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=== Relationship between [[Intended1stSrvc]] and [[Transfer for bed management]] ===
=== Relationship between [[Intended1stSrvc]] and [[Transfer for bed management]] ===
*[[Intended1stSrvc]] only applies when a patient is initially admitted to an ICU service from a non-ICU location (e.g. ED) or non-ICU service (e.g. ward), thus it does not apply upon direct ICU-to-ICU transfer.  If such a patient is transferred to the receiving ICU service for bed management reasons, that patient should have coding as [[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.
*[[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.
**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
*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 the patient has [[Intended1stSrvc]] of MICU and [[Service/Location]] of SICU.  Two days later, SICU has a bed crunch and the patient is transferred to Grace ICU, so then in that SICU database record [[Transfer for bed management]] is coded as an [[Acquired Diagnosis]].
**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 ===
=== 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]] is SICU and [[Intended1stSrvc]] is MICU.
*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 (as ECIP).  She/he should go to MICU but it is full, so decision is made for patient to go from ED (on MICU service) to SICU on SICU service.  So, for the initial MICU service record, [[Service/Location]] is MICU and [[Intended1stSrvc]] is blank.  For the SICU service record, [[Service/Location]] is SICU, and [[Intended1stSrvc]] does not apply and is left blank, but the patient should be coded as [[Transfer for bed management]].  
*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 goes to HSC MICU.  Here upon admission to HSC MICU, [[Service/Location]] is MICU and [[Intended1stSrvc]] is Grace ICU.  This example shows that the [[Intended1stSrvc]] can be at a different hospital altogether.  
*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]]=GGH ICU, [[Boarding Loc]]=MICU.  This example shows that the [[Intended1stSrvc]] can be at a different hospital altogether.  
*Example#4: Patient in ED at Grace still and has been officially admitted to the Grace ICU service.  So, for that Grace ICU record [[Service/Location]] is Grace ICU and [[Intended1stSrvc]] is blank because the patient has been admitted to her/his intended first service.  But Grace ICU is full, so decision is made for patient to go t HSC MICU.  Here upon admission to Grace ICU MICU, [[Service/Location]] is Grace ICU, and [[Intended1stSrvc]] is blank because the patient HAS been admitted to the intended ICU service.  Upon admission to HSC MICU, that record has [[Service/Location]] of MICU, and [[Intended1stSrvc]] does not apply and is left blank, but the patient should be coded as [[Transfer for bed management]].  
*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, with [[Service/Location]] as MICU and [[Intended1stSrvc]] is left blank.  Due to bed issues, later on the day of initial MICU admission, patient is transferred to SICU on SICU service.  For the SICU record, [[Service/Location]] is SICU, [[Intended1stSrvc]] is left blank, but patient should be coded as [[Transfer for bed management]].
*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 the SICU record has [[Intended1stSrvc]] of MICU and [[Service/Location]] of SICU. Two days later, SICU has a bed crunch and the patient is transferred to Grace ICU, so in the SICU database record [[Transfer for bed management]] is coded as an [[Acquired Diagnosis]], while the Grace ICU record has [[Transfer for bed management]] coded as an [[Admit 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-SICU service for surgical problem.  Then goes to surgery ward where he develops severe pneumonia needing intubation and again goes to SICU service. For both the first and the separate second SICU records [[Intended1stSrvc]]=blank.  As the 2nd ICU record was not a direct ICU-to-ICU transfer, there is no [[Transfer for bed management]].
*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 severe pneumonia needing intubation and although he should go to SICU, it's full so he goes to MICU ''but is boarding there only as he IS cared for by the SICU service. As we keep track of ICU records by service, not physical location, here also for both SICU service records [[Intended1stSrvc]]=blank.  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 from STB ED to STB-SICU service for surgical problem.  Then goes to surgery ward where he develops severe pneumonia needing intubation and although he should go to SICU, it's full so he goes to MICU on the MICU service. For the SICU service record [[Intended1stSrvc]]=blank.  For the 2nd, MICU record [[Intended1stSrvc]]=SICU, and as this 2nd ICU record was not a 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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=== Terminology for services inconsistent with [[EPR]] ===
=== Terminology for services inconsistent with [[EPR]] ===
*We recognize that the drop-downs we chose are different from the standardized terms in [[EPR]]; it was decided that this is OK because the perception is that our terms are what leadership actually wants
*We recognize that the drop-downs we chose are different from the standardized terms in [[EPR]]; it was decided that this is OK because the perception is that our terms are what leadership actually wants
{{Discuss | JALT
 
* [[JALT Meeting - Rolling Agenda and Minutes 2025#JALT 2025-12-18 | 2025-12-18 JALT]] - We may want to discuss the discrepancy of our naming and its implications with the recipients of our reports and possibly the team that reports similar out of EPR. [[User:Ttenbergen|Ttenbergen]] 14:44, 23 December 2025 (CST)
 
}}


== Left to resolve ==
== Left to resolve ==
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{{Discuss | JALT
* Can these entries only be at the same site as the record (eg would "Gra ICU" be a legit entry for a patient at HSC MICU)? If only same siet that may be a relevant cross-check.
}}


{{DJ |
{{DJ |
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