Previous Service field: Difference between revisions

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~~''This field is currently being implemented~~, ~~please check the instructions and put a discussion for anything that isn't clear~~. ''

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)

The ~~[[Previous_Service field]] contains info about the physician~~ service the ~~patient was admitted under prior to admission~~ to ~~the~~ [[Service/Location field| current location]].

{{Data element

|field_name=Previous_Service

|CCMDB_label=Previous Service

|CCMDB_tab=Dispo

|in_table=L_Log table

|data_type=number

|datafield_length=long integer

|program_collecting=Med and CC

|created_raw=Raw

|data_element_start_date=2016-07-01

|data_element_end_date=2022-09-07

|data_element_sort_index=38

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

}}

== Collection Instruction ==

For each patient,

*For each patient enter the option that most closely matches

* enter the option that most closely matches

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

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

** For ICU-to-ICU moves, code "Critical Care" if no other specific service is documented

** ~~for~~ ICU-to-ICU moves, code "Critical Care" if no other specific service is documented

** For pt from ER, code "Emergency Medicine" unless a different service had accepted them and is handing them off to Medicine

** ~~for~~ pt from ER, code "Emergency Medicine" unless a different service had accepted them and is handing them off to Medicine

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

* ~~for~~ pt direct from ambulatory ~~care~~ not via ER, code "not applicable"

* Patients admitted after having a problem during an outpatient procedure are more complicated:

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

**Such procedures include outpatient: GI endoscopy, bronchoscopy, cardiac cath, invasive radiology, procedures done at surgicentres, etc.

** in these cases we don't care about the details; if we see too many others we may add additional options in future

**If the patient goes DIRECTLY from the outpatient procedure area to a Medicine ward or an ICU, then code the type of physician who was doing the procedure:

***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 before being admitted to hospital the patient was sent from the procedure area to the ED:

***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:

** [[Previous Location]]=dialysis

** [[Previous Service]]=ED

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

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

** [[Previous Location]]=dialysis

** [[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 ===

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

~~{{discussion}}~~

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]].

*currently we treat ~~these pts as discharges or readmits from Grace~~ Nursing Home ~~ie not~~ as ~~a continuous~~ admission ~~or interhospital transfer~~. ~~These pts are covered~~ by ~~one~~ of the ~~Medicine attendings while here~~. ~~Do you want~~ the previous service to be ~~entered~~ as ~~Medicine~~ then? [~~User:SCortilet|Scortilet~~]]

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

** still waiting to ~~hear back~~ from ~~Julie~~ on ~~that~~. ~~Ttenbergen 13:23~~, ~~2016 May 11 (CDT)~~

===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".

=== Direct admit ===

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.

{{Ex|

* 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]]

== Data Use ==

~~Used to be:~~

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.

* [[ER_Wait#Reporting_and_Analysis]]

* Sending service to ICU will be reported to the Critical Care Director.

== {{~~CCMDB~~ Data Integrity ~~Checks~~}} ==

== Integrity checks ==

~~Can't be empty.~~

== Implementation ==

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Line 102:

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

For '''critical care''' this concept is related to [[Service Sending to ICU]].

For '''critical care''' this concept is related to [[Service Sending to ICU]] - refer to Task Meeting minutes dated June 11, 2015.

*see updated minutes dated August 24, 2017.

== Related articles ==

[[Category: 2016 Time and Place changes]]

[[Category:2016 Time and Place changes]]

[[Category: Admit/Discharge]]

[[Category:Admit/Discharge]]

[[Category:Data Collection Guide]]

@@ Line 1: / Line 1: @@
- ''This field is currently being implemented, please check the instructions and put a discussion for anything that isn't clear. ''
+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)
-The [[Previous_Service field]] contains info about the physician service the patient was admitted under prior to admission to the [[Service/Location field| current location]].
+{{Data element
+|field_name=Previous_Service
+|CCMDB_label=Previous Service
+|CCMDB_tab=Dispo
+|in_table=L_Log table
+|data_type=number
+|datafield_length=long integer
+|program_collecting=Med and CC
+|created_raw=Raw
+|data_element_start_date=2016-07-01
+|data_element_end_date=2022-09-07
+|data_element_sort_index=38
+|element_description=The most recent "originating service" which sends the patients to their [[Service/Location field| current service location]].
+}}
 == Collection Instruction ==
-For each patient,
+*For each patient enter the option that most closely matches
-* enter the option that most closely matches
+** For medicine ward-to-ward moves, code "medicine" as previous service
-** for medicine ward-to-ward moves, code "medicine" as previous service
+** For ICU-to-ICU moves, code "Critical Care" if no other specific service is documented
-** for ICU-to-ICU moves, code "Critical Care" if no other specific service is documented
+** For pt from ER, code "Emergency Medicine" unless a different service had accepted them and is handing them off to Medicine
-** for pt from ER, code "Emergency Medicine" unless a different service had accepted them and is handing them off to Medicine
+** For pt direct from '''ambulatory''' not via ER, code "not applicable" if no other specific service is documented
-* for pt direct from ambulatory care not via ER, code "not applicable"
+* Patients admitted after having a problem during an outpatient procedure are more complicated:
-* if the service is not listed, code "other (known but not on list)"
+**Such procedures include outpatient:  GI endoscopy, bronchoscopy, cardiac cath, invasive radiology, procedures done at surgicentres, etc.
-** in these cases we don't care about the details; if we see too many others we may add additional options in future
+**If the patient goes DIRECTLY from the outpatient procedure area to a Medicine ward or an ICU, then code the type of physician who was doing the procedure:
+***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 before being admitted to hospital the patient was sent from the procedure area to the ED:
+***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:
+** [[Previous Location]]=dialysis
+** [[Previous Service]]=ED
+** [[Pre-admit Inpatient Institution]]=n.a.
+* Came to dialysis from a prior, different, inpatient location:
+** [[Previous Location]]=dialysis
+** [[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 ===
@@ Line 17: / Line 58: @@
 === Nursing Home Wards (HSC/GRA)===
-{{discussion}}
+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]].
-*currently we treat these pts as discharges or readmits from Grace Nursing Home ie not as a continuous admission or interhospital transfer.  These pts are covered by one of the Medicine attendings while here.  Do you want the previous service to be entered as Medicine then? [User:SCortilet|Scortilet]]
+This does not affect the [[Visit Admit DtTm field]] definition - remember, that is defined by EPR entry.
-** still waiting to hear back from Julie on that. Ttenbergen 13:23, 2016 May 11 (CDT)
+===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".
+=== Direct admit ===
+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.
+{{Ex|
+* 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]]
 == Data Use ==
-Used to be:
+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.
-* [[ER_Wait#Reporting_and_Analysis]]
-* Sending service to ICU will be reported to the Critical Care Director.
-== {{CCMDB Data Integrity Checks}} ==
+== Integrity checks ==
-Can't be empty.
+{{Data Integrity Check List}}
 == Implementation ==
@@ Line 35: / Line 102: @@
 For '''medicine''' this concept is related to [[ER Wait]].
-For '''critical care''' this concept is related to [[Service Sending to ICU]].
+For '''critical care''' this concept is related to [[Service Sending to ICU]] - refer to Task Meeting minutes dated June 11, 2015.
+*see updated minutes dated August 24, 2017.
+== Related articles ==
+{{Related Articles}}
-[[Category: 2016 Time and Place changes]]
+[[Category:2016 Time and Place changes]]
-[[Category: Admit/Discharge]]
+[[Category:Admit/Discharge]]
+[[Category:Data Collection Guide]]