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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. |
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| == Background == | | == Background == |
| The dates are not yet finalized.
| | === 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. | | * 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]] |
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| {{Discuss|
| | === GRA MICU === |
| * Patients that were on [[GRA N5]] began moving to [[GRA 2S]] on March 28. It was a staggered move, and because we're not going to the wards to review charts, I can't say for sure if there was a reason why that was. For example, one patient was admitted to [[GRA N5]] in February and was moved to [[GRA 2S]] on March 28. Another was admitted Jan 14 and was moved April 7. EPR doesn't give any clues as to why they were staggered this way (if there was a medical reason why they stayed behind). | | * 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}} |
| * We have confirmed with one of the doctors that [[GRA 2S]] IS a non-teaching medicine ward with the 2 doctors that previously covered [[GRA N5]]. So yes, [[GRA 2S]] is what [[GRA N5]] was pre-COVID. <!-- added to [[GRA 2S]] -->
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| * I don't know what bed capacity [[GRA N5]] and [[GRA_5S_C]] will have but I do know that
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| ** everyone COVID SUS or COVID POS will default to [[GRA N5]]] <!-- added to GRA_N5 -->
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| ** If they have more than 2 POS admissions, they will open [[GRA_5S_C]] <!-- added to [[GRA_5S_C]] -->
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| ** We're assuming if a COVID SUS is swabbed negative, they will be moved to [[GRA 2S]]. Currently there is 1 admission on [[GRA N5]] that are not labelled COVID in EPR, so again, I don't know if there's another medical reason why they stayed behind.
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| * The COVID POS patients are usually under the internist that admitted them unless they are coming from ICU (COVID POS patients are under internal medicine).
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| * The COVID SUS patients are under the medicine doctor that admitted them (general medicine) [[User:Surbanski|Surbanski]] 09:09, 2020 April 15 (CDT)}}
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| #Julie wrote: Tina, Trish – we need to decide how to handle the COVID suspects admitted at N5 -
| | *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) |
| #*1. If the result is negative and patient moves to 2S – a case of transition, Service_location change from GRA_N5 to GRA_2S
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| #**Tina- If we change the service location Pagasa will get orphans
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| #*2. If the result is negative and patient did not move to 2S but somewhere else - ??? Service_location = GRA_N5 - keep as is
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| #*3. If the result is positive and patient moves to 5S – new record Service_location= GRA_5S
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| #**Tina- If we change the service location Pagasa will get orphans.
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| #*4. If the result is positive and patient remains in N5 - ??? Service_location=GRA_N5_C – added _C to denote covid positive
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| #**Tina- Unless other collectors also get this right, this will cause linking errors
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| #*Items 1 and 3 - no issue. Items 2 and 4 – need to decide, do you agree with the red entry. If so, need to add item 4 entry (was added already because I thought we had decided to use it) OR you have other thoughts?
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| #*DC - will it be easy to distinguish the negative and positive at N5?
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| #Sherry-we won’t know until their charts are physically in medical records. Cadham does not put the swab results on EPR and we have no way of knowing the results. As of right now, Trish has given us the direction to NOT go to the wards to view charts.
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| #*Tina-We would not likely be able to use eChart for this. When we looked into this before the answer was that eChart is only allowed to be used for direct patient care activities. I have contacted Allan to see if there is another option.
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| # Lisa
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| #*1. If Sherry and Mindy are dividing workload on 5N by provider (so it can be and is currently a mix of 5N patients, one 3S patient and one 3N patient) , then a negative covid (moved to its home location) is just an extension of the same admission. by transition Julie do you mean use the transition instructions on the wiki for the moves from 5N to 2S? Would Mindy do the same for a negative that then transfers back to 3N? or a patient that goes back to 3S? (BTW we are not doing any of this at HSC for our COVID suspects we enter our home location and just put the D2 in the tmp boarding and if they transfer back to our home ward we use the medicine home ward option in the tmp, we have not been instructed otherwise)
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| #*2. If the result is negative and the patient and moves somewhere else wouldn't that be boarding?, if they stay under medicine but not on a medicine ward
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| #*3. if positive and move to 5S I think Julie means create a new profile with service location 5S
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| #*4. Makes sense to add a new location 5N_c but how will they handle those cases if 5S opens up because there are more than 2 patients and the patient then moves from 5N_C to 5S, is this a new profile? or track in tmp? [[User:Lkaita|Lisa Kaita]] 11:28, 2020 April 15 (CDT)
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| #Mindy
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| #*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)
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| #**Are there new patients admitted at N5 (primarily as COVID suspects)? --[[User:JMojica|JMojica]] 16:01, 2020 April 14 (CDT)
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| #***On closer inspection the new people being admitted to this ward are all Covid suspects, was hard to tell at first because patients that stayed on this ward were 5 North patients. So it looks like the new patients on the ward are boarders[[User:Mcrawley|Mcrawley]] 08:01, 2020 April 15 (CDT)
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| == Transition plan == | | * 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. |
| # There is no transition plan for the new COVID ward [[GRA_5S_C]] which has already been added to the [[s_dispo table]]. | | |
| # This transition plan is only for the patients in N5 who were moved to 2S or who remained on N5 under the N5 physicians. | | == Medicine Situation == |
| #* [[GRA_2S]] needs to be added to the [[s_dispo table]]. | | === New COVID ward === |
| #* [[GRA_N5]] needs to be added to [[s_tmp]] of Project BoardingLoc | | # The new COVID ward is [[GRA_5S_C]] which has already been added to the [[s_dispo table]]. |
| {{Discuss|* Maybe we need to add GRA_2S as a s_tmp of Project BoardingLoc as well since there are random medicine patients there like from 3South?[[User:Mcrawley|Mcrawley]] 12:22, 2020 April 15 (CDT
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| ** is this case also started at 5N as suspect or started at 2S? the date gives the clue. if date is before the move of N5 to 2S, then enter generic GRA boarding. let us know before we decide to add it as another tmp item. --[[User:JMojica|JMojica]] 13:53, 2020 April 15 (CDT))}}
| | === Transition plan A - from N5 to 2S on and after April 15, 2020 and before May 15 === |
| === collector instructions === | | # 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 |
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| | === 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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| #** add a line for "GRA - Home medicine ward" with the time that the patient was actually moved | | #** 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 | | #* if there were patients who actually were in a borrow location during the transition, let's talk about how we would enter those |
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| | === 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 |
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| | === Collector Instructions for Transition Plan B === |
| | # 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 |
| | # 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 |
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| ===N5 COVID suspect ward=== | | ===N5 COVID suspect ward=== |
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| # in the tmp the [[Boarding Loc]] will be N5 | | # in the tmp the [[Boarding Loc]] will be N5 |
| # 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 | | # 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 |
| # if the patient's result is positive, create a new profile using S5 as [[Service/Location]] if they do not physically move to S5 and remain on N5 then enter [[Boarding Loc]] N5 with the date and time closest to the positive result, if or when they move to S5 enter [[Boarding Loc]] Gra home medicine ward with the date and time they are transferred to S5 | | # 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 |
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| == Outstanding issues ==
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| I have spoken with Richard Q the manager on the 5th floor today and this is what he has told me:
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| * 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.
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| * 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.
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| * 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.
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| * 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.
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| {{Discuss |
| | ===Special Circumstances=== |
| * 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)
| | 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. |
| ** Julie? Ttenbergen 14:59, 2020 April 14 (CDT)
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| *** refer to the transition instruction. --[[User:JMojica|JMojica]] 16:02, 2020 April 14 (CDT)}}
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| {{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]] |
| * 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)
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| ** 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)
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| {{Discuss |
| | === Serial Number=== |
| * 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)
| | # For transition unit (ie. N5 to 2S or 2S to N5) use your continuous serial numbers |
| ** 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)
| | # For 5S_C start with serial number 150 |
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| {{Discuss |
| | === Examples of Entries === |
| * 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)
| | 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 |
| **are these covid suspects under the medicine service? this will be a bit tricky if being taken care by medicine service. should it be considered as 2S medicine service borrowing bed at 5N, so it will not be missed? --[[User:JMojica|JMojica]] 16:30, 2020 April 14 (CDT)}} | | * 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 |
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| {{Discuss|
| | == ICU Situation == |
| *This just in .... as we're going through our admissions guess what we've found on 2S? Patients admitted under 3S doctors! Are we having fun yet? | | *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. |
| ** I'll be admitting these folks on 3S and have them boarding on 2S. There are no COVID flags on their EPR accounts.
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| [[User:Surbanski|Surbanski]] 11:30, 2020 April 15 (CDT)}} | |
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| == Reporting == | | == Reporting == |
| service location [[GRA_N5]] before ?? and [[GRA_2S]] can be reported together.
| | * Service location [[GRA_N5]] and [[GRA_2S]] are reported together. |
| | | * Service location [[GH-Recovery Room]] and [[GRA_MICU]] are reported together. |
| == Cross checks ==
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| {{Discuss |
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| * 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? | |
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| {{Discuss |
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| * 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?
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| }}
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| == 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]] |