Bed borrow: Difference between revisions

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A bed borrow is when a patient is located in one place while admitted under the physician of a different location (the home location).  
A bed borrow is when a patient is located in one place (e.g. a boarding location, [[Boarding Loc]]) while admitted under the physician of a different location (the home location).  


If a patient overflows into another unit, they are still patient of the unit where they are admitted and in the location on the laptop. Return to the unit is not a transfer.  
Over time we have had various incarnations of collecting this data, this page is an aggregator for the info, and specific collection info for old projects lives on the respective pages.  


=== collection instructions ===
== Currently collected concepts ==
* If a patient comes from arrives on your ward from a bed borrow location, code [[Pre-admit Inpatient Institution field]]/[[Previous Location field]] as the home location, not the bed borrow one.
* [[Boarding Loc]]
* If a patient you collect is currently in a borrowed bed somewhere off-ward, collect the [[Service/Location field]] as the home ward.
* [[Service tmp entry]]
* If you discharge a patient to a bed borrow location, code [[Dispo field]] as the home location.


=== Exception: [[EMIP]] ===
== Legacy concepts ==
EMIP patients are essentially bed borrows in the Emergency Room, but we collect and are specifically interested in this group, so follow the [[EMIP]] collection instructions for these patients.
The following concepts were collected separately before [[Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry]]:  
 
* [[EMIP]]  
=== [[Parked in ER]] ===
* [[Direct admit]]
A patient is considered parked in ER if they are a direct admit but when they arrive a bed is borrowed in the ER. The location they came from is encoded as [[Accept Loc Park]].
 
=== [[Project Borrow arrive]] ===
For all bed borrows for ICU patients only.  We are not using for medicine.
This new project replaces:
*[[ACCU borrow]]
*[[ICUotherService]]
 
==== Allan’s Suggestion for Bed Borrow Coding ====
*There are 2 sorts of bed borrowing when a TypeA patient should be in UnitA but is boarded in UnitB
**(1) Patient is in Unit B but still under the care of TeamA -- this is coded in the database as a UnitA patient
**(2) Patient is in Unit B and under the care of TeamB -- this is coded in the database as a UnitB patient
*Here’s what they’re borrowing:
**For ‘1’ the patient is just borrowing a bed
**For ‘2’ the patient is borrowing a bed AND the service, i.e. TeamB
*To capture all of this, we need to create 2 PAIRS of parameters -- that should be coded separately for each day, if applicable.  Each pair comprises a binary Flag combined with FlaggedUnitcode
**(a) Flag1 indicates that on the given day the patient is borrowing a bed -- the FlaggedUnitCode indicates WHERE that bed is. 
**(b) Flag2 indicates that on the given day the patient is borrowing a bed & service -- the FlaggedUnitCode code indicates WHERE that patient would otherwise be located
*Example:  A=ACCU  B=ICMS
**In situation#1, set Flag1=1 and FlaggedUnitCode=ICMS
**In situation#2, set Flag2=1 and FlaggedUnitCode=ACCU
*THUS, here is how the 2 kinds of pieces of data sought by administrators related to bed borrows would each be calculated:
**Administrators for UnitA want to know how many bed-days in a given interval that they had TypeA patients boarding elsewhere.  This number is the sum of the following 2 things:
***#Bed-days in the given interval that patients assigned to UnitA had Flag1=1 +
***#Bed-days in the given interval that patients assigned to any other unit had Flag2=1 AND the FlaggedUnitCode for Flag2 was UnitA
**Administrators for UnitB want to know how many bed-days in a given interval were taken up by boarders from elsewhere.  This number is the sum of the 2 following things:
***#Bed-days in the given interval that patients assigned to UnitB had Flag2=1 +
***#Bed-days in the given interval that patients assigned to any other unit had Flag1=1 AND the FlaggedUnitCode for Flag2 was UnitB


== Background ==
== Background ==
The concept is important because it affects the [[Previous Location field]], [[Service/Location field]], [[Dispo field]], various cross-checks, and concepts like [[EMIP]], [[Off ward]], [[Definition of an ICU admission]] and [[Definition of a Medicine Service admission]].
The concept is important because it affects the [[Previous Location field]], [[Service/Location field]], [[Dispo field]], various cross-checks, and concepts like [[EMIP]], [[Boarding Loc]], [[Definition of a Critical Care Laptop Admission]] and [[Definition of a Medicine Laptop Admission]].  
 
The concept is the counterpart of an [[Off ward]] - a patient who is counted as an off-ward by one site could be seen as a bed borrow by the site where they actually are.


=== Circumstances leading to bed borrows ===
=== Circumstances leading to bed borrows ===
Examples of circumstances leading to bed borrows are:  
Examples of circumstances leading to bed borrows are:  
* Own ward to own ER under ICU the care of ICU Service Physicians,  then move to ICU, when bed available (Grace-started end of March 2019)
* ER borrows a ICU bed to do hemodialysis and then the pt goes back to ER.
* ER borrows a ICU bed to do hemodialysis and then the pt goes back to ER.
* medicine borrows a ICU bed for central line insertion or for dialysis or for a bronchoscopy, etc.   
* medicine borrows a ICU bed for central line insertion or for dialysis or for a bronchoscopy, etc.   
* post angio monitoring because pre and post procedure in angio is closed in late evening and night shifts.
* post angio monitoring because pre and post procedure in angio is closed in late evening and night shifts.
* medicine borrows a ICU bed for [[Cardioversion]]
* medicine borrows a ICU bed for [[Cardioversion]]
* (does anyone have additional bed borrow scenerios?)
* (any examples for borrowed med beds?)


=== Considerations ===
=== Considerations ===
Bed-borrowing in other locations has always occurred but appear to becoming more common.  
Bed-borrowing in other locations has always occurred but appear to becoming more common.  
In the meantime, our definition of ICU patient stands and '''excludes''' bed borrows.


=== Implication: mis-estimation of workload ===
=== Implication: mis-estimation of workload ===
Our decision to code borrowed beds according to their attending rather than to their physical location means we will underestimate work load in some places and overestimate it in others. There is no way to not have this problem in one direction or the other, so we decided on this one.
Our decision to code borrowed beds according to their attending rather than to their physical location means we will underestimate work load in some places and overestimate it in others. There is no way to not have this problem in one direction or the other, so we decided on this one.
== Legacy concepts, or considered but never implemented ==
* [[ECIP]]
* [[Moves for Medicine]]


==Related articles ==
==Related articles ==

Latest revision as of 16:28, 3 August 2021

A bed borrow is when a patient is located in one place (e.g. a boarding location, Boarding Loc) while admitted under the physician of a different location (the home location).

Over time we have had various incarnations of collecting this data, this page is an aggregator for the info, and specific collection info for old projects lives on the respective pages.

Currently collected concepts

Legacy concepts

The following concepts were collected separately before Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry:

Background

The concept is important because it affects the Previous Location field, Service/Location field, Dispo field, various cross-checks, and concepts like EMIP, Boarding Loc, Definition of a Critical Care Laptop Admission and Definition of a Medicine Laptop Admission.

Circumstances leading to bed borrows

Examples of circumstances leading to bed borrows are:

  • Own ward to own ER under ICU the care of ICU Service Physicians, then move to ICU, when bed available (Grace-started end of March 2019)
  • ER borrows a ICU bed to do hemodialysis and then the pt goes back to ER.
  • medicine borrows a ICU bed for central line insertion or for dialysis or for a bronchoscopy, etc.
  • post angio monitoring because pre and post procedure in angio is closed in late evening and night shifts.
  • medicine borrows a ICU bed for Cardioversion

Considerations

Bed-borrowing in other locations has always occurred but appear to becoming more common.

Implication: mis-estimation of workload

Our decision to code borrowed beds according to their attending rather than to their physical location means we will underestimate work load in some places and overestimate it in others. There is no way to not have this problem in one direction or the other, so we decided on this one.

Legacy concepts, or considered but never implemented

Related articles

Related articles:
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