Pre-admit Inpatient Institution 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. ''
{{Data_element
 
| field_name = Pre_admit_Inpatient_Institution
The [[Pre-admit Inpatient Institution field]] identifies the '''previous inpatient location''' of patients who were already '''inpatients''' elsewhere before coming to our unit. This does not include patients who just arrived at an ER elsewhere and were not admitted as inpatient there.
| CCMDB_label = Pre-admit Inpatient Institution
 
| CCMDB_tab = Dispo
For example, a patient arriving from Selkirk Hospital via the local ER would have the ER coded in the [[Previous Location field]] and Selkirk coded in the [[Pre-admit Inpatient Institution field]].
| element_description = The most recent '''previous ''inpatient'' location''' of patients who were already '''inpatients''' elsewhere and who have been under medical care continuously before coming to our unit.
| 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_sort_index = 36
}}


== Collection Instruction ==
== Collection Instruction ==
For each patient,  
* For each patient, enter the most recent '''in-patient''' location where the patient has been admitted during this continuous episode of hospitalization at this or other hospitals
* enter the option that most closely matches
** for patients who were accepted by a service at the previous site, but never left the site's ER to get to the ward ("EMIP" concept), consider these in-patients
{{PrePrevDispo listing}}
{{Ex |
*HSC MICU --- family medicine ward at the Vic --- HSC_ER --- STB_ER --- cath lab --- HSC_MICU. 
**Code the Pre-admit Inpatient Institution field as: VIC_Ward}}
* if you know the situation but nothing on the list matches closely, enter '''other - known but not listed'''
* if you know the situation but nothing on the list matches closely, enter '''other - known but not listed'''
* if the situation is unknown, enter '''location missing/unknown'''
* if the situation is unknown, enter '''location missing/unknown'''
 
* if the patient did not come from an '''in'''patient location, enter "not applicable"  
If the patient did not come from an inpatient location, enter "not applicable", for example if they came from home or a clinic. The ER is '''not''' an inpatient location.
** for example if they came from home or a clinic
 
** the ER (at your site or elsewhere) is '''not''' an inpatient location, so enter "not applicable"  
If you know how we code the location exactly, you can type it. Otherwise press the "magic wand" button to take you to the [[S dispo chooser‎]] to help filter options if desired.


=== Where to find this information ===
=== Where to find this information ===
If patient came from a different Winnipeg hospital this will be recorded in the  “Visit History” on the EPR.
If patient came from a different Winnipeg hospital this will be recorded in the  “Visit History” on the EPR.


=== Example ===
=== Ambiguous locations ===
*ICU Vic---family medicine ward at the Vic---ED HSC---ED STB---cath lab---ICU HSC.
* Day-surgery locations - use "<hosp> ambulatory care"
**The PrevInptLocation field is: VIC_Ward
*The following '''ARE NOT''' considered inpatient locations, enter "NA / not applicable"
** Any PCH (see [[Chronic Health Facility]] for additional instructions)
** Nursing stations - they are not inpatient locations, and Julie and Tina met with Randy Martin 2016-04 and he confirmed he doesn't need them.  


==Questions==
=== Chronic Care Facilities ===
=== how about nursing stations? ===
They are a changing and complicated case, see [[Chronic Health Facility]].
*We used to collect nursing stations in [[hospital previous]] but would not include them under the new scheme because they are not inpatient locations.  
We are planning a meeting with Randy Martin to discuss. For now you can't enter nursing stations here, so, don't. Ttenbergen 18:16, 2016 April 28 (CDT)


=== ER -> cath lab -> ward scenario ===
=== Intra-facility and inter-facility transfers  ===
*If the previous location is the heart cath lab (which is a temporary location), then I should add a pre-admit inpatient institution.  However, if the patient comes to the cath lab from ER, I cannot put this location because it also is a temporary location. Currently we do not put in the heart cath lab as a place to admit from, instead we use where they were located just prior to the cath lab  (ER in this example). I thought that Julie tracked Winnipeg hospital use of ER's for Randy so if we will no longer be able to put that the pt came from ER in this setting, then this will be entirely missed.  Just checking!  --[[User:LKolesar|LKolesar]] 14:21, 2016 April 14 (CDT)
If a patient gets transferred to another ward in the same or different hospital, enter <site>_Med, <site>_Ward or <site>_CC (as appropriate) as both the [[Previous Location field]] and the [[Pre-admit Inpatient Institution field]].
**A scenario of patient who went  ICU elsewhere --> Ward elsewhere --> ER1 --> ER2 --> Cath Lab --> ICU/Ward  will enter the pre-admit inpatient Institution as '''Ward elsewhere''' according to Allan Garland.  [[User:JMojica|JMojica]] 13:28, 2016 May 2 (CDT)


=== are EMIPs inpatients? ===
=== Arrivals from a borrowed bed ===
*GRA_emip is not a pre admit location
See and follow [[Previous Location field#Borrowed Bed Or Boarding Loc]]
** Or are they? their name would suggest they are. Emailing Julie for answer. Ttenbergen 18:16, 2016 April 28 (CDT)
** Good question. I would consider EMIPS as in-patient and therefore STB, VIC and GRA ER should be included in the downlist of PRE-admit location (not HSC,CON,OAK ER). [[User:JMojica|JMojica]] 10:01, 2016 April 29 (CDT)


===HSC ER to GGH ICU to GGH Ward===
=== Several pre-admit locations ===
*pt sent to GGH ICU from HSC ER  with order to transfer presumably because no critical care beds at HSC.  Not treated as an admission by ER standards, but clearly had to be admitted or would not have been sent to ICU.  Should this be treated as an inpatient admission for our purposes, so HSC ER would be entered as preadmit institution location?
If a patient travels through several pre-admit inpatient locations we will only have data on the last one. We understand that. Just to be clear.
** They were never an inpatient at HSC so the entry for [[Pre-admit Inpatient Institution field]] needs to be "not applicable". Ttenbergen 10:34, 2016 May 3 (CDT)
***I have a patient I admitted from the recovery room to ICU (prior to recovery room they were an emergency room patient, went to the OR as an E1), previous location is recovery room, but there is no option for Grace OR or recovery in the pre-admit inpatient institution field, do I put this as n/a? because she was in the ER? I put previous service as general surgery [[User:Lkaita|Lisa Kaita]] 13:00, 2016 May 3 (CDT)


=== intra-hospital transfers ===
{{Ex |  Pt was on a ward as an inpatient then went to ICU, then was transferred to the ward you are collecting on. Previous location would be ICU and previous inpatient institution would also be ICU.}}
{{discussion}}
*When we have patients moving from ward to ward, we normally do not go back to their original admission date to gather data especially as some patients have been admitted for over a year. Will it be acceptable to continue this practice?--[[User:CMarks|CMarks]] 12:39, 2016 April 11 (CDT)
** For intra-hospital transfers of inpatient (excluding ER transfers), code the previous hospital location. Ttenbergen 10:34, 2016 May 3 (CDT)


===Readmission from Grace/HSC Nursing Home===
{{Pre-admit, Previous content}}
*currently discharges to and admissions from Grace Nursing Home are treated as new admissions (with the exception of the Discharge Screening Tool which is labelled 'transferred form').  Technically, though, this is an interhospital transfer, and the hospital treats it as a continuous admission.  Will this require a previous Inpatient Institution entry? And will the visit admission date then be the original admission date, or the date transferred from one ward to the other? [[User:SCortilet|SCortilet]]
** We treat these nursing home wards as inpatient locations for at least some scenarios, so we will treat them as inpatient locations for this. So, code e.g. Grace Nursing Home as [[Previous Location field]] and code Grace Ward (or e.g. VIC_S5 if known) as [[Pre-admit Inpatient Institution field]].


=== Day Surgery ===
{{Location dropdown cleanup}}
If a patient was a day-surgery patient and ends up on our unit directly, their day surgery would be treated and an inpatient experience.


== Data Use / Purpose ==
== Data Use / Purpose ==
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The information will also give our administrators a better idea of which other hospitals are sending us patients, which they will use for planning.
The information will also give our administrators a better idea of which other hospitals are sending us patients, which they will use for planning.


== {{CCMDB Data Integrity Checks}} ==
== Cross Checks ==
* Records for all [[Admit from]]s in [[#Temporary locations]] need to have an entry (possibly "none")
{{Data Integrity Check List}}
* Records for all [[Admit from]]s ''not'' in [[#Temporary locations]] need to '''not''' have an entry
Not yet implemented Ttenbergen 14:11, 2015 May 27 (CDT)
*{{discussion}} do these make sense?  (old q from Tina)
**YES.  if these are done, you may delete the ones I wrote above.  [[User:JMojica|JMojica]] 12:31, 2015 May 28 (CDT)


== Reports ==
== Reports ==
{{discussion}} Which reports will this be on? Ttenbergen 10:33, 2016 March 22 (CDT)
The information is part of the [[Critical Care Program Quality Indicator Report]] and the [[ICU Interfacility Report]].  Also the information will be useful for research projects where it will mark a patient as inpatient before arrival to the unit or ward.


== Implementation ==
== Implementation ==
Line 74: Line 70:


== Legacy ==
== Legacy ==
This field is part of the [[2016 Time and Place changes]] and did not previously exist.
This field is part of the [[2016 Time and Place changes]]. Some of the data previously existed in [[hospital previous]] but it is not a 1-to-1 mapping.
 
== 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]]

Latest revision as of 22:58, 30 July 2025

Data Element (edit)
Field Name: Pre_admit_Inpatient_Institution
CCMDB Label: Pre-admit Inpatient Institution
CCMDB tab: Dispo
Table: L_Log table
Data type: number
Length: long integer
Program: Med and CC
Created/Raw: Raw
Start Date: 2016-07-01
End Date: 2300-01-01
Sort Index: 36
Data Dependencies(Reports/Indicators/Data Elements):

The most recent previous inpatient location of patients who were already inpatients elsewhere and who have been under medical care continuously before coming to our unit.

  • SMW

Legacy implementation right in the table

  • Cargo


  • Categories
  • Forms


Collection Instruction

  • For each patient, enter the most recent in-patient location where the patient has been admitted during this continuous episode of hospitalization at this or other hospitals
    • for patients who were accepted by a service at the previous site, but never left the site's ER to get to the ward ("EMIP" concept), consider these in-patients
    • for places where we collect, use the Service/Location used by the counterpart admission: <site>_Med, GH-CC, HSC MICU , HSC SICU, HSC_IICU, STB MICU, STB_ICCS, STB_ACCU
    • for wards where we don't collect: <site>_Ward or other external entry e.g. home
Example:   
  • HSC MICU --- family medicine ward at the Vic --- HSC_ER --- STB_ER --- cath lab --- HSC_MICU.
    • Code the Pre-admit Inpatient Institution field as: VIC_Ward
  • if you know the situation but nothing on the list matches closely, enter other - known but not listed
  • if the situation is unknown, enter location missing/unknown
  • if the patient did not come from an inpatient location, enter "not applicable"
    • for example if they came from home or a clinic
    • the ER (at your site or elsewhere) is not an inpatient location, so enter "not applicable"

Where to find this information

If patient came from a different Winnipeg hospital this will be recorded in the “Visit History” on the EPR.

Ambiguous locations

  • Day-surgery locations - use "<hosp> ambulatory care"
  • The following ARE NOT considered inpatient locations, enter "NA / not applicable"
    • Any PCH (see Chronic Health Facility for additional instructions)
    • Nursing stations - they are not inpatient locations, and Julie and Tina met with Randy Martin 2016-04 and he confirmed he doesn't need them.

Chronic Care Facilities

They are a changing and complicated case, see Chronic Health Facility.

Intra-facility and inter-facility transfers

If a patient gets transferred to another ward in the same or different hospital, enter <site>_Med, <site>_Ward or <site>_CC (as appropriate) as both the Previous Location field and the Pre-admit Inpatient Institution field.

Arrivals from a borrowed bed

See and follow Previous Location field#Borrowed Bed Or Boarding Loc

Several pre-admit locations

If a patient travels through several pre-admit inpatient locations we will only have data on the last one. We understand that. Just to be clear.

Example:    
 Pt was on a ward as an inpatient then went to ICU, then was transferred to the ward you are collecting on. Previous location would be ICU and previous inpatient institution would also be ICU.

Instructions that apply to both Pre-admit Inpatient Institution and Previous Location

Special Case - Temporary locations

Special Case - ... what is the case?

  • direct admissions to the ER that are under a service that we do not collect, and then are admitted to either an ICU or medicine service, while still physically in the ER

the Previous Location: <site>_ward; Pre-admit Inpatient Institution would also be <site>_ward

  • for EMIP or ECIP follow instructions on those wiki pages


I can not remember which particular data collection instruction applies only to those two that is related to sending someone to the ED, but then, my brain is full. This template was to contain the instructions collectors need to enter this, and then link to an index page with reasons, implications and decision point info. That page is Patients who appear to transfer from in-patient situation to Emergency Room.

"Can we remove the items that are no longer Service/Locations, Previous Locations, Pre-admit Inpatient Institutions or dispo locations from the dropdowns?"

We can and will remove them, but that can only happen once no more laptops use them. We will need to keep track of this and then remove them when ready. If I removed them now, then any box that currently has them enter would misbehave.

SQL query of what is currently available    
SELECT s_dispo.location_name, s_dispo.Site, s_dispo.active, s_dispo.inpatient, s_dispo.previous_location, s_dispo.s_location, s_dispo.dispo
FROM s_dispo
WHERE (((s_dispo.Site)>"") AND ((s_dispo.active)=True) AND ((s_dispo.inpatient)=True)) OR (((s_dispo.Site)>"") AND ((s_dispo.active)=True) AND ((s_dispo.previous_location)=True)) OR (((s_dispo.Site)>"") AND ((s_dispo.active)=True) AND ((s_dispo.s_location)=True)) OR (((s_dispo.Site)>"") AND ((s_dispo.active)=True) AND ((s_dispo.dispo)=True));
  • query of what is currently used: query z_s_dispo_inactivatable

Data Use / Purpose

To document where those patients who were inpatients immediately before arriving on our ward/unit came from.

The detailed information will allow us also to distinguish between patients who were or were not inpatients before arrival. This is relevant to a patient's risk of bad outcomes.

The information will also give our administrators a better idea of which other hospitals are sending us patients, which they will use for planning.

Cross Checks

Data Integrity Checks (automatic list)

 AppStatus
Query check prev pre-admit consistentCCMDB.accdbimplemented
Function Validate Pre admit Inpatient InstitutionCCMDB.accdbimplemented
Check function preAdmit NE LocationCCMDB.accdbimplemented
Check Accept Loc ParkCCMDB.accdbretired
Link suspect mismatch pre inpt ours incomplete queryCentralized data front end.accdbimplemented
Link_suspect_not_same_visitAdmitDtTm queryCentralized data front end.accdbimplemented

Reports

The information is part of the Critical Care Program Quality Indicator Report and the ICU Interfacility Report. Also the information will be useful for research projects where it will mark a patient as inpatient before arrival to the unit or ward.

Implementation

The field is populated with options from the s_dispo table.

Legacy

This field is part of the 2016 Time and Place changes. Some of the data previously existed in hospital previous but it is not a 1-to-1 mapping.

Related articles

Related articles:
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