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ER Delay: Difference between revisions

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| field_name = ER Delay
| field_name = ER Delay
| element_description = The ER Delay is the difference between the pre-ER [[Boarding Loc]] and first post-ER [[Boarding Loc]], for patients arriving from the ER.
| element_description = The ER Delay is the difference between the pre-ER [[Boarding Loc]] and first post-ER [[Boarding Loc]], for patients arriving from the ER.
| in_table = Created_Variables_Common table
| in_table = Created_Variables_Common_2021 table
| data_type = date
| data_type = date
| datafield_length = n/a
| datafield_length = n/a
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}}
}}


It's is calculated by [[Created_Variables_Common_maker query]] and stored in [[Created_Variables_Common table]] in [[CFE]].  
It's is calculated by [[Created_Variables_Common_maker_2021 query]] and stored in [[Created_Variables_Common_2021 table]] in [[CFE]]. It is related to one of our [[Indicators]], [[Length_of_Time_for_Transfer_from_ED_to_ICU_within_same_facility]].  


== Data use ==
== Data use ==
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* Measure the delay of movement of patient from ER bed to Medicine or Critical Care bed.
* Measure the delay of movement of patient from ER bed to Medicine or Critical Care bed.


== ER Delay when there are [[Visits to temporary locations]] between initial ER and first unit ==
== ER Delay Calculation ==
{{Todo
* Before Oct 2020 : If [[Previous Location]] is own ER
  | who = all
** Non-EMIP / Non-ECIP :  [[Arrive DtTm]] - [[Accept DtTm]]  and [[Accept DtTm missing]] is not marked
  | question =
*** if [[Accept DtTm missing]] is marked then ER Delay is missing.
* Make sure to update [[Visits to temporary locations]]when this is resolved, if needed.  
** EMIP/ECIP: [[Dispo DtTm]] - [[Accept DtTm]]
}}
*Starting Oct 2020 : if first [[Boarding Loc]] is own ER
** Only one ER [[Boarding Loc]]: [[Dispo DtTm]] - first ER  [[Boarding Loc]] start Dttm
** At least two  [[Boarding Loc]]: First NonER [[Boarding Loc]] start Dttm  - first ER  [[Boarding Loc]] start Dttm
 
Implemented as
:: ER_Delay:
::: IIf(Not [PatientFollow],
:::: IIf([location_name] Like "*EMIP*",[Dispo_DtTm],[Arrive_DtTm])-Nz([Accept_dttm],
:::: [Arrive_dttm]),Nz([created_FirstNonER_BoardingLoc].[dttm],[Dispo_DtTm])-[created_FirstER_BoardingLoc].[dttm])
 
=== Outliers ===
==== ED stays in mid-hospitalization ====
* there are occasions where pts go back to the ED while under the care of ICU; we do not include these in ER Delays; discussed at [[JALT_Meeting_-_Rolling_Agenda_and_Minutes_2023#JALT_Meeting_%E2%80%93_October_31,_2024 | JALT 2024-10-31]]...
 
==== Moves for Medicine ====
{{DJ |
* This data is problematic before 2011-Q2,the only reason there are any is because it derives them for EMIPs. Some data may be available in [[Moves for Medicine]], but that would still leave a gap. [[User:Ttenbergen|Ttenbergen]] 23:09, 2024 November 16 (CST)
** OK, will be working on this getting data from [[Moves for Medicine]] from period Sept 2007 to June 3, 2011.  will give to Pagasa for upload to [[Arrive DtTm field]]. I will update the WIKI as soon as done.  Conclusion: for Medicine, prior Sept 2007, no ER delay while for Critical Care, no ER Delay prior July 1, 2016 -- these are treated as missing.  --[[User:JMojica|JMojica]] 16:35, 2024 December 11 (CST)}}
 
== Log ==
{{Discuss |
* I have re-updated [[Created_Variables_Common_maker_2021 query]], for some reason the change I had made was not reflected in the master version. Ready to test. [[User:Ttenbergen|Ttenbergen]] 13:25, 2022 June 28 (CDT)
** emailed Tina some inconsistencies found in ER Delays Aug 15,2022. --[[User:JMojica|JMojica]] 13:21, 2022 August 29 (CDT)
*** are these still an issue? [[User:Ttenbergen|Ttenbergen]] 11:15, 2024 May 1 (CDT)
**** I will re-check again.  Can't remember if have been resolved. --[[User:JMojica|JMojica]] 14:40, 2024 October 2 (CDT)}}


{{DiscussTask |
* 2022-06-28 - previous change got lost somehow, re-applied it; updated query to use [[query created_PatientFollow]] rather than in-query definition
*Lisa replied    ‘when boarding loc is only ER the arrivedttm equals accept dttm equals first service dttm, dispo time should be the discharge dttm'.  I have thought the same – that  this is how we were doing it with EMIPs. Can’t find this rule in WIKI.
* 2022-06-09 - updated [[Created_Variables_Common_maker_2021 query]] with the new definition.  
*Before we move to tmp service and boarding loc.  I calculated ER delay equals  Arrive dttm – accept dttm.    Now we added another or second way,  ER Delay equals first post-ER Boarding Loc dttm - ER Boarding Loc dttm.
*This caused an issue for boarding loc only ER.  There is no post-ER boarding loc.  if I follow the first way, ER delay is ZERO since arrive dttm is the same as accept dttm. 
*Should the whole stay at ER be considered as an ER delay or NOT?  If yes, then in the past I was underestimating it because all EMIPs have ZERO  delay.
*If YES in the question above, then we should add this rule for EMIP or ECIP cases
#Arrive dttm equals dispo dttm
#first post-ER Boarding Loc dttm equals dispo dttm
in this way, ER Delay will be consistent in both formulas. 
*For discussion. --[[User:JMojica|JMojica]] 10:17, 2022 March 9 (CST)
** Discussed at [[Task Team Meeting - Rolling Agenda and Minutes 2022#ICU Database Task Group Meeting – March 9, 2022]] - Julie and Lisa will bring more data to next task meeting Apr 6. [[User:Ttenbergen|Ttenbergen]] 22:27, 2022 March 9 (CST)
** now that we have retired accept/arrive concepts can we delete this? or do we need to update first service/second boarding loc? [[User:Lkaita|Lisa Kaita]] 08:01, 2022 April 28 (CDT)
*** I think the question of how Julie will interpret and report the scenario she describes is still open, even when defined with [[Boarding Loc]] and [[Service tmp entry]] rather than Accept/Arrive. I think Julie was going to bring data today to hopefully decide and be done with this. [[User:Ttenbergen|Ttenbergen]] 10:42, 2022 May 4 (CDT)
}}


{{Data Integrity Check List}}
{{Data Integrity Check List}}
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== Reporting and Analysis ==
== Reporting and Analysis ==
The SAS Program to read the data is in X:\Julie\SAS_CFE\CFE_macros\datetimes.sas
The SAS Program to read the data is in {{S:\MED\CCMED}}Julie\SAS_CFE\CFE_macros\datetimes.sas
 
{{DJ|
* I just had a look at that sas file (they open as text files) to see how you define transfer delay. If that file is still being used we may have a problem, it still defines tdelay different if a pt goes to a higher level of care, goes AMA or dies, and we changed that some time ago. So is this still the reference of how you calculate this? [[User:Ttenbergen|Ttenbergen]] 22:50, 2024 November 16 (CST)
}}


== Legacy ==
== Legacy ==
Retrieved from "https://ccmdb.kuality.ca/index.php?title=ER_Delay"