PatientFollow Project: Difference between revisions

Our database collects patient ward stays, which means the data of a patient may be processed by several collectors during the admission. This leads to extra, wasted work of different collectors familiarizing themselves with the same patient. We are looking at ways to reduce this waste.

Specifically, we are looking into having a single collector/laptop follow a patient for their whole admission, and how our processes would need to change to accommodate this, and what extra tools we might need.  

== Identifying admissions / Starting collection ==

Currently patients are assigned to collectors/laptops based on where they are admitted. To change to the new system, we would need to identify patients who enter a given site and then assign them to the collector pool equitably. We are planning on a process based on the last two digits of the chart number. We are currently developing the [[EPR Reports Integrator]] that will help facilitate this (aside from making dealing with reports easier in the first place).  

=== What would be the process for picking up new patients ===

See [[Using Cognos Report Integrator to keep track of patients]]; there would be a filter to limit the list to your location.

=== If we split by chart number, how do we ensure no pts are missed or duplicated? ===

** main office can run a check between Cognos Data and our data for the first few weeks to make sure all Cognos data is also in our data

=== Medical Records requests ===

The split is automatically reflected in [[Cognos Admitter]], no additional filtering needed.  

The assignment is a matter of laptop, chart number ending and the date at which point a specific distribution started. We don't want to store it here on the wiki because it is kind of messy and hard to keep updated. Use [["Show PatientFollow allocation" button]] to see which numbers are assigned to the laptop you are working on during which timeframe.  

== Entering into the laptop ==

The initial ward would need to be entered as usual. For stays on subsequent wards, [[Cognos Admitter]]/[[Patient Viewer Tab Cognos ADT]] and if need be the [[Patient copier button]] can be used to create the next record.

== Fallback process when Cognos data is unavailable ==

Use [[Using_Cognos_Report_Integrator_to_keep_track_of_patients#Downtime_procedure]]

For now we are testing this just following patients within the same program, eg if a patient were admitted to a medicine ward, then ICU, and then back to the same medicine ward, then the medicine collector would get the two med admissions, and the CC collector would collect the ICU stay. This may change in the future but would require fairly significant changes to [[CCMDB.accdb Data Integrity Checks]] and other settings in [[CCMDB.accdb]].

 

** Julie did additional analysis by looking at the distribution of the '''last two digits''' numbers from last 5 years 2014 to 2018 as follows: 1) all sites together, 2) each site separately 3) each year from all sites separately and 4) each site and year - the distributions showed similarity with few peaks in some numbers.  She grouped the last two digits numbers  into a) 10 subgroups (e.g. 0-9,10-19,20-29, …, 90-99 ) and b) 20 subgroups (e.g. 0-4, 5-9, 10-14, 15-19, …, 95-99)  and their distributions showed uniformly across subgroups. Each of the 10 subgroups showed counts close to 10% while each of the 20 subgroups showed counts close to 5%. The histograms are in ''X:\CCMDB_Special_Projects\Project_PatientFollow_ChartNumberDistribution''.  The results support the viability of using the last two digits of the chart number in allocating patients among the data collectors. Additional analysis info is in S:\MED\MED_CCMED\ChartLastDigitAnalysis\NormalizedCounts_Comparison\2_Paired T-Test and Data.xlsx

*** Additional analyses were done separately for Medicine and Critical Program for each site and 1) each year, 2) each quarter and 3 )each month to determine any seasonal variation across time. The distributions are generally uniform across subgroups with relatively few peaks.  However, there seems to be some seasonal variation  which is observed more in Critical Care than Medicine Program. The histograms are also in  in ''X:\CCMDB_Special_Projects\Project_PatientFollow_ChartNumberDistribution''.

** Julie also did the distribution of the '''first two digits''' numbers and  found out that the distribution was skewed to the right. Therefore, this cannot be used as a tool for allocating patients. The distribution is in ''X:\CCMDB_Special_Projects\Project_PatientFollow_ChartNumberDistribution'' .

** There would be no extra lists, the allocation would happen automatically within Cognos, so the processes you guys have now would just go away, you would simply enter the patients that show up on your [[Cognos Admitter]], and you wouldn't even see the ones that are not yours. RE concerns about patients that may be missing from Cognos, that is a separate issue: if pts are missing from Cognos, and still don't show up on the 2nd day after their admission, you need to tell me so we can troubleshoot that. If those are addressed then this should no longer be relevant to patientFollow. If this answers the concerns, please remove this discussion. If not, please elaborate. Ttenbergen 21:41, 2020 October 15 (CDT) }}

*patient allocation by Chart last two digits starting 2020-Oct-01;  All patients who have an [[Accept DtTm field |Accept DtTm]] or [[Dispo DtTm field | Dispo DtTm]] ON or AFTER 2020-Oct_1, the collector will apply the patient follow model

HSC Med and HSC CC (MICU) (SICU)   

**All patients who have an [[Accept DtTm field |Accept DtTm]] or [[Dispo DtTm field | Dispo DtTm]] ON or AFTER '''2020-Oct-15''' the collector will apply the patient follow model

*All patients who have a [[Accept DtTm field |Accept DtTm]] or [[Dispo DtTm field | Dispo DtTm]] ON or AFTER '''2020-Oct-15''', the collector will apply the patient follow model

* S8-STB_CICU - Stephanie Cortilet: since Steph pre-enters, start with Patients with [[Accept DtTm]] >= 2020-10-16

** [[STB_CC#Decision to not combine collection of STB CC on one laptop]] but the [[Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry]] still apply