EMIP: Difference between revisions

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EMIP stands for '''E'''mergency '''M'''edicine "'''IN'''" patient and is used as a [[Location field|location]] / in the Medicine database. It is used to as location for patients who are admitted to the medicine service and spend their entire '''admission under the medicine service''' in the ER (emergency department).
EMIP stands for '''E'''mergency '''M'''edicine "'''I'''n" '''P'''atient. It is used for patients who are admitted to our internal medicine service and spend their entire '''admission under one of the medicine services we follow''' in the ER (emergency department).  
We are tracking this at VIC, GRA, STB.  


== Collection Instructions ==
==Definition of EMIP==  
* [[Service/Location field]] - your EMIP (e.g. GRA_EMIP)
An EMIP is a Patient who has a record in [[EPR]]/[[Cognos Report Integrator]] for a [[Service tmp entry | Service]] we collect while in ER, and who does not then end up on one of the wards/units that correspond with that service, regardless where they go instead.
* [[Previous Service field]] - likely emergency medicine, unless some other service accepted them prior to medicine, and was never able to get them out of the ER either, and medicine accepted the patient from them  -in order for a pt to be an EMIP they must have been accepted by Medicine for admission otherwise they would just be an Emergency patient
 
* [[Accept DtTm field]] - the time Medicine accepted them, i.e. the time they became an EMIP
{{Ex |
* [[Arrive DtTm field]] - same as [[Accept DtTm field]]
# Pt has an order or some entry that medicine has accepted the patient while still in ER.
* [[Previous Location field]] - use normal instructions
# The patient leaves the ER to either
#* home or
#* any other '''out of hospital location''' or
#* the patient is transferred '''within the hospital to any service''' because Medicine decides that they will not take the pt but the patient needs different care or
#* dies in ER ("ED Death after Arrival" in [[Cognos]])
#* leaves [[AMA]] ("ED Reg/Triaged/Assess LAMA" in [[Cognos]])
}}
 
=== Patients in ER admitted under other services are not EMIPs ===
Our definition of EMIP includes only patients that were followed by one of '''''our''''' services. So, patients who were followed by Family Medicine or Trauma while still in the ER are '''not EMIPs'''.


=== identifying patients ===
== Identifying EMIPs ==
see [[Identifying patients in boarding locations]]
=== Identifying EMIPs in [[Cognos2 Service Starter]] ===
[[EMIP]]s show up in [[Cognos2 Service Starter]]. They can't be identified there as EMIPs, but that's OK, since they really are just like any other patient now and should just be entered.


=== Patients discharged to other locations in hospital ===
There has been some discussion whether or not a patient accepted by our service but still in ER when Cognos first lists them should actually be entered then, or only after they either leave from ER or become an inpatient. People have been leaving these un-entered both out of old habit (when EMIPs were entered following different rules you first had to know if a pt would need to be entered as EMIP or as regular) and to be able to enter the unit at the same time, rather than having to remember to go back to the record later to enter the unit. There really is no longer a reason to delay these, especially starting with [[Using Cognos2 to keep track of patients]], instead they become something for which we would need to add tools to CSS to identify them. Please enter them as they show up on [[Cognos2 Service Starter]]o.
Collection includes patients who are discharged to other locations in the hospital. Should have been like this all along, but the definition said otherwise. Please collect as this going forward, as discussed with Trish and Julie. Ttenbergen 11:18, 2016 May 16 (CDT)
{{discussion}} what other locations do you mean?  If the EMIP is admitted to a bed on a Medicine ward, they are no longer EMIP but are captured in the Medicine database; if they are transferred to ICU, they are no longer EMIP but are captured in the ICU database. If they go to an overflow bed on any other ward but are admitted under Medicine, they will be captured in the Medicine database, and entered as overflow.  My understanding of the definition of an EMIP is a patient who has been accepted to Medicine but for whatever reason, never makes it to a Medicine ward, but is discharged directly from ER to a location outside the current facility ie home, another acute care facility, expires
* Even with the new definition, those patients that are discharged/transferred/admitted under MEDICINE, but to another ward other than an active medicine ward that we collect on, should not be considered an EMIP but rather an admission in our medicine database, as either an overflow (if they spend their entire length of stay on another ward) or as a regular admission in our medicine database if they are at sometime transferred to an active medicial ward.  I believe what Trish and Julie want to capture is if the patient is under MEDICINE in ER for any length of time, and are then admitted to an off service ward, under A DIFFERENT SERVICE (ie. surgery, critical care etc) then we are to capture those patients as EMIP patients.  We need clarification on this...... [[User:Lkaita|Lisa Kaita]] 13:42, 2016 May 16 (CDT)
**I think the confusion here is how to use the term "EMIP".  If you  are talking about the category as in the current "location" in CCMDB to use EMIP designation there, the pt remained in ER during their stay and was transferred out to some other hospital or home. (never went to a ward or unit in the hospital).   However,  if you are talking about utilizing the term "EMIP" in the previous location spot (meaning they were accepted to medicine and then transferred to a ward or an ICU then this use of the term (EMIP) needs to be clearly differentiated.  Which dispo tab entries will have the option of EMIP? This is still not organized totally yet.--[[User:LKolesar|LKolesar]] 07:25, 2016 May 17 (CDT)
'''EMIP scenario''' 
*Entire LOS in ER under '''Medicine service'''  and left your hospital to Home or died in ER
*Entire LOS in ER under '''Medicine service''' and discharge to other locations under '''different''' service in your hospital
*Entire LOS in ER under '''Medicine service''' and discharge to other locations under '''different''' service in another hospital
'''NOT an EMIP'''
*if LOS has partial stay in ER under '''Medicine service''' and then move to a '''Medicine service''' ward  (i.e. a regular Medicine admission)
*if LOS has partial stay in ER under '''Medicine service''' and then move to other ward but under '''Medicine service''' (i.e. a case of OVER)
[[User:JMojica|JMojica]] 12:13, 2016 June 2 (CDT)


== No ICU counterpart ==
== Entering data for EMIPs ==
While these do, in theory, happen in ICU, we will not collect them.
=== Entering patients in dispo tab fields ===
* [[Service/Location field]] - your Generic [[HSC_Med]], [[GRA_Med]], [[STB_Med]]
* [[Previous Location field]] - use normal instructions


== Locations ==
'''Follow the instructions in [[Boarding Loc]], [[Service tmp entry]], [[Transfer Ready DtTm tmp entry]]; if you do, none of the old special instructions for EMIPs should be required. That's part of the point of going to the new scheme. '''
=== [[VIC EMIP]] ===
See [[VIC_Medicine_Collection_Guide#Identifying_OVER_and_EMIP_patients]].


=== [[GRA EMIP]] ===
=== Collecting an EMIP who has been transferred to your location ===
* start date: November, 2010
Collection includes patients who are discharged to another service's location in the hospital. (eg Med to CC or CC to Med)
* see [[GRA_Medicine_Collection_Guide#EMIPs_at_the_Grace]] for how these are identified at the Grace.
*if an EMIP patient is transferred to an ICU, that ICU would use e.g. [[GRA_Med]] as [[Previous Location]] for the new scheme.  Before start date of new scheme,[[Previous Location]] is '''site_EMIP'''
** For [[Pre-admit Inpatient Institution field | Pre-admit Inpatient Institution]] = GRA_Med for the new scheme.  Before start date of new scheme,[[Previous Location]] is '''site_EMIP'''
** For [[Previous Service]] = Medicine
*If a pt who starts out on the EMIP track turns into a medicine [[Boarding Loc]] patient, collect them as you would any other [[Boarding Loc]] patient.  


=== [[STB_EMIP]]===
'''EMIP scenario''' 
See [[STB_Medicine_Collection_Guide#Process_for_identifying_Overflow_and_EMIP_patients]]
* In ER under '''Medicine service''' and left your hospital to Home or died in ER
* In ER under '''Medicine service''' and transferred to other locations under '''different''' service in your hospital
* In ER under '''Medicine service''' and discharged to other locations in another hospital
'''NOT an EMIP'''
* In ER under '''Medicine service''' and then moved to a '''Medicine service''' ward  (i.e. a regular Medicine admission)
* In ER under '''Medicine service''' and then moved to other ward but under '''Medicine service''' (i.e. a case of [[Off_ward_field|off ward patients]]).


=== [[HSC_EMIP]] ===
{{Ex|
*(1) Internal Med answered consult but deferred and admitted under Critical Care service. Consults do not count as admissions, the patient has to be accepted to Internal med service, and in this scenario would be considered an admission to Critical care only.
*(2) Rural Patient accepted by Internal Med service but deteriorated enroute to Winnipeg. Transport team transferred to ER resus room and Critical care consulted, admitted, and assumed care of the patient. This should only be collected as a Critical care service profile, as the patient was assumed by CC service upon arrival at the hospital. (Just as we would not collect for any other patient who died before they ever made it to the hospital).
}}


== Serial numbers used ==
== Related articles ==  
Patients in EMIP have their own [[serial number]]s starting at number 1.
{{Related Articles}}


== Related Articles ==
{{Collapsable
* [[Site and Location table]]
| always= Legacy Information
* [[OVER]]
| full=
* [[VIC_EMIP]], [[GRA_EMIP]], [[STB_EMIP]] and [[HSC_EMIP]] used to be [[Service/Location field]] entries in the Medicine database until [[2020-10 EMIP changes]] / [[Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry]]  
* there used to not be a critical care counterpart, see [[ECIP]] for more info
* since the concept only applied to Med pts and we didn't collect those at CON and OAK, patients in Concordia ER or Oaks ER could not become EMIPs
}}


[[Category: Site and Location]]
[[Category: Information Specific to Victoria Hospital]]
[[Category: Overflow]]
[[Category: Overflow]]
[[Category: Multiple Encounter linking]]
[[Category: EMIP| *]]
[[Category: Dispo]]
[[Category: EMIP]]

Latest revision as of 14:40, 2023 November 3

EMIP stands for Emergency Medicine "In" Patient. It is used for patients who are admitted to our internal medicine service and spend their entire admission under one of the medicine services we follow in the ER (emergency department).

Definition of EMIP

An EMIP is a Patient who has a record in EPR/Cognos Report Integrator for a Service we collect while in ER, and who does not then end up on one of the wards/units that correspond with that service, regardless where they go instead.

Example:   
  1. Pt has an order or some entry that medicine has accepted the patient while still in ER.
  2. The patient leaves the ER to either
    • home or
    • any other out of hospital location or
    • the patient is transferred within the hospital to any service because Medicine decides that they will not take the pt but the patient needs different care or
    • dies in ER ("ED Death after Arrival" in Cognos)
    • leaves AMA ("ED Reg/Triaged/Assess LAMA" in Cognos)

Patients in ER admitted under other services are not EMIPs

Our definition of EMIP includes only patients that were followed by one of our services. So, patients who were followed by Family Medicine or Trauma while still in the ER are not EMIPs.

Identifying EMIPs

Identifying EMIPs in Cognos2 Service Starter

EMIPs show up in Cognos2 Service Starter. They can't be identified there as EMIPs, but that's OK, since they really are just like any other patient now and should just be entered.

There has been some discussion whether or not a patient accepted by our service but still in ER when Cognos first lists them should actually be entered then, or only after they either leave from ER or become an inpatient. People have been leaving these un-entered both out of old habit (when EMIPs were entered following different rules you first had to know if a pt would need to be entered as EMIP or as regular) and to be able to enter the unit at the same time, rather than having to remember to go back to the record later to enter the unit. There really is no longer a reason to delay these, especially starting with Using Cognos2 to keep track of patients, instead they become something for which we would need to add tools to CSS to identify them. Please enter them as they show up on Cognos2 Service Startero.

Entering data for EMIPs

Entering patients in dispo tab fields

Follow the instructions in Boarding Loc, Service tmp entry, Transfer Ready DtTm tmp entry; if you do, none of the old special instructions for EMIPs should be required. That's part of the point of going to the new scheme.

Collecting an EMIP who has been transferred to your location

Collection includes patients who are discharged to another service's location in the hospital. (eg Med to CC or CC to Med)

EMIP scenario

  • In ER under Medicine service and left your hospital to Home or died in ER
  • In ER under Medicine service and transferred to other locations under different service in your hospital
  • In ER under Medicine service and discharged to other locations in another hospital

NOT an EMIP

  • In ER under Medicine service and then moved to a Medicine service ward (i.e. a regular Medicine admission)
  • In ER under Medicine service and then moved to other ward but under Medicine service (i.e. a case of off ward patients).
Example:   
  • (1) Internal Med answered consult but deferred and admitted under Critical Care service. Consults do not count as admissions, the patient has to be accepted to Internal med service, and in this scenario would be considered an admission to Critical care only.
  • (2) Rural Patient accepted by Internal Med service but deteriorated enroute to Winnipeg. Transport team transferred to ER resus room and Critical care consulted, admitted, and assumed care of the patient. This should only be collected as a Critical care service profile, as the patient was assumed by CC service upon arrival at the hospital. (Just as we would not collect for any other patient who died before they ever made it to the hospital).

Related articles

Related articles:
Legacy Information