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Boarding Loc: Difference between revisions

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Use unit start dttm even if it is before Accept DtTm
 
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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.  
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.  


This project tracks where and when a patient '''arrives''' into a new physical location.  
This project tracks where and when a patient '''arrives''' into a new physical location under the Medicine or ICU service.  


== Data Collection Instructions ==
== Data Collection Instructions ==
=== 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]]


=== How to enter this ===
==== First set of vital signs for CC ====
You can use the [["Make loc" button]] to generate and pre-populate these entries.  
[[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.


==== 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.
=== How to enter ===
You can use the [["make loc" button]] to generate and pre-populate these entries.
*Use tmp fields:
*Use tmp fields:
** Project: '''{{PAGENAME}}'''
** Project: '''{{PAGENAME}}'''
** Enter start_dt: '''arrival date at physical location''', under column E.
** start_dt and start_tm:  
** Enter start_tm: '''arrival time at physical location''', under column M.
*** enter as per Cognos initially
*** '''These will be the actual arrivals on the unit, which might of course be before the [[Accept DtTm]] / Service start dttm''' ( see [[#Why do we use the actual unit start dttm rather than the time they became our pt on a unit | why]])<!-- as discussed at Task 2020-12-02 -->
*** before setting [[RecordStatus]] to complete update the DtTm to comply with [[DtTm for First Boarding Loc and First Service]]  
** checkbox: not used for this project <!-- was used for cross checks in data before 2020-10-15 -->
** checkbox: not used for this project <!-- was used for [[cross check]]s in data before 2020-10-15 -->
** Item:  
** Item:  
*** '''no location entered''' is the default (that entry will not be allowed in a complete record)
*** 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]]
**** change the original entry to the first location the patient was during the admission in this record, e.g. ER, specific medicine ward etc
*** 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]])
**** for any physical move to another unit, enter an additional [[Boarding Loc]] entry:
**** 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
*** for "home" locations or other locations where there is a specific entry listed in the dropdown (eg ER)
{{Discuss |
**** item: the actual ward, e.g. STB_B5 or HSC_MICU
**** 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.
**** comment: leave blank
***** what is this about? [[User:Ttenbergen|Ttenbergen]] 17:42, 19 August 2025 (CDT)
*** for "boarding" and '''COVID Suspect''' locations
}}
**** item: "<your site> - boarding" (eg. "HSC - boarding", resp. "HSC - ICU boarding")  
* '''no location entered''' is the default
**** comment: actual unit
** 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.
*** for '''COVID Positive''' locations
<!--
**** item: "<your site> - COVID unit" (eg. "GRA - COVID unit")  
*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)  
**** comment: actual unit
** 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) -->


==== GRA MICU ====
{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}
{{Discuss |
<!-- the above are general instructions, put any special case info below here -->
***Grace Main ICU Choose Boarding Location and GRA_MICU. Grace Recovery Room (ICU) Choose boarding location and GRA-recovery and enter comment Covid+ICU. For External(SDC/NFA) beds choose boarding loc and GRA-ICU boarding and enter exact location in comments.[[User:Gthomson2|Gthomson2]] 08:47, 2020 November 18 (CST)
****  These seem to be different from what is written up there. [[User:Ttenbergen|Ttenbergen]] 10:36, 2020 November 18 (CST)}}


==== Why do we use the actual unit start dttm rather than the time they became our pt on a unit ====
==== Special Case - Can't have two Boarding Locs with same DtTm ====
We decided to use the actual unit start dttm because as the start of the boarding loc entry for two reasons:  
* 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.
* it is the actual time a pt arrived on that unit, so it's a more intuitive data point for someone not familiar with our data
* The date and time for these entries must be confirmed by looking at the chart, specifically orders, flowsheets, and progress notes
* it allows clean matching to Cognos entries so the various Cognos tools can identify if an entry has already been dealt with
{{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 - cross-program boarding ===
* This case is especially common in the context of [[DtTm for First Boarding Loc and First Service]]
If a patient is accepted by your service but remains at a location of a different service for some time before moving to your service, you need to enter a [[Boarding Loc]] entry for that period.
{{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.  
For Critical Care collection, 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" (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. The generic "<Site>_Med" entry would only be available on CC laptops.  
}}
For Medicine laptops this isn't an issue because all CC locations are explicitly included in Boarding Loc.


=== Special Case - Parked ===
==== Special Case - GRA MICU boarding in GH-Emergency ====
*For patients who are [[Parked in ER]], just follow usual instructions, a special entry is no longer needed, since the ER delay will take care of them.
''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 - EMIP/ECIP ===
=== Special Case - Cross-program boarding ===
See [[2020-10 EMIP changes]]
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 - COVID ===
'''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.
* For details of which patients to inlcude, see [[2020-10 COVID unit collection]].
{{DJ|
* For units with special designation see [[COVID Designated Ward]]
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)
}}


=== Special Case - COVID ''status of unit'' changes while patient location and service remains same ===
'''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.  
* If the unit a patient is on changes to be a [[COVID Designated Ward]], or changes to no longer be a COVID unit, and the patient stays put and remains on your service, put a new boarding loc entry to reflect the new unit status:
** If the unit a patient is on changes to be a COVID unit, enter a [[Boarding Loc]] entry of <your site> - COVID unit (e.g. "STB - COVID unit") for any admission to and time spent in a COVID unit
*** enter the actual location into the comment field, e.g. E6
** If the unit a patient is on changes to no longer be a COVID unit, and the patient stays put, enter a [[Boarding Loc]] entry of the [[Service/Location]], e.g. STB_E6_B


=== Special Case - Erroneous Unit information in [[Cognos EPR Report]] ===
Sometimes there are location entries in Cognos that are errors. EG. a patient may be listed as having gone to a weird unit for 5 minutes and then moved to a more reasonable one. They were probably never on that weird unit. For those cases, just exclude the location from your list so it doesn't clutter things, and don't enter this as a location.


{{Discuss | who = Julie |
{{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.}}
* To confirm: Julie, this means that if a pt was listed in Congos as some bogus unit for the first 6 hours of their stay, we would list their stay on our unit as starting 6 hours later. this would probably trigger some of Pagasa's cross checks, and give you 6 hours of missing occupancy. I still think it's the right way to deal with this error since messing with the times would break how entries are linked to Cognos, but I want to make sure we are all aware that this is a thing and how we approach it. Ttenbergen 13:29, 2020 November 9 (CST)
** when does this phenomenon occur - at the beginning or in between transfers? (Julie)
*** It seems to be a matter of data entry errors, so I suppose it can occur at any time. [[User:Ttenbergen|Ttenbergen]] 11:00, 2020 November 18 (CST)
** if at the beginning, then just exclude. (Julie)
***If we ignore it if it happens at the beginning, it will mean Cognos lines that are not linked to anything. They will either clutter the screen as "not yet entered", or will need to be excluded manually by collectors. I think manually excluding them would get them off the list, but if a collector then tries to make sense of what they see the next day it will be confusing. [[User:Ttenbergen|Ttenbergen]] 11:00, 2020 November 18 (CST)
** If in between transfers during an episode, is there a query done for that? Pagasa' query will crosschecks between records and not within episode. But if that happens, since only the arrived date is entered, I will always assume continuous stay defining the end date as the start date of the next boarding location. (julie)
*** Not sure what kind of query you have in mind. We only collect the unit starts, so there are no unit ends to cross check against. This means we should define how to enter these "bogus" units as either including them with the previous or including them with the next unit. I would prefer including them with previous because it doesn't break linking with Cognos for the next unit. [[User:Ttenbergen|Ttenbergen]] 11:00, 2020 November 18 (CST)


=== Special Case - [[Visits to temporary locations]] that happen to be Boarding Locs ===
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.
*Sometimes [[Visits to temporary locations]] may look like boarding locations. See that page for info on making the distinction.
{{Ex|
Medicine patient is transferred to ICMS for a scope and is not admitted under critical care -> don't enter a [[Boarding Loc]] for ICMS
}}
}}


== Start/End Dates ==
=== Special Case - parked in ER ===
*Start: 2019-Sep-01: new admissions on and after this date.
For further information please see
*End: there is no planned end date
* [[Parked in ER]]


== Loose ends ==
{{Boarding Loc, Service content}}
{{DT |
* [[Query ''check ER Delay not too big'']] needs to be changed to include the new [[Boarding Loc]] schema . }}


{{Discuss |
== Start/End Dates of collection ==
Which if any of [[Project_Borrow_arrive#Data_Integrity_Checks_.28SMW.29]] will need to be moved over to this instead? }}
*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.  
{{DT |
*CC and Med Start Oct,1 2020 : modified according to [[PatientFollow Project]] to include ER as boarding loc.
* inactivate legacy entry '''Home Medicine ward''' once last pt using it is discharged
* 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


{{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:EMIP]]
[[Category:EMIP]]
[[Category:PatientFollow Project]]
[[Category:PatientFollow Project]]
[[Category:Admit/Discharge]]
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