Unplanned hospital readmissions for patients within 28 days for selected surgical procedures (per 1,000 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 reduction is a common focus of health systems worldwide as they seek to improve the quality and efficiency of healthcare delivery, in the face of rising healthcare costs and increasing prevalence of chronic disease.
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 7 surgeries selected for this indicator are based on those in the current National Healthcare Agreement Unplanned Readmission performance indicator (NHA PI 23).
Target
The 2023 target for each procedure is indicated with the results. Improved or maintained performance is demonstrated by a result below or equal to target.
| Procedure | Target |
|---|---|
| (a) knee replacement | ≤ 18.7 |
| (b) hip replacement | ≤ 17.1 |
| (c) tonsillectomy & adenoidectomy | ≤ 77.3 |
| (d) hysterectomy | ≤ 42.4 |
| (e) prostatectomy | ≤ 34.5 |
| (f) cataract surgery | ≤ 1.5 |
| (g) appendicectomy | ≤ 23.9 |
Results
Click the drop-down arrow to see different KPI categories
(a) knee replacement
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023 | Target 18.7 | Actual 14.3 |
|
| Years 2022 | Target | Actual 10.4 |
|
| Years 2021 | Target | Actual 15.4 |
|
| Years 2020 | Target | Actual 26.1 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023 | Target 17.1 | Actual 16.4 |
|
| Years 2022 | Target | Actual 11.1 |
|
| Years 2021 | Target | Actual 20.4 |
|
| Years 2020 | Target | Actual 18.1 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023 | Target 77.3 | Actual 58.8 |
|
| Years 2022 | Target | Actual 84.7 |
|
| Years 2021 | Target | Actual 138.7 |
|
| Years 2020 | Target | Actual 106.4 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023 | Target 42.4 | Actual 47.9 |
|
| Years 2022 | Target | Actual 25.9 |
|
| Years 2021 | Target | Actual 73.2 |
|
| Years 2020 | Target | Actual 67.8 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023 | Target 34.5 | Actual 69.4 |
|
| Years 2022 | Target | Actual 54.5 |
|
| Years 2021 | Target | Actual 49.3 |
|
| Years 2020 | Target | Actual 59.1 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023 | Target 1.5 | Actual 2.6 |
|
| Years 2022 | Target | Actual 2.3 |
|
| Years 2021 | Target | Actual 2.4 |
|
| Years 2020 | Target | Actual 1.5 |
|
| Year | Target | Actual | |
|---|---|---|---|
| Years 2023 | Target 23.9 | Actual 22.3 |
|
| Years 2022 | Target | Actual 25.8 |
|
| Years 2021 | Target | Actual 30.1 |
|
| Years 2020 | Target | Actual 21.4 |
|
Commentary
EMHS strives to provide safe, high-quality care to its patients at all times.
In 2023, improved performance in reducing unplanned hospital readmissions for selected surgical procedures was attributed to individual clinical case reviews. These reviews can identify variations in care and outcomes, fostering system-wide learning and service improvement.
Unplanned readmissions following hysterectomy, prostatectomy and cataract surgery exceeded target this reporting period. Although these results are based on a small number of cases which can lead to year on year variation, individual case reviews noted a high degree of patient complexity contributing to the need for readmission. The case reviews also identified quality improvement initiatives to streamline preoperative and postoperative care delivery, particularly for readmission following hysterectomy.
Whilst there was an increase in readmission rates in 2023 for prostatectomy surgery, readmission rates for this category remain low, at a rate of 6.94 per cent of all reportable prostatectomy cases (i.e. 69.4 per 1,000 or 6.94 per cent). Case reviews – for both prostatectomy and cataract surgery – have indicated the readmissions were related to known complications with no system issues identified. EMHS will continue to monitor performance of these indicators and learn from cases.
Period: 2020 to 2023 calendar years
Contributing sites: Armadale/Kelmscott District Memorial Hospital, Bentley Hospital, Kalamunda Hospital, Royal Perth Hospital, St John of God Midland Hospital (public patients)
Data source: Hospital
Morbidity Data Collection (HMDC); WA Data Linkage System
Outcome one // Effectiveness KPI