Adult

Data source

PRIMHD

Description

Percentage of overnight discharges from the mental health and addiction service organisation’s inpatient unit(s) where a community service contact was recorded in the seven days immediately following that discharge.

This KPI calculates an overall follow up rate, which is the percentage of all acute inpatient discharges that were followed up, regardless of where that follow up occurred (DHB, NGO or both)

Indicator rationale

A responsive community support system for persons who have experienced an acute psychiatric episode requiring hospitalisation is essential to maintain clinical and functional stability and to minimise the need for hospital readmission.

Service users leaving hospital after a psychiatric admission with a formal discharge plan, involving linkages with community services and supports, are less likely to need early readmission. Research indicates that service users have increased vulnerability immediately following discharge, including higher risk for suicide.

Denominator

Count of acute inpatient discharges

Numerator

Count of acute inpatient discharges where a follow up community contact (for the same person) exists where:

Community follow-up activity start date is between 1 and 7 days after acute inpatient discharge date

• ActivityStartDate >= dateadd(1, day, InpatientDischargeDate)
• ActivityStartDate < dateadd(8, day, InpatientDischargeDate)

Note: as of November 2020 terminology has changed from ReferralClosureDate to InpatientDischargeDate to eliminate confusion.

Technical notes

This denominator is shared with the other members of the acute inpatient KPI suite: 28-day readmission, length of stay, and pre-admission community contact.

General terminology

An acute inpatient discharge is any referral record where:

1. ReferralEndDate is not null — ended referral
2. TeamType is Inpatient — into an inpatient team
3. ReferralEndCode is DR, DW or DT — ended in a way where we expect follow-up
4. ReferralTo is not PI, AE or NP — was not moving on to another hospital setting
5. Exists at least one activity where — there was at least one acute inpatient bednight
   1. ActivityTypeCode is T02 or T03 — acute inpatient bednight codes
   2. ActivityUnitCount > 0 — for more than 0 days

An inpatient discharge date is calculated as the:

1. Maximum ActivityEndDate for a referral record where: — end of last activity
   1. ActivityType is T02, T03, T04 or T37 — inpatient activity only

A community contact is any activity record where:

1. TeamType is not Inpatient — not inpatient follow up
2. ActivityUnitType is contact — not a bednight, seclusion or leave
3. ActivitySetting is not WR, OM or SM — includes service user participation
4. ActivityType is not T08, T35 or T32 — includes service user participation

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Data Source

PRIMHD

Description

Percentage of overnight discharges from the mental health and addiction service organisation’s acute inpatient unit(s) that result in readmission within 28 days of discharge.

This KPI calculates an overall readmission rate, which is the percentage of all acute inpatient discharges that were readmitted, regardless of where that readmission occurred (same DHB or different DHB)

Indictor rationale

Psychiatric inpatient services aim to provide treatment that enables individuals to return to the community as soon as possible. Unplanned admissions to a psychiatric facility following a recent discharge may indicate that inpatient treatment was either incomplete or ineffective, or that follow-up care was inadequate to maintain the person out of hospital.

Denominator

Count of acute inpatient discharges

Numerator

Count of acute inpatient discharges where a readmission occurs within 28 days; that is where an activity exists (for the same person), where:

• Referral team type is Inpatient — into an inpatient team
• Activity type is T02 or T03 — acute inpatient bednight codes
• Activity unit count > 0 — for more than 0 days
• Activity start date is between 0 and 28 days after inpatient discharge date
  • ReadmissionActivityStartDate >= dateadd(0, day, InpatientDischargeDate)
  • ReadmissionActivityStartDate < dateadd(29, day, InpatientDischargeDate)

Technical notes

This denominator is shared with the other members of the acute inpatient KPI suite: 7-day follow-up, length of stay, and pre-admission community contact.

General terminology

An acute inpatient discharge is any referral record where:

1. ReferralEndDate is not null — ended referral
2. TeamType is Inpatient — into an inpatient team
3. ReferralEndCode is DR, DW or DT — ended in a way where we expect follow-up
4. ReferralTo is not PI, AE or NP — was not moving on to another hospital setting
5. Exists at least one activity where — there was at least one acute inpatient bednight
   1. ActivityTypeCode is T02 or T03 — acute inpatient bednight codes
   2. ActivityUnitCount > 0 — for more than 0 days

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Data source

PRIMHD and StatsNZ population projections

Technical notes and shared definitions

A seclusion activity has:

• ActivityTypeCode = T33
• ActivityUnitType = “SECLUSION”

and is recorded against a referral with:

• TeamSetting = “Inpatient based”
• TeamType of
  • Inpatient
  • Forensic
  • Intellectual Disability Dual Diagnosis
  • Speciality

A bednight activity (for the purposes of the seclusion KPI) has:

• ActivityTypeCode not TCR
• ActivityUnitType = “BEDNIGHT”
• ActivityUnitCount > 0
• And where there does not exist a LEAVE record for the same date
• Same team restriction as above
• Note that there are no checks on ActivityTypeCode against the TeamType

A bednight is:

• A single midnight (00:00) that is crossed by a bednight activity
  For example, a bednight activity with start date 2020-01-20 17:30 and end date 2020-01-21 09:00 would have one bednight; a bednight with start date 2020-01-20 00:00 and end date 2020-01-21 09:30 would also have one bednight.
• Where bednight activities have been recorded with both start and end times of 00:00, we count only one of those.
  For example, a bednight with start date 2020-01-20 00:00 and end date 2020-01-21 00:00 counts as only a single bednight. This is in line with the ActivityUnitCount calculated by MOH.

Total # bednights (sometimes seen as beddays) is the distinct count of bednights between the reporting start and end date. Where a single bednight activity crosses multiple reporting periods, only the individual bednights within the reporting period are counted.
For example, a bednight activity with start date of 2019-12-20 18:00 and end date of 2020-01-13 09:00 would have 11 bednights counted in the Oct-Dec19 quarter and 13 bednights counted in the Jan-Mar20 quarter.

Population = sourced from StatsNZ, DHB projection for the reporting period

Seclusion activities are sometimes recorded differently due to varying business processes. To accommodate this, we create seclusion events or seclusion episodes in line with Ministry of Health recommendations.

Where there are fewer than 60 minutes between seclusion activities (for the same person and the same referral), these activities are rolled up into a single seclusion event.

A seclusion event combines overlapping or adjacent seclusion activities for an individual tangata whai ora within a single referral.

Indicator definitions

Total # seclusion events = distinct count of seclusion events where the seclusion event start date falls within the reporting period.

# tāngata whai ora secluded = distinct count of tāngata whai ora with a seclusion event where the seclusion event start date falls within the reporting period.

Seclusion events per 1000 bednights = Total # seclusion events / (Total # bednights / 1,000)

Seclusion events per 100k population = Total # seclusion events / (Population / 100,000)

Seclusion tāngata whai ora per 100k population = # tāngata whai ora secluded / (Population / 100,000)

Hours seclusion = sum of the hours of T33 seclusion activity that occur within the reporting period. When a single seclusion event crosses multiple reporting periods, only the hours within the reporting period are counted.
For example, a seclusion event with start date of 2019-12-28 18:00 and end date of 2020-01-02 09:00 would have 78 hours counted in the Oct-Dec19 quarter and 33 hours counted in the Jan-Mar20 quarter.

Additional notes

Seclusion events are allocated to a shift based on the seclusion event start time:

• 00:00 – 06:59 night
• 07:00 – 14:59 morning
• 15:00 – 23:59 afternoon

Likewise, seclusion events are allocated to a weekday based on the seclusion event start date.

Note the fundamental distinction between seclusion events, which are allocated to a reporting period based on their start date, and seclusion hours and bednights, which are broken apart when they cross reporting boundaries and then apportioned pro rata. There are variations in these definition across the sector, so if you observe seclusion numbers that are close but not identical, this date logic may be a good place to check first.

A note about forensic data

Forensic seclusion events are summarised in a separate report. All forensic seclusion events and bednights are excluded from the national and DHB overviews.

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