Definition of 'hospital readmission'
A hospital readmission occurs when a patient has been discharged from hospital and is admitted again within a certain time interval.
Generally, hospital readmissions can be considered in two broad categories:
- Readmissions that relate to routine care, for example those that relate to necessary treatments such as chemotherapy or dialysis, and are required to ensure safe clinical care.
- Readmissions that are potentially avoidable.
Reducing avoidable hospital readmissions supports better health outcomes, improves patient safety and leads to greater efficiency in the health system.
Definition of 'avoidable hospital readmissions'
The Commission was tasked with developing a list of avoidable hospital readmissions to inform safety and quality reforms in Australia. In progressing this work, the Commission adopted the following working definition of ‘avoidable hospital readmissions’.
An avoidable hospital readmission occurs when a patient who has been discharged from hospital (index admission) is admitted again within a certain time interval, and the readmission:
- Is clinically related to the index admission, and
- Has the potential to be avoided through improved clinical management and/or appropriate discharge planning in the index admission.
During 2019, the Commission held a roundtable to provide advice towards establishing a nationally consistent definition. The roundtable comprised of jurisdictional representatives, technical experts and clinical experts from the public and private sectors. The final recommendation of this will be taken to AHMAC in late 2019 for formal endorsement.
List of conditions considered to be avoidable hospital readmissions
The following is the list of conditions considered to be avoidable hospital readmissions and associated condition-specific time intervals. The list was developed by the Commission and has been agreed by the Australian Health Ministers’ Advisory Council.
|Readmission complication||Readmission diagnosis||Interval (days)|
|Pressure injury||Stage III ulcer||14|
|Stage IV ulcer||7|
|Unspecified decubitus and pressure area||14|
|Infections||Urinary tract infection||7|
|Surgical site infection||30|
|Blood stream infection||2|
|Central line and peripheral line associated blood stream infection||2|
|Infection associated with devices, implants and grafts||90|
|Infection associated with devices, implants and grafts in genital tract or urinary system||30|
|Infection associated with peritoneal dialysis catheter||2|
|Surgical complications||Postoperative haemorrhage/haematoma||28|
|Surgical wound dehiscence||28|
|Cardiac vascular graft failure||28|
|Pain following surgery||14|
|Other surgical complications||28|
|Respiratory complications||Respiratory failure including acute respiratory distress syndromes||21|
|Venous thromboembolism||Venous thromboembolism||90|
|Renal failure||Renal failure||21|
|Gastrointestinal bleeding||Gastrointestinal bleeding||2|
|Medication complications||Drug-related respiratory complications/depression||2|
|Cardiac complications||Heart failure and pulmonary oedema||30|
|Ventricular arrhythmias and cardiac arrest||30|
|Acute coronary syndrome including unstable angina, STEMI and NSTEMI||30|
|Nausea and vomiting||7|
The Commission worked with the Independent Hospital Pricing Authority to finalise specifications for the list.
The Commission has also developed and maintains, four condition specific unplanned readmission indicators, as part of the Core Hospital-based Outcome Indicators (CHBOI) toolkit.
The National Health Reform Agreement Addendum reforms
All Australian governments have committed to reforms under the National Health Reform Agreement Addendum, which include a focus on avoidable hospital readmissions. These reforms aim to integrate safety and quality into the pricing and funding of Australian public hospitals in a way that:
- Improves patient outcomes
- Provides an incentive in the system to provide the right care, in the right place, at the right time
- Decreases avoidable demand for public hospital services
- Signals to the health system the need to reduce instances of preventable poor quality patient care, while supporting improvements in data quality and information available to inform clinicians’ practice.
Development of the avoidable hospital readmissions list
At the request of the Australian Health Ministers’ Advisory Council, and in line with the National Health Reform Agreement Addendum, the Commission developed the list of conditions considered to be avoidable hospital readmissions.
This list of conditions, and the related condition-specific time intervals, was developed in consultation with clinical and consumer experts, taking into consideration:
- Literature on avoidable hospital readmissions
- Australian public hospital data, through analysis of the admitted patient care national minimum data set.
The Independent Hospital Pricing Authority will be canvassing options for pricing and funding for avoidable readmissions over 24 months, starting from 1 July 2019. The options are outlined in the Independent Hospital Pricing Authority's Pricing Framework for Australian Public Hospital Services 2019-20.