Boarding Loc

Projects
Active?:	active
Program:	CC and Med
Requestor:	internal
Collection start:	2019-Sep-20
Collection end:

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 under the Medicine or ICU service.

Data Collection Instructions

How to enter this

You can use the "make loc" button to generate and pre-populate these entries.

• Use tmp fields:
  • Project: Boarding Loc
  • start_dt and start_tm:
    • enter as per Cognos initially
    • before setting RecordStatus to complete, change the first Boarding Loc DtTm to be consistent with the First Service tmp entry; see DtTm for First Boarding Loc and First Service
  • checkbox: not used for this project
  • Item:
    • 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
    • please note that 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
      • 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; Julie will note the change for her reports. eg. during the various COVID waves, many surgical wards were used for medicine overflow or COVID patients
      • 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.
• no location entered is the default
  • 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.

Exception: no two with same DtTm

• No two different boarding locations should have same start_dt and start_tm.
  • if two boarding locations have the same Start_DtTm, this is an error, change one to be off by one minute, put a note in "notes" section to check boarding location to confirm the correct date and time for the boarding locations of concern.
  • 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. We then put a note in the notes section to confirm the boarding location(s) date and time and the first service_DtTm.

Exception

• when a patient is transferred to one of our units, ideally the first service and first boarding Loc should be the same date and time. However, often they are not. In these cases, always use the first service entry line as the date and time for first service and first boarding Loc (make a note in the notes field to change to the first Boarding Loc date and time at a later date when reviewing the chart)
• example- patient transfers from ICU to medical unit. first medicine service=May10@1400, First boarding loc=May10@1630. While the correct first service and first Boarding Loc should be May 10@1630, enter the first service date and time from COGNOS (May 10@1400) for both the first service and first boarding Loc. There are two reasons for this: if you change the first service date and time without excluding that service it will fill up your CSS and you will not get the associated service end date and time. If you exclude that service entry all together than you will also not get the associated service end date and time.

Combining Transfer Ready DtTm tmp entry and Boarding Loc records

• There needs to be one Transfer Ready DtTm tmp entry for each Boarding Loc and vice versa. To mark which entries belong together, use the same integer number in the "combiner" field in Patient Viewer Tab Cognos ADT2 for both records and in sequential order according to Boarding start_dt and start_tm. The presence of matching records is validated by query s_tmp_check_combined_Boarding_Loc_and_TransferReadyDtTm, and their sequential status by query s_tmp_check_combined_BL_and_TRDtTm_nonsequential.
• the integer number should be entered at the time that the paired Boarding Loc and Transfer Ready DtTm tmp entry are entered, as Julie uses this data early to report on

GRA MICU

• 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

Special Case - cross-program boarding

If a patient is accepted by your service, taken care of but remains at a location of a different service where we collect for some time before moving to your service, you need to enter a Boarding Loc entry for that period. That originating and different service location becomes the first Boarding loc.

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 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 on CC laptops.

Example:

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.

Special Case- temporary boarding locations

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 in the TMP, 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.

eg. Medicine patient is transferred to ICMS for a scope and is not admitted under critical care, that Boarding Loc for ICMS should not be entered in the TMP

Special Case - Erroneous Unit information in Cognos EPR Report

Use what you know to be correct from chart and your knowledge of your hospital.

parked in ER

For further information please see

• Parked in ER

sources for Boarding Loc DtTm

Sometimes the times are not when people really show up at a boarding loctation.

Cognos Unit Listing

Usually the Cognos Unit start time can be used as Boarding Loc.

First set of vital signs

The first set of vital signs is used as Boarding Loc dttm for arrival on the unit in ICU collection, if it is different from the Cognos Unit Start DtTm.

Start/End Dates

• 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

Data Integrity Checks (automatic list)

	App	Status
Query check tmp ER Boarding Loc should exist if from ER	CCMDB.accdb	declined
Check if awaiting code is primary dx then Transfer Ready DtTm must be equal to Arrive DtTm	CCMDB.accdb	declined
Query s tmp check Boarding Loc and TransferReadyDtTm pairs	CCMDB.accdb	implemented
Query check tmp 2 BL TR S same tm	CCMDB.accdb	implemented
Query Check BL TR combiner null	CCMDB.accdb	implemented
Query check Transfer DtTm after paired BL and before later BL	CCMDB.accdb	implemented
Query s tmp Boarding Loc ER delay reasonable	CCMDB.accdb	implemented
Query check no consecutive same BL or Service	CCMDB.accdb	implemented
Query check CCI TISS matching BoardingLoc time	CCMDB.accdb	implemented
Query check tmp Boarding Loc Service first same	CCMDB.accdb	implemented
Query s tmp check combined Boarding Loc and TransferReadyDtTm	CCMDB.accdb	implemented
Query check transfer DtTm during admission	CCMDB.accdb	implemented
Query check tmp Service and Boarding Loc during admission timeframe	CCMDB.accdb	implemented
Query check tmp service or location duplicate	CCMDB.accdb	implemented
Query s tmp Boarding Loc date item	CCMDB.accdb	implemented
Query check minimal data set incomplete	CCMDB.accdb	implemented
Query check tmp Transfer Ready not before Boarding Loc	CCMDB.accdb	retired
Query s tmp check combined BL and TRDtTm nonsequential	CCMDB.accdb	retired
Query check transfer ready tmp for each Boarding Loc	CCMDB.accdb	retired
Query s tmp Boarding Loc no borrow but entry	CCMDB.accdb	retired

Data Use

Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.

SAS Program

The SAS program calculates the time spent in a borrowed bed at each ICU stay and summarize the total bed-days in a given interval that are taken up by boarders from elsewhere and how much a certain unit is boarding elsewhere.

Time spent in borrowed bed = Next Arrival Date_time - First 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 S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas.

• the specific macros are %BoardingLoc, %ACCUBorrow, %ICUOtherService

Background

See Bed borrow as aggregator page for other boarding and borrow related concepts.

The concept is similar to EMIPs but we will keep the EMIP separate from this project. The current EMIP will stay the same.--JMojica 10:37, 2019 September 20 (CDT)

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