Patients classification System

tools for
Cost management

tools for
Quality management

tools for

4  Why to choose US

4  implementation


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


If a patient is readmitted in a hospital for a medical condition already known during the previous stay and if this readmission was not foreseeable at the moment of the discharge, this is an unexpected and undesirable event independently of the type of illness (e.g. acute or chronic). Unplanned readmissions cannot be used as proxy for potentially avoidable readmissions, although it is frequently see in the medical literature. First, some unplanned readmissions are expected and desired at time of discharge, but without being able to set up a readmission date (e.g. readmission for delivery or for organ transplant of a patient on a waiting list). Second, unplanned readmissions may be due to a new problem unrelated to any condition treated during the previous stay. Third, some readmissions due to a complication, unforeseen at time of discharge, are planned during the follow-up (e.g. reopening of a surgical site after discharge may be planned some days before).

As for any quality indicator (premature deaths, iatrogenic complications, potentially avoidable reoperations, etc.) all undesirable events cannot be avoided even with optimal care. Hospital medicine is always associated to risks, which has to be analyzed with statistical tools. Thus, the quality of the discharges’ preparation is questionable if observed readmissions rate is higher than expected rates, computed by taking into account the case mix of eligible discharges. (4EXPECTED READMISSION RATES). In this case, analyzing the causes of potentially avoidable readmissions is recommended to capture the ways to improve the quality of the discharges’ preparation. The practice show that finding improvement measures might be difficult when potentially avoidable readmissions rate is too low, because often related to a various set of causes. Having difficulties to determine the exact cause of an undesirable event does not mean that it is not an adverse event: they are not false positives because they should ideally not occur.

Observed rate

-   internal (AR1i): in the same hospital readmission

-   external (AR1e): in other hospital readmission

-   global (AR1): AR1i + AR1e

Expected rate

-   average (AR0)

- minimal (AR0min)

- maximal (AR0max)

Rate ratio (RAR): observed rate (AR1) / expected rate (AR0).

If the rate ratio is greater than 1.2, it is recommended to conduct a detailed review of medical records to analyze the causes of readmissions (4MEDICAL REVIEW)
If the rate ratio is lower than 0.8, it is considered as a good result.

Statistical significance

A   significantly lower than expected rate (AR1 < AR0min)        
B   not significantly different from AR1 (AR0min < AR1 < AR0max)
C   significantly higher than expected rate (AR1 > AR0max).

© SQLape s.ŕ.r.l. 2014. Last update: 20.05.2014