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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 and who have been under medical care continuously 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", for example if they came from home or a clinic. The ER is '''not''' an inpatient location.
* if the patient did not come from an '''in'''patient location, enter "not applicable"  
 
** for example if they came from home or a clinic
If you know how we code the location exactly, you can type it. Otherwise press the "?" button to take you to the [[S dispo chooser‎]] to help filter options if desired.
** the ER (at your site or elsewhere) is '''not''' an inpatient location, so enter "not applicable"  


=== 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.  


=== Chronic Care Facilities ===
They are a changing and complicated case, see [[Chronic Health Facility]].


I am posting the following scenario for feedback please, is this correct? Thanks! [[User:Ppiche|Pamela Piche]] 15:43, 2016 May 20 (CDT)
=== 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]]


*VIC ER under ER Medicine Service---STB ER admitted as inpatient under B Service Medicine received thrombolytic for CVA, did not leave ER Department---VIC ER; accepted by Medicine Service and transferred to inpatient unit.
=== Several pre-admit locations ===
**The PrevInptLocation field is: STB EMIP
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.
**The Previous Service is: Emergency Medicine
*** I think the Previous Service is Medicine, nor Emergency Medicine. [[User:JMojica|JMojica]] 10:15, 2016 May 24 (CDT)
****OK, to clarify........a patient discharged as STB EMIP returning to VIC ER and cared for under ER physican/service until Medicine consulted and accepts patient....the most recent Previous Service caring for the patient in the example is Emergency Medicine not Medicine? Or is this wrong? Thanks, [[User:Ppiche|Pamela Piche]] 11:36, 2016 May 24 (CDT)
****The case of VIC EMIP to STB EMIP to VIC ER to VIC Ward is a bit tricky because both VIC EMIP and 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. Let us discuss, any suggestions/thoughts by anyone?


=== EMIP ===
{{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.}}
If pt goes from Medicine [[EMIP]] to an ICU, use the EMIP location in [[Pre-admit Inpatient Institution field]].


=== Ambiguous locations ===
{{Pre-admit, Previous content}}
The following '''are''' considered inpatient locations in this context:
* day-surgery patients ending up on our unit directly


The following are '''not''' considered inpatient locations, enter "NA / not applicable"
{{Location dropdown cleanup}}
* care homes, including units with higher levels of care at Deer Lodge or Riverview
 
=== movement within the same hospital ===
If a patient gets transferred from one ward in a hospital to another ward, enter the previous ward as both the [[Previous Location field]] and the [[Pre-admit Inpatient Institution field]].
 
=== Cath lab confusion ===
We did not use to collect cath lab and would instead code the location before, usually ER. We will now allow cath lab. If a patient comes from the cath lab it does not result in any other exceptional collection instructions. If they were an inpatient before, without interruption, code that location as [[Pre-admit Inpatient Institution field]]. If they were not an '''inpatient''' code it as not available.
 
===Code Readmission from Grace/HSC Nursing Home as NA ===
We consider admissions from there as re-admissions, so would be coded as if they had come from home. Consistent with that we will consider these '''not''' inpatient locations, so code them as "NA / not applicable".
(As per meeting with Dr Roberts 2016-05-05)


== 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 ==
Can not be blank.
{{Data Integrity Check List}}


== 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 ==
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== 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.
 
=== Nursing stations ===
We used to collect nursing stations in [[hospital previous]] but would not include them under the new scheme because they are not inpatient locations. Julie and Tina met with Randy Martin 2016-04 and he confirmed he doesn't need them.


== 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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