Direct admit: Difference between revisions

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This is relevant to [[ER Wait]]. There originally was a question there regarding why we collect this. I think we collect it primarily to prevent the cross-check for ER Wait from firing if there is no legitimate ER wait entry. However, if an ER bed is taken up, is that what we want to be collecting? {{discussion}}
{{LegacyContent
|explanation=Used to have special instructions, but with collection instructions as of 2022-02 this is now collected just like everything else. No more special instructions.
|successor=[[Previous Location]], [[Previous Service]], [[Pre-admit Inpatient Institution]]
|content=


==Direct Admissions==
Direct admissions are patients who are accepted from another site (within region or from out-of-town) and come directly to the next site.
DEFINITION: If a patient has been sent from a ward, ER or ICU to your hospital where the sending physician has discussed the case with the accepting physician and the accepting physician has accepted the pt to their service, this is a direct admission. These patients could still stop off in your ER, but are not seen by the ER doctors. Normally, when these direct admit patients arrive in ER, the accepting physician or service will be paged by ER and they will go down to assess the patient there and arrange for the pt admission. (this is usually the case with patients sent form other hospital ER's or wards). Patients that require ICU care and the ICU physician has accepted them will usually go directly to the ICU (without stopping in ER)
==Clarification for TMP "ER Wait" category "Direct Admit" (medicine program only)==
To use the ER WAIT (ER ADMIT)in the TMP section, the pt must have been located in '''your hospital''' ER.. ("admit from" must be ER of own hospital)  
*To use the ER WAIT (DIRECT ADMIT) in the TMP section, the pt must have come from another location (other than your own hospital ER) The "admit from " must be anything but your own hospital ER.  This setting means that the pt came usually from another hospital and the sending physician has already discussed the pt with the medicine doctor at the receiving hospital.  The medicine doctor has already agreed to accept the pt to their service.  The pt goes to ER because they need to still wait for a medicine bed, but the pt has been accepted by the medicine service on arrival.  The ER doctors do not see these patients so they are "direct admit" under ER waits. 
*See  [[ER Wait]]
*If there is not a delay in moving a pt from one hospital to another in the setting of a direct transfer, then there is no need to use the ER wait at all.  Just put it in as a transfer from that facility.  The ER wait is only for delays where the pt must wait for a bed in ER.


=== Direct to Medicine ward from Ambulatory Care ===
These patients can go straight to the accepting ward at the second site, or they can be admitted via the ER.
DIRECT to Medicine are patients who the medicine service attending Dr. has already accepted to their service, but the patient is sent to the ER to wait for a ward bed.


Example of Direct to medicine from ambulatory care clinic:
== Collection Instruction ==
Admit FROM: HA
*There are '''two types of Direct admits:'''
Registry Admit date: Medicine service Accept date (date and time admitted to medicine service): is the date and time patient came to ER
**'''already an Inpatient''' - the [[Pre-admit Inpatient Institution]] and the [[Previous Location]] will be the same
[[ER Wait]] Tmp entry: the date and time patient actually arrived on the ward
**'''not an Inpatient''' - the [[Pre-admit Inpatient Institution]] would be not applicable and the [[Previous Location]] would be their last physical location  e.g. Thompson ER
Comment type in as follows:  '''parked in ER'''


If a patient is sent to ER from ambulatory care to be assessed by Medicine Service in ER to see if he should or should not be admitted to a med ward bed, then this is not a direct admission to medicine. Admit from is HE.
* The [[Visit Admit DtTm field]] and the first [[Service tmp entry]] will be the same
** The COGNOS service time is often later than the [[Visit Admit DtTm field]] so the first [[Service tmp entry]] must be changed to = [[Visit Admit DtTm field]]
* For First [[Boarding Loc]] with the same date/time as the first [[Service tmp entry]]
** if via ER,  enter  own <site>_ER for first [[Boarding Loc]]
** if direct to Ward, enter own <site> physical location for first [[Boarding Loc]]


=== NOT direct Admits ===
== Data use / Reporting ==
==== eg Stroke 25s to HSC ER from home ====
inter facility transfers report (semi annual and Fiscal year) given to Critical Care Admin Director and Quality Officer.
When a patient comes in as a stroke 25 to HSC ER from home, we are to code it as an ER Wait: ER Admit in Temp Studies,and admission is not to be considered a "Direct" from home. Admit time is as usual on MD admit sheet.--[[User:PStein|PStein]] 13:44, 2015 July 23 (CDT)
*Start Date - April 2003, End Date - March 2020
*Patient Flow - where patient were have been admitted FROM


{{discuss@task}}
How is it used?
[[Category: Admit/Discharge]]
* To distinguish the reason of transfer due to bed management reason 
[[Category: Dispo]]
* To distinguish the reason of transfer due Medical Necessity reason
* To determine the flow of patients from teaching hospital to teaching hospital, teaching to community, community to teaching, community to community, from outside city/province facility to regional hospital.
 
=== Data to be Reported ===
* Counts for Inpatient direct admit
** Site Ward via ED
** Site ICU via ED
 
* Counts For Non Inpatient direct Admit (e.g. Emergency, Ambulatory Clinic, PCH, Home, Nursing Station)
** Site Emergency via ED
** Site Ambulatory via ED
** PCH via ED
** Home via ED
** Nursing Station via ED
 
* Time spent at ED before transfer to Ward or ICU
 
== Legacy ==
Collection for this was changed as part of the [[2016 Time and Place changes]].
 
This used to be relevant to [[ER Wait]] and [[ICU Var 4 - Parked in ER]], [[Parked in ER tmp entry]].
 
This used to be collected as [[Parked in ER tmp entry]], and prior to that as '''<hosp> - ER (parked)''' entries in  [[s_dispo table]]. Changed as of [[PatientFollow_Project#Transition_dates]] .
 
Content of the article was deleted 2016-06-30 so it doesn't inadvertently show up in searches. See article history if needed.
 
== Related articles ==
{{Related Articles}}
}}

Latest revision as of 11:36, 9 February 2022

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