Wheaton Franciscan Healthcare-All Saints


About the Facility

CMS Certification Number (CCN)
52T096
Ownership Type
Non-profit
CMS Region
Chicago
Certification Date
Address
3801 Spring Street
Phone Number
(262) 687-5205

Facility Medical Condition Statistics

All other conditions
41
Brain disease or condition (non-traumatic)
23
Brain injury (traumatic)
13
Hip or femur fracture
18
Hip or knee replacement, amputation or other bone or joint condition
29
Nervous system disorder (excluding stroke)
29
Spinal cord disease or condition (non-traumatic)
15
Spinal cord injury (traumatic)
Data not available for this reporting period.
Stroke
71

Facility Quality of Patient Care Measures

Catheter-associated urinary tract infections (CAUTI)
Standardized infection ratio (SIR) 95% confidence interval - lower limit
Not Available
SIR 95% confidence interval - upper limit
Not Available
Comparative performance category
Not Available
Catheter days
241
Predicted number of infections (B)
0.505
Number of infections reported (A)
1
SIR (A/B)
Not Available
Percentage of patients whose functional abilities were assessed and functional goals were included in their treatment plan
Numerator
233
Denominator
233
Facility rate
100.0
Change in patients ability to care for themselves
Average risk-adjusted change score
13.5
Denominator
204
Average observed change score
14.0
Change in patients ability to move around
Average risk-adjusted change score
33.5
Denominator
204
Average observed change score
34.5
Percentage of patients who are at or above an expected ability to care for themselves at discharge
Numerator
144
Denominator
204
Facility rate
70.6
Percentage of patients who are at or above an expected ability to move around at discharge
Numerator
142
Denominator
204
Facility rate
69.6
Percentage of IRF patients who experience one or more falls with major injury during their IRF stay
Numerator
0
Denominator
233
Facility rate
0.0
Clostridium difficile Infection (CDI)
Standardized infection ratio (SIR) 95% confidence interval - lower limit
Not Available
SIR 95% confidence interval - upper limit
1.808
Comparative performance category
No Different than the National Benchmark
Patient days
3,638
Predicted number of infections (B)
1.657
Number of infections reported (A)
0
SIR (A/B)
0.000
Percentage of healthcare personnel who got a flu shot for the current season
Number of health care workers vaccinated
25
Number of health care workers
25
Rate of flu vaccination
100.0
Rate of potentially preventable hospital readmissions 30 days after discharge from an IRF
Number of potentially preventable readmissions following discharge
18
Number of eligible stays
262
Unadjusted potentially preventable readmission rate
6.87
Risk-standardized potentially preventable readmission rate (RSRR)
8.21
Lower limit of the 95% confidence interval on the RSRR
6.54
Upper limit of the 95% confidence interval on the RSRR
10.36
Comparative performance category
No Different than the National Rate
Rate of potentially preventable hospital readmissions during the IRF stay
Number of potentially preventable readmissions
7
Number of eligible stays
283
Unadjusted potentially preventable readmission rate
2.47
Risk-standardized potentially preventable readmission rate (RSRR)
4.02
Lower limit of the 95% confidence interval on the RSRR
2.88
Upper limit of the 95% confidence interval on the RSRR
5.82
Comparative performance category
No Different than the National Rate
Rate of successful return to home or community from an IRF
Observed number of discharges to community (DTC)
166
Number of eligible stays
220
Observed discharge to community rate
75.45
Risk-standardized discharge to community rate
73.68
Lower limit of the 95% confidence interval on the risk-standardized discharge to community rate
68.43
Upper limit of the 95% confidence interval on the risk-standardized discharge to community rate
78.45
Comparative performance category
Better than the National Rate
Medicare Spending Per Beneficiary (MSPB) for patients in IRFs
MSPB score
0.94
Number of eligible episodes
261
Percentage of patients whose medications were reviewed and who received follow-up care when medication issues were identified
Numerator
229
Denominator
233
Facility rate
98.3
Percentage of patients with pressure ulcers/pressure injuries that are new or worsened
Numerator
8
Denominator
233
Facility observed rate
3.4
Facility risk-adjusted rate
3.3
Percentage of IRF healthcare personnel who completed COVID-19 primary vaccination series
Number of health care workers vaccinated
23
Number of health care workers
24
Rate of COVID-19 vaccination
95.8