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|ProjectActive=active
|ProjectActive=active
|ProjectProgram=CC and Med
|ProjectProgram=CC and Med
|ProjectRequestor=Critical Care program (Allan Garland)
|ProjectRequestor=internal
|ProjectCollectionStartDate=2019-Sep-20
|ProjectCollectionStartDate=2019-Sep-20
|Project=Borrow arrive
|Project=Boarding Loc
}}
}}


This project tracks where and when a patient '''arrives''' into a "borrowed bed".  
This isn't so much a project as way to track how patients physically move around the hospital. See [[Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry]] for information about it and why we needed to change it to this model.  


A "borrowed bed" is when a patient is '''not physically located''' in the place designated by the [[Service/Location]].
This project tracks where and when a patient '''arrives''' into a new physical location under the Medicine or ICU service.  
 
This project does '''not''' replace [[ICUotherService]]; we will still need this item in the event that both the bed and the service are both borrowed. Administration at STB want this data.  


== Data Collection Instructions ==
== Data Collection Instructions ==
In [[L TmpV2 table |TMP]], a "no borrow" entry will automatically be added to every new Critical Care or Medicine patient's record.
=== Sources for Boarding Loc DtTm ===
==== [[CSS]] / [[Cognos2 Unit Starter]] ====
Usually the Cognos Unit start time from [[CSS]] or [[Cognos2 Unit Starter]] can be used as [[Boarding Loc]].
* sometimes the first [[Service tmp entry]] and first and second [[Boarding Loc]] all have the same date and time; see [[#Special Case - Can't have two Boarding Locs with same DtTm]]


If the patient never ends up in a "borrowed bed" during their stay then, leave the default in Item as ''no borrow'' and also put a check mark in the checkbox. (this is to verify that there was no bed borrow, otherwise no one is sure is missed or not).
==== First set of vital signs for CC ====
If the patient does end up in a "borrowed bed", change the item to the location of the borrow and enter the rest as per below: [[#How to enter this]].  
[[ICU Curriculum]]: The first set of vital signs is used as [[Boarding Loc]] dttm for arrival on the unit for [[Critical Care program]] admissions, if it is different from the Cognos Unit Start DtTm.


Add a new tmp entry for every additional move/borrow within your centre that a patient makes during their stay at your [[Service/Location]]; including moves from borrowed location to your actual unit.
==== Erroneous Unit information in [[CSS]]/[[Cognos2 Unit Starter]] ====
Sometimes the times are not when people really show up at a location. Use what you know to be correct from chart and your knowledge of your hospital.


==Moved to a Borrow Location PRIOR to being moved to your Unit or ward ==
=== How to enter ===
*if moved into a borrowed location '''prior to''' coming your unit or ward, then the [[Arrive DtTm field]] in Dispo tab should be the same the arrive DtTm in TMP.
You can use the [["make loc" button]] to generate and pre-populate these entries.  
 
=== How to enter this ===
*Use tmp fields:
*Use tmp fields:
** Project: '''{{PAGENAME}}'''
** Project: '''{{PAGENAME}}'''
** Item: '''no borrow''' is the default (check off the box under column B for all patients that are '''not''' borrowing a bed).
** start_dt and start_tm:  
** Item: '''borrowed bed location''' (select the ward/unit where the bed was borrowed):
*** enter as per Cognos initially
**** For beds borrowed in an ICU, specify the actual location of the borrowed bed.
*** before setting [[RecordStatus]] to complete update the DtTm to comply with [[DtTm for First Boarding Loc and First Service]]
**** For beds borrowed in a Medicine location,
** checkbox: not used for this project <!-- was used for [[cross check]]s in data before 2020-10-15 -->
***** for borrowed bed enter your hospital's "boarding" entry, eg "HSC - boarding"
** Item:
***** enter your hospital's "Home medicine ward" when pt comes (back) to home ward, eg "GRA - Home medicine ward"
*** for the initial unit or ER and each physical move to another unit, enter the location by using the "make loc" button in [[Patient Viewer Tab Cognos ADT2]]
*** GRA - boarding (includes step-downs)
*** if a boarding location appears in COGNOS but the patient does NOT move/arrive to that boarding location, do NOT enter that boarding location.  We only capture boarding locations where the patient physically arrives (also see [[Wrong service or unit entries in Cognos]])
*** GRA - Home medicine ward
**** if the ward is not available in the dropdown, please notify Tina, Lisa, and Julie; Tina/Lisa will add the location to the dropdown and update the wiki as needed
*** GRA - recovery
{{Discuss |
*** GRA_ER (a strange thing they only do at Grace for now) - added May 2.19
**** leave what is in Cognos, the main office doesn't use this part for anything for home locations, but it can be used to crosscheck accuracy.
*** [[GRA MICU]]
***** what is this about? [[User:Ttenbergen|Ttenbergen]] 17:42, 19 August 2025 (CDT)
*** HSC - boarding (includes step-downs)
}}
*** HSC - Home medicine ward
* '''no location entered''' is the default
*** HSC  -recovery
** that entry will not be allowed in a complete record; it is automatically deleted when by Cognos Make Loc button, but needs to be removed before setting a record to complete if it is still present.
*** [[HSC_CCU]]
<!--
*** [[HSC_IICU]]
*emailed to see if this automatic entry is still useful now that things are entered with make loc button [[User:Ttenbergen|Ttenbergen]] 13:05, 2023 January 25 (CST)
*** [[HSC_MICU]]
** We discussed this and decided to leave for now, as we don't manually delete it is populated by COGNOS when we choose the Make location button [[User:Lkaita|Lisa Kaita]] 13:59, 2023 February 1 (CST) -->
*** [[HSC_SICU]]
*** STB - recovery
*** STB - boarding (includes step-downs)
*** STB - Home medicine ward
*** [[STB_ACCU]]
*** [[STB_CICU]]
*** [[STB_MICU]]
** Enter start_dt: '''arrival date at borrowed bed''', under column E.
** Enter start_tm: '''arrival time at borrowed bed''', under column M.
** checkbox: '''to be checked only in case of "no borrow"
** comment field:
*** see [[#Special Case - moving from one borrowed ward bed to another]]
*** There are now additional circumstances where we use comment field for Borrow Loc, to do with COVID moves. Documented in pages in [[:Category:2020 COVID unit transition]] and some info below in [[#COVID]]


===Return from boarding Loc to own unit during same stay ===
{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}
* If the patient moves back to their "home unit", or "intended unit", make another '''borrowed bed location''' entry and select your home unit, e.g. ''HSC - Home medicine ward''. Enter the date/time for this move, as above.
<!-- the above are general instructions, put any special case info below here -->
*Dispo Tab
 
**[[Service/Location field]] enter: '''home''' ward/unit
==== Special Case - Can't have two Boarding Locs with same DtTm ====
* No two different [[Boarding Loc]] records can have same start_dt and start_tm; if two locations have the same Start_DtTm in [[CSS]]/[[Cognos2 Unit Starter]] this is an error.
* The date and time for these entries must be confirmed by looking at the chart, specifically orders, flowsheets, and progress notes
{{DJ | It says:
* Change one to be off by one minute, put a note in [[Notes field]] to check boarding location to confirm the correct date and time for the boarding locations of concern.
** how does that fit in with reviewing reality in the chart?
** I don't know what you mean by this?  It means you double check the correct first service and first and second boarding loc dttm [[User:Lkaita|Lisa Kaita]] 21:14, 6 September 2025 (CDT)
*** Well, it seems like this triggers an error check, so you pull the times a minute apart to overcome the error check and put a note to remind you to check later. So either the check should run later (on complete or send) or we shouldn't have it at all. But a check that just gets you to "tweak" the data to make it go away isn't a good idea.
* sure if you can have the cross check on completion that would be better, the prior scenario is almost always for SICU admissions from ER [[User:Lkaita|Lisa Kaita]] 15:51, 26 November 2025 (CST)
** Julie, do you use Boarding Loc info on incomplete charts? Would either the current collection practice, or delaying the check, mess with measures or indicators? [[User:Ttenbergen|Ttenbergen]] 22:09, 26 November 2025 (CST)
}}


=== Special Case - original arrival is in "borrowed bed" ===
* This case is especially common in the context of [[DtTm for First Boarding Loc and First Service]]
If pt is admitted to your physician service but the original location is from an off-ward bed, code that location  [[Arrive DtTm]] = borrow date and time.
{{Ex |
* Example: Not infrequently, the COGNOS data for HSC_SICU patients coming from the ER  will show the first service, first boarding location (ER) and the second boarding location (SICU) as all having the same start_DtTm. Our solution for this is to change the second boarding location (SICU) to be off by one minute.
}}


The APACHE elements time frame will start in the off-ward bed location and TISS starts from the off-ward bed as well.
==== Special Case - GRA MICU boarding in GH-Emergency ====
''This is a case of [[Patients who appear to transfer from in-patient situation to Emergency Room]], see there for more info.
* Grace ICU boarding in ER choose Boarding Location GH-Emergency
* Grace Main ICU choose Boarding Location and GH-Intensive Care
* Grace Recovery Room (ICU) choose Boarding Location and [[GH-Recovery Room]] and enter comment Covid+ICU
* For External(SDC/NFA) ICU beds choose Boarding Loc and GH-External ICU and enter exact location in comments
* The [[Previous Location]] and [[Pre-admit Inpatient Institution]] would be <site>_med or <site>_ward


=== Special Case - moving from one borrowed ward bed to another ===
=== Special Case - Cross-program boarding ===
If there are two consecutive boarding locations in the same type of Boarding Loc entry (e.g. "HSC - boarding"), just have one entry with the first date and add in the comment the other locations.
If a patient is accepted by one of our services, and is on an off-service ward, enter a [[Boarding Loc]] entry for that period.  


=== Special Case - PACU ===
'''For medicine pts boarding in ICU''' you can use the explicit ICU entry that applies because all CC locations are explicitly included in Boarding Loc.
If a bed is borrowed in PACU / post-anesthesia care / recovery unit, code this as a '''borrow'''. (i.e. <hosp> - recovery, e.g. "HSC - recovery").
{{DJ|
what is this sentence telling me, can I not use the specific medicine entry? Why/how? What would a new collector need to know?
* I have no idea, I suppose this can happen although I have not ever seen this at any of the facilities, I believe you were the original author of this so feel free to do what you want with this [[User:Lkaita|Lisa Kaita]] 13:46, 6 August 2025 (CDT)
** Julie, do you know what this is about? If the same applies for Med as for ICU in this, then lets get rid of the confusing entry. [[User:Ttenbergen|Ttenbergen]] 17:23, 6 August 2025 (CDT)
*** we have one  case S4_STB_Med-2892 where first3 days at SBGH ICMS then transferred to SBGH-L2CC.--[[User:JMojica|JMojica]] 16:42, 18 August 2025 (CDT)
**** What else would they use? The entry would come from Cognos, no? It's entered by drop-down, so I don't think they could enter anything but the actual entry. Is this stated here really as a reminder for you, in case this happens again? If so, would it be better to store it in L_Problems table? If it is an instruction to collectors, would you explain further what you actually intend?  [[User:Ttenbergen|Ttenbergen]] 17:33, 19 August 2025 (CDT)
}}


If the decision to accept to the service happens in PACU, the [[Arrive DtTm]] = the borrow date and time.  The APACHE elements are collected at PACU stay and TISS starts at PACU.
'''For CC patients boarding on a Med ward where we collect''', enter "GRA_Med"/"HSC_Med"/"STB_Med" as applicable. We added these boarding loc options specifically for this scenario, and they are available only for [[Critical Care program]] admissions.  


=== Special Case - From ER ===
Not included in this project. 
*The time spent/waiting in ER is done using [[Arrive DtTm]] vs [[Accept DtTm]].
**March 30.19: own ward, to own ER (under ICU physician care) then to own ICU when bed available.  Started occurring at Grace- March 30.19
*** See [[GRA ER use as borrow location]]


=== Special Case - Parked ===
{{Ex | This could happen if the team runs a code on a patient and accepts care for that patient, but for a period of time hasn't yet moved the patient. For Critical Care, you would enter a generic "<Site>_Med"  "<Site>_Med" (ie [[GRA_Med]], [[HSC_Med]], [[STB_Med]]) for this patient so we don't have CC collectors keeping track of where regular, boarding or covid locations are.}}
Not included.
*For patients who are [[Parked in ER]], no need an entry for these, since the ER delay will take care of them.


=== Special Case - EMIP/ECIP ===
=== Special Case - [[Visits to temporary locations]] that happen to be Boarding Locs ===
{{Discuss|
Occasionally a patient may be transferred to a location that is normally a [[Boarding Loc]] that we would enter or discharge to, however that location may be used as a temporary boarding location for a procedure.  If after reading through the chart this is in fact the case, that [[Boarding Loc]] should not be entered, as it should be regarded as though the patient were going for any procedure and then back to their home ward location.
* [[ECIP]] - these ''are'' now happening, so how would we enter them?
*Sometimes [[Visits to temporary locations]] may look like boarding locations. See that page for info on making the distinction.
* [[EMIP]] - this structure ''could'' accommodate EMIPs, but the problem is
{{Ex|
** how do we identify then (right now people take turns at some sites...
Medicine patient is transferred to ICMS for a scope and is not admitted under critical care -> don't enter a [[Boarding Loc]] for ICMS
** which collector would collect them what service/location do we collect them as? Right now we have a special service location for these...
** how about that "service x" at HSC?
}}
}}


=== COVID ===
=== Special Case - parked in ER ===
During the [[COVID-19 (SARS-COV-2)|COVID-19]] pandemic there were a lot of movements of entire wards. The {{PAGENAME}} project was a convenient place to store this information, so we added some specific locations for this purpose:
For further information please see
*HSC_D5_p
* [[Parked in ER]]
*HSC_D4_P
*HSC_H4H
*STB_E6_B
*GRA_N5


== Start/End Dates ==
{{Boarding Loc, Service content}}
*Start: 2019-Sep-01: new admissions on and after this date.  
 
== Start/End Dates of collection ==
*CC Start: 2018-July-19 as [[Project Borrow arrive]] and has been renamed and continued as Boarding Loc starting 2019-Sep-01
*Med Start: 2019-Sep-01: new admissions on and after this date.  
*CC and Med Start Oct,1 2020 : modified according to [[PatientFollow Project]]  to include ER as boarding loc.
* 2020-12-16: [[Change of GRA location names from "our" names to EPR/Cognos names]]
* 2022-01-01: [[Change of remaining location names from "our" names to EPR/Cognos names]]
*End: there is no planned end date
*End: there is no planned end date
== data checks ==
{{Discuss |
Which if any of [[Project_Borrow_arrive#Data_Integrity_Checks_.28SMW.29]] will need to be moved over to this instead? }}


{{Data Integrity Check List}}
{{Data Integrity Check List}}
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::: where Next Arrival Date_time = Dispo Date_time if there is no more next arrival date_time.  
::: where Next Arrival Date_time = Dispo Date_time if there is no more next arrival date_time.  


The SAS program is saved in X:\Julie\SAS_CFE\CFE_macros\Bed_Borrow.sas
The SAS program is saved in S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas.
*the specific macros are %BoardingLoc, %ACCUBorrow, %ICUOtherService


== Background ==
== Background ==
See [[Bed borrow]] as aggregator page for other boarding and borrow related concepts.
See [[Bed borrow]] as aggregator page for other boarding and borrow related concepts.


The concept is similar to [[EMIP]]s but we will keep the EMIP separate from this project. The current EMIP will stay the same.--[[User:JMojica|JMojica]] 10:37, 2019 September 20 (CDT)
The concept of  [[EMIP]]s which  was similar from [[Bed borrow]] and collected separately before are now collected as part of [[Boarding Loc]]. See [[EMIP#Legacy information]] information for how they were collected before/


==Related articles ==
==Related articles ==
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[[Category:Overflow]]
[[Category:Overflow]]
[[Category:EMIP]]
[[Category:EMIP]]
[[Category:PatientFollow Project]]
[[Category:Admit/Discharge]]
Retrieved from "https://ccmdb.kuality.ca/index.php?title=Boarding_Loc"