ACP Status Collection for LAU: Difference between revisions

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{{Project
{{Project
|ProjectActive=active
|ProjectActive=legacy
|ProjectProgram=CC and Med
|ProjectRequestor=Dr. Dan Roberts
|ProjectRequestor=Dr. Dan Roberts
|ProjectCollectionStartDate={{LAU Collection StartDt}}
|ProjectCollectionStartDate={{LAU Collection StartDt}}
|ProjectCollectionStopDate={{LAU Collection EndDt}}
|ProjectCollectionStopDate={{LAU Collection EndDt}}
|Project={{PAGENAME}}
}}
}}
This dataset contains data in support of the [[LAU Collection Project]].


{{DT | this needs to be reverted to the version at the end of the LAU collection. }}
ACP status affects care decisions (and sometimes indecision) and therefore Length Of Stay and also outflow pathways.  


 
See [[ACP Status Collection over time]] for related collection projects.
This dataset contains data in support of the [[LAU Collection Project]] and regular data collection for both ICU and medicine programs. A similar dataset was previously collected as [[ACP Status Collection in ICU]].
 
ACP status affects care decisions (and sometimes indecision) and therefore [[LOS| Length Of Stay]] and also outflow pathways. 


== Data Collection ==
== Data Collection ==
For any record collected, enter the initial status on admission and the first change to ACP status.
* For any record collected as part of [[LAU Collection Project]], enter  
 
* The '''first''' documented ACP status
For the initial PTA (prior to admission) status, use the ACP status if documented anywhere.
* The '''last''' documented ACP status if different than the first
 
* Do not collect multiple changes in the ACP status during the course of their hospitalization
For the first change, use the first change to ACP status entry by a physician). Collect these if they are documented by a physician in writing. We only want deliberately discussed changes to goals of care or plan, not pre-terminal switches to comfort care. That is, do not enter a situation where a pt is deteriorating quickly and the patient is changed to ACP C or in ICU and they withdraw care as a ACP status change.
, only as directed above.   
 
Do not collect multiple changes in the ACP status during the course of their hospitalization only as directed above.   
 
=== Data Entry Instructions ===   
=== Data Entry Instructions ===   
For every new record, the project records with an entry of "not entered" will be automatically generated.
For every [[LAU Collection Project]], a line with Project = "ACP first" and item = "not entered" will automatically be entered. Update that line to one of the following:  
 
* '''Project:'''
Update that line to one of the following:  
** ACP first
* '''Project:''' ACP initial
** ACP last
** '''Items''':
* '''Items''':  
*** ''not yet entered'' (automatic entry)
** ACP-C
*** [[ACP-C]]
** ACP-M
*** ACP-M
** ACP-R
*** ACP-R
** not documented
*** not documented
* Date/Time: dttm of the status decision
** Date/Time, Checkbox, Integer, Real: not used
 
* '''Project:''' ACP first change
** '''Items''':  
*** ''not yet entered'' (automatic entry)
*** [[ACP-C]]
*** ACP-M
*** ACP-R
*** no change
* Date/Time: dttm of the status decision, or blank if "no change"
** if decision was made before admission, use the first service/admit dttm
** if decision was made before admission, use the first service/admit dttm
** if a '''time is not available''', enter 12:00
** if a '''time is not available''', enter 12:00
** if the ACP last status is the same as the ACP first status, enter the same ACP status as the first, and use the same dttm as the first ACP.
* Checkbox, Integer, Real, Comment: not used
** if the ACP last status is different than ACP first status, enter the last documented ACP Status and the dttm that it was changed, you do not need another ACP last entry. 
* Comment (optional): If there are multiple ACP status changes/family discussions that are affecting the LOS or seem unusual, leave this as a comment in the "Q" column, NOT the notes section
* Checkbox, Integer, Real: not used
 
{{DT|
* many patients are deemed comfort care, with no official change in their status except in the notes and orders, can we use the dttm in orders or notes to reflect ACP last status? I would think yes based on [[ACP-C]] and [[Palliative care]] criteria?  [[User:Lkaita|Lisa Kaita]] 09:53, 11 June 2025 (CDT)
** Interesting. It would depend on the purpose of this field, to some degree. Also, we discussed today that there has been category creep in those over time:
*** [[ACP-C]] content I think was really only ever intended as page intro for what is essentially an index page to make sure we keep in mind all places where the concept is used.
*** APC-C setting qualifies for [[Transfer Ready DtTm tmp entry]]
*** Having ACP-C status qualifies for [[Palliative care]] dx, but other things do as well, so not interchangeable. The page explicitly says they are not the same.
:: I think we are actually looking for properly completed and documented advanced care plans, specifically, but will confirm. [[User:Ttenbergen|Ttenbergen]] 16:30, 11 June 2025 (CDT)
* "note indicating that there was a discussion with patient or care team", a definition similar to that ...
}}
{{DL|
* if date/time is not documented, is a date/time required? would it be date of first service and 1200?
** that might put it before the first service start dttm, which (and needs to) trigger the cross check. The DtTm is important since we will look at this in the context of delays, so even a best guess would be better than a not-filled. So I would say enter best guess. If it is clear the discussion was on the unit and after admission, and there really is no way to figure out when, we could have some sort of standard, eg xhrs after admission. I will confirm. [[User:Ttenbergen|Ttenbergen]] 16:30, 11 June 2025 (CDT)
* How about something like this: Use the best estimate for the time. If there is no estimate at all, use noon (or the closest to noon that the requirement that it has to be within the admission will allow).
}}
 
*if status is documented as "presumed", is this what we should use?
** then you enter "not documented" (but maybe we need to fine-tune the wording)
 
{{DT| meeting with Dr R today where we changed the approach, he would like the ACP status PTA (prior to admission) if documented anywhere, and the first ACP status established by a physician only, this could be found in the orders, the ACP sheet or the progress notes.  It was pointed out the actual ACP form does not have a time entry field it only has a date, he instructed to use our best guess/judgment for the time. He no longer wants the ACP last status
* he also described the situation where a pt is deteriorating quickly and the patient is changed to ACP C or in ICU and they withdraw care, he does not want this captured a a true ACP status.
* on the medicine admission order forms there is a checkbox for "previously established ACP" These patient's sometimes have an ACP status form completed so we are uncertain if the previously established ACP is referring to the form or a PTA ACP status, should we use this as an established first ACP status? 
* I have suspended collection until T & L discuss this further [[User:Lkaita|Lisa Kaita]] 14:07, 16 June 2025 (CDT)
* How about the changes I made above, do they capture the new rules? We can discuss today Wednesday if I can catch you while there. [[User:Ttenbergen|Ttenbergen]] 01:09, 24 June 2025 (CDT)}}
 
*but if there is no documented ACP status?
** then you enter "not documented"
*** yes, but using date & time of first service, date & time of current boarding location service or one of these dates & 12:00?
**** I have removed the date requirement from the initial listing, and updated what to use for the "change" listing. If clear now, pls delete the question. If still not clear, pls explain.


==== Sources ====
==== Sources ====
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* Admission sheets
* Admission sheets
* Progress notes
* Progress notes
* If a patient arrives from another facility, or transferred from another ward/service with an ACP status already documented use that as the first ACP status and the dttm would be the same as the first service dttm
 
{{DT| if we follow the instructions above would this not be a previously established ACP status and not a new one? so we would enter this as PTA and capture the first ACP status established by a medicine doc? [[User:Lkaita|Lisa Kaita]] 14:07, 16 June 2025 (CDT)
For patients who were transferred from another facility, we checked that ACP status against the ACP status determined by the LAU MD.
* Agreed; in any case, I think this info would belong above with the other when-to-enter-what content rather than here. [[User:Ttenbergen|Ttenbergen]] 09:08, 24 June 2025 (CDT) }}


==== About the data ====
==== About the data ====
* For the [[LAU Collection Project]], every patient in our sample had a ACP done by the end of their stay. This was confirmed with the data collector. Likely related to these patients being elderly. There might be a policy at the sites, we have not investigated this. Documenting this because it raised questions on initial data analysis .
* Every patient in our sample had a ACP done by the end of their stay. This was confirmed with the data collector. Likely related to these patients being elderly. There might be a policy at the sites, we have not investigated this.  


== Data Use ==
== Data Use ==
Line 99: Line 50:


== Log ==
== Log ==
* 2025-06-24 TT updated the page, and edited the [[S_tmp table]]
* 2025-03-06 - discussed with DR if we should use the same dataset and definitions as for [[ACP Status collection in ICU]] ; we don't need the source or the M+/- distinction, but we do want the first and last ACP as we did for that project.  
* 2025-06-16 LK, TT, DR met and discussed; LK updated this page
 
* 2025-06-10 opening up collection for all medicine and ICU admissions
* 2025-03-15 - 2025-04-13: collection of data for LAUs as part of [[LAU Collection Project]]
* 2025-03-06 - discussed with DR if we should use the same dataset and definitions as for [[ACP Status Collection in ICU]] ; we don't need the source or the M+/- distinction, but we do want the first and last ACP as we did for that project.  
* 2025-06-10 added to [[S tmp table]] for regular data collection
== Related articles ==
== Related articles ==
{{Related Articles}}
{{Related Articles}}


[[Category: LAU Collection Project]]
[[Category:LAU Collection Project]]
[[Category:ACP]]
[[Category:ACP]]

Latest revision as of 15:50, 19 August 2025

Projects
Active?: legacy
Program:
Requestor: Dr. Dan Roberts
Collection start: 2025-03-15
Collection end: 2025-04-13

This dataset contains data in support of the LAU Collection Project.

ACP status affects care decisions (and sometimes indecision) and therefore Length Of Stay and also outflow pathways.

See ACP Status Collection over time for related collection projects.

Data Collection

  • For any record collected as part of LAU Collection Project, enter
  • The first documented ACP status
  • The last documented ACP status if different than the first
  • Do not collect multiple changes in the ACP status during the course of their hospitalization

, only as directed above.

Data Entry Instructions

For every LAU Collection Project, a line with Project = "ACP first" and item = "not entered" will automatically be entered. Update that line to one of the following:

  • Project:
    • ACP first
    • ACP last
  • Items:
    • ACP-C
    • ACP-M
    • ACP-R
    • not documented
  • Date/Time: dttm of the status decision
    • if decision was made before admission, use the first service/admit dttm
    • if a time is not available, enter 12:00
  • Checkbox, Integer, Real, Comment: not used

Sources

  • ACP form
  • Admission sheets
  • Progress notes

For patients who were transferred from another facility, we checked that ACP status against the ACP status determined by the LAU MD.

About the data

  • Every patient in our sample had a ACP done by the end of their stay. This was confirmed with the data collector. Likely related to these patients being elderly. There might be a policy at the sites, we have not investigated this.

Data Use

This data is being collected as a current state for LAU Collection Project.

Consistency Checks

Data Integrity Checks (automatic list)

 AppStatus
Query check ACP Status CollectionCCMDB.accdbimplemented

Log

  • 2025-03-06 - discussed with DR if we should use the same dataset and definitions as for ACP Status collection in ICU ; we don't need the source or the M+/- distinction, but we do want the first and last ACP as we did for that project.

Related articles

Related articles:
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