Patients classification System

tools for
Cost management

tools for
Quality management

tools for
HOSPITAL PLANNING

4  Why to choose US

4  implementation

4  ANECDOTE

4  contact

4  Logic

4  diagnoses

4  procedures

4  inpatients

4  outpatients

4  insurance

4  readmissions

4  reoperations

4  complications

4  deaths

4  length of stay

4  day surgery

4  unjustified stays

READMISSION ALGORITHM

 


 

Step 1. Forseen readmissions

Inclusions*

Step 2. Exclusions*

Material removal or replacement

0122, 0129, 0207, 0243, 0295, 0394, 0398, 0493, 1192, 146, 1671, 1672, 3764, 3777, 3785-3789, 3797-3799, 3943, 4494, 5195, 5598, 5694, 5798, 6496, 6694, 6996, 7697, 786, 800, 8393, 8594, 8596, 9788 as readmission procedure

Unplanned readmission or surgery complications (see step 6 below) for ungrouped cases, reason of readmission=complication (OFS variable 4.7.V03/V13/V23/V33=2) for grouped cases.

Temporary stoma closure

3172, 3472, 4283, 4462, 4650-4652, 4872, 5192, 5582, 5683, 5782, 5842 as readmission procedure

Idem

Postoperative aftercare

Z42-Z48 as readmission diagnosis

Idem

Programmed surgical readmission after a surgical or obstetrical stay

main readmission diagnosis of the same system as at least one diagnosis of the previous stay

Idem or reopening of surgical site: 0070-0073, 0080-0084, 0123, 0242, 0302, 0397, 0475, 0602, 1152, 1266, 1267, 1283, 156, 1662-1664, 1666, 1921, 1929, 196, 2062, 2092, 2184, 2763, 3163, 3174, 3403, 3595, 3775, 3779, 3942, 3949, 445, 4496, 4640, 4641, 4643, 4693, 4694, 4975, 5194, 5412, 5461, 5492, 5652, 5662, 5672, 5722, 8153, 8155, 8159, 8197, 843, 8466, 8467, 8468, 8469, 8481, 8483, 8485, 8593, 8675 as readmission procedure.

Programmed surgical readmission after a non-surgical/non-obstetrical stay

main readmission diagnosis of the same system as at least one diagnosis of the previous stay

None

Programmed non-surgical intervention after a non-surgical/non-obstetrical stay

main readmission diagnosis of the same system as at least one diagnosis of the previous stay and intervention performed during the two first days of readmission. Non-surgical interventions: 0058, 0059, 0068, 0069, 011, 0120, 0332, 0339, 041, 051, 0611-0613, 070, 0711-0717, 0751, 0771, 0791, 0811, 0911, 0912, 1021, 1121, 1122, 1222, 1411, 1501, 1623, 1812, 2032, 2122, 2211, 2212, 2411, 2412, 2501, 2502, 2612, 2721, 2722, 2723, 2724, 2811, 2912, 3143, 3144, 3145, 3324-3328, 3393, 3421-3428, 3721-3725, 3727-3729, 3821, 3823-3826, 3829, 4011, 4019, 411, 4131-4133, 4139, 4221, 4224, 4225, 4411, 4412, 4414, 4415, 4511, 4514, 4515, 4516, 4521, 4525-4527, 4821, 4824, 4825, 4826, 4922, 4923, 5011-014, 5112-5115, 5151, 5211, 5212, 5214, 5421-5425, 5524, 5632, 5633, 5634, 5733, 5734, 5823, 5824, 5921, 6011-6015, 6111, 6211, 6212, 6301, 6411, 6511-6514, 6611, 6711, 6712, 6813-6816, 7023, 7024, 7111, 7611, 774, 803, 8198, 8321, 8329, 8511, 8512, 8611, 884, 8851-8857, 8859.

Drug, radiation and insemination complications

Step 3. Deliveries and transplants

 

 

Labor and deliveries

Obstetrical conditions as readmission diagnosis

 

Organ transplants

0794, 335, 336, 3751, 4194, 4697, 505, 528, 556 as readmission procedure

 

Leucopherese, bone marrow grafts

410, 9972-9974, 9979 as readmission procedure

 

Step 4. Chemo- and radiotherapy

Z510-Z512 as readmission diagnosis                             
922, 9925, 9928, 9929 as readmission procedure
D70 as readmission diagnosis (agranulocytosis) after chemotherapy
Z23, Z24, Z27 readmission main diagnosis (vaccination) after
      premature new born stay (weight<2200g).

 

Step 5. Follow-up

 

 

Treatment follow-up

Z08, Z09 as readmission diagnosis

 

Rehabilitation

Z50 as readmission main diagnosis

 

Procedure not carried out

Z53 as any programmed readmission diagnosis

 

Step 6. Complications

 

 

Iatrogenic complications

Following complications as readmission main diagnosis:

-         surgical complications

-         health care complications

-         obstetrical complications

-         possible surgical complications

or complication as reason of readmission

 

Other health care complications:

E86, I460, I461, I469, K316, K382, K603, K604, K632, K661, K823, K832, K833, K922, N321, N322, N82, O678, O679, O95, O960, O961, O969, O970, O971, O979, R048, R049, R570-R572, R578, R579, R58, R960, R961, R98, R99, T793.

 

Preventable disease (deep vein thrombosis, pulmonary embolism, decubitus ulcer)

I260, I269, I801-I809, I820-I829, L89 as readmission main diagnosis.

 

Step 7. New medical condition

 

 

The readmission damaged system (determined by the main diagnosis) is not equal to any damaged system of the index hospitalisation (determined by all diagnoses of the previous stay).

List of systems: blood, circulatory, cutaneous, digestive, endocrine, ENT, female, hepatic, locomotion, nervous, new-born, mental, ocular, respiratory, urinary.

 

Step 8. Trauma and diseases difficult to cure

 

Trauma

K131, L550-L552, L559, M125, M242-M244, M483, M626, M660-M665, M843, M992, S00-S99, T00-T35, T691, Z57, Z584, Z585 as unplanned readmission main diagnosis

 

Diseases difficult to cure:
Idiopathic thrombocytopenic purpura, myelodysplastic syndrome, multiple sclerosis, cirrhosis of liver, urinary calculus, acute bronchiolitis of nurseling,
non-surgical intestinal adhesion,
transplant rejection

D693, G35, J21 (< 2 years old), K700, K703, K717, K746, N20, N21, N220, N228, N23, R18, as readmission main diagnosis
K704 as readmission main diagnosis if K703 as secondary diagnosis.

D46, D570 as any readmission diagnosis with 9904 as readmission procedure (packed cell transfusion)

D694-D696 as any readmission diagnosis with 9905 as readmission procedure (platelet transfusion)

K565 or K660 main diagnostic codes for index non-surgical hospitalisation and the same main diagnostic codes for readmission (intestinal obstructions/adhesions relapses)

T860, T862, T863, T868 as any readmission diagnosis with 9988 as readmission procedure (therapeutic photopheresis)

 

*Diagnostic and procedure codes

 

The SQLape® tools are updated every year with latest valid international nomenclatures: ICD-10 (WHO version) for diagnoses and ICD-9-CM (US version). Subdivisions are not given in the documentation if they do not have an impact on the algorithms or have no effect on SQLape® diagnostic or operation groups. For instance, the procedure code 513 (three digits) correspond to 5131, 5132, 5133, 5134, 5135, 5136, 5137, 5139 ICD-9-CM procedure codes.

New case definition, since 2012

In Switzerland, a new definition of the case was introduced in 2012. If a patient is readmitted within 18 days in the same hospital for the same major diagnostic category (MDC), corresponding cases are merged. The Swiss medical records provides the dates of interruptions, as well as the dates of procedures and the reason of the readmissions. To ensure the continuity of the temporal comparisons, actual stays are re-built to identify each hospital stay separately, with corresponding procedures with their dates; however, diagnoses are allocated to every stay. Grouped cases caused by a complication are considered as potentially avoidable. The user can identify those cases with their stay identifier followed by its rank (e.g. 19222110_1, 19222110_2, 19222110_3 if there were two interruptions).

The cases grouped because of complications are considered potentially preventable. The other cases are processed normally by the algorithm.

The new case definition was simulated on the basis of 2010 data (January to November). The proportion of errors was 2.7% (false positives and false negatives), which is fortunately relatively low and ensures continuity of results.

This good result is due to several reasons:

- planned readmissions (stage 1) remain identifiable since the operations are properly attached to each of the stays (material removal or
  replacement, temporary stoma closure, scheduled surgery, obstetrics stay);

- complications of readmission (steps 2 and 6) are recognizable by reason of readmission (new OFS variable);

- readmissions for transplantation, leukopherese, bone marrow transplant, radiation therapy or chemotherapy (stages 3 and 4) are correctly
  assigned to each stay through their procedure dates;

- readmissions for a new condition (step 7) are generally not affected by the consolidation of cases (various MDC);

- trauma and diseases difficult to cure are still identifiable (step 8);

- readmissions occurring after 18 days are not concerned by the new definition of case;

- readmissions by retransfer (excluded from the eligible population) can be identified by the reason for readmission (new OFS variable).

© SQLape s.à.r.l. and Yves Eggli, 2014. Last update: 29.05.2017