View source for Pre-2017-07-30 Overstay Predictor Project Collection Instructions

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This article documents what data collectors need to do with the [[Media:!Nursing Discharge Screening Tool WRHA January 2014.pdf| Discharge Planning Screening Tool form (DPST Form)]]. This is the latest generic form as of January 2014. Each hospital nurse education coordinator took the generic form and replaced the WRHA logo with the hospital logo. HSC also applied a form number.

'''Be aware that this project is a [[Vacation and staff shortage collection priorities|Vacation and staff shortage collection priority]]!'''

For '''STB SITE''': the Overstay Predictor Project is currently on hold. We do not collect at STB at this time because the medicine wards have all stopped filling out our Discharge Planning Screening Tool (DPST) forms. We do however, still generate a DPST color at the time of admission. Under the temp studies tab we change one line on the overstay project to "Overstay (column P)", and "DPST data missing (column I)". We then delete the remaining five lines from the Overstay Project. At that point the color can be generated by pressing the Overstay color generating button. [[User:DPageNewton|DPageNewton]] 12:53, 2017 May 18 (CDT)

For '''HSC SITE''': [[Overstay Project Start Stop dates | '''Go here''']] as we continue do ''minimal'' collection of items that are required for Overstay. This changed occurred on Nov 25.15 

== when you have questions or problems with the overstay project ==
Please email [[p:Trish Ostryzniuk | Trish]] or [[p:Tina Tenbergen | Tina]] 
*For HSC site: Please email Trish and Shellie Anderson.--[[User:CMarks|CMarks]]

== ensuring completeness within 24 hrs ==
The '''bedside nurses''' have 24 hours from the time of [[Admit date and time#Definition for Medicine | admission to the unit]] to fill out the [[Media:Discharge Planning Screening Tool.pdf | DPST]] Form. This time frame allows for the nurse to clarify unanswered questions with the patient or caregivers during the day. Question 2: If the DPST form is filled out by the nurse but it took more than 2 days say 5 days  for the nurse  to do it  do you still want this data entered  or do you say (form data missing) , if it took more than 2 days, yes fill it out but let me or the manager be aware if this is a consistent issue.

The nurse can update the [[Media:Discharge Planning Screening Tool.pdf | DPST]] form within the first 24 hours after admission if, for example they receive information from the patients family that contradicts the patients answers. It is possible that depending on when you review that document these changes are not captured. This a known risk that we are accepting.

See [[STB_Medicine_Collection_Guide#Overstay_Project]] for special considerations in gathering this data at StB Medicine.

==Special situations==

=== Possible Scenarios ===
See
* [[#Possible Scenario - complete DPST Form missing or blank]] 
* [[#Possible Scenario - colour change due to data entry error]]
* [[#Possible Scenario - individual questions missing]]
* [[#Possible Scenario - Patient transferred from other participating ward]] 
* [[#Possible Scenario - Patient died/discharged before assessment]]
* [[#Possible Scenario - EMIP patient that never made it to the ward]]
* [[#Possible Scenario - HSC overflows to RR5 & RR6]]
* any others? Think first whether they ''really'' are not addressed in these instructions...

== entering the data in TMP==
'''Within two business days''' after the bedside nurse has completed the [[Media:Discharge Planning Screening Tool.pdf | DPST]] Form the rest of the predictor data must be collected & entered into laptop by data collector. 

=== 6 Questions Data ===
When a new medicine patient is entered, 6 rows for questions are generated for them in the tmp table. They are labelled "Enter(1)" through "Enter (6)". 
You need to change the "Enter (x)" for each to the corresponding entry, i.e. "Enter (1)" becomes "1 Alert ad Orientated". Then you need to check the checkbox in column B if the answer on the [[Media:Discharge Planning Screening Tool.pdf | DPST]] form is "yes". Leave the box blank to indicate no. 

Question "4 managing independently" consists of several sub-questions. If '''even one'' of the activities raises a concern then the summary answer for the question needs to be '''no'''.

Take answers to questions directly from the [[Media:Discharge Planning Screening Tool.pdf | DPST]] form, no interpretation, even if you disagree after reading the chart. We will be testing the answers provided by the nurses to determine if they are a better predictor of transition support needs or can be used in conjunction with existing admission data to improve the effectiveness of the prediction tool. If the data were interpreted by the collector it would introduce another factor and make this test less valid. If you identify a discrepancy please note it in the Temp Comments field also known as column Q.

=== "From" Data ===
When a new medicine patient is entered, a line "Enter where from" is created in the tmp table. 
Change this entry to indicate where the patient was admitted from. If the information is not indicated on the [[Media:Discharge Planning Screening Tool.pdf | DPST]] form, but you can identify it easily from the chart, enter that; i.e. '''you may interpret this one'''. If information where the patient is from is unavailable, enter "From  location missing".

== Changes to regular minimal data collection and entry required for the Overstay Project ==
A number of items in addition to the regular [[Minimal Data Set]] needs to be entered '''before the generation of the chart colour in the next step''' because the algorithm uses this data: 

* "from" and "questions" tmp entries, or else "transferred" entry if applicable
* [[Date of Birth]]
* [[Province]]
* "Accept DtTm" if used, else "Arrive DtTm" 
** Enter as before; we are aware that this can be different from the time of admission to the unit and the algorithm takes that into account
* [[Pre-admit Inpatient Institution]]
* ADL
* Glasgow Coma Scale
* Charlson Comorbids 
** still working on list for the wiki; in the meantime, please just code all comorbids for the patient
** will be here: [[List of diagnoses affecting Overstay Project]]
* admit diagnoses important to code if applicable: 
** '''[[Dementia]]''' or '''[[Violent 2nd to dementia]]'''

== Colored Chart Stickers ==
Once the required information has been entered click the "Overstay" button on the patient viewer screen next to the [[Notes field]] and it will turn a colour based on an [[Media:Two_Stage_Predictive_Model_of_Patients_in_Need_of_a_Transition_Coordinator.pdf | underlying algorithm]]. 
* GREEN - low/no risk for discharge issues
* YELLOW - some risk for discharge issues
* RED - significant risk for discharge issues assign a transition coordinator.
* GRAY - if some needed data is missing you will not be able to generate a colour; there will be a specific error, please act on it; there are no gray stickers, gray is just a colour the laptop will give when it gets bad data for the algorithm. 

The program will ask you if this is the final colour you will submit. If so, it will be stored and sent. The colour will also be automatically added to the beginning of the Notes field, since most collectors were manually putting it there anyways. 

Based on the color displayed circle the colour on the DPST Form. Also place a colored sticker on the spine of the patient chart. The 3/4 inch stickers will be located in the transition coordinator binder at the unit clerk desk.  

=== copies of forms? ===
No copy of the DPST is required.

=== Other coloured dots on charts? ===
* There is currently a small red dot used to indicate long term chart. There is also a small yellow dot used to indicate VRE.
** Are you talking about the small dots that the ward staff use on the addressograghs?--[[User:CMarks|CMarks]] 12:56, 2013 July 30 (CDT)
** Are these other dots relevant to the overstay project? Is there any risk of someone confusing these? Ttenbergen 17:50, 2013 August 8 (CDT)

== Notifying the Transition Coordinator ==
If the patient has been designated as "red" for purposes of overstay prediction, the data collector will notify a Transition Coordinator by placing the patients name on the [[Media:!Transition_Coordinator_Assignment_Sheet.pdf |Transition Coordinator Assignment Sheet]].

== Possible Scenarios ==
=== Possible Scenario - complete [[Media:Discharge Planning Screening Tool.pdf | DPST]] Form missing or blank ===
If the entire form is missing, delete 5 of the questions and replace the remaining one with "DPST Data missing"
If the bedside nurse's DPST Form is incomplete the patient will be evaluated as if they had identified a problem, i.e. the patient will become yellow or red; the program will give a message that data had been missing. If possible, check with the bedside nurse and remind them to complete it or notify the medicine ward unit manager; enter the remaining data into CCMDB.accdb if it now becomes available.
'''''Even if the form is missing you still need to generate a colour for the patient.'''''

==== entry instructions ====
* ''erase'' the 6 questions
* enter an entry Project "Overstay", Item '''"DPST Data Missing"'''
** I have been unable to generate a color if I follow the above instructions. In addition to entering a line that says "DPST Data Missing", I also have to enter a line that says "From location missing". Only after BOTH lines are entered, will a color be generated. [[User:DPageNewton|DPageNewton]] 16:59, 2013 August 12 (CDT)
*** The "from" topic is completely separate of this, and there are separate answers for it above. Ttenbergen 14:59, 2013 August 13 (CDT)

=== Possible Scenario - individual questions missing from the [[Media:Discharge Planning Screening Tool.pdf | DPST]] form ===
If the answer to an individual question is missing, replace the "Enter (x)" for that question with "DPST Data missing". The algorithm will treat this as if a problem was identified, but by entering it like this we can identify in the data whether the colour escalated because of known problems or because of missing information.
'''''Even if the answer to a question is missing you still need to generate a colour for the patient.'''''

==== entry instructions ====
Replace "Enter (x)" for the missing answer with "DPST Data missing".

=== Possible Scenario - Patient transferred from other ward - admit ward was participating ward ===
If the patient was admitted from a another '''medicine''' ward at the same location, and if that ward also participates in the Overstay project, then the '''[[Media:Discharge Planning Screening Tool.pdf | DPST]] form does not need to be filled out''' and and the original Green/Yellow/Red designation is retained. Ensure that these charts have the appropriate colour dot on them. If the form is not available, treat as missing form.

If they were pre-determined to be a "red" then the name and date of the patient transferred in should be written in the transition coordinator binder, indicating that they are a transfer in from another ward.

The completed form, with colour written on it, should arrive on the new unit with the patient. The designated colour should be written on the form.

If the patient is admitted to a participating ward, then transferred to a non-participating ward, and finally back to a participating ward, then use the colour on the original ward.

=== Possible Scenario - Patient transferred from other ward - admit ward was '''NON'''-participating ward ===
If the patient is transferred either '''from''' or '''via''' any unit not participating in the Overstay project (e.g. an ICU) then the form needs to be filled out; if it is not, treat it as a [[#Possible Scenario - complete DPST Form missing or blank]]. 

=== Possible Scenario - colour change due to data entry error ===
After 24 hours all information required to make the assessment as to if the patient is at risk should be available (or not known to the nurse within the first 24 hours and thus considered a risk). The only case where the colour should be changed is if the data-collector knew they had made an error on data entry. In that case, click the button again and answer "yes" to the question whether this is the final entry; this will overwrite the previous entry in the tmp table, and it will add the new entry to the beginning of the Notes field. This means you may have multiple colours in notes, the first one being the current one.
It is '''not be necessary to document''' when a sticker colour changes. Just change the colour.

If the change results in the patient no longer needing a transition coordinator, then the data coordinator needs to notify the transition coordinator to ensure they are ware of the change.

=== Possible Scenario - Patient died/discharged before assessment ===
If the patient was discharged/died before a colour could be assigned write "not assessed" and write the discharge date on the Discharge Planning Screening Tool. If the [[Media:Discharge Planning Screening Tool.pdf | DPST]] form is filled out, enter the data and generate a colour even after the fact - this scenario applies only if the paper form was filled out.   Question 1: The patient is admitted on the Friday the nurse completes the discharge planning screening tool ([[Media:Discharge Planning Screening Tool.pdf | DPST]])  then the patient is discharge home on Sunday.   I am in on Tuesday and complete the patient profile in medical records.  Do you want us to complete and enter  the 6 questions in the computer and generate a color or do you want us to put (EARLY DISCHARGE) and not fill in the 6 questions and put form missing?  The answer is above.  

==== entry instructions ====
* ''erase'' the 6 questions
* enter an entry Project "Overstay", Item '''"Form Data Missing"'''; put "early death" or "early discharge" into the notes field

=== Possible Scenario - EMIP patient that never made it to the ward ===
If a pt was an [[EMIP]] and never got as far as the ward, then enter "Form Data Missing" in the temp field. We will know from the patient data why this patient does not have any Overstay information. 

==== entry instructions ====
* ''erase'' the 6 questions
* enter an entry Project "Overstay", Item '''"Form Data Missing"'''; put "EMIP" into the notes field

===Possible Scenario - HSC overflows to RR5 & RR6===
'''May 13, 2013''' - HSC medicine data collection will follow all OVERFLOW patient that are going to RR5 & RR. These are patients that are under a medicine attending service while on '''RR5''' or '''RR6'''.  They are sent there from medicine wards we are collecting on at HSC. They are also admitted there under Internal medicine service attending physicians from the ER department.[[User:TOstryzniuk|Trish Ostryzniuk]] 16:20, 2013 June 14 (EDT)

Medical records will auto print patient list for RR5 & RR6 directly to the printer in GF216.  HSC collector should now have access to ADT (Admit/Transfer/Discharge) for patient wards list via [[EPR]] also.  If not, please contact '''Denise Felbel''' (she is in global address in your email).

===Possible Scenario - Incorrect information===
If the [[Media:Discharge Planning Screening Tool.pdf | DPST]] has information on it that disagrees with documentation in the chart, do not correct it. For example it sometimes happens that a patient reports no falls but upon review of the home-care record it is clear that the patient has fallen in the past.  While it seems important to correct the DPST the assumption is the [[Media:Discharge Planning Screening Tool.pdf | DPST]] was filled out with information available in the first 24 hours and the things will be missed. The care team still needs to do their diligent discharge planning regardless of the colour assigned.--[[User:LHathout|LHathout]]

== Legacy Info ==

=== Legacy Info - red for PCH or out-of-province patients ===
The original implementation of the Overstay colouring algorithm used between project start and 2013-Feb-08 would never assign a red to palliative, out-of-province or PCH patients. As of 2013-Feb-09 the algorithm has moved consideration of PCH and out-of-province status into the logistic regression analysis; the two are still a factor, but a minor one, and both types of patients could now become red in the right circumstances. Palliative patients continue to be evaluated such that they can not be assigned a red.

=== Legacy Info - multiple colour entries ===
Until version [[]] a new colour was added to the dataset each time the button was pressed. We thought this would be OK because it should only be pressed once, maybe a second time shortly after to fix a mistake, but it turned out to be pressed at all odd times. 

Trish's note at the time:
* Every time collector presses the Color generating button, the color generated is show and is stored. If they keep pressing button every time they add data, and press the button again, this event is stored.  If they exit profile and go back later the last color they generated is not visible to collect, only when pressed button again then they can see the color.  So if they press 3 times, then it is stored 3 times.    Color can be generated numerous times when staff update data, or are waiting for data that they are following up or generate color just to check if changes to color after when they added data even after posting sticker on chart. These multiple color generation show up in TMPV2.mdb every time data is sent in. Because of this, it is a challenge to analyses because it is not always clear what the final color was posted on a chart. This is especially the case when a new color is generate each day after admission.  [[User:TOstryzniuk|Trish Ostryzniuk]] 19:00, 2013 July 23 (CDT)


[[Category:Overstay Legacy]]
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