Infectious Disease Readmission Rate Report Form
Submit data on readmissions related to infectious disease cases for quality improvement and monitoring.
Reporting Hospital or Unit Name
*
Reporting Period (Month and Year)
*
Type of Infectious Disease
*
Please Select
Pneumonia
Sepsis
Clostridioides difficile (C. diff)
Urinary Tract Infection (UTI)
Surgical Site Infection
Other
Total Number of Discharges (for this disease and period)
*
Total Number of Readmissions (within 30 days for this disease and period)
*
Calculated Readmission Rate (%)
*
Primary Reasons for Readmission
*
Disease recurrence
Complications
Medication issues
Non-adherence to treatment
Other
Average Interval Between Discharge and Readmission (in days)
*
Interventions Implemented to Reduce Readmissions
Enhanced discharge planning
Patient education
Follow-up calls/visits
Medication reconciliation
Other
Reporter Name and Contact Information
*
Submit Report
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