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{{Data_element
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)
| field_name = Previous_Service
 
| CCMDB_label = Previous Service
{{Data element
| CCMDB_tab = Dispo
|field_name=Previous_Service
| element_description = The most recent "originating service" for those patient's who where already in a prior ''inpatient location'' before coming to their [[Service/Location field| current service location]].
|CCMDB_label=Previous Service
| in_table = L_Log
|CCMDB_tab=Dispo
| data_type = number
|in_table=L_Log table
| datafield_length = long integer
|data_type=number
| program_collecting = Med and CC
|datafield_length=long integer
| created_raw = Raw
|program_collecting=Med and CC
| data_element_start_date = 2016-07-01
|created_raw=Raw
| data_element_sort_index = 38
|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]].
}}
}}


{{discussion}}
== Collection Instruction ==
*This definition seems to exclude Emergency so why is emergency medicine even in the previous service list? Emergency is not an inpatient location).
*For each patient enter the option that most closely matches
** CCMDB makes sure nothing is left blank, so we needed to enter something in here. You are right, though, we should adjust the defnition accordingly. Could you please and then take this out? Ttenbergen 18:10, 2017 July 26 (CDT)
** 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 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
* Patients admitted after having a problem during an outpatient procedure are more complicated:
**Such procedures include outpatient:  GI endoscopy, bronchoscopy, cardiac cath, invasive radiology, procedures done at surgicentres, etc.
**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)


== Collection Instruction ==
===From HD / From hemodialysis===
For each patient,
* Came to dialysis from being an outpatient: 
* enter the option that most closely matches
** [[Previous Location]] =dialysis 
** for medicine ward-to-ward moves, code "medicine" as previous service
** [[Previous Service]]=Nephrology
** for ICU-to-ICU moves, code "Critical Care" if no other specific service is documented
** [[Pre-admit Inpatient Institution]]=n.a.
** for pt from ER, code "Emergency Medicine" unless a different service had accepted them and is handing them off to Medicine
* Came to dialysis from ED: 
* for pt direct from ambulatory care not via ER, code "not applicable"
** [[Previous Location]]=dialysis
* if the service is not listed, code "other (known but not on list)"
** [[Previous Service]]=ED
** in these cases we don't care about the details; if we see too many others we may add additional options in future
** [[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===
===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.
*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.  
*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.  
    
    
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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]].  
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.
This does not affect the [[Visit Admit DtTm field]] definition - remember, that is defined by EPR entry.
===Admit from home===
===Admit from home===
For an admission directly from home bypassing the ER enter Previous Service = 'Not applicable'.
For an admission directly from home bypassing the ER enter Previous Service = 'Not applicable'.
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=== admission from a nursing station ===
=== admission from a nursing station ===
*For direct admission from a nursing station, put "other (known, but not on list)".  
*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".
*If from a nursing station, patient dropped by ER , put "Emergency Medicine".


== Data Use ==
=== Direct admit ===
Patients with [[Previous Location field]] critical care must have [[Previous Service field]] critical care, and patients from medicine must have previous service 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. 
{{Ex|
* direct admit from Steinbach ER, [[Previous Service]] = emergency
* direct admit from Steinbach ward, [[Previous Service]] = medicine or family medicine
}}


Sending service to ICU will be reported to the Critical Care Director.
=== Urgent Care ===
For patients directly admitted from urgent care, code previous service as "Emergency Medicine".


== {{CCMDB Data Integrity Checks}} ==
=== [[Clinical Assessment Unit]]s ===
* Can't be empty.
Specific instructions apply for coding previous service for the specific CAUs. See
* [[GRA CAU#Collection instructions]]
* [[HSC CAU#Collection instructions]]
* [[STB CAU#Collection instructions]]


* query check_previous_location_vs_service_inconsistent: patients with [[Previous Location field]] in medicine must have [[Previous Service field]] medicine; patients from ICU (except CCU) must have previous service "critical care".
== Data Use ==
 
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.
Not sure if the following makes sense in new context, but moved here from the tmp article: {{discussion}}
* Query ''s_tmp_Service_Sending_to_ICU'' - Error if:
** not admitted from inpatient location (([[S AdmitDischarge table|S AdmitDischarge]].inpatient = true)) but has "Srv to ICU" entry
** admitted from inpatient location and one of  
*** no "Srv to ICU" entry
*** has "Srv to ICU" = "z_not applicable" and no comment
Right now our consistency check would not allow someone from other hosp via ER. We won't be able to do this check until we have [[Pre-admit Inpatient Institution field]]. I will take that check out for now. Ttenbergen 11:50, 2015 June 24 (CDT) {{discussion}}


== Integrity checks ==
{{Data Integrity Check List}}


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