Re-admission to hospital within 28 days of discharge from acute specialised mental health units

The rate of re-admission to hospital within 28 days of discharge is a Key Performance Indicator (KPI) for mental health services. This indicator only includes instances where a person is discharged from and re-admitted to the same or another dedicated mental health unit. This is a nationally reported indicator and is intended to measure the appropriateness and quality of care provided by mental health services. It is based on the premise that a person returning to hospital within 28 days is representative of incomplete care.[1]

The DoH’s hospital data is stored as separations, also refered to as discharges. When separations are used as a basis for calculations, a transfer from one hospital to another could be counted as a discharge in calculating this indicator. This is because transfers and discharges are both coded as separations in the hospital data.

As part of our analysis we re-calculated the indicator using our definition of a ‘stay[2]’, to avoid those types of effects from data input issues. Our calculation showed that, from 2013 to 2017, 28-day re-admission rates increased from 14 percent of stays to 17 percent of stays.

We also looked at the percentage of people who were readmitted within 28 days of discharge. This stayed relatively constant at 9 or 10 per cent of people each year (Figure 14).

The overall rate of re-admission is higher than the percentage of people who are re-admitted in any year, indicating that some people are re-admitted to hospital more than once within the report year. We did not assess how many people were in this group, or how often people were re-admitted, but it could be a useful subject for further analysis to better understand patient journeys through the mental health system.

Percentage of contacts with community treatment services within 7 days post discharge from a dedicated mental health unit

The MHC and the DoH report the percentage of separations from dedicated mental health units that are followed up by a contact with a community treatment service within 7 days of discharge. This is often referred to as the 7-day follow-up KPI. Similar to the 28-day readmission KPI, the MHC and the DoH calculate this indicator using separations. We calculated this indicator based on ‘stays’, using only stays where the patient was discharged from a dedicated mental health unit.

Figure 15 shows that the percentage of stays that are followed by a contact within 7 days has increased over the 5 years. Stays refers to the time a person spends in hospital from admission to discharge.

We also calculated the percentage of people who were discharged from a dedicated mental health unit at least once and received contact with a community treatment service within 7 days. The percentage of people with a follow-up within 7 days is lower than the percentage of stays receiving follow-up contact. It was not clear from our analysis what this meant, but it does highlight an opportunity for the DoH to extend the analysis we undertook.

[1] KPIs for Australian Public Mental Health Services: PI 02J – 28 day readmission rate, 2017 (https://meteor.aihw.gov.au/content/index.phtml/itemId/663806)

[2] Refer to glossary on page 24