Skilled Nursing Facilities

Managing the Hospital Tracking Portal

The Hospital Tracking Portal allows you to access hospital admission and transfer data and hospital readmission rates, to support root cause analysis for hospital transfers. You can compare hospital readmission rates to national standards when available.

Information contained in the Hospital Tracking Portal is based on data collected during resident admission, transfer, and discharge census events. In census entry, there are fields specifically related to hospital transfers. You can navigate to the Census/Rates tab of the resident's chart from the Admission and Transfer Logs by clicking the resident's name.

Warning

You can edit some fields in the Admission Log and Transfer Log. Any changes are automatically saved and also update the corresponding census event.

  1. Clinical > Hospital Tracking.

  2. Select tab.

  3. Click + to see filters.

  4. Complete fields as required.

  5. Click Search.

Below is a list of the Hospital Tracking Portal tabs and a description of each. 

Note

If the eINTERACT Program is enabled, you see additional tabs: QI Reviews, QI Analysis, and Utilization Reporting.

Admission Log

The Admission Log shows all residents who are within 30 days of admission to the facility

The Admitted From shows the hospital the resident came from, selected during census entry in the To/From Location. You can also see the name of the resident's physician.

Icons may appear next to resident names in the Admission Log and the Transfer Log.

  • Yellow icon - Indicates the resident is within 30 days of the admission date. After 30 days, if the resident is not transferred or discharged back to the hospital, they are no longer considered at risk and the yellow icon disappears.

  • Red icon - Indicates the resident was transferred or discharged to the acute care hospital within 30 days of admission. After the red icon appears in the Transfer Log, it always remains next to the resident's name.

Transfer Log

The Transfer Log shows all resident transfers or discharges to an acute care hospital within the last 30 days. To ensure Hospital Rates are calculated correctly, all fields in the Transfer Log must be complete. A warning message appears alerting you to any blank fields. 

To calculate the percentage for the 30-Day Readmission Rate, select the following values in the Display Filters to show the records:

  • Transfers  - Select required start date. The end date autopopulates, but can be changed.

  • Select View Transfers by Hospital Discharge/Admission Date Range. 

  • Planned - Select No.

  • Outcome - Select Admitted, Inpatient; Admitted, Observation; and Admitted, Status Uncertain.

  • Length of Stay - Select <30 days (includes dates less than or equal to 30 days).

Note

PointClickCare recommends as a best practice not to select Acute Care Hospital in the To/From Type field for a Discharge census entry due to the end of a Bed Hold. This creates 2 Transfer Log records for the resident. For example, if the Discharge census entry is due to the end of a bed hold after a Transfer Out census entry, and the To/From Type selected is Acute Care Hospital, then both census events show on the Transfer Log.

Trends

The Trends section plots the admission and transfer details so you can identify patterns. You can filter by dates to see trends from a selected period of time, by hospital or by physician. A maximum of one year of data shows at one time. The trends include admissions and unplanned transfers where the To/From Type selected in census is mapped to an External Facility Type of Hospital with Include in Hospital Rates selected. Details for all trends are as follows:

  • Admissions to Our Facility by Day of Week - Shows admissions by day of the week: Monday through Sunday. The day of the week is based on the date of admission. The percentage of admissions on each day is calculated as Total Number of Admissions for Specific Day divided by Total Number of Admissions.

  • Admissions to Our Facility by Hospital (Top 5 Hospitals) - Shows the top 5 hospitals with the most admissions. This also shows All Other Hospitals as a 6th value and Not Recorded as a 7th value for instances where a hospital was not selected in census. The hospital is based on the To/From Location for each admission. The percentage of admissions for each hospital is calculated as Total Number of Admissions for Specific Hospital divided by Total Number of Admissions for All Hospitals.

  • Transfers from Our Facility by Time of Day - Shows all transfers for the 4 time ranges of the day.

  • Transfers from Our Facility by Doctor (Top 5 Doctors) - Shows the top 5 doctors with the most transfers. This also shows All Other Doctors as a 6th value, Emergency Transfer as a 7th value and Not Recorded as an 8th value when a doctor is not selected in the census entry. The doctor is based on the Ordered By in the census entry for each transfer. The percentage of transfers for each doctor is calculated as Total Number of Transfers for Specific Doctor divided by Total Number of Transfers for All Doctors.

  • Transfers from Our Facility by Outcome - Shows all outcomes of transfers, in the order of the Outcome of Transfer list. This also shows Not Recorded as an additional value when an outcome is not selected in the census entry. The outcome is based on the Outcome of Transfer in the census entry for each transfer. The percentage of transfers for each outcome is calculated as Total Number of Transfers for Specific Outcome divided by Total Number of Transfers.

  • Transfers from Our Facility by Reason - Shows all reasons for transfers, in the order of the Reason for Transfer list. This also shows Not Recorded as an additional value when a reason is not selected in the census entry. The reason is based on the Reason for Transfer in the census entry for each transfer. The percentage of transfers for each reason is calculated as Total Number of Transfers for Specific Reason divided by Total Number of Transfers.

Hospital Rates

The Hospital Rates section shows hospitalization metrics, in calculated values expressed per 1000 resident days. The metrics are summarized in a table by month, and are also in a graph showing the trends.

Note

For the 30-Day Readmission Rate, if the current month is selected in the filter, results for that month appear as N/A because a full month is required for calculations.

  • Resident Days in the Hospital Rates tab are not the same as Census Days. Resident Days are always greater than Census Days because Resident Days include the day a resident is discharged from a facility, whereas Census Days do not.

  • Navigate from the Admission Log and Transfer Log to the Census/Rates tab in Admin by clicking the resident's name. 

  • The time of day of the admission or transfer census entry is based on the following time ranges:

    • Morning - if the census event occurred between 07:00am to 11:59am.

    • Afternoon - if the census event occurred between 12:00pm to 6:59pm (18:59).

    • Evening - if the census event occurred between 7:00pm (19:00) to 11:59pm (23:59).

    • Night - if the census event occurred between 12:00am (00:00) to 06:59am.

  • The Admission Log and Transfer Log can be exported in Excel format by clicking Export. Residents can be de-identified before exporting if required.