Definitions

Indicators or Data Elements Calculations Interpretation Notes

ICU Admission Volume = Total Number of Total number of patients admitted to the ICU within the specified
ICU Admissions
Patients Admitted to the ICU period.
Total patient discharges include patients transferred/discharged alive
ICU Discharge Volume = Total Number of
ICU Discharges and deaths. Patients discharged are counted in the month of
Patients Discharged From ICU
discharge.
Live Discharges are comprised of patients with any discharge
Live Discharges
destination except 'Deceased'
Live IP Discharges are comprised of patients with the discharge
destinations:
Live IP Discharges - 'Unit/Ward'
- 'Inpatient - Rehab'
- 'Level 2 Unit or Step Down Unit'
Number of patients discharged to a hospital within the originating
Discharges to Hospitals Within LHIN
hospital's LHIN.
Number of patients discharged to a hospital outside of the originating
Discharges to Hospitals Outside LHIN
hospital's LHIN.
Number of patients discharged between 22h00 and 06h59 to one of
the following destinations:
Night Time Discharges - 'Unit/Ward'
- 'Inpatient - Rehab'
- 'Level 2 Unit or Step Down Unit'
Patients previously discharged to a non-ICU inpatient location
Readmissions Within 48 Hours (Emergency, Unit/Ward, Step Down Unit, Rehab, OR/PACU) and
readmitted to the critical care unit within 48 hours.
Average Days in Reporting Period Average number of days in that specific period.
Total number of days the ICU has been occupied across all patients.
The following assumptions are considered in the Patient Days
calculation:
-All patients in the ICU's active patient list are counted.
-patients admitted in any month prior to the reporting period and
Total Patient Days discharged in the reporting period will be counted only for the days in
the reporting period
-patients will be counted in each month.
-Example: A patient is admitted on January 15 and discharged on
March 15. The patient days for this patient are: January = 16, February
= 28, March = 15.
Total number of days the ICU has been occupied across all patients,
who were receiving ventilation services. The CCIS definition of
ventilation includes both invasive ventilation (ventilation support
Patient Days with Ventilation requiring endotracheal tube or tracheotomy) and non-invasive
ventilation. Patients on BiPAP or patients on CPAP to facilitate ICU
ventilation (i.e. weaning from a ventilator) are considered on a
ventilator.
Total number of days the ICU has been occupied across all patients,
Patient Days with Central Venous Line
who were receiving central venous line services.
Average Beds in Inventory Based on figure reported by ICU to MOHLTC
Average Ventilated Beds in Inventory Based on figure reported by ICU to MOHLTC
This includes the number of patients awaiting transfer, for a period
Total Delayed Cases (Waiting >4 Hours)
greater than 4 hours.
This is the total number of days that all patients were awaiting
Delayed Cases - Total Days (Waiting >4 Hours) transfer, where the individuals had a delay of a period greater than 4
hours.
Delayed Cases - Average Days (Waiting >4 This is average number of days each patient awaiting transfer for a
Hours) period greater than 4 hours was delayed.
Total Awaiting Transfer Cases This refers to the total number of patients awaiting transfer.
This is the total number of days that all patients were awaiting
Awaiting Transfer Cases - Total Days
transfer.
This is the average number of days a single patient has been awaiting
Awaiting Transfer Cases - Average Days
transfer.
Total length of stay for all patients that have been discharged within
the indicated period. Length of stay is reported in the month of
Total LOS (Days) discharge. For example, an individual patient who was admitted in the
ICU between January 1 and March 10 would have a total LOS of
31+28+10=69 days reported in the month of March.
Median length of stay for all patients that have been discharged within
the indicated period. Length of stay is reported in the month of
Median LOS (Days) discharge. For example, an individual patient who was admitted in the
ICU between January 1 and March 10 would have a total LOS of
31+28+10=69 days reported in the month of March.

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 Definitions
Indicators or Data Elements Calculations
Average LOS (Days)
ICU Occupancy = Patient Days / Average beds as per LHIN Critical Care Services Inventory 2006. Bed counts
ICU Occupancy (%)
Inventory Bed Days in Reporting Period are changed only upon approval of written change requests signed by
ICU Mortality = ICU Deaths / Total
ICU Mortality Rate (%)
Discharges from ICU
Transfers out of the ICU:
Intra-LHIN Hospital Transfer Rate (%) and Transfer Rate = Number of patients
Extra-LHIN Hospital Transfer Rate (%) transferred from the reporting unit to
another hospital within or outside the
LHIN / Total Live Discharges
Night Time Discharge Rate = IP
Night Time Discharges Rate (%) Discharges Between 22h00 and 6h59 /
Live IP Discharges
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Interpretation Notes
Average length of stay for all patients that have been discharged
within the indicated period. Length of stay is reported in the month of
discharge. For example, an individual patient who was admitted in the
ICU between January 1 and March 10 would have a total LOS of
31+28+10=69 days reported in the month of March.
Can be used to monitor ICU bed capacity, document and plan for
surges, and guide staffing levels. Adjusting capacity will generally be
based on occupancy trends over several months or anticipated
changes in demand. Regional partnerships can be used to smooth
variations in occupancy between ICUs. Literature supports 80%
target; large variations indicate unpredictable demand and difficulty in
staffing efficiently. Minor transient surges up to 95% are expected and
plans should be in place to manage this. Extended surges or major
surges (>= 100%) require increased capacity or wider systems
planning. High occupancy (>80% compared to <80%) has been
associated with increased mortality. High occupancy indicates lack of
critical care capacity or challenges with patient flow, while low
occupancy is not efficient.
Occupancy rates reflect the accuracy of reported baseline number of
a hospital CEO submitted to the Ministry of Health and Long Term
Care. Reported occupancy rates will be lower if sites report on only a
subset of patients admitted to the ICU service. Average bed days
does not currently distinguish for beds staffed and in operation.
Current occupancy rate includes bedspaced patients.
The following assumptions are considered in the Patient Days
calculation:
-All patients in the ICU's active patient list are counted.
-patients admitted in any month prior to the reporting period and
discharged in the reporting period will be counted only for the days in
the reporting period
-patients will be counted in each month.
-Example: A patient is admitted on January 15 and discharged on
March 15. The patient days for this patient are: January = 16, February
= 28, March = 15.
Deaths of patients under the care of the ICU service. A severity of
illness measure is planned to be introduced in a future version to allow
for adjustment of mortality. Hospitals may choose to contrast this ICU
mortality rate with hospital mortality rates for patients who die
following transfer out of ICU.
Captures the number of patients transferred from the reporting ICU to
another hospital either within the same LHIN in or another LHIN for the
purpose of bed management or access to a required medical service.
Transferring patients may increase the time to appropriate
management as well as place patients at risk during the transport.
Transfers may occur because of inadequate resources on site or for
other operational reasons.
A high transfer rate (compared to other similar institutions) or an
increase may indicate the need to explore alternative resource
management. Some transfers may be appropriate (e.g. returning a
patient to a home hospital). This metric may be used to identify
patients being repatriated.
The online CCIS reports and data exports can be used to investigate
primary receiving or feeder hospitals by name and volume.
Patients transferred to another site within the same hospital will be
included as Intra-LHIN hospital transfer patients
Discharge from the ICU at night may occur because of either 1) the
delay of an elective discharge initiated during the day due to a lack of
ward beds or 2) an unplanned discharge that is forced because of
inadequate ICU capacity (e.g. a triaged discharge), that may place the
patient at an increased risk of ICU readmission or death. A high rate of
night discharges might be due to pressure during high occupancy.
Other indicators such as readmission rates and hospital mortality may
also be affected and should be reviewed. IP Discharge Destination
Inclusions: 'Unit/Ward', 'Inpatient - Rehab', 'Level 2 Unit or Step Down
Unit'. Excludes discharges to another ICU.

Indicators or Data Elements
Readmission Within 48 Hours Rate (%)
Ventilator Occupancy (%)
Ventilated Patient Day Rate (%)
Avoidable Days Rate (%)
Reference ranges (Average, +1 Standard Deviation, -1 Standard Deviation) differ depending on the report:
Comparison of LHINs (in Provincial Report)
Comparison of Units (in Community and
Teaching Reports)
Number of Consults (CCRT Indicator Tab)
Definitions
Calculations
Readmission Within 48 Hours Rate =
Readmissions Within 48 hours from non-
ICU IP locations/ Live non-ICU IP
Discharges
Ventilator Occupancy Rate=Total Patient
Days with Ventilation / (Ventilated Beds in
Inventory*Days in Reporting Period)
Ventilated Patient Day Rate = Total
Patient Days with Ventilation / Total
Patient Days
Avoidable Days Rate = Total delayed
transfer days / Total ICU patient days
Wait durations above 4 hours are
considered avoidable hours; therefore,
delayed transfer days exclude the first 4
hours of a wait.
The average of the base dataset is taken
to determine the quarterly average value Patient record-level data was utilized to compute the "LHIN average"
for each LHIN
The average of the base dataset is taken
to determine the quarterly average value Patient record-level data was utilized to compute the "Community" and
for each unit
Sum of All Consults per entity
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Interpretation Notes
High 48-hour readmission rate may indicate an early and/or
inappropriate transfer out of the ICU. Unplanned readmission is
associated with poorer patient outcomes, and is a reflection of
possible errors in clinical judgment or system constraints. This
calculation includes all readmissions within the reporting period and is
not specific to readmissions only within the same hospitalization. Both
planned and unplanned readmissions are included.
All patients readmitted within 48 hours after the initial discharge month
will be counted as readmissions in the initial discharge month, even if
their readmission falls into the next month. The numerator will only
include patients readmitted from non-ICU inpatient locations
(Emergency, Unit/Ward, Step Down Unit, OR/PACU) that were
previously discharged to a non-ICU inpatient location. The
denominator will only include discharges to non-ICU inpatient
locations, and active patients not yet discharged are excluded.
This indicator approximates the utilization of ventilator capacity.
Please note that this is not an exact reflection of mechanical
ventilators used since the CCIS definition of ventilation includes both
invasive ventilation and non-invasive ventilation, and the MOHLTC
ventilated bed count refers to invasive mechanical ventilation
capability. Patients on BiPAP or patients on CPAP to facilitate ICU
ventilation (i.e. weaning from a ventilator) are considered on a
ventilator.
Ventilator Patient Day Rate is a measure of the proportion of ICU days
being spent on ventilation. The CCIS definition of ventilation includes
both invasive ventilation and non-invasive ventilation, and the
MOHLTC ventilated bed count refers to invasive mechanical
ventilation capability. Patients on BiPAP or patients on CPAP to
facilitate ICU ventilation (i.e. weaning from a ventilator) are considered
on a ventilator.
Ventilation can reflect severity of illness of ICU patients, practice
patterns of the ICU medical team, as well as the efficiency of
discharging patients once liberated from ventilation (i.e. “avoidable
ICU days”). This rate will vary based on hospital setting (e.g. other
high dependency areas) but a low rate may indicate inefficient use of
critical care resources. A high rate may indicate an opportunity to
reduce duration of ventilation, or the need to review staffing
requirements. Ventilated Patient Day Rate may be higher than 100%
in some cases because of the way the CCIS records LSI data in 12-
hour time blocks -- if a patient was in a ventilated bed for less than 12
hours, the assumption is that ventilation was for 12 hours.
Avoidable days reflects the amount of time that patients spend
occupying an ICU bed when they no longer require the intensity of
care. It can be used to measure/identify issues around forward flow
out of ICU.
CCIS users are instructed to mark a patient as Awaiting
Transfer/Discharge once the patient has been deemed ready for
transfer by the most responsible physician (this may be when order
has been written or when otherwise confirmed). For the purpose of
this calculation, a maximum of 4 hours is assumed to be an
acceptable threshold for awaiting transfer. Data quality will be site-
dependent. The "official time" to start Awaiting Transfer may vary by
site (e.g. at point order is written, or when most responsible physician
has deemed patient ready for transfer). Please note that not all units
at this time appear to be marking patients as Awaiting Transfer
accurately (real-time, retroactively, or at all).
for each LHIN for the quarter.
"Teaching" average for these hospital types, for the quarter.
Number of Consults specifies the total number of consults each critical
care response team has reacted to from the following types of
consults: 'Follow-Up Consult', 'ICU Discharge Follow -Up', 'New
Consult', 'No Consult Audit'