Intended1stSrvc: Difference between revisions
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{{Project | {{Project | ||
|ProjectActive= | |ProjectActive=Active | ||
|ProjectProgram=CC | |ProjectProgram=CC | ||
|ProjectRequestor=Bojan Paunovic | |ProjectRequestor=Bojan Paunovic | ||
|ProjectCollectionStartDate=2026-01-01 | |||
|Project={{PAGENAME}} | |Project={{PAGENAME}} | ||
}} | }} | ||
== Data Collection Instructions == | |||
=== When to code === | |||
*Collect this if the ''initial'' ICU service to which the patient was admitted to (as encoded in [[Service/Location]] for records under the [[Definition of a Critical Care Program Admission]]) is '''''not the service the patient "should" have been on. | |||
**Example: MICU-type patient is in HSC ED, but due to MICU being full, the patient is admitted to the SICU service. Here [[Service/Location]] is HSC-SICU and [[Intended1stSrvc]] = HSC-MICU | |||
**This variable is left blank when the patient's first ICU service is, in fact, the ICU service they "should" be on -- obviously this is most ICU admissions | |||
*So, this variable only applies UPON ADMISSION to an ICU service -- regardless of the patient's physical location when that occurs (e.g. can include ECIP situations) | |||
**BUT this variable CANNOT be coded until the patient was offically admitted to an ICU service -- irrespective of care advice being provided by an ICU team, and irrespective of any role ICU team members have in facilitating eventual admission to an ICU service | |||
*Reconsider the [[Intended1stSrvc]] for each new ICU profile for the same patient | |||
* | === Changes of "intended service" during the ICU stay === | ||
* '''< | * Although it occasionally happens that the "intended" service for an ICU patient changes after initial admission to an ICU service, we will NOT attempt to keep track of such changes. The reason is that such changes often reside only in the heads of the ICU attending physicians, i.e. they're not reliably reflected in the progress notes. | ||
*This is why this variable is called intended FIRST service. | |||
*Thus, only consider the '''initial intent'''<!-- turning this into a reference to this project is circular, the point is that _the_intent_ a t the beginning of the admission counts --> for each new profile (see [[#Changes within an ICU service admission]] and [[#Changes between successive ICU service admissions]] ) | |||
== | === Relationship between [[Intended1stSrvc]] and [[Transfer for bed management]] === | ||
*Keeping track of this requires remembering that ICU database records are according to ICU service, not location. Thus, when the service changes the patient gets a new ICU record, while a change of physical location with no change in ICU service is ''not'' a new record (it's just a change in [[Boarding Loc]]. | |||
* | *[[Intended1stSrvc]] ''only'' applies when a patient is initially admitted to an ICU service from a non-ICU location (e.g. ED, ward) -- it DOES NOT apply to direct transfer from one ICU service to a different ICU service (i.e. ICU-to-ICU transfer). If a patient undergoes direct ICU-to-ICU transfer for bed management reasons, the sending ICU record should have [[Transfer for bed management]] as an [[Acquired Diagnosis]], while the receiving ICU record should have [[Transfer for bed management]] as an [[Admit Diagnosis]] | ||
* | *[[Transfer for bed management]] only applies to direct ICU-to-ICU service transfers. | ||
* | **and this is regardless of the physical location of the patient upon that transfer, e.g. a patient who is "ECIP", still physically in ED but has been officially admitted to an ICU service, can have [[Transfer for bed management]], but cannot have [[Intended1stSrvc]] because such a patient has already been admitted to an ICU service and any opportunity to code [[Intended1stSrvc]] would apply to that initial ICU record when they were admitted to that first ICU service. | ||
*Although it IS possible for a single ICU record to include BOTH of these, they would be for ''different ends'' of the ICU record, i.e. the beginning vs. the end | |||
**e.g. Patient with pneumonia in HSC ED is admitted to SICU on SICU service due to lack of MICU beds. So that SICU service record has [[Intended1stSrvc]]=MICU and [[Service/Location]]=SICU. Two days later, SICU has a bed crunch and the patient is transferred to Grace ICU, so the SICU database record [[Transfer for bed management]] is coded as an [[Acquired Diagnosis]], while the Grace ICU record will have [[Transfer for bed management]] coded as an [[Admit Diagnosis]] | |||
=== | === Examples === | ||
* | *Example#1: Patient admitted from HSC ED with severe pneumonia, is still on ED service in ED. She/he should go to MICU but it is full, so goes to SICU and is taken care of by the SICU service. Here [[Service/Location]]=SICU, [[Intended1stSrvc]]=MICU, [[Boarding Loc]]=SICU. | ||
*Example#2: Patient admitted from HSC ED with severe pneumonia, and while in ED is officially admitted to MICU service (i.e. is ECIP). So this initial ICU record has: [[Service/Location]]=MICU, [[Intended1stSrvc]]=left blank as it doesn't apply for direct ICU service-to-ICU service transfers, [[Boarding Loc]]=HSC ED. But MICU but it is full, so decision is made for patient to go from ED (having already been admitted to the MICU service) to SICU on SICU service. For the SICU service record, [[Service/Location]]=SICU, [[Intended1stSrvc]]=left blank since it doesn't apply to direct ICU service-to-ICU service transfers, [[Boarding Loc]]=SICU, plus [[Transfer for bed management]] as an [[Admit Diagnosis]]. The earlier MICU service record should have [[Transfer for bed management]] as an [[Acquired Diagnosis]]. | |||
*Example#3: Patient in ED at Grace still on the ED service. Should go to Grace ICU but it's full, so is instead initially admitted to HSC MICU, upon which [[Service/Location]]=MICU, [[Intended1stSrvc]]=none, [[Boarding Loc]]=MICU. This example shows that the [[Intended1stSrvc]] can be at a different hospital altogether. | |||
*Example#4: Patient in ED at Grace but has been officially admitted to the Grace ICU service. So, for that Grace ICU record [[Service/Location]]=Grace ICU, [[Intended1stSrvc]]=Grace ICU, [[Boarding Loc]]=Grace ED . But Grace ICU is full, so decision is made for patient to go to HSC MICU. Upon admission to HSC MICU, that record has [[Service/Location]]=MICU, [[Intended1stSrvc]]=left blank since it doesn't apply to direct ICU service-to-ICU service transfers, [[Boarding Loc]]=MICU, and [[Transfer for bed management]] coded as [[Admit Diagnosis]]. The earlier Grace ICU service record should have [[Transfer for bed management]] as an [[Acquired Diagnosis]]. | |||
*Example#5: Patient with pneumonia was admitted from ED to HSC MICU, so [[Service/Location]]=MICU, [[Intended1stSrvc]]=left blank because this patient WAS admitted to the intended first service, [[Boarding Loc]]=MICU. Due to bed issues in MICU, later on the day of that initial MICU admission, patient is transferred to SICU on SICU service. For the SICU record, [[Service/Location]]=SICU, [[Intended1stSrvc]]=left blank since this is a direct transfer not an initial admission to an ICU, [[Boarding Loc]]=SICU, [[Transfer for bed management]] as an [[Admit Diagnosis]]. The earlier MICU service record should have [[Transfer for bed management]] as an [[Acquired Diagnosis]]. | |||
*Example#6: Patient with pneumonia in HSC ED should go to MICU but is admitted to SICU on SICU service due to lack of MICU beds. So for this SICU record [[Service/Location]]=SICU, [[Intended1stSrvc]]=MICU, [[Boarding Loc]]=SICU. Two days later, SICU has a bed crunch and the patient is transferred to MICU, so in the MICU database record has [[Service/Location]]=MICU, [[Intended1stSrvc]]=left blank as it doesn't apply to direct ICU transfers, [[Boarding Loc]]=MICU, [[Transfer for bed management]] as an [[Admit Diagnosis]]. The earlier SICU service record should have [[Transfer for bed management]] coded as an [[Acquired Diagnosis]]. | |||
*Example#7: Patient admitted from STB ED to STB-ICMS service for surgical problem. Then goes to surgery ward where he develops a postop complication and again goes to STB-ICMS service. Because of the intervening surgical ward admission, this patient will have 2 separate STB-ICMS service records. For each of them [[Intended1stSrvc]]=blank because for both the patient WAS admitted to the intended first service. As the 2nd ICU record was not a direct ICU-to-ICU transfer, there is no [[Transfer for bed management]]. | |||
*Example#8: Patient admitted from STB ED to STB-SICU service for surgical problem. Then goes to surgery ward where he develops a postop complication and although he ''should'' go to SICU, it's full so he goes to MICU but under the care of the SICU service, i.e. he's an SICU service patient boarding in MICU -- for this ICU record: [[Service/Location]]=SICU, [[Intended1stSrvc]]=blank as he was admitted to the intended service, [[Boarding Loc]]=MICU; and since there was no direct ICU-to-ICU transfer, there is no [[Transfer for bed management]]. | |||
*Example#9: Patient admitted to SBGH ACCU for complete heart block and had a permanent pacemaker inserted. Subsequently had multiple, severe complications and was transferred to HSC MICU because it was felt that the ACCU service had insufficient expertise to handle all these complications. After awhile in MICU, was transferred to IICU. This is a complicated situation: | |||
**For the initial ACCU service record: [[Service/Location]]=ACCU, [[Intended1stSrvc]]=blank as he was admitted to the intended service, [[Boarding Loc]]=ACCU. | |||
**For the MICU service record: [[Service/Location]]=MICU, [[Intended1stSrvc]]=blank as it doesn't apply to direct ICU transfers, [[Boarding Loc]]=MICU. Here the transfer was judged to be for medical necessity, so no [[Transfer for bed management]] -- and the same would be the case if the patient had gone to STB-ICMS instead of HSC MICU. | |||
**For the IICU service record: [[Service/Location]]=IICU, [[Intended1stSrvc]]=blank as it doesn't apply to direct ICU transfers, [[Boarding Loc]]=IICU. Here [[Transfer for bed management]] doesn't apply since IICU is a lower level than MICU and (except for ward to LAU transfers) it only applies to service transfers at the SAME level. | |||
*Example#10: Patient with severe pneumonia admitted from Grace ED to SICU service in SICU because both Grace ICU and MICU are full. A few days later patient remains physically in SICU but care is taken over by MICU service. Initial SICU service record: [[Service/Location]]=SICU, [[Intended1stSrvc]]=MICU, [[Boarding Loc]]=SICU Subsequent MICU service record: [[Service/Location]]=MICU, [[Intended1stSrvc]]=left blank, [[Boarding Loc]]=SICU. | |||
*Example#11: Grace ICU patient goes to MICU for an EEG, with an official transfer from Grace ICU service to MICU service for this relatively brief interval. This is a transfer for medical necessity, and MICU service record has: [[Service/Location]]=MICU, [[Intended1stSrvc]]=left blank, [[Boarding Loc]]=MICU. For the transfer back to Grace ICU, this is a [[Transfer for bed management]] with [[Service/Location]]=Grace ICU, [[Intended1stSrvc]]=left blank, [[Boarding Loc]]=Grace ICU. | |||
=== Data Entry Instructions === | === Data Entry Instructions === | ||
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* Item: one of (HSC-MICU, HSC-SICU, HSC-IICU, STB-MICU, STB-CICU, STB-ACCU, GH-CC) | * Item: one of (HSC-MICU, HSC-SICU, HSC-IICU, STB-MICU, STB-CICU, STB-ACCU, GH-CC) | ||
* all other fields are not used for this project | * all other fields are not used for this project | ||
* although the service tmp entry is not used for this project, continue to enter service tmp entries from COGNOS as per [[Service tmp entry]] | |||
{{Data Integrity Check List|}} | {{Data Integrity Check List|}} | ||
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* Without an additional signal, it would appear as if the capacity was sized right and accommodated the load, when really the sending service was over capacity, and the receiving service had (possibly excess) capacity to absorb the admission. | * Without an additional signal, it would appear as if the capacity was sized right and accommodated the load, when really the sending service was over capacity, and the receiving service had (possibly excess) capacity to absorb the admission. | ||
* This project encodes when the ICU service a patient is actually on (as encoded in [[Service/Location]]: MICU, SICU, IICU, ICMS, CICU, Grace ICU) is different from the service the patient '''should be on'''. | * This project encodes when the ICU service a patient is actually on (as encoded in [[Service/Location]]: MICU, SICU, IICU, ICMS, CICU, Grace ICU) is different from the service the patient '''should be on'''. | ||
=== Possible Responsibility/Location Scenarios === | === Possible Responsibility/Location Scenarios === | ||
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* Adding the ability to maintain multiple entries for this relatively rare event would significantly increase reporting complexity | * Adding the ability to maintain multiple entries for this relatively rare event would significantly increase reporting complexity | ||
* We explicitly decided '''NOT''' to try and track the service a patient should be on as time goes by, but only upon initiation of an ICU profile, which is why this variable is called "Intended1stSrvc" | * We explicitly decided '''NOT''' to try and track the service a patient should be on as time goes by, but only upon initiation of an ICU profile, which is why this variable is called "Intended1stSrvc" | ||
* The exception to this is when the patient, changes to a new service or the service they "should" have been under, and also has a new [[Boarding Loc]] | |||
{{Ex | x= | {{Ex | x= | ||
* Patient with acute MI admitted via ED. He should have been under the ACCU service in ACCU but ACCU was full. So he was admitted to ICMS instead '''''under the ICMS Service'''''. Thus here [[Intended1stSrvc]] = ACCU. | * Patient with acute MI admitted via ED. He should have been under the ACCU service in ACCU but ACCU was full. So he was admitted to ICMS instead '''''under the ICMS Service'''''. Thus here [[Intended1stSrvc]] = ACCU. | ||
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=== can be left until later but may complicate analysis or degrade data === | === can be left until later but may complicate analysis or degrade data === | ||
{{Discuss | JALT | {{Discuss | JALT | ||