AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits
Electronic Reports
Five reports are described here. Each section presents a sample report followed by purpose, description, and users and potential uses. The reports are:
- Transfer Risk Reports (A high risk or medium-risk report can be produced.)
- ED Treat and Release Report
- Monthly Transfers by Facility or Nursing Unit
- Monthly Transfers by Provider
- Key Metrics Trend Report
A printable version of all the reports and descriptive information is available [PDF, 1.2 MB].
Transfer Risk Report
Table 1. Sample High-Risk Transfer Report
Facility Name:
Unit:
Report Date:
Select for accessible version of report.
Key: ED=emergency department; DNR=Do Not Resuscitate; DNH=Do Not Hospitalize; MOLST=Medical Order for Life-Sustaining Treatment; POLST=Physician Order for Life-Sustaining Treatment; LOS=length of stay; COPD=chronic obstructive pulmonary disease; GI=gastrointestinal; ADL=activities of daily living.
* Circulatory problems include vascular disease, and venous and arterial ulcer.
** Certain medical conditions include cellulitis, hypertension, deep vein thrombosis, moderate dementia, peripheral neuropathies, quadriplegia, paraplegia, and hemiparesis.
*** High-risk medications include insulin, anticoagulants, antibiotics, alpha blockers, antipsychotics, antianxiety, sedative /hypnotics, anticonvulsants, antihypertensives, opioids, and diuretics.
Purpose
Transfer Risk Reports (high- and medium-risk residents) provide a weekly snapshot of residents at risk for transfer to a hospital or ED that may be avoidable. The report is designed to help nursing staff see the changes in resident clinical status earlier and identify residents at risk for transfer. To accomplish this goal, staff can use the Transfer Risk Report to display transfer risk factors by resident each week.
The report summarizes risk elements recorded on Minimum Data Set (MDS) assessments, medication profiles, and daily or weekly nurse documentation and applies risk rules to provide a list of residents meeting criteria for high or medium risk for transfer to the hospital or ED. Using the report will enhance existing communication patterns among the multidisciplinary clinical team and facilitate proactive management of residents at risk.
Members of the multidisciplinary team can use the Transfer Risk Report each week to monitor changes in the resident risk profile and confirm that appropriate interventions are in place and are understood by the entire care team. Specific questions that the report may answer include:
- How many residents on the nursing unit are at high risk for transfer?
- What are the most common risk factors among high-risk residents?
- Which high-risk changes in residents’ conditions are flagging more often than others?
- Which clinical conditions contributing to risk are flagging more often than others?
- How often is polypharmacy seen in residents at risk for transfer?
Description
This weekly report displays resident identifier, resident age, and advance directive status (Do Not Resuscitate [DNR], Do Not Hospitalize [DNH], etc.), and notes the following:
- ED visits: number within 7, 30, and 90 days, discharge diagnosis.
- Hospital admissions: number within 7, 30, and 90 days of report date, discharge diagnosis, and length of stay for most recent hospitalization.
- High-risk diagnosis associated with transfer risk: congestive heart failure (CHF), myocardial infarction (MI), angina, pneumonia or bronchitis, asthma or chronic obstructive pulmonary disease (COPD), urinary tract infection (UTI), sepsis or fever or infection, dehydration, circulatory problems (includes vascular disease, venous and arterial ulcer), renal failure, diabetes or hypoglycemia, anemia, and gastroenteritis.
- Current clinical conditions contributing to transfer risk: use of oxygen, catheter or ostomy, any pressure ulcer other than stage I, fall risk, late-loss activities of daily living (ADL) score greater than or equal to 12,i cognitive impairment, certain medical conditions (cellulitis, hypertension, deep vein thrombosis, moderate dementia, peripheral neuropathies, quadriplegia, paraplegia, hemiparesis), high-risk medications (insulin, anticoagulants, antibiotics, alpha blockers, antipsychotics, antianxiety medications, sedative/hypnotics, anticonvulsants, antihypertensives, opioids, and diuretics).
- Polypharmacy.
-
High-risk change in condition within 7 days (CHF or chest pain or MI, pneumonia or bronchitis, mental status change or neurological, UTI, sepsis or fever or infection, dehydration). For each of the six high-risk change categories, the number of symptoms that were found in the last 7 days is shown.
The total number of residents at risk for each type of transfer risk is provided, enabling users to identify the most prevalent risk factors. This report can be filtered to display a single nursing unit or to display all residents in the facility with transfer risk.
i Late-loss ADL score is the numeric total of the self-performance codes for the MDS items for bed mobility, transfer, toileting, and eating. The score is based on Resource Utilization Group (RUG-III).
Risk Factors Associated With Hospital and Emergency Department Visits
Risk factors known to be associated with preventable hospital and ED visits are grouped in six categories:
- ED visits within last 90 days
- Hospital admissions within last 90 days
- Active high-risk diagnoses
- Clinical conditions that contribute to high risk
- Polypharmacy
- High-risk change in condition within last 7 days
ED Visits Within Last 90 Days. This section displays the number of ED visits that occurred in the following timeframes:
- 0-7 days
- 8-30 days
- 31-90 days
It also displays the ED discharge diagnosis for the most recent ED visit. Observation stays are included in the count of ED visits.
Hospitalizations Within Last 90 Days. This section displays the number of hospitalizations that occurred in the following timeframes:
- 0-7 days
- 8-30 days
- 31-90 days
It also displays the hospital discharge diagnosis and length of stay for the most recent hospitalization.
Active High-Risk Diagnoses. Certain medical diagnoses are associated with preventable hospital and ED visits. Specifically, the following 12 diagnoses are considered high risk:
- CHF
- Chest Pain or MI
- Pneumonia or Bronchitis
- Asthma or COPD
- UTI
- Sepsis or Fever or Infection
- Dehydration
- Circulatory Problems
- Renal Failure
- Diabetes
- Anemia
- Gastroenteritis
Clinical Conditions That Contribute to High Risk. Certain medical conditions and treatments are associated with preventable hospital and ED visits and contribute to transfer risk, such as:
- Oxygen therapy.
- Presence of catheter or ostomy.
- Presence of stage II or greater pressure ulcer.
- Fall risk or previous fall in last 90 days.
- Late-loss ADL score ≥12.
- Cognitive impairment
- Certain medical conditions (with examples of ICD-9-CMii diagnosis codes):
- Cellulitis (682.0-9)
- Hypertension (401.0-9)
- Deep vein thrombosis (453.40)
- Moderate dementia (290.0)
- Peripheral neuropathies (356.0-9)
- Quadriplegia (344.0)
- Paraplegia (334.1)
- Hemiparesis (342.9; 438.2)
- High-risk medications:
- Insulin
- Anticoagulants
- Antibiotics
- Alpha blockers
- Antipsychotics
- Antianxiety medications
- Sedative/hypnotics
- Anticonvulsants
- Antihypertensives
- Opioids
- Diuretics
ii ICD-9-CM is the International Classification of Diseases, Ninth Revision, Clinical Modification. Facilities are transitioning to ICD-10, but ICD-9 was used to develop the On-Time tools.
Polypharmacy. A higher number of medications increases the risk of complications and contributes to transfer risk. We have chosen 15 or more medications as a threshold to be considered a high risk for hospital and ED visits. This threshold represents about 20 percent of nursing home residents. The count of medications includes over-the-counter medications but excludes medications ordered to be given as needed (PRN).
High-Risk Changes in Condition. Certain clinical conditions or symptoms are associated with high risk for transfer. These symptoms and clinical condition elements are captured from multiple data sources within the facility’s electronic medical record and represent changes that occurred in a resident’s clinical condition within 7 days of report date. Sources of these data include nurse documentation, 24-hour reports, electronic medication administration records, and physician orders. Such data provide information more timely than MDS assessments and enable clinicians to recognize resident changes sooner.
The high-risk change in condition elements are grouped into six categories, as shown on the risk report:
- CHF or chest pain or MI
- Pneumonia or Bronchitis
- Mental Status Change or Neurological Symptoms
- UTI
- Sepsis or Fever or Infection
- Dehydration
Rules for Determining High and Medium Transfer Risk
High Risk. A resident is considered high risk for hospital or ED visit based on one of three rules:
- Rule 1: High risk based on prior hospital or ED visit AND an existing high-risk factor
Criteria: Resident has prior hospital or ED visit in last 90 days and at least one additional high-risk factor from the following (Table 2, Rows 1-4):
- Active High-Risk Diagnosis
- Current Clinical Conditions Contributing to Risk
- Polypharmacy: 15 or More Medications
- High-Risk Change in Condition Within 7 Days
To illustrate Rule 1:
- A resident with ED visit within 90 days of report date and active high-risk diagnosis of COPD present within 7 days of report date would trigger Rule 1.
- A resident with hospital admission within 90 days of report date and clinical condition (or associated procedure) contributing to risk, such as use of oxygen or presence of Foley catheter, within 7 days of report date would trigger Rule 1.
- Rule 2: High risk based on polypharmacy AND at least four risk factors from existing high-risk diagnoses or clinical conditions contributing to risk combined
Criteria: Resident has polypharmacy (15 or more medications) and a minimum of four risk factors from high-risk diagnosis list or clinical conditions contributing to risk combined (Table 2, Row 5).
To illustrate Rule 2:
- A resident with a medication profile indicating 16 active medications during the report week, active high-risk diagnoses of pneumonia and renal failure, presence of oxygen therapy, and Foley catheter use during the report week would trigger Rule 2.
- A resident with medication profile indicating 15 active medications during the report week, active high-risk diagnosis of UTI, presence of Stage III pressure ulcer, and two medical conditions, cellulitis and hypertension, would trigger Rule 2.
- Rule 3: High risk based on high-risk change in condition within last 7 days
Criteria: Resident has at least one high risk change in condition within last seven days AND at least one active high risk diagnosis or polypharmacy (Table 2, Rows 6-7).
To illustrate Rule 3:
- A resident with new cough within 7 days of report date and active high-risk diagnosis of CHF would trigger Rule 3.
- A resident with new or worsened urinary incontinence documented within 7 days of report date and two active high-risk diagnoses of renal failure and diabetes would trigger Rule 3.
Medium Risk. The resident is at medium risk for hospital or ED visit if one of the following four conditions is true:
- Prior hospital or ED visit within 90 days of report date (Table 2, Row 8)
- At least one Current Clinical Condition Contributing to Risk (Table 2, Row 9)
- Polypharmacy (Table 2, Row 10)
- At least one High-Risk Change in Condition Within 7 Days (Table 2, Row 11)
Note: Having a high-risk diagnosis alone is not sufficient to categorize a resident as at risk for transfer (Table 2, Row 12).
Table 2. Rules for High and Medium Transfer Risk
Risk Factors | Risk Level | ||||||
---|---|---|---|---|---|---|---|
Row No. | ED Visit or Hospital Admission | Active High-Risk Diagnoses | Clinical Conditions Contributing to Risk | Poly-pharmacy | High-Risk Change in Condition Within 7 Days | High | Medium |
1 | X | X | X | ||||
2 |
X | X | X | ||||
3 |
X | X | X | ||||
4 |
X | X | X | ||||
5 |
At least four in these two categories |
X | X | ||||
6 |
X | X | X | ||||
7 |
X | X | X | ||||
8 |
X | X | |||||
9 |
X | X | |||||
10 |
X | X | |||||
11 |
X | X | |||||
12 |
X |
Users and Potential Uses
The primary users of this report are the facility leadership, direct care nurses, and members of the multidisciplinary team. The table below displays potential users of the Transfer Risk Reports and potential uses.
Table 3. Transfer Risk Reports Users and Potential Uses
Users | Potential Uses |
---|---|
Multidisciplinary team | Care plan meetings |
Dietary Department staff | Dietary Department internal review |
Charge nurse or nurse manager, nursing supervisor | Nurse shift change report |
Director of Nursing (DON), nursing supervisors, nurse managers or charge nurses, MDS* nurse, quality improvement (QI) nurse, infection control nurse | Nursing leadership meeting |
DON, nurse managers, pharmacist, nursing supervisor | Pharmacist medication review meeting |
Rehab Department staff | Rehab Department internal review |
DON or Assistant DON, nurse manager, wound nurse, dietitian, Rehab director or therapist | Weekly transfer risk meeting |
DON or ADON, nurse manager, wound nurse, dietitian, Rehab director, medical director or wound physician, nurse practitioner, QI nurse | Weekly wound review meeting |
* MDS=Minimum Data Set.
ED Treat and Release Report
Table 4. Sample ED Treat and Release Report
Select for accessible version of report.
Purpose
The purpose of this monthly report is to support the facility’s current process of understanding trends of resident transfers to the ED with subsequent return to the nursing home, without hospital admission. Treat and release transfers are a prime source of preventable transfers.
The report allows clinicians to identify common reasons for transfer to the ED and potential root causes (e.g., treatment unavailable at facility, treatments prior to transfer) that occurred during the last month. This information may provide insights into ways they be able to reduce ED visits. The report reduces the need to manually compile these data and enhances quality improvement monitoring and root cause analysis activities.
The report can be used to answer the following questions:
- How many residents had an ED visit and returned to the nursing home during the report month?
- For the residents who appear on the report, which reasons for transfer are cited most often?
- Are any patterns seen with reason for transfer this month compared with previous months?
- How many residents were transferred for diagnostic treatment not available at the nursing home?
- How many residents were transferred to receive IV fluids or to gain IV access?
- Did every resident transferred for a respiratory reason receive oxygen within 24 hours of transfer time? How many received a respiratory treatment? How many were suctioned? How many were seen by a respiratory therapist?
- How many residents were seen by the primary care provider (physician, nurse practitioner, or physician’s assistant) within 24 hours of transfer?
- How many residents had prior ED visits within the same report month? How many had ED visits within 3 days? 30 days?
- How many residents with an ED visit also flagged as at high risk for transfer during the same month?
Description
The report displays a list of residents transferred to the ED for treatment and returned to the nursing home. Any resident with an ED visit date within 30 days of the report date displays on the report. The report may be run for the entire facility or for a single unit. It displays the following:
- ED Visit (date and discharge diagnosis)
- Reason for Transfer (cardiac/circulatory, respiratory, mental/psychiatric/neurological, gastrointestinal/genitourinary, endocrine/metabolic/nutrition, wound and skin, injury (fall related or not fall related), musculoskeletal, abnormal labs or anemia, fever/possible infection, malaise/fatigue, possible surgical complication)
- Reason for Transfer: Treatment Unavailable at Facility (diagnostics, IV access, transfusion, catheter insertion/reinsertion)
- Authorized by (primary care physician, covering provider, medical director, Medicare managed care organization, outside clinic or service)
- Nursing Home Treatments 24 Hours Prior to Transfer (labwork, x rays, IV fluid/subcutaneous (SQ) fluids, oxygen, respiratory treatment or suctioning, medications [IV, intramuscular, SQ, or oral])
- Seen by (Within 24 Hours Prior to Transfer (primary care physician, covering provider, consulting physician, nurse practitioner or physician’s assistant, respiratory therapist, other)
- Prior ED Visit (within 3 days or between 4 and 30 days)
- Prior Hospital Discharge (within 7 days or between 8 and 30 days)
Users and Potential Uses
The primary users of this report are the facility leadership, direct care nurses, and members of the multidisciplinary team. The table below displays potential users of the ED Treat and Release Report and potential uses.
Table 5. ED Treat and Release Report Users and Potential Uses
Users | Potential Uses |
---|---|
Multidisciplinary team | Care plan meetings |
Dietary Department staff | Dietary Department internal review |
Charge nurse or nurse manager, nursing supervisor | Nurse shift change report |
Director of Nursing (DON), nursing supervisors, nurse managers or charge nurses, MDS* nurse, quality improvement (QI) nurse, infection control nurse | Nursing leadership meeting |
DON, nurse managers, pharmacist, nursing supervisor | Pharmacist medication review meeting |
Rehab Department staff | Rehab Department internal review |
DON or Assistant ADON, nurse manager, wound nurse, dietitian, Rehab director or therapist | Weekly transfer risk meeting |
DON or ADON, nurse manager, wound nurse, dietitian, Rehab director, medical director or wound physician, nurse practitioner, QI nurse | Weekly wound review meeting |
* MDS=Minimum Data Set.
Monthly Transfers by Facility or Nursing Unit
Table 6. Sample Monthly Transfers by Facility or Nursing Unit
Select for accessible version of report.
Purpose
The Monthly Transfers Report provides counts of hospital and ED visits for the month by unit or by the facility at large. The report helps clinicians understand the most common reasons for transfer and discharge diagnoses for all transfers.
A facilitywide or unit-based team can use the report to answer questions such as:
- What is the most frequent reason for transfer to ED for the facility, for each nursing unit?
- What is the most frequent reason for hospitalization for the facility, for each nursing unit?
- What is the most frequent discharge diagnosis from the ED? From the hospital?
- How many discharge diagnoses were “potentially preventable”?
Description
The report displays the number of total transfers and total residents with observation stays, hospital stays, and ED visits. It also displays the number of residents associated with each reason for transfer and preventable diagnosis. In addition, for each reason for transfer and potentially preventable diagnosis, the percentage of the total hospital and ED visits is calculated, with the top five of each category noted.
The scoring of the top five takes into account any ties by allowing categories with the same percentage to be ranked the same. For example, if discharge diagnoses pneumonia and urinary tract infection are both noted as ED discharge diagnosis in 10 percent of ED visits, their rank order would be the same.
Experts do not agree on which discharge diagnoses should be considered potentially preventable. Nursing homes may opt to modify the diagnoses presented in the sample Monthly Transfers Report by working with their electronic medical record vendor to select the diagnoses they are most interested in tracking.
Reasons for transfer follows
- Mental/psychiatric/neurological symptoms
- Cardiac/circulatory symptoms
- Pneumonia/respiratory symptoms
- Gastrointestinal/genitourinary symptoms
- Endocrine/nutritional/metabolic issues
- Musculoskeletal/joint symptoms
- Wound or skin issues
- Fall-related injury
- Non-fall-related injury
- Abnormal labs
- Fever/possible infection
- Malaise/fatigue
- Potential surgical complications
- Treatment unavailable at facility
Potentially preventable discharge diagnoses are as follows:
- Congestive heart failure
- Pneumonia
- Urinary tract infection
- Sepsis or fever or infection
- Skin ulcers or cellulitis
- Dehydration or metabolic problems
- Chronic obstructive pulmonary disease
- Asthma
- Circulatory problems
- Hypertension
- Gastroenteritis
- Angina pectoris
- Falls/trauma
- Anemia
- Diabetes
Users and Potential Uses
The director of nursing, nurse managers, nursing supervisors, medical director, and other clinicians participating in quality improvement activities or root cause analysis will use this report. The table below displays potential users of the Monthly Transfers Report and potential uses.
Table 7. Monthly Transfers Report Users and Potential Uses
Users | Potential Uses |
---|---|
Director of Nursing (DON), nurse managers, nursing supervisors | Nursing leadership meeting |
Department heads | Quality improvement review |
DON or Assistant DON, nurse manager, dietitian, Rehab director, quality improvement director, medical director, consultant pharmacist | Root cause analysis for hospital admissions/ED visits |
Monthly Transfers by Provider
Table 8. Sample Monthly Transfers by Provider
Primary Care Provider | Authorizing Provider | ED Visits | Observation Stays | Hospitalizations | Total Transfers |
---|---|---|---|---|---|
Brown. B. | Primary care physician | 2 | 0 | 1 | 3 |
Brown, B. | Covering provider | 4 | 1 | 0 | 5 |
Total | 8 | ||||
White. W. | Primary care physician | 1 | 0 | 1 | 2 |
Total | 2 | ||||
Franklin, B | Primary care physician | 2 | 1 | 1 | 4 |
Franklin, B. | Medical director | 1 | 0 | 0 | 1 |
Franklin, B. | Managed care case manager | 1 | 0 | 0 | 1 |
Total | 6 |
Purpose
The Monthly Transfers by Provider Report provides nursing home management with information on how many residents each provider is sending to the hospital or ED. Further investigation of these hospital and ED visits can help determine if the visits were for potentially preventable conditions, the time of day/day of week the transfers occurred, and whether the transfer order was made by the primary care physician, a covering physician, or another provider.
If a trend is detected, leadership staff such as the Director of Nursing and the medical director can work with individual providers to review cases, educate providers on the nursing home’s capabilities, and invite providers to participate in root cause analysis of preventable hospital and ED visits.
Description
The report displays the number of ED visits, observations stays, hospitalizations, and total transfers for each of the facility's providers. Each transfer is counted only once at the highest level of care provided. For example, if an ED visit results in a hospitalization, the transfer is counted as one hospitalization.
Users and Potential Uses
The Director of Nursing, administrator, nurse managers, nursing supervisors, and medical director will use this report. The table below displays potential users of the Monthly Transfers by Provider Report and potential uses.
Table 9. Monthly Transfers Report by Providers Users and Potential Uses
Users | Potential Uses |
---|---|
Director of Nursing (DON), nurse managers, nursing supervisors | Nursing leadership meeting |
Administrator, DON or Assistant DON, nurse managers, dietitian, Rehab director, quality improvement director, medical director, consultant pharmacist | Root cause analysis for hospital admissions/ED visits |
Key Metrics Trend Report
Table 10. Sample Key Metrics Trend Report
Unit Name: A100 | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sept | Oct | Nov | Dec |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Monthly Census (ADC) | 30 | 28 | 35 | 35 | 31 | 30 | 30 | 23 | 24 | 27 | 32 | 30 |
Resident Days (Including Bed Hold) | 900 | 840 | 1,050 | 1,050 | 930 | 900 | 900 | 690 | 720 | 810 | 960 | 900 |
Total Transfers From Nursing Home to ED or Hospital | 24 | 14 | 14 | 14 | 16 | 25 | 11 | 11 | 12 | 11 | 3 | 15 |
Total Residents Transferred From Nursing Home to ED or Hospital | 19 | 10 | 14 | 9 | 20 | 14 | 14 | 10 | 10 | 10 | 3 | 17 |
Observation Stays | ||||||||||||
# Observation Stays | 2 | 3 | 1 | 0 | 3 | 5 | 5 | 2 | 1 | 0 | 0 | 3 |
Observation Stay Rate: # Observation Stays/1,000 Resident Days | 2.2 | 3.6 | 1.0 | 0.0 | 3.2 | 5.6 | 5.6 | 2.9 | 1.4 | 0.0 | 0.0 | 3.3 |
# Residents in Observation Stays | 2 | 3 | 1 | 0 | 1 | 3 | 4 | 2 | 1 | 0 | 0 | 2 |
Residents in Observation Stays/Monthly Census (ADC) (%) | 7% | 11% | 3% | 0% | 3% | 10% | 13% | 9% | 4% | 0% | 0% | 7% |
ED Visits (Treat and Return to Nursing Home) | ||||||||||||
# ED Visits | 10 | 8 | 3 | 10 | 11 | 5 | 3 | 4 | 3 | 5 | 0 | 10 |
ED Visit Rate: # ED Visits/1,000 Resident Days | 11.1 | 9.5 | 2.9 | 9.5 | 11.8 | 5.6 | 3.3 | 5.8 | 4.2 | 6.2 | 0.0 | 11.1 |
# Residents to ED | 9 | 4 | 3 | 8 | 10 | 3 | 2 | 3 | 2 | 3 | 0 | 10 |
Residents to ED/Monthly Census (ADC) (%) | 30% | 14% | 9% | 23% | 32% | 10% | 7% | 13% | 8% | 11% | 0% | 33% |
# Residents With >1 ED Visit in Last 30 Days | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Hospital Visits | ||||||||||||
# Hospital Visits of Nursing Home Residents | 12 | 3 | 10 | 4 | 2 | 15 | 3 | 5 | 8 | 6 | 3 | 2 |
# Hospital Visits With Preventable Discharge Diagnosis | 4 | 0 | 8 | 4 | 2 | 1 | 1 | 1 | 3 | 4 | 2 | 1 |
Hospital Visits With Preventable Discharge Diagnosis/Total Hospital Visits (%) | 33% | 0% | 80% | 100% | 100% | 7% | 33% | 20% | 38% | 67% | 67% | 50% |
Hospitalization Rate: # Hospitalizations/1,000 Resident Days | 13.3 | 3.6 | 9.5 | 3.8 | 2.2 | 16.7 | 3.3 | 7.2 | 11.1 | 7.4 | 3.1 | 2.2 |
# Residents Readmitted to Nursing Home From Hospital | 8 | 3 | 10 | 1 | 9 | 8 | 8 | 5 | 7 | 7 | 3 | 5 |
Residents Hospitalized/Monthly Census (ADC) (%) | 27% | 11% | 29% | 3% | 29% | 27% | 27% | 22% | 29% | 26% | 9% | 17% |
Hospital Readmissions (All Cause) | ||||||||||||
# Residents Hospitalized With Previous Hospitalization in Last 3 Days | 1 | 1 | 3 | 0 | 3 | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
# Residents Hospitalized With Previous Hospitalization in Last 7 Days | 1 | 1 | 3 | 0 | 4 | 0 | 0 | 0 | 3 | 1 | 0 | 0 |
# Residents Hospitalized With Previous Hospitalization in Last 30 Days | 3 | 1 | 5 | 0 | 4 | 0 | 2 | 1 | 4 | 1 | 0 | 0 |
# Residents Hospitalized With Previous Hospitalization in Last 90 Days | 4 | 1 | 5 | 0 | 4 | 0 | 2 | 1 | 7 | 3 | 0 | 0 |
# Residents Hospitalized With Previous Hospitalization in Last 180 Days | 5 | 1 | 6 | 1 | 5 | 0 | 5 | 1 | 7 | 5 | 0 | 0 |
Purpose
The Key Metrics Trend Report summarizes and shows the monthly trends for key metrics related to rates of transfer to the ED and hospital. Key rates are calculated each month and trended over time. Management teams can use the report to track patterns, follow up on areas of decline, and monitor progress of new prevention strategies and programs. In addition, these data can be used in discussions with hospital stakeholders or managed care organizations.
Description
This report displays the total number of transfers from nursing home to hospital or ED and the total number of residents transferred from the nursing home to acute care. It also displays:
- Observation Stays: number of observation stays, observation stay rate, number of residents with observation stays, percentage of residents in observation stays.
- ED Visits: number of ED visits, ED visit rate, number of residents transferred to the ED, percentage of residents transferred to the ED, number of residents with more than one ED visit in the last 30 days.
- Hospitalizations: number of hospital visits of nursing home residents, number of hospitalizations with preventable diagnoses, percentage of hospitalizations with preventable diagnoses, hospitalization rate, number of residents readmitted to nursing home from hospital, percentage of residents hospitalized. Preventable discharge diagnoses include congestive heart failure, pneumonia, urinary tract infection, sepsis/fever/infection, skin ulcers or cellulitis, dehydration, chronic obstructive pulmonary disease, asthma, circulatory problems, hypertension, gastroenteritis, angina, falls/trauma, anemia, and diabetes.
- Hospital Readmissions (all cause in last 180 days): number of residents readmitted with previous hospital discharge in last 3, 7, 30, 90, and 180 days.
Users and Potential Uses
The primary users of this report are facility leadership, directors of nursing, medical directors, and quality improvement teams. The table below displays other potential users of the Key Metrics Trend Report and potential uses.
Table 11. Key Metrics Trend Report Users and Potential Uses
Users | Potential Uses |
---|---|
Director of Nursing (DON), nurse managers, nursing supervisors, MDS* nurse, quality improvement nurse, infection control nurse | Nursing leadership |
Department heads, medical director | Quality improvement review |
DON or Assistant DON, nurse manager, dietitian, Rehab director, medical director, consultant pharmacist | Root cause analysis for hospital admission/ED visits |
* MDS=Minimum Data Set.