Unplanned hospital readmissions for patients within 28 days for selected surgical procedures (per 1000 separations)
Rationale
Unplanned hospital readmissions may reflect less than optimal patient management and ineffective care pre-discharge, post-discharge and/or during the transition between acute and community-based care. These readmissions necessitate patients spending additional periods of time in hospital as well as utilising additional hospital resources.
Readmission rate is considered a global performance measure, as it potentially points to deficiencies in the functioning of the overall healthcare system. Along with providing appropriate interventions, good discharge planning can help decrease the likelihood of unplanned hospital readmissions by providing patients with the care instructions they need after a hospital stay and helping patients recognise symptoms that may require medical attention.
The seven surgeries selected for this indicator are based on those in the current National Healthcare Agreement Unplanned Readmission performance indicator (NHA PI 23).
Target
The 2021 targets for unplanned readmissions for each procedure (per 1000 separations) are outlined below. Improved or maintained performance is demonstrated by a result below or equal to target:
| Procedure | Target |
|---|---|
| (a) knee replacement | <23.0 |
| (b) hip replacement | <17.1 |
| (c) tonsillectomy and adenoidectomy | <81.8 |
| (d) hysterectomy | <42.3 |
| (e) prostatectomy | <36.1 |
| (f) cataract surgery | <1.1 |
| (g) appendicectomy | <25.7 |
Results
Click the drop-down arrow to see different KPI categories
(a) knee replacement
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021 | Target 23.0 | Actual 15.4 |
|
| Year 2020 | Target 23.0 | Actual 26.1 |
|
| Year 2019 | Target 26.2 | Actual 28.3 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021 | Target 17.1 | Actual 20.4 |
|
| Year 2020 | Target 17.1 | Actual 18.1 |
|
| Year 2019 | Target 17.1 | Actual 15.0 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021 | Target 81.8 | Actual 138.7 |
|
| Year 2020 | Target 81.8 | Actual 106.4 |
|
| Year 2019 | Target 61.0 | Actual 120.0 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021 | Target 42.3 | Actual 73.2 |
|
| Year 2020 | Target 42.3 | Actual 67.8 |
|
| Year 2019 | Target 41.3 | Actual 33.9 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021 | Target 36.1 | Actual 49.3 |
|
| Year 2020 | Target 36.1 | Actual 59.1 |
|
| Year 2019 | Target 38.8 | Actual 14.9 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021 | Target 1.1 | Actual 2.4 |
|
| Year 2020 | Target 1.1 | Actual 1.5 |
|
| Year 2019 | Target 1.1 | Actual 3.0 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Year 2021 | Target 25.7 | Actual 30.1 |
|
| Year 2020 | Target 25.7 | Actual 21.4 |
|
| Year 2019 | Target 25.7 | Actual 28.7 |
|
Commentary
EMHS strives to provide safe, high-quality care to its patients at all times. When there is variation in care and outcomes, EMHS has established processes to ensure individual clinical case reviews are conducted. This has occurred for all unplanned hospital readmissions for system wide learnings and to identify service improvement opportunities.
Performance for unplanned readmissions following knee replacement achieved target in 2021. The result can, in part, be attributed to the implementation of several quality improvement actions within orthopaedics, such as improved clinical pathways and standard operating procedures.
Unplanned readmissions following hip replacement, hysterectomy and prostatectomy procedures have exceeded target across 2021. While these results represent very small case numbers, several quality improvement actions have been identified from individual case reviews to streamline existing care delivery. EMHS will continue to monitor performance of this indicator.
Performance for tonsillectomy and adenoidectomy is over target for the third year in a row. Peer review of all readmissions is conducted as part of the ear, nose and throat (ENT) morbidity and mortality review process and case review has demonstrated that patients are often managed conservatively, being readmitted as a precaution with minor post-operative bleeding. This is standard practice across health services.
Performance for cataract surgery is over target for the third year in a row. While rates continue to exceed the target, EMHS continues to undertake clinical case reviews to identify opportunities for improvement.
Readmissions following appendicectomy did not achieve target in 2021. The clinical case reviews of the episodes of readmissions noted a high degree of complexity with these individual cases but did not identify any significant trends or areas of clinical concern. EMHS will continue to monitor performance of this indicator.
Period: 2019 – 2021 calendar years
Contributing sites: Armadale Health Service, Bentley Health Service, Kalamunda Hospital, Royal Perth Hospital, St John of God Midland Public Hospital
Data source: Hospital Morbidity Data Collection (HMDC); WA Data Linkage System
Outcome one // Effectiveness KPI