Previous Service field: Difference between revisions

Collection stopping as per [[Task_Team_Meeting_-_Rolling_Agenda_and_Minutes_2022#ICU_Database_Task_Group_Meeting_%E2%80%93_August_24,_2022]]. [[User:Ttenbergen|Ttenbergen]] 16:00, 2022 September 7 (CDT)

|element_description=The most recent "originating service" which sends the patients to their [[Service/Location field| current service location]].

*For each patient enter the option that most closely matches

** For medicine ward-to-ward moves, code "medicine" as previous service  

** For pt direct from '''ambulatory''' not via ER, code "not applicable" if no other specific service is documented

***if, for example, it was a GI endoscopy, then the previous service was "GI", but as GI is not specifically listed in the dropdown list of services, then list it as "other"

***if the patient was actually an ED patient (under the care of the ED docs) then code "Emergency Medicine"  

***if, for example, it was a GI endoscopy and the patient was not actually under ED care, but instead was directly admitted to the ED on the Medicine ward service, then the previous service was "Medicine"

* If the service is not listed, code "other (known but not on list)"

** in these cases we don't care about the details; if we see too many others we may add additional options in future (as of January 2022 we checked and these account for <1% of all previous services)

===From HD / From hemodialysis===

* Came to dialysis from being an outpatient: 

** [[Previous Location]] =dialysis 

** [[Previous Service]]=Nephrology

** [[Pre-admit Inpatient Institution]]=n.a.

* Came to dialysis from ED: 

** [[Pre-admit Inpatient Institution]]=n.a.

* Came to dialysis from a prior, different, inpatient location:

** [[Previous Service]]=service of that prior inpatient location

** [[Pre-admit Inpatient Institution]]=that prior inpatient location

===From Cardiac Cath Lab===

*A patient goes to emergency, then is sent to the cardiac cath lab for an angiogram. Julie would like the sending service to be Emergency Medicine in these cases (not cardiology). Discussed at the task group meeting on July 20, 2017.

*Most patients come to CCU or ICU via the heart cath as a code stemi, in which case the previous service is cardiology because they bypass ER and go direct to the heart cath lab.

*The previous service is who was looking after the pt before the heart cath in some situations. For example, if ECMO is done in the heart cath lab : If the pt was on a ward or unit prior to the procedure, the service is whatever ward or unit it was that sent the pt there. If ER sends a pt for a VV ECMO, the ER is the sending service, unless ICU takes over the pt prior to the ECMO. (They would need to consult cardiac surgery for the ecmo procedure but it would be the ICU that takes over the care ultimately). 

This was discussed at the task group meeting on June 21, 2017.

=== from OR ===

If a patient comes from an OR/RR, code the responsible surgical service as previous service.  

=== Nursing Home Wards (HSC/GRA)===

We treat patients that went through the HSC/GRA Nursing Home as having been discharged. So, admission from there should be as if admitted from home, so put "not applicable" into the [[Previous Service field]].

This does not affect the [[Visit Admit DtTm field]] definition - remember, that is defined by EPR entry.

===Admit from home===

For an admission directly from home bypassing the ER enter Previous Service = 'Not applicable'.

=== from EMIP via ER ===

The case of VIC ER to STB EMIP to VIC ER to VIC Ward is a bit tricky because STB EMIP signify being an inpatient under Medicine service before going to VIC ER. WIKI defines Previous Service as the "originating service" for those patient's who where already in a prior inpatient location. It would be easier to define the previous service if this is a case of direct transfer to VIC Medicine service and parked only in VIC ER. This is a good question - which to use, Emergency Medicine or Medicine? Since it is known that there is prior inpatient service, I am more on the second one 'Medicine'. This can be a similar case when the previous location is Operating or Recovery and the responsible surgical service is coded as previous service. If coming from home to another ER to own ER to own Ward, then previous service is clearly Emergency medicine.

=== admission from a unit partly collected by us ===  

see [[Previous_Location_field#from_a_unit_that_is_partly_collected_by_us.2C_and_partly_not]].

=== admission from a nursing station ===

*For a direct admission to a collection unit from nursing stations, put "other (known, but not on list)".

*If from a nursing station, patient dropped by ER , put "Emergency Medicine".

For a direct admit via the ER, the [[Previous Service]] will be the primary service looking after the patient, prior to admission at your facility. 

* direct admit from Steinbach ER, [[Previous Service]] = emergency

* direct admit from Steinbach ward, [[Previous Service]] = medicine or family medicine

=== Urgent Care ===

For patients directly admitted from urgent care, code previous service as "Emergency Medicine".

=== [[Clinical Assessment Unit]]s ===

Specific instructions apply for coding previous service for the specific CAUs. See

* [[GRA CAU#Collection instructions]]

* [[HSC CAU#Collection instructions]]

* [[STB CAU#Collection instructions]]

Sending service to ICU will be reported to the Critical Care Director whose interest is to determine the sending services for patients who where already in a prior ''inpatient location'' before coming to ICU (refer to minutes of Task Meeting dated 13 April 2015 and 11June 2015).  The  data to be reported will be filtered  to include only those in-patients prior to ICU.

== Integrity checks ==

{{Data Integrity Check List}}

== Implementation ==

The field is populated with options from the [[s_previous_service table]].

== Legacy ==

For '''medicine''' this concept is related to [[ER Wait]].  

[[Category:2016 Time and Place changes]]

[[Category:Admit/Discharge]]

[[Category:Data Collection Guide]]