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Dispo field: Difference between revisions

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{{Data_element
{{Data element
| field_name = dispo
| CCMDB_tab = Dispo
| CCMDB_label = Dispo
|field_name=dispo
| element_description = The Dispo field contains information about what happens to the patient at the end of their admission.
|CCMDB_label=Dispo
| in_table = L_Log
|Rank=Dispo
| data_type = integer
|in_table=L Log table
| datafield_length = long  
|data_type=number
| program_collecting = Med and CC
|datafield_length=long
| created_raw = Raw
|program_collecting=Med and CC
| data_element_start_date = 2016-07-01
|created_raw=Raw
| data_element_sort_index = 41
|data_element_start_date=2016-07-01
|data_element_sort_index=41
|element_description=The Dispo field contains information about what happens to the patient at the end of their admission.
}}
}}


== Collection Instruction ==
== Collection Instruction ==
If you know 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.
=== surviving patients ===
* Enter:
{{PrePrevDispo listing}}
* see [[Visits to temporary locations]] for dispo to temporary locations, ie. OR, dialysis, procedure suites of all types, imaging suites/radiology
* [[HSC Stepdown Units]]
* [[AMA]] see also [[BedHeldEnd DtTm]]
 
===Home===
* Includes:
**hotel
**rooming house
**boarding home
 
==== Additional options similar to "Home" ====
We have several "Home" like discharge options that may appear in [[Cognos2 Unit Starter]]. If the entry from ADT doesn't align with what is found in the chart then correct the entry to what you think is correct:
* '''Home with Support Services''' - Discharged to a private residence or apartment with support from the community at home or referred to services.  example home care, [[Alternative Integrated Accommodation (AIA) | AIA]].  '''Note''' a patient with instructions to return for follow-up or referral to a specialist (as part of a routine discharge order) is '''NOT''' considered discharge home with support service/referral
** includes people on Home O2, they are part of the Home Oxygen home care program
** includes CIVP
** excludes: GPAT/GMAT assessments
* '''TRSF Group/Supportive housing'''
** includes group home
** excludes [[Assisted Living]] facilities
** includes Virtual Ward, as they are sent home and followed by a Physician and monitored
{{Discuss |
* does this include patients who are discharged home with private nursing service? (steph)
** With "this" do you mean "TRSF Group/Supportive housing"? I would not have thought so. If you mean "Home with Support Services", good question. How would HIS use it (aside from getting it wrong at times)? We should probably stick with their definition for consistency. Convince me otherwise. Julie also might have thoughts on how we would use this entry, will flag for her. [[User:Ttenbergen|Ttenbergen]] 01:02, 24 October 2025 (CDT)
* I think this would be belong under home with support services, but do the virtual wards fall under transfer to Group/Supportive housing? [[User:Lkaita|Lisa Kaita]] 14:03, 14 November 2025 (CST)
}}
 
{{DiscussTask | JALT
I thought we had decided at [[JALT Meeting - Rolling Agenda and Minutes 2025#JALT 2025-03-11 |JALT]] to collect this as presented by EPR... do I remember this wrong? I had already added it in [[CCMDB.accdb Change Log 2025#2025-03-11-1]]. [[User:Ttenbergen|Ttenbergen]] 22:52, 11 March 2025 (CDT)
* Yes, I saw that, come to think of it I don't think we decided, not in my notes, but we can use it and I will change the wiki instructions [[User:Lkaita|Lisa Kaita]] 11:25, 13 March 2025 (CDT)
* If we are going to collect this detail for dispo, should we consider whether or not to also look at SH in preadmit living situation?, currently lumped with community facility with support. [[User:Lkaita|Lisa Kaita]] 14:45, 16 April 2025 (CDT)
* The entry name includes "TRSF" - is the entry for the previous location equivalent in EPR? [[User:Ttenbergen|Ttenbergen]] 23:30, 16 April 2025 (CDT)
* no because the previous location would usually be <site>_ER [[User:Lkaita|Lisa Kaita]] 09:53, 28 May 2025 (CDT)
** Sorry, I should have asked about "pre-hospital location in ADT". [[User:Ttenbergen|Ttenbergen]] 16:21, 28 May 2025 (CDT)
}}
* '''TRSF to Residential Care'''- Includes transfer to long-term care home (24 hour nursing), mental health and/or addiction treatment center or hospice/palliative care facility. 
** for PCH use [[Dispo]] PCH options
** for hospice, see [[Hospice]]
** for palliative care use the appropriate palliative care options
** for mental health or addiction treatment center use [[Dispo]] '''Home with Support Services'''


=== surviving patients ===
===LAU (low acuity unity)===
For each patient,
see [[LAU]]
* enter the location that most closely matches
** for wards where we don't collect, enter e.g. HSC_ward
** for wards where we do collect enter the actual ward as available in the dropdown
* consider [[bed borrow]]s


==== [[AMA]] ====
===Geri Rehab wards===
* for patients who leave against medical advice, enter "AMA (left against medical advice)" (type "AMA" to open up drop down where you want it)
see [[Geri Rehab]]
* {{discussion}} There was a discussion whether this should be used only for medically competent patients who follow the WRHA process an sign out as AMA, or also for patients who just up and leave. How do collectors code this? How does Julie use this?  Ttenbergen 10:03, 2017 September 7 (CDT)
** If the chart indicates that the patient left AMA then I document this as such, I do not check to see if the patient was medically competent or if the WRHA process was adhered to. Generally, if there is some question as to the competency of the patient as it pertains to decision making, there is documentation in the chart, and often consults to psychiatry to assess this [[User:Lkaita|Lisa Kaita]] 11:18, 2017 September 7 (CDT)
**I agree with Lisa.  If there is a competency issue, psych is consulted and if they feel the pt cannot make the decision and they are not medically stable, they will keep them in under a legal form that is completed to cover this. --[[User:LKolesar|LKolesar]] 12:06, 2017 September 7 (CDT)
*** That would address patients who end up '''not''' leaving, so those should not be a matter of collecting as AMA. AMA in Dispo field is only about patients who do manage to leave, right? So even if held under a some sort of form, if they get away, they get away. Should "those who got away" be coded as AMA even if they should not have got away, and didn't follow the process? Ttenbergen 10:54, 2017 September 11 (CDT)
** How AMA is used? 1) AMA is being excluded in the  calculation of Readmission rate. 2) AMA is being added to HOME for the location the patient went after discharge.  3) AMA as itself for specific request.  I think the above issue will only affect item 3 if our AMA definition is a mixed of medically competent or not which will then be a case to case basis depending on the purpose of the requestor. --[[User:JMojica|JMojica]] 11:24, 2017 September 11 (CDT)


==== [[Homeless]] patients ====
==== [[Homeless]] patients ====
If a homeless patient is discharged, either to a place like Siloam Mission or even without a specific plan, then code them as discharged to '''home'''. Consider whether they might have left [[AMA]].
*If a homeless patient is discharged, either to a place like Siloam Mission, shelter or even without a specific plan, then code them as discharged to '''home'''. Consider whether they might have left [[AMA]].
* If discharged to an [[Alternative Integrated Accommodation (AIA)|Alternative Integrated Accommodation]] with services use '''home with support services'''


==== [[Prison / Jail / Correctional Institution]] ====
==== [[Prison / Jail / Correctional Institution]] ====
If a patient is discharged to prison, jail or a correctional institution, code this as a discharge to home.  
If a patient is '''discharged to prison, jail or a correctional institution''', code this as "TRSF to Correctional Facility" as dispo to be consistent with EPR
 
See [[Prison / Jail / Correctional Institution]] for additional coding instructions that may apply.
 
 
==== [[Chronic Health Facility]] ====
This is somewhat messy and fluid, so see [[Chronic Health Facility]]


==== [[Parked in ER]] ====
==== Discharged to ER or [[Urgent Care]] ====
==== [[Operating room visits]] ====
This is a case of [[Patients who appear to transfer from in-patient situation to Emergency Room]].


=== deceased patients ===
If a patient is discharged to the ER or Urgent Care at your own site you can't enter this in the dispo field. The reason is that this should not happen. If it really does happen:
* for patients who expire, one of
* enter '''Not Canada or USA - unknown/other''' (this is a very rare entry so when we see it, we can question it. Put a note in to the [[Notes field]] so Pagasa can check there first.)
** "Died - [[Organ_Donor]]" (follow definitions in that article)
* email Pagasa so she can enter your ER / Urgent Care location as dispo.
** "Died - NOT Organ Donor"
 
[[Category:End-of-life related data]]
We don't want ER to be available in the dropdown because it had been mistakenly entered a number of times. If it turns out there are a lot of legitimate ''discharges'' to ER we will make the option available.
 
===Manitoba Nursing Station===
* use ''"Outside City - unknown/other"''
{{Discuss | If this is actually done then why don't we just make the nursing stations available? We already have [[s_dispo table]] entries for them. 35 entries since 2016, 6 in the last 12 months. Are there other things for which this entry is used? Checked for reasons for this decision but they don't appear documented [[User:Ttenbergen|Ttenbergen]] 19:42, 13 March 2025 (CDT)  
}}
 
=== [[Deceased patients]] ===
See
* [[Deceased patients#General instructions for deceased patients]]
* [[Guideline for coding organ donation after death]]
* [[Visits to temporary locations]]
 
{{Location dropdown cleanup}}


== Data Use ==
== Data Use / [[Indicators]] ==
* Mortality Rate
* [[Unit Mortality]]
* Intra or Inter Transfer Rate
* [[ICU Interfacility Transfer]]/[[Length of Time for Transfer from ED to ICU within same facility]]/[[Transfer Delay (Critical Care)]]/[[Transfer Delay (Medicine)]]
* Discharges out of hospital
* Discharges out of hospital
* Organ donor rate
* Organ donor rate
* AMA Rate  
* AMA Rate  
* Linking admissions
* Linking admissions
* [[Readmission Rate to ICU]]/[[Readmission to MedWard]]


== {{CCMDB Data Integrity Checks}} ==
== Cross checks ==
* cannot use: not applicable
{{Data Integrity Check List}}
* location_NE_dispo() - [[Service/Location field]] can't be same as [[Dispo field]]


Following might still need to be implemented:
== Implementation ==
* [[Check organ donors must be dead]] - this is a dx cross check - can it wait for ICD10? {{ICD10}} Actually, I don't think this dx will be available in ICD10, since it's not a diagnosis. So, likely it will only be coded in dispo field once ICD10 is in place, at which point this comment could go. Ttenbergen 09:56, 2016 June 16 (CDT)
The field is populated with options from the [[s dispo table]].


== Implementation ==
== Related Articles ==
The field is populated with options from the [[s_dispo table]].
{{Related Articles}}
 
== Log/Legacy ==
Also see info in the various [[CCMDB.accdb_Change_Log]]s over time.
* [[CCMDB.accdb_Change_Log_2025#2025-03-11-1 | 2025-03-11]]
** added granularity Discharged to community: "TRSF Group/Supportive housing", "TRSF to Correctional Facility", "Home with Support Services"
** one other option in EPR for discharge to was "TRSF to Residential Care" - we decided not to switch to this because we currently record more detailed information.
{{DL |
That more detailed info included things like [[HSC Lennox Bell]]; we discussed whether or not we need to document the details of this. If so, the following is likely a starting point:
* Home
* Home with support
* Institution NOS
* TRSF Group/Supportive housing
* TRSF to Correctional Facility
* any [[Hospice]]s
* GH-Transitional care
* HSC - Transitional care
* Misericordia  - Transitional care
* STB - Transitional care
* VIC - Transitional care
* HSC Lennox Bell
* Manitoba Adolescent Treatment Center - unknown/other
** what is this about again?  we already collect these with the exception of the transitional care units, which don't exist, at GH, HSC, SBGH and VIC, but there is a TCU at Miseri and DLC [[User:Lkaita|Lisa Kaita]] 21:18, 6 September 2025 (CDT)
*** we discussed whether we should shift to EPR's "TRSF to Residential Care" and decided not to because our data is more granular. But we should be able to compare to their TRSF, so should understand which of our data would compare to theirs, and how. I ''think'' the above is a list of what  we have in dispo, so which of those correspond do what listing in EPR? [[User:Ttenbergen|Ttenbergen]] 10:31, 8 September 2025 (CDT)
}}
** added locations for [[LAU Collection Project]]: VGH_LAU, VGH_Geriatrics, COH_LAU, SOH_LAU, SOH_Geriatrics
 
* 2025-03-07
** started to collect "TRSF to Correctional Facility" as dispo to be consistent with EPR; for [[Previous Location]] continue to use the old entry "Institution, NOS"
 
{{Change to collecting prison as "Institution NOS"}}


== Legacy ==
=== earlier legacy info ===
This field is part of the [[2016 Time and Place changes]].
This field is part of the [[2016 Time and Place changes]] and was affected by the [[PatientFollow_Project]].


It a combination of our previous  
It a combination of our previous  
* [[Admit From & Discharged To | Discharge To]]
* [[Admit From & Discharged To|Discharge To]]
* [[Var 2 - Discharge-to Ward]]
* [[Var 2 - Discharge-to Ward]]
* [[ICU Var 6 - AMA]]
* [[ICU Var 6 - AMA]]
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When data was brought across from the old [[discharge to]] field the [[dispo]] fields of these records were set to 'survive(Legacy)'.  
When data was brought across from the old [[discharge to]] field the [[dispo]] fields of these records were set to 'survive(Legacy)'.  


[[Category: 2016 Time and Place changes]]
[[Category:2016 Time and Place changes]]
[[Category: Admit/Discharge]]
[[Category:Admit/Discharge]]
[[Category: Registry Data]]
[[Category:Registry Data]]
[[Category: L Log]]
[[Category:Dispo]]
[[Category:Data Collection Guide]]
[[Category:End-of-life related data]]
Retrieved from "https://ccmdb.kuality.ca/index.php?title=Dispo_field"