2020 GRA COVID unit transition: Difference between revisions

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This page is about the transition of collection units at GRAto accommodate the new COVID unit.  
This page is about the transition of collection units at GRA to accommodate the new COVID unit.  


== Background ==
== Background ==
The dates are not yet finalized.
=== Grace Medicine ===
* '''Monday?? April ??.20''' – patients in [[GRA_N5]]  will be moving to  [[GRA_2S]]
* Saturday March 28.20 – start date patients in [[GRA_N5]]  move to  [[GRA_2S]] but not all. Moves are are on staggered basis in April.
* '''?? April ?? .20'''  -  '''5S''' will be a new COVID-19 ward [[GRA_5S_C]] with ?? adult beds
**Wednesday April 15.20 - the decided date as a cut-off for the service_location change
***All admit dates before April 15, 2020 will have service_location = [[GRA_N5]]
*** All admit dates on or after April 15, 2020 and discharge before May 15,2020 will have service_location=[[GRA_2S]]  
* ?? April ?? .20 -  '''5S''' will be a new COVID-19 ward [[GRA_5S_C]] with ?? adult beds
* Friday May15.20 - start date patients in [[GRA_2S]] move back to  [[GRA_N5]]
**All admit dates before April 15, 2020 and discharge after May 15, 2020 will have service_location = [[GRA_N5]]
**All admit dates on or after April 15, 2020 and discharge after May 15, 2020 will have service_location = [[GRA_N5]]


== Transition plan ==
=== GRA MICU ===
# There is no transition plan for the new COVID ward [[GRA_5S_C]] which has already been added to the [[s_dispo table]].
* 2020-10-16 the PACU will not be used as the GRACE ICU COVID Unit unless absolutely necessary. Two NFA theatres in the SDC area next to the ICU are being renovated to accommodate four COVID Positive patients.  I do not know how the beds will be numbered yet, but these 4 beds will be part of the 10 bed census for the GRA ICU, they are not extra beds, just extra isolation rooms.[[User:Gens|Gens]] 07:25, 2020 October 16 (CDT)gens}}
# This transition plan is only for the patients in N5 who were moved to 2S.   
#* [[GRA_2S]] needs to be added to the [[s_dispo table]].
#* [[GRA_N5]] needs to be added to [[s_tmp]] of Project BoardingLoc


=== collector instructions ===
*The GRACE ICU COVID UNIT in the SDC NFA Theatres will potentially be opened on November 6 or November 9, 2020.  There will be 4 isolation beds for COVID-19 positive patients.  They will be labelled as:  ICU NFA 1,ICU NFA 2,ICU NFA 3 and ICU NFA 4.[[User:Gens|Gens]] 11:44, 2020 October 30 (CDT)
 
* 2020-04-14 - [[GH-Recovery Room]] with 15 beds are added to Grace ICU for non-covid pts.  The current [[GRA_MICU]] with 10 beds are for covid pts.
 
== Medicine Situation ==
=== New COVID ward ===
# The new COVID ward is [[GRA_5S_C]] which has already been added to the [[s_dispo table]].
 
===  Transition plan A - from N5 to 2S on and after April 15, 2020 and before May 15 ===
# This transition plan is only for the patients on N5 who were moved to 2S or who remained on N5 under the N5 physicians.
#  [[GRA_N5]] patients discharged '''before April 15''' remain [[GRA_N5]]
# All admission to N5 on or after April 15, 2020 and discharge before May15  will have service_location=[[GRA_2S]]
# All admission to N5 before April 15, 2020 and discharge after May15  will have service_location=[[GRA_N5]] - refer to case#1 in  Transition plan B
 
=== Collector Instructions for Transition Plan A ===
# change the [[Service/Location]] of the record to the new location (ie from [[GRA_N5]] to [[GRA_2S]] )
# change the [[Service/Location]] of the record to the new location (ie from [[GRA_N5]] to [[GRA_2S]] )
# enter the actual location as part of [[Boarding Loc]]:  
# enter the actual location as part of [[Boarding Loc]]:  
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#* if there were patients who actually were in a borrow location during the transition, let's talk about how we would enter those
#* if there were patients who actually were in a borrow location during the transition, let's talk about how we would enter those


===  Transition plan B - from 2S to N5 on and after May 15, 2020 ===
# This transition plan is only for the patients with service_location= [[GRA_2S]] who were 1) moved back to [[GRA_N5]] or 2) boarding on N5  under the N5 physicians.
#* Identify the patient who stayed the 1) whole time at 5N  with service_location=[[GRA_2S]]
#* Identify the patient who stayed the 2) whole time at 2S  with service_location=[[GRA_2S]]
#* Identify the patient who stayed 3) first in N5 and then moved to 2S with service_location=[[GRA_2S]]
#* Identify the patient who stayed 4) first in 2S and then moved to N5 with service_location=[[GRA_2S]]
# All new patients admitted after May 15, 2020 on N5 will have service_location= [[GRA_N5]] and follow the usual guideline in tmp


{{Discuss|
=== Collector Instructions for Transition Plan B ===
*5North is NOT a boarding location. It's still a regular sub acute medicine ward. Yes the patients are Covid suspects we think due to being  Exposed but this is not confirmed. No boarders here [[User:Mcrawley|Mcrawley]] 15:15, 2020 April 14 (CDT)
# For patients Discharged before May 15, 2020
**Are there new patients admitted at N5 (primarily as COVID suspects)? --[[User:JMojica|JMojica]] 16:01, 2020 April 14 (CDT)}}
#* For cases in #1 - change the [[Service/Location]] from [[GRA_2S]] to [[GRA_N5]] and in tmp change the line "GRA_N5" to "no borrow" and delete the date and time
#* For cases in #2 - keep the [[Service/Location]]= [[GRA_2S]] and in tmp "no borrow"
#* For cases in #3 - keep the [[Service/Location]]= [[GRA_2S]] and keep in tmp line "GRA_N5" and date/time the patient arrived in N5 and the line for "GRA - Home medicine ward" with the time that the patient was actually moved
# For patients Discharged on or after May 15, 2020  
#* For cases in #1 - change the [[Service/Location]] from [[GRA_2S]] to [[GRA_N5]] and in tmp change the line "GRA_N5" to "no borrow" and delete the date and time
#* For cases in #4 - change the [[Service/Location]] from [[GRA_2S]] to [[GRA_N5]] and in tmp add line "GRA_2S" and date/time the patient arrived in 2S and the line for "GRA - Home medicine ward" with the time that the patient was actually moved to N5


== Outstanding issues ==
===N5 COVID suspect ward===
I have spoken with Richard Q the manager on the 5th floor today and this is what he has told me:
This ward is a mix of different medicine patients ie. 3S, 2S, and 3N patients, therefore each data collector will enter their own patients
* As of right now, they still don't have confirmation on the designated COVID units, but at this time, 5N is being used for COVID SUS and 5S is being used for COVID POS admissions. Currently according to EPR there are 2 positive cases admitted to 5S.
* Over the past week, there has been a lot of movement from 5N to 2S, which in the past was where our boarders were moved to. When I asked Richard, he indicated that 2S has become the "clean" medicine unit. Again, this is all yet to be confirmed by GH and/or WRHA.
* Currently, there is 1 doctor who has taken on the COVID patients, but again, this could be temporary and may change over time depending on what the demand is.
* Unless they are labeled COVID POS in EPR, there is no way for us to know what the swab results return as. This information will only be gathered once the chart is available in Medical Records. If you would like to grant us the ability to go to eChart to review, I'll leave that to the powers that be to decide. My understanding is in this Data Collector role, we are no to review records in eChart.


{{Discuss |
# the [[Service/Location]] will be your home ward location
* For the patients who have been moved from [[GRA N5]] to [[GRA 2S]] - I have been tracking these as boarders. Do you want me to continue in this manner? [[User:Surbanski|Surbanski]] 14:42, 2020 April 8 (CDT)
# in the tmp the [[Boarding Loc]] will be N5
** Julie? Ttenbergen 14:59, 2020 April 14 (CDT) 
#  if the patient's result is negative and they are moved back to their home ward then enter [[Boarding Loc]] GRA home medicine ward with the date and time they are transferred back
*** refer to the transition instruction. --[[User:JMojica|JMojica]] 16:02, 2020 April 14 (CDT)}}
#  if the patient's result is positive,and if they do not physically move to S5 and remain on N5 then no change is required, if they move to S5 create a new profile for using [[Service Location]] 5S_C


{{Discuss |
===Special Circumstances===
* For the POS patients who have moved from 5N to 5S - How do we want to track these? There is a dispo location to this unit, but I don't yet see a Service Location for this unit (unless Tina/Julie are still working on this step and it is yet to come). [[User:Surbanski|Surbanski]] 14:42, 2020 April 8 (CDT)
When Reviewing a chart in MR and you find a COVID positive or  COVID suspect patient that occurred BEFORE the new COVID positive/suspect wards were opened, use [[Service Location]] home ward location and use the appropriate [[COVID-19 (SARS-COV-2)]] or [[Observation for suspected infection NOS]] code.
** Made [[GRA_5S_C]] available for collection now. Sorry, I missed a step earlier for this. If you van now enter this please delete the question, otherwise put a comment that this is still an issue. Ttenbergen 14:59, 2020 April 14 (CDT)
}}


{{Discuss |
When reviewing a chart in MR and you find a COVID suspect patient on your home ward and the patient is transferred to another location where the diagnosis of COVID positive is made, check the date/time the swab was sent. If it was sent less than 48 hours after admission code this as an [[Admit Diagnosis]], if the swab was sent greater than 48 hours after admission code this as an [[Acquired Diagnosis]]
* I would like some direction on how to proceed - I didn't know that my medicine unit (5N) was transitioned into a COVID floor. I've been entering and tracking the 5N admissions and 2S boarders. I know it's difficult to make decisions when no one really knows what's going on, but before I get too deep in COVID I'd like to have some direction to avoid duplication of work (i.e. having a profile for a 5N admission and a second profile for a 5S admission if we decide to track them).[[User:Surbanski|Surbanski]] 14:42, 2020 April 8 (CDT)
** do you mean both N5 and 5S are COVID wards, please confirm because we need to distinguish the N5 as acute med unit vs N5 as covid ward.  Covid ward(s) will be reported separately from the other med wards. thanks. --[[User:JMojica|JMojica]] 16:23, 2020 April 14 (CDT)
}}


{{Discuss |
=== Serial Number===
* I have another question - currently I am recording data and admissions on 5N (as per the current process), which we are assuming is the COVID SUS ward. Some of these patients are discharged from the ward after a couple of days once (I assume) their swab results are back negative. If we're not interested in collecting for COVID SUS, then we need to change the process for data entry on this unit. Technically, my 5N medicine patients are admitted on 2S, which are now all being labelled as "Boarders". I'm not sure what that would look like but I'm open to a discussion with whoever it would be who would decide this. [[User:Surbanski|Surbanski]] 08:57, 2020 April 9 (CDT)
# For transition unit (ie. N5 to 2S or 2S to N5) use your continuous serial numbers
}}
# For 5S_C start with serial number 150


== Reporting ==
=== Examples of Entries ===
service location [[GRA_N5]] before ?? and [[GRA_2S]] can be reported together.
If in the documentation from ER it says that a COVID swab was sent and they do NOT indicate the result, we assume they were admitted to whichever ward as COVID SUS
* If they were admitted to 5N, service location= home ward location (3N, 3S or 2S), boarding loc in tmp= 5N
* If they’re admitted to their home ward, Service Location = home ward (3N, 3S, 2S), no boarding loc in tmp is necessary, unless they are transferred to 5N at some point during their stay
* If they’re swabbed positive, the initial profile will be discharged to 5S_C, and a new profile will be created Service Location= 5S_C, and if they’re physically anywhere other than 5S_C use their home ward location.
** We do not follow surgery patients that are COVID suspect unless they are under the care of medicine


== Cross checks ==
== ICU Situation ==
{{Discuss |
*The current Grace ICU will be the COVID unit. A new 15 bed ICU has been set up in the [[GH-Recovery Room]] area, this will be the non-covid ICU.
* We have no [[CCMDB.accdb Data Integrity Checks]] yet for [[Boarding Loc]] , so that won’t limit our options. Is this the time to add cross-checks?
}}


{{Discuss |
== Reporting ==
* Have not yet checked how this will impact [[CFE Data Integrity Checks]]. Pagasa, of the top of your head which would be impacted and how? 
* Service location [[GRA_N5]] and [[GRA_2S]] are reported together.
}}
* Service location [[GH-Recovery Room]] and [[GRA_MICU]] are reported together.


== Related articles ==  
== Related articles ==  
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[[Category: 2020 COVID unit transition]]
[[Category:2020 COVID unit transition]]
[[Category: Legacy Data Collection]]
[[Category:Legacy Data Collection]]

Latest revision as of 11:29, 30 July 2025

This page is about the transition of collection units at GRA to accommodate the new COVID unit.

Background

Grace Medicine

  • Saturday March 28.20 – start date patients in GRA_N5 move to GRA_2S but not all. Moves are are on staggered basis in April.
    • Wednesday April 15.20 - the decided date as a cut-off for the service_location change
      • All admit dates before April 15, 2020 will have service_location = GRA_N5
      • All admit dates on or after April 15, 2020 and discharge before May 15,2020 will have service_location=GRA_2S
  • ?? April ?? .20 - 5S will be a new COVID-19 ward GRA_5S_C with ?? adult beds
  • Friday May15.20 - start date patients in GRA_2S move back to GRA_N5
    • All admit dates before April 15, 2020 and discharge after May 15, 2020 will have service_location = GRA_N5
    • All admit dates on or after April 15, 2020 and discharge after May 15, 2020 will have service_location = GRA_N5

GRA MICU

  • 2020-10-16 the PACU will not be used as the GRACE ICU COVID Unit unless absolutely necessary. Two NFA theatres in the SDC area next to the ICU are being renovated to accommodate four COVID Positive patients. I do not know how the beds will be numbered yet, but these 4 beds will be part of the 10 bed census for the GRA ICU, they are not extra beds, just extra isolation rooms.Gens 07:25, 2020 October 16 (CDT)gens}}
  • The GRACE ICU COVID UNIT in the SDC NFA Theatres will potentially be opened on November 6 or November 9, 2020. There will be 4 isolation beds for COVID-19 positive patients. They will be labelled as: ICU NFA 1,ICU NFA 2,ICU NFA 3 and ICU NFA 4.Gens 11:44, 2020 October 30 (CDT)
  • 2020-04-14 - GH-Recovery Room with 15 beds are added to Grace ICU for non-covid pts. The current GRA_MICU with 10 beds are for covid pts.

Medicine Situation

New COVID ward

  1. The new COVID ward is GRA_5S_C which has already been added to the s_dispo table.

Transition plan A - from N5 to 2S on and after April 15, 2020 and before May 15

  1. This transition plan is only for the patients on N5 who were moved to 2S or who remained on N5 under the N5 physicians.
  2. GRA_N5 patients discharged before April 15 remain GRA_N5
  3. All admission to N5 on or after April 15, 2020 and discharge before May15 will have service_location=GRA_2S
  4. All admission to N5 before April 15, 2020 and discharge after May15 will have service_location=GRA_N5 - refer to case#1 in Transition plan B

Collector Instructions for Transition Plan A

  1. change the Service/Location of the record to the new location (ie from GRA_N5 to GRA_2S )
  2. enter the actual location as part of Boarding Loc:
    • for patients who had no location borrowing during transition:
      • change the "no borrow" line to "GRA_N5" and enter the time the patient arrived in N5
      • add a line for "GRA - Home medicine ward" with the time that the patient was actually moved
    • if there were patients who actually were in a borrow location during the transition, let's talk about how we would enter those

Transition plan B - from 2S to N5 on and after May 15, 2020

  1. This transition plan is only for the patients with service_location= GRA_2S who were 1) moved back to GRA_N5 or 2) boarding on N5 under the N5 physicians.
    • Identify the patient who stayed the 1) whole time at 5N with service_location=GRA_2S
    • Identify the patient who stayed the 2) whole time at 2S with service_location=GRA_2S
    • Identify the patient who stayed 3) first in N5 and then moved to 2S with service_location=GRA_2S
    • Identify the patient who stayed 4) first in 2S and then moved to N5 with service_location=GRA_2S
  2. All new patients admitted after May 15, 2020 on N5 will have service_location= GRA_N5 and follow the usual guideline in tmp

Collector Instructions for Transition Plan B

  1. For patients Discharged before May 15, 2020
    • For cases in #1 - change the Service/Location from GRA_2S to GRA_N5 and in tmp change the line "GRA_N5" to "no borrow" and delete the date and time
    • For cases in #2 - keep the Service/Location= GRA_2S and in tmp "no borrow"
    • For cases in #3 - keep the Service/Location= GRA_2S and keep in tmp line "GRA_N5" and date/time the patient arrived in N5 and the line for "GRA - Home medicine ward" with the time that the patient was actually moved
  2. For patients Discharged on or after May 15, 2020
    • For cases in #1 - change the Service/Location from GRA_2S to GRA_N5 and in tmp change the line "GRA_N5" to "no borrow" and delete the date and time
    • For cases in #4 - change the Service/Location from GRA_2S to GRA_N5 and in tmp add line "GRA_2S" and date/time the patient arrived in 2S and the line for "GRA - Home medicine ward" with the time that the patient was actually moved to N5

N5 COVID suspect ward

This ward is a mix of different medicine patients ie. 3S, 2S, and 3N patients, therefore each data collector will enter their own patients

  1. the Service/Location will be your home ward location
  2. in the tmp the Boarding Loc will be N5
  3. if the patient's result is negative and they are moved back to their home ward then enter Boarding Loc GRA home medicine ward with the date and time they are transferred back
  4. if the patient's result is positive,and if they do not physically move to S5 and remain on N5 then no change is required, if they move to S5 create a new profile for using Service Location 5S_C

Special Circumstances

When Reviewing a chart in MR and you find a COVID positive or COVID suspect patient that occurred BEFORE the new COVID positive/suspect wards were opened, use Service Location home ward location and use the appropriate COVID-19 (SARS-COV-2) or Observation for suspected infection NOS code.

When reviewing a chart in MR and you find a COVID suspect patient on your home ward and the patient is transferred to another location where the diagnosis of COVID positive is made, check the date/time the swab was sent. If it was sent less than 48 hours after admission code this as an Admit Diagnosis, if the swab was sent greater than 48 hours after admission code this as an Acquired Diagnosis

Serial Number

  1. For transition unit (ie. N5 to 2S or 2S to N5) use your continuous serial numbers
  2. For 5S_C start with serial number 150

Examples of Entries

If in the documentation from ER it says that a COVID swab was sent and they do NOT indicate the result, we assume they were admitted to whichever ward as COVID SUS

  • If they were admitted to 5N, service location= home ward location (3N, 3S or 2S), boarding loc in tmp= 5N
  • If they’re admitted to their home ward, Service Location = home ward (3N, 3S, 2S), no boarding loc in tmp is necessary, unless they are transferred to 5N at some point during their stay
  • If they’re swabbed positive, the initial profile will be discharged to 5S_C, and a new profile will be created Service Location= 5S_C, and if they’re physically anywhere other than 5S_C use their home ward location.
    • We do not follow surgery patients that are COVID suspect unless they are under the care of medicine

ICU Situation

  • The current Grace ICU will be the COVID unit. A new 15 bed ICU has been set up in the GH-Recovery Room area, this will be the non-covid ICU.

Reporting

Related articles

Related articles:
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