comorbidity profile of patients; the number who

returned to acute care within 30 days of discharge; and reasons, location and timing of returns to acute care.

RSRR

RSMR

RSRR

RSMR

RSRR

RSRR

RSMR

RSRR

RSMR

RSRR

RSMR

RSRR

RSMR

RSRR

RSRR

RSMR

RSRR

RSMR

Bureau of Health Information | Kempsey Hospital 1

NOTES:

1. For patients whose acute hospitalisation ends with discharge home, a return to acute care involves readmission to hospital; while

for patients whose acute hospitalisation ends with a 'discharge' to non-acute care, a return involves a move back into an acute

care setting regardless of whether they physically left the hospital.

2. The “Not reported” category is used when there were fewer than 50 index cases admitted in the time period. Risk-standardised

mortality ratios have been taken from the BHI publication The Insights Series: 30-day mortality following hospitalisation, five

clinical conditions, NSW, July 2009 – 2012 and further information about this measure can be found there. RSRR outlier status is

determined using funnel plot control limits of 95% and 99.8%.

3. For calculation of average length of stay, index admissions that were transferred in from, or transferred out to, another acute care

hospital were excluded. Unreasonably long episodes are trimmed on the basis of the Diagnosis Related Group (DRG) of the

episode. The trim point is the third quartile plus 1.5 x the interquartile range of all in-scope episodes in each DRG.

4. Discharge destinations are based on the mode of separation of the index case. For episodes coded as 'Discharged by hospital' or

'Discharged on leave', patients are considered to be destined for their place of usual residence. All other modes of separation are

deemed to indicate a discharge destination other than a patient‟s place of usual residence.

5. Age of the patient at admission for the index case is used. Percentages may not add to 100% due to rounding.

6. Comorbidities are identified from the hospital discharge records using the Elixhauser comorbidity set (plus dementia) with a one

year look-back from the admission date of the index case. Percentage labels have been rounded to the nearest integer.

7. Results for hospitals with

This hospital NSW

115 27,325

5.8 6.0

70 11,648

101 24,132

14 3,193

*Age was a significant factor in the final model of 30-day returns to acute care following an index hospitalisation for AMI.

Presence of factors associated with 30-day AMI return to acute care6

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30-day return to acute care following hospitalisation for AMI

Patient cohort, index cases3,4

Total AMI index cases

Age profile for index cases (years)* 5

Other

Home

Average length of stay (days)

Patients transferred in from acute care in another hospital

Discharge destination

space for chart5

4

33

26

22

29

24

24

16

17

0 10 20 30 40 50 60 70 80 90 100

% index cases

15–44 45–64 65–74 75–84 85+

This hospital

NSW

40

24

10

12

13

8

14

8

2

5

3

4

1

2

27

20

16

15

11

10

7

7

4

3

2

2

1

Hospital level AMI RSRR by number of expected returns to acute care (readmissions)7

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Observed and expected 30-day returns to acute care, grouped with peers8

Hospital-specific RSRRs report the ratio of actual or „observed‟ number of returns to acute care to the „expected‟

number of returns. A competing risk regression model draws on the NSW patient population‟s characteristics and

outcomes to estimate the expected number of returns for each hospital, given the characteristics of its patients. An

RSRR less than 1.0 indicates lower-than-expected returns to acute care, and a ratio higher than 1.0 indicates higher-

than-expected returns. Small deviations from 1.0 are not considered to be meaningful. Funnel plots with 95% and

99.8% control limits around the NSW rate are used to identify outliers.

0 5 10 15 20 25 30 35

Blue Mountains

Cessnock

Maclean

Moruya

Bateman's Bay

Kempsey

Number of 30-day returns to acute care

This hospital,observed returns

Peer group hospital,observed returns

Expected returns to acutecare (based on model)

RSRR 1.52

NSW

0

0.5

1

1.5

2

2.5

3

0 50 100 150 200 250 300

Ris

k-s

tandard

ised r

eadm

issio

n r

atio

(O

bserv

ed/E

xpecte

d)

Expected number of returns to acute care (readmissions) within 30 days

This hospital

Other hospital

99.8% limit (3SD)

95% limit (2SD)

Bureau of Health Information | Kempsey Hospital | July 2009 – June 2012 4

This hospital NSW

30 4,453

30 3,042

0 1,411

0

0

0

Distribution of reasons for returns to acute care

Number of, and reasons for, returns to acute care following hospitalisation for AMI, by days post discharge

Returned to a different hospital

Of these:

To an urban public hospital


Location of returns to acute care9

Returned to the hospital where acute care was completed

Total returns to acute care following AMI index hospitalisation

To a private hospital

Reasons for and time to returns to acute care10

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space for chart

To a regional or rural public hospital

14 33

30

8

3

8

13

20

37

18

17

0 10 20 30 40 50 60 70 80 90 100

% returns to acute care

Principal diagnosis Condition related to principal diagnosis Potentially related to hospital care (relevant at any time)

Potentially related to hospital care (time sensitive, ≤ 7 days post discharge)

Potentially related to hospital care (time sensitive, 8–30 days post discharge)

Other condition

This hospital

NSW

3

5

1

1 4

6

4 1

4

1

0

2

4

6

8

10

12

14

1–7 days 8–14 days 15–21 days 22–30 days

Num

ber

of re

turn

s to a

cute

care

Days post discharge


This hospital NSW

66 12,776

6.0 9.5

14 1,713

25 6,772

41 6,004

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*Age was not a significant factor in the final model of 30-day returns to acute care following an index hospitalisation for ischaemic

stroke.


Home

Other

Age profile for index cases (years)* 5

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Presence of factors associated with 30-day ischaemic stroke return to acute care6


30-day return to acute care following hospitalisation for ischaemic stroke


Total ischaemic stroke index cases


4

3

20

17

23

29

32

21

21

30

0 10 20 30 40 50 60 70 80 90 100

% index cases

15–44 45–64 65–74 75–84 85+

This hospital

NSW

33

11

14

11

0

11

0

0

32

15

7

6

4

4

1

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Hospital level ischaemic stroke RSRR by number of expected returns to acute care (readmissions)7

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Bowral

Goulburn

Grafton

Broken Hill

Moruya

Griffith

Kempsey

Hawkesbury

Bathurst

Ryde

Shellharbour

Belmont

0 5 10 15 20





RSRR 1.57

NSW

0

0.5

1

1.5

2

2.5

3

0 50 100 150 200 250 300

Ris

k-s

tandard

ised r

eadm

issio

n r

atio

(O

bserv

ed/E

xpecte

d)


This hospital

Other hospital

99.8% limit (3SD)

95% limit (2SD)


This hospital NSW

12 1,321

12 1,022

0 299

0

0

0


space for chart

Number of, and reasons for, returns to acute care following hospitalisation for ischaemic stroke, by days post discharge

Of these:





space for chart





Total returns to acute care following ischaemic stroke index hospitalisation

19

25

10 21

17

7

8

15

25

28

25

0 10 20 30 40 50 60 70 80 90 100





Other condition

This hospital

NSW

1

2

1

1

1

3

2

1

0

1

2

3

4

5

6


Num

ber

of re

turn

s to a

cute

care

Days post discharge


This hospital NSW

152 29,961

6.3 6.6

6 2,820

135 26,099

17 3,862

space for chart

*Age was a significant factor in the final model of 30-day returns to acute care following an index hospitalisation for congestive heart

failure.


Home

Other

Age profile for index cases (years)*5

space for chart

Presence of factors associated with 30-day congestive heart failure return to acute care6


30-day return to acute care following hospitalisation for congestive heart failure


Total congestive heart failure index cases


1

1

11

8

18

30

37

28

32

34

0 10 20 30 40 50 60 70 80 90 100

% index cases

15–44 45–64 65–74 75–84 85+

This hospital

NSW

53

35

23

30

22

24

22

4

9

52

38

30

27

22

21

16

8

8

0 10 20 30 40 50 60

Cardiac arrhythmia

History of congestive heart failure

Fluid and electrolyte disorders

Renal failure

Diabetes, complicated

Chronic pulmonary disease

Valvular disease

Coagulopathy

Deficiency anaemia

% of index cases

This hospital NSW


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Hospital level congestive heart failure RSRR by number of expected returns to acute care (readmissions)7

space for chart


Inverell

Maclean

Cessnock

Deniliquin

Blue Mountains

Ballina

Queanbeyan

Cooma

Bateman's Bay

Moruya

Kempsey

0 10 20 30 40 50





RSRR 1.38

NSW

0

0.5

1

1.5

2

2.5

3

0 50 100 150 200 250 300

Ris

k-s

tandard

ised r

eadm

issio

n r

atio

(O

bserv

ed/E

xpecte

d)


This hospital

Other hospital

99.8% limit (3SD)

95% limit (2SD)


This hospital NSW

47 6,850

44 5,608

3 1,242

1

2

0


Number of, and reasons for, returns to acute care following hospitalisation for congestive heart failure, by days post discharge

space for chart

Of these:





space for chart





Total returns to acute care following congestive heart failure index hospitalisation

37

19

11

13

6

9

7

17

19

28

19

15

0 10 20 30 40 50 60 70 80 90 100





Other condition

This hospital

NSW

4 4

1

2 1

1

2

1

1

2

8

5

7 1

1

3

2

1

0

2

4

6

8

10

12

14

16


Num

ber

of re

turn

s to a

cute

care

Days post discharge


This hospital NSW

337 42,777

5.8 6.1

14 4,358

309 37,971

28 4,806

space for chart

*Age and sex were significant factors in the final model of 30-day return to acute care following an index hospitalisation for pneumonia.

The percentage of index hospitalisations that were female patients at this hospital was 51% compared to 48% for NSW.


Home

Other

Age profile for index cases (years)*5

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Presence of factors associated with 30-day pneumonia return to acute care6


30-day return to acute care following hospitalisation for pneumonia


Total pneumonia index cases


15

18

22

24

18

18

26

25

19

16

0 10 20 30 40 50 60 70 80 90 100

% index cases

18–44 45–64 65–74 75–84 85+

This hospital

NSW

15

15

15

13

12

9

8

1

4

9

1

2

4

3

2

1

1

2

1

24

20

20

19

14

10

9

6

6

5

4

4

3

3

3

3

3

2

1

0 5 10 15 20 25

Fluid and electrolyte disorders

Chronic pulmonary disease

Cardiac arrhythmia

Hypertension, uncompl. or compl.

Congestive heart failure

History of pneumonia

Renal failure

Weight loss

Solid tumour without metastasis

Alcohol abuse/drug abuse/psychoses

Coagulopathy

Other neurological disorders

Pulmonary circulation disorders

Deficiency anaemia

Metastatic cancer

Depression

Diabetes, uncomplicated

Liver disease

Lymphoma

% of index cases

This hospital NSW


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Hospital level pneumonia RSRR by number of expected returns to acute care (readmissions)7

space for chart


0 10 20 30 40 50

Cooma

Casino

Queanbeyan

Moruya

Macksville

Cessnock

Blue Mountains

Cowra

Mudgee

Milton and Ulladulla

Bateman's Bay

Lithgow

Kempsey





RSRR 1.10

NSW

0

0.5

1

1.5

2

2.5

3

0 50 100 150 200 250 300

Ris

k-s

tandard

ised r

eadm

issio

n r

atio

(O

bserv

ed/E

xpecte

d)


This hospital

Other hospital

99.8% limit (3SD)

95% limit (2SD)


This hospital NSW

44 5,412

42 4,323

2 1,089

0

2

0


Number of, and reasons for, returns to acute care following hospitalisation for pneumonia, by days post discharge

space for chart

Of these:





space for chart




Total returns to acute care following pneumonia index hospitalisation


19

18

17

18

8

9

9

5

17

14

30

36

0 10 20 30 40 50 60 70 80 90 100





Other condition

This hospital

NSW

6

1 1

2

2 3 1

3

1

2

2

2

2

9

3

1

3

0

2

4

6

8

10

12

14

16

18

20


Num

ber

of

retu

rns to a

cute

care

Days post discharge


kempsey hospital - bureau of health informationkempsey number of 30-day returns to acute care this...

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