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| Overstay Predictor Project for Medicine [http://ccmdb.kuality.ca/index.php/Minutes_Team_Meeting_December_5,_2011 - collection team meeting discussion]
| | {{Project |
| *Primary Investigator: [[Dr. Dan Roberts]]
| | |ProjectActive=legacy |
| | |ProjectProgram=Med |
| | |ProjectRequestor=Mary Ann Lynch and Dr Eberhard Renner |
| | |ProjectCollectionStartDate=2012-11-05 |
| | |ProjectCollectionStopDate=2019-10-01 |
| | |Project={{PAGENAME}} |
| | }} |
| | {{LegacyContent |
| | |explanation= no more [[overstay]] as of October 1, 2019 |
| | |successor=[[Project Overstay2]] |
| | |content= |
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| == Instructions ==
| | '''''See [[Overstay Predictor Project Collection Instructions]] for collection instructions for this project.''''' |
| For every '''medicine''' patient at the '''Grace''' hospital, '''as soon as possible''', but definitely '''within 48 business hrs of admission''':
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| * find the new "Overstay" form on the chart
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| *for the first 6 check boxes on the form, create a record for each in tmp entries and check the checkbox if the answer is Yes. (one to one from the form, no interpretation necessary)
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| *(I will add a picture of the form here once we have a final version)
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| * Also, enter at least all the following as part of minimal dataset
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| ** DOB
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| ** Admit Date
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| ** ADLs
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| ** whether there was any '''CVA''' or '''Dementia''' as a comorbid
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| ** whether there was a '''stroke''' as an admit diagnosis
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| * Click the new “Overstay” button on the patient viewer form next to the notes field and it will turn a colour:
| | See [[Overstay Project Start Stop dates]] |
| ** GREEN - low/no risk for discharge issues
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| ** YELLOW - some risk for discharge issues
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| ** RED - significant risk for discharge issues.
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| ** GRAY - if some needed data is missing
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| *colors based on an underlying algorithm too complicated to get into here, but based on tmp entries, age, comorbids, admit dxs and ADLs
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| ** If the chart already has a sticker the '''same''' colour then you are done
| | A small number of patients overstays for a significant amount of time after they are medically ready for discharge. Though the number of patients is small, a significant proportion of bed-days is wasted in the process. The Overstay Predictor Project uses an [[Overstay Predictor Project Algorithm | algorithm]] to that uses data collected by the Critical Care and Medicine Database to predict an overstay risk. This risk is communicated to ward staff using a red sticker on charts and a direct communication to the unit manager. |
| ** if the colour in the program is different from the one on the chart put a sticker of the program colour over the sticker on the chart. Stickers will be supplied.
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| === If you can't find data === | | ==Legacy== |
| * I have emailed Linda to please fill in who the collector should talk to if there are problems with the Overstay form or the other data required for the project in a timely manner.[[User:Ttenbergen|Ttenbergen]] 14:45, 2012 April 23 (CDT)
| | see [[Overstay Project Start Stop dates | Implementation Dates]] |
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| ==Questions==
| | {{Data Integrity Check List|}} |
| === location of form and sticker ===
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| Where on the chart will this new form be and will it be a colored form?[[User:TOstryzniuk|Trish Ostryzniuk]] 10:43, 2012 April 24 (CDT)
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| * not known yet, will add details when we get them. [[User:Ttenbergen|Ttenbergen]] 12:56, 2012 April 27 (CDT)
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| === no need to document sticker colour changes === | | == Related Articles == |
| #Will it be necessary to document a difference in sticker colours if we need to change the colour once the algorithm has run?
| | {{Related Articles}} |
| #* no need. The original colour is based on the items you enter into tmp, so we can go back from that if needed. [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
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| === test scenarios for colours ===
| | [[Category: OverstayProject]] |
| #How can I test the yellow colour?-I can only get the overstay button to be red or green using multiple different combinations of the check boxes
| | }} |
| #* yellow would be based on a combination of comorbids and ADLs and age. Make a patient a little less sick and they will become yellow. Sorry, can't give you exact instructions, the algorithm is pretty messy. [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
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| === admission times and conditions at admission ===
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| The time we use as the time of admission will be different than the time of admission to the unit, and often significant time has passed between the 2 times so the information collected is different e.g. pt is confused at our admission time but by the time the patient goes to the unit, the patient is now A & O etc or vice versa. Will this affect the algorithm?
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| * Use the data as you would have entered before as that is what the algorithm was based on. I hope that helps, since I know some collectors used to collect this much later. Pls let me know if you need more info. [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
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| === coding of extra diagnoses ===
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| ==== [https://secure.wikimedia.org/wikipedia/en/wiki/Lacunar_stroke Lacunar Strokes]====
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| Should lacunes or lacunar infarcts that are/have been asymptomatic but are reported on a CT be included as CVAs in the comorbids?
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| *No. If no physical/funtional impairment what so ever then no, don't code.--[[User:TOstryzniuk|Trish Ostryzniuk]] 15:52, 2012 April 27 (CDT)
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| ** They should be reported like they always have been. We are basing the algorithm on previous data. This does not preclude us from discussing that question independently on the appropriate wiki page. Trish, I have no idea what a lacunar infarct is, could you provide the link? [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
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| * If I read that question and the wikipedia article, then I wonder: are talking about Silent lacunar infarctions only here? Surely if there are symptom's it's coded, no? But as what code? Did we enter them into the comorbids before? Either way, this should probably be coded at the appropriate article, '''not''' here. [[User:Ttenbergen|Ttenbergen]] 17:54, 2012 April 27 (CDT)
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| ==== [[Intracerebral hemorrhage]]s in comorbids ====
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| We code Intracerebral hemorrhage (ICH) as 502** if it is a diagnosis, but we don't have a comorbid code for it.
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| #Should ICHs be considered CVA in comorbids?
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| #*Yes if it caused a stroke then code 505 in comorbid.
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| #*They should be reported like they always have been. We are basing the algorithm on previous data. This does not preclude us from discussing that question independently on the appropriate wiki page. Trish, I have no idea what a ICH is, could you provide the link? [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
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| === Did we consider all alternative diagnosis for CVA ===
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| We code several diagnosis as alternatives to a CVA:
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| * [[Intracerebral hemorrhage]] and subcodes
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| * [[Brain Stem Hemorrhage]]
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| * '''are there more?''' {{discussion}}
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| Whether they should be included in our algorithm depends on how we code them. Neither article gives instructions to code in addition to or instead of CVA 505 (we have this instruction for some other dxs). What is the coding practice? {{discussion}}
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| '''current status'''
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| * as of 2012-04-27
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| ** only CVA 505 is included in the algorithm to generate the colour
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| ** only data pertaining to CVA 505 was given to Rodrigo (the programmer) for overstay analysis
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| ** '''This issue might be relevant for other topics like the MOST score and wherever else we report on CVA'''
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| == Purpose ==
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| A small number of patients overstays for a significant amount of time after they are medically ready for discharge. Though the number of patients is small, a significant proportion of bed-days is wasted in the process. We are piloting a process at the Grace where an "overstay coordinator" will be assigned to patients at risk of overstaying. Whether a patient is at risk is determined by the ward nurse assessing risk factors on a form, and by an assessment algorithm that takes into account the values mentioned as mandatory above; the combination of these results in a chart being assigned a colour sticker, and the transition coordinators monitor these chart stickers.
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| [[Category: All Projects]]
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