Table 3.

Indicators recommended for retirement

Type	Indicator	Mean Likert score	Rationale	Pre-Consensus Conference Survey Agreement for retirement (as a % of responses)
Facility	28-day readmission after prostatectomy	5.2	These indicators have low volumes of cases leading to unstable rates as well as to the suppression of a large number of results for public reporting. Furthermore, these cases are included in the surgical/medical readmission indicators, and can still be derived through private reporting tools.	82%*
	28-day readmission after hysterectomy	5.6		80%*
	90-day readmission after knee replacement	6.4		73%*
	90-day readmission after hip replacement	6.4		72%*
	28-day readmission after stroke	6.2		58%
	Use of coronary angiography following AMI	6.4	Angiography may not be indicated for every AMI patient, depending on his or her clinical history, and the clinical appropriateness of angiography is difficult to ascertain from the administrative hospitalisation data. Therefore, it is challenging to interpret and compare the results for this indicator.	78%*
	Hip fracture surgical procedures performed within one facility (48 hours)	6.4	This indicator does not measure the true proportion of surgeries performed within 48 hours of admission to an acute care hospital, since it does not account for transfers across hospitals. Many patients are transferred from their initial admitting acute care facility to another facility for surgery. The indicator hip fracture surgical procedures performed within 48 hours, which measures total time across all acute care facilities, will continue to be produced and reported on.	72%*
	28-day readmission after AMI	6.4	Concerns have been raised regarding hospitals’ ability to take action on this indicator. It is felt that with the regionalisation of cardiac care, it is more appropriate to measure readmission after AMI at the regional level (by patient residence) than at the hospital level. In addition, having a low volume of cases leads to unstable rates and to the suppression of a large number of results for public reporting. Therefore, it was proposed to keep the Readmission after AMI indicator at the regional level and to retire the facility-level indicator. Furthermore, readmissions after AMI are included in the 30-day overall readmission indicator at the facility level.	59%
	Primary caesarean section rate	4.6	A new indicator (low-risk caesarean section) measures the rate of deliveries via caesarean section among singleton term cephalic pregnancies for women without placenta previa or previous C-section. Since this new indicator is limited to women who have not had a previous C-section, it can take the place of primary caesarean section rate and be a better indicator of appropriateness.	57%

Mean Likert Scale Score: 7–9, robust indicator, recommending continued reporting; 4–6, equivocal indicator, further discussion at inperson Delphi session required; 1–3, weak indicator, recommending indicator retirement.

*Passing the threshold (of 70% agreement among responses) for automatic ratification.