Level of care hierarchy: Difference between revisions

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== Levels of Care ==

The ~~actual~~ levels of care are:

*The list of levels of care from highest to lowest are:

* WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU

**WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU, Brandon ICU (also for PACU or OR)

~~{{Discuss | who = Julie |~~

**Other MB RHA ICU or Other Province ICU

* We need a level for ER; with our new scheme, ~~someone could conceptually be ready for a lower level of care than ER but be stuck there. Certainly for GRA who uses it for~~ ICU~~. I think that level would be between ICU and IICU. Thoughts? Might be a question~~ for ~~Allan. For now I am setting this ER as a level between ICU and IICU; if OK please update this page accordingly, if needs discussion, please make it happen. Ttenbergen 19:18, 2020 October 15 (CDT~~) }}

**WRHA IICU

* Other MB RHA ICU or Other Province ICU

**WRHA HOB Medicine ward ([[HSC_HOBS]] as of 2022-05)

* WRHA IICU

**WRHA regular Medicine ward (CTU or NTU)

* WRHA HOB ward

**WRHA non-Medicine (e.g. surgery, family med, OB, palliative, etc) AND lower acuity ward in acute care hospital, whatever flavour of the month word they use for this, incl. rehab, geri-rehab, palliative care unit, etc

* WRHA regular ward (CTU or NTU)

***To be clear here, we DO consider these locations "lower" levels than are Medicine wards, and the reason is that a major purpose of the levels is to be able to count up "wasted" bed-days in ICUs or Medicine wards. But of course the care provided in these other locations are not ''truly'' lower levels.

* WRHA lower acuity ward in acute care hospital, whatever flavour of the month word they use for this

**Ward outside WRHA

* ~~ward~~ outside WRHA

**PCH or home

* PCH or home

=== level of care of the ED ===

* morgue (e.g. in case of [[~~Brain death~~]])

'''We consider the ER to be at the standard level of care for the [[Service tmp entry | Service]] taking care of the patient''' i.e. regular med ward for Medicine (not HOBS) and regular ICU (not IICU).

This definition is relevant for decisions about the [[Transfer Ready DtTm tmp entry]] and consequently about reporting [[Transfer Delay]].

Rationale for Medicine - ER will be treated as regular ward because the intention to where to transfer the patient is usually unknown or not documented. Thus, any delay in transfer from ER is treated as a bed wasted to regular ward. If it happens that the patient with transfer ready at ER went to HOBS, the TR Dttm until the start dttm at HOBS is bed wasted '''regular ward'''. If at HOBS, patient becomes transfer ready, it is '''bed wasted to HOBS''' until the start of the different level of care. This case will have two wasted bed - one regular and one HOBS.

=== When to use the Levels of Care ===

When the intent is to move the patient from a higher level of care to a lower level of care, transfer ready date and time has to be entered corresponding to the physical location where the decision was made. The entries are done following the guidelines in the [[Boarding Loc]] and [[Transfer Ready DtTm tmp entry]].

The level of care of [[Boarding Loc]]s that a patient is actually on is used to aggregate [[Transfer Delay (Medicine)]].

=== Data for levels of care ===

This was implemented one way before [[PatientFollow Project]] and is set up differently now:

* Before: the 'acuity_level' column in [[s_dispo table]] maps the [[Service/Location]] in [[L_Log table]] to level of care in single digits

* Now: the [[s_level_of_care table]] in [[CCMDB.accdb]] maps the 'item' in [[Boarding Loc]] to level of care in double digits

=== Why are some non-med locations considered "lower" ===

We DO consider some non-medicine locations "lower" levels than are Medicine wards, and the reason is that a major purpose of the levels is to be able to count up "wasted" bed-days in ICUs or Medicine wards. But of course the care provided in some of these other locations are not truly lower levels.

== Related articles ==

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 == Levels of Care ==
-The actual levels of care are:
+*The list of  levels of care from highest to lowest are:
-* WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU
+**WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU, Brandon ICU (also for PACU or OR)
-{{Discuss | who = Julie |
+**Other MB RHA ICU or Other Province ICU <!--(confirmed by Dr. Allan Garland 2Oct2017)-->
-* We need a level for ER; with our new scheme, someone could conceptually be ready for a lower level of care than ER but be stuck there. Certainly for GRA who uses it for ICU. I think that level would be between ICU and IICU. Thoughts? Might be a question for Allan. For now I am setting this ER as a level between ICU and IICU; if OK please update this page accordingly, if needs discussion, please make it happen. Ttenbergen 19:18, 2020 October 15 (CDT) }}
+**WRHA IICU
-* Other MB RHA ICU or Other Province ICU <!--(confirmed by Dr. Allan Garland 2Oct2017)-->
+**WRHA HOB Medicine ward ([[HSC_HOBS]] as of 2022-05)
-* WRHA IICU
+**WRHA regular Medicine ward (CTU or NTU)
-* WRHA HOB ward
+**WRHA non-Medicine (e.g. surgery, family med, OB, palliative, etc) AND lower acuity ward in acute care hospital, whatever flavour of the month word they use for this, incl. rehab, geri-rehab, palliative care unit, etc
-* WRHA regular ward (CTU or NTU)
+***To be clear here, we DO consider these locations "lower" levels than are Medicine wards, and the reason is that a major purpose of the levels is to be able to count up "wasted" bed-days in ICUs or Medicine wards.  But of course the care provided in these other locations are not ''truly'' lower levels.
-* WRHA lower acuity ward in acute care hospital, whatever flavour of the month word they use for this
+**Ward outside WRHA
-* ward outside WRHA
+**PCH or home
-* PCH or home
+=== level of care of the ED ===
-* morgue (e.g. in case of [[Brain death]])
+'''We consider the ER to be at the standard level of care for the [[Service tmp entry | Service]] taking care of the patient''' i.e.  regular med ward for Medicine (not HOBS) and regular ICU (not IICU).
+This definition is relevant for decisions about the [[Transfer Ready DtTm tmp entry]] and consequently about reporting [[Transfer Delay]].
+Rationale for Medicine - ER will be treated as regular ward because the intention to where to transfer the patient is usually unknown or not documented. Thus, any delay in transfer from ER is treated as a bed wasted to regular ward.  If it happens that the patient with transfer ready at  ER went to HOBS, the TR Dttm until the start dttm at HOBS is bed wasted '''regular ward'''.  If at HOBS, patient becomes transfer ready, it is  '''bed wasted to HOBS'''  until  the start of the different level of care.  This case will have two wasted bed - one regular and one HOBS.
+=== When to use the Levels of Care ===
+When the intent is to move the patient from a higher level of care to a lower level of care, transfer ready date and time has to be entered corresponding to the physical location where the decision was made. The entries are done following the guidelines in the [[Boarding Loc]] and [[Transfer Ready DtTm tmp entry]].
+The level of care of [[Boarding Loc]]s that a patient is actually on is used to aggregate [[Transfer Delay (Medicine)]].
+=== Data for levels of care ===
+This was implemented one way before [[PatientFollow Project]] and is set up differently now:
+* Before: the 'acuity_level' column in [[s_dispo table]] maps the [[Service/Location]] in [[L_Log table]] to level of care in single digits
+* Now: the [[s_level_of_care table]] in [[CCMDB.accdb]] maps the 'item' in [[Boarding Loc]] to level of care in double digits
+=== Why are some non-med locations considered "lower" ===
+We DO consider some non-medicine locations "lower" levels than are Medicine wards, and the reason is that a major purpose of the levels is to be able to count up "wasted" bed-days in ICUs or Medicine wards. But of course the care provided in some of these other locations are not truly lower levels.
 == Related articles ==