National Partnership Agreement on Improving Public Hospital Services: Unplanned re-attendances to the emergency department within 48 hours of previous attendances

Collection and usage attributes

The scope of this indicator is all hospitals reporting to the Non-admitted patient emergency department care (NAPEDC) NMDS (Peer Groups A, B and other) as at August 2011, when the National Health Reform Agreement - National Partnership Agreement on Improving Public Hospital Services (NPA IPHS) was signed. For the duration of the NPA IPHS, hospitals that have not previously reported to the NAPEDC NMDS can come into scope, subject to agreement between the jurisdiction and the Commonwealth. This includes emergency departments located in publicly funded privately operated hospitals.

Initial presentations: An 'initial presentation' is an emergency department presentation that may be followed by an unplanned re-attendance occurring ≤ 48 hours later (i.e. ≤ 2,880 minutes later) by the same patient.

Initial presentations that are out-of-scope for the indicator calculation are:

• Presentations with a Type of visit to emergency department of Patient in transit or Dead on arrival
• Presentations with an Episode end status of Admitted to this hospital, Service episode complete—referred to another hospital, Died in emergency department or Dead on arrival

The reference period for initial presentations commences 48 hours prior to the start of the quarter and concludes 48 hours prior to the end of the quarter.

Subsequent presentations: A 'subsequent presentation' is an emergency department presentation occurring ≤ 48 hours (i.e. ≤ 2,880 minutes) after an emergency department presentation by the same patient (referred to as the initial presentation).

Subsequent presentations that are out-of-scope for the indicator calculation are:

• Presentations with a Type of visit to emergency department of Return visit, planned, Pre-arranged admission or Patient in transit

The reference period for subsequent presentations commences 48 hours prior to the start of the quarter and concludes with the end of the quarter.

For the indicator calculation: subtract the Emergency department physical departure date and Emergency department physical departure time of the initial presentation from the Date patient presents and Time patient presents of the subsequent presentation.

Numerator: The number of in-scope initial presentations that are followed by an in-scope subsequent presentation.

The numerator uses the Person identifier to match initial and subsequent presentations at a single patient level. An initial presentation is linked to the first in-scope subsequent presentation only. An individual presentation may be counted as both an initial presentation (if it meets the requirements of an in-scope initial presentation) and as a subsequent presentation (if it meets the requirements of an in-scope subsequent presentation).

Denominator: The total number of in-scope initial presentations.

As per Figure 1 below, the reference periods are framed around the date of the initial presentation; the timing of the initial presentation determines the quarter against which the resulting data are reported. The indicator will count the number of initial presentations that are followed by an in-scope subsequent presentation. For example, an initial presentation occurring between 30 December and 29 March followed by an in-scope subsequent presentation occurring between 30 December and 31 March is to be counted in the January-March quarter for the purposes of this indicator.

Figure 1: Quarterly reference periods for initial and subsequent presentations

Invalid records are to be excluded, and are records for which:

• Physical departure date or time is missing (for initial presentations only)
• Presentation date or time is missing (for subsequent presentations only)
• Type of visit to emergency department is missing
• Episode end status is missing (for initial presentations only)

Analysis is by state and territory and hospital, based on location of service.

Presented as a number and percentage.

100 × (Numerator ÷ Denominator) 

The number of in-scope emergency department presentations that are followed by an unplanned re-attendance to the same emergency department within ≤ 48 hours (i.e. ≤ 2,880 minutes).

The NPA IPHS stipulates a performance indicator measuring unplanned re-attendances to emergency departments. The NAPEDC NMDS uses the term 'presentation' to describe an attendance at an emergency department. In this indicator, the term 'attendance' has been interpreted as 'presentation' to align with the NAPEDC NMDS terminology.

The lack of presenting problem/diagnosis data in the NAPEDC NMDS reduces the ability to identify whether an unplanned re-attendance is for a problem related to the previous presentation. This will result in over-reporting of unplanned re-attendances.

In most states and territories, the Person identifier is unique to a hospital and cannot be used to identify individual patients who present to more than one hospital. Therefore this indicator is based on initial and subsequent presentations to the same hospital. This will result in an undercount of unplanned re-attendances.

Representational attributes

Data source attributes

Accountability attributes

Source and reference attributes

Standing Council on Federal Financial Relations. National Partnership Agreement on Improving Public Hospital Services. Standing Council on Federal Financial Relations, Canberra. Viewed 15 April 2013,
http://www.federalfinancialrelations.gov.au/content/npa/health_reform/
national-workforce-reform/national_partnership.pdf