LACE Readmission Risk
Plentiful evidence shows that patients with multiple comorbidities, frequent emergency room visits or other frailty indicators are more likely to present for readmission to hospital within a short time following their last discharge. Many of these readmissions are preventable, mostly through anticipation, communication and provision of post-discharge supports.
AHS uses the "LACE readmission risk index" to stratify patients into those who are at low, moderate or high risk for early readmission. The index considers the patient's length of stay, admission type, comorbidities and frequency of emergency room visits.
Automated Calculation
Most of the information needed to calculate a LACE Index is available to Connect Care in-system, and does not need to be entered by prescribers. Accordingly, an automatically calculated LACE Index is continually updated for all inpatients.
Location
The automated LACE Index can be found and used in a variety of ways:
Inpatient Chart Sidebar
A rightward sidebar is present when any chart is opened to an inpatient encounter. The default view includes "Checklists" as well as a "Transition Planning" section that includes the current LACE Index.
The sidebar has an index at the top, which includes an item for "Planning". This can be selected to bring more transition planning tools into the sidebar, such as the "Transition Planning" section that includes the LACE Index.
Rapid Rounds Patient List, Column and Report
Inpatient care teams may support Rapid Rounds with Connect Care tools that facilitate discharge planning. These include a Patient List template with columns summarizing key information affecting discharge readiness, including the LACE Index.
A "LACE Index" column can be added to any patient list. This column displays a patient's LACE score, colour-coded to indicate low (green), moderate (yellow) and high (red) risk. Hovering over the score reveals subcategory scores and double-clicking on the score opens a summary of details and implications for discharge planning.
Rapid Rounds lists typically show a "Rapid Rounds Report" when a patient row is selected. This report also displays LACE Index information.
The same Rapid Rounds report can be viewed from the Transition Planning section of the inpatient sidebar.
Discharge Summative Documents
LACE Index values are included in the Basic and Advanced provincially standardized discharge summary templates in the "Follow Up Arrangements" section.
SmartLink
A ".LACEINDEX" SmartLink can be used to pull LACE information into any inpatient documentation. The LACE index value and level is inserted.
A ".LACEINDEXFOLLOWUP" SmartLink may be more appropriate for discharge or transfer documentation. It pulls in the LACE risk level together with the AHS suggested post-discharge follow-up interval.
Interaction
All of the above LACE Index inclusions are interactive. Selecting the "LACE" label will open a pop-up display that contains information about how the index was calculated, what in-system data was used, and how the index might be interpreted to guide discharge planning.
Validity
The comorbidities component of the LACE Index calculation is sensitive to whether a patient chart complies with minimum use norms. It is essential that a patient's chronic illnesses be documented in the problem list and/or medical history sections of the chart. If a particular LACE Index seems inappropriately low, be sure to confirm that the patient's comorbidities are appropriately reflected in the problem list and medical history. The LACE pop-up report (accessed by selecting the LACE label wherever it appears) includes summaries of relevant in-system data.
Manual Calculation
The LACE pop-up report includes a link to a pop-up flowsheet that can be used to manually calculate a LACE Index. Manual calculations can help validate Connect Care's automated calculation. The LACE flowsheet is also available in the Flowsheets activity.