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{{Project
{{Project
|ProjectActive=planned
|ProjectActive=active
|ProjectProgram=CC and Med
|ProjectProgram=CC and Med
|ProjectRequestor=Critical Care program (Allan Garland)
|ProjectRequestor=internal
|ProjectCollectionStartDate=TBA
|ProjectCollectionStartDate=2019-Sep-20
|Project=Borrow arrive
|Project=Boarding Loc
}}
}}


{{DiscussTask | *reviewed planned change concept proposal again on June 20.19.}}
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.  


{{Discuss | Need to start page about contingency locations as discussed in team meeting. To take over from [[Project Borrow arrive]].}}
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.


This project tracks where and when a patient arrives into a "borrowed bed".
*Use tmp fields:
 
** Project: '''{{PAGENAME}}'''
A "borrowed bed" is when a patient is not physically located in the place designated by the [[Service/Location]].
** start_dt and start_tm:
 
*** enter as per Cognos initially
*Critical Care will track '''all instances''' of bed borrows and moves between beds
*** 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]]
*Medicine will track '''only the initial borrow location'''
** checkbox: not used for this project <!-- was used for cross checks in data before 2020-10-15 -->
 
** Item:
This new project replaces [[Project Borrow arrive]].
*** 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
This project does '''not''' replace [[ICUotherService]]; we will still need this item in the event that both the bed and the service are both borrowed. Administration at STB want this data.
**** 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.
<!--
*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)
** 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) -->


== Data Collection Instructions ==
==== Exception: no two with same DtTm ====
In [[L TmpV2 table |TMP]], a "no borrow" entry will automatically be added to every new Critical Care patient's record.  
* '''No two different boarding locations should have same start_dt and start_tm.'''
{{Discuss|we will likely need to add this to each Med pt as well
** 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.
*will have to discuss if going forward, it is necessary to auto entry no bed borrow for every new record for ICU or Med.  Note: currently in TMP there are 72 rows with a off ward location recorded and 5,062 with no bed borrow.}}
** 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.


If the patient never ends up in a "borrowed bed" during their stay then, leave the default in Item as ''no borrow'' and also put a check mark in the checkbox. (this is to verify that there was no bed borrow, otherwise no one is sure is missed or not).
=Exception=
If the patient does end up in a "borrowed bed", change the item to the location of the borrow and enter the rest as per below: [[#How to enter this]].  
* 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. 
{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}


'''For Critical Care only''', add a new tmp entry for every additional move/borrow within your centre that a patient makes during their stay at your [[Service/Location]]; including moves from borrowed location to your actual unit.
==== 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


=== How to enter this ===
=== Special Case - cross-program boarding ===
{{Discuss|need to update these. }}
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.  


*Use tmp fields:
'''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.
** Project: '''{{PAGENAME}}'''
** Item: '''no borrow''' is the default (check off the box under column B for all patients '''not''' borrowing a bed).
** Item: '''borrow arrive''' (select the ward/unit where the bed was borrowed):
*** CON - recovery
*** GRA - recovery
*** GRA - ER (a strange thing they only do at Grace for now) - added May 2.19
****will update March 30.19 profile GRA_MICU_10422 master database to reflect this event.
*** HSC - recovery
*** [[HSC_CCU]]
*** [[HSC_IICU]]
*** [[HSC_MICU]]
*** [[HSC_SICU]]
*** OAK - recovery
*** STB - recovery
*** [[STB_ACCU]]
*** [[STB_CICU]]
*** [[STB_MICU]]
{{Discuss|We will need med locations, how about the following:
* HSC-off ward
* STB-off ward
* GRA-off ward
}}
**** '''If a location borrowed from is not available in the drop down, email Tina and Trish to have them added.'''
** Enter start_dt: '''arrival date at borrowed bed''', under column E.
** Enter start_tm: '''arrival time at borrowed bed''', under column M.
** checkbox: '''to be checked only in case of "no borrow"


* ''For Critical Care only:'' If the patient moves back to their "home unit", or "intended unit", make another '''borrow arrive''' entry and select your home unit. Enter the date/time for this move, as above.
'''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.  


*Dispo Tab
{{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.}}
**[[Service/Location field]] enter: '''home''' ward/unit


=== Special Case - original arrival is in "borrowed bed" ===
===Special Case- temporary boarding locations ===
If pt is admitted to your physician service but the original location is from an off-ward bed, code that location  [[Arrive DtTm]] = borrow date and time.
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


The APACHE elements time frame will start in the off-ward bed location and TISS starts from the off-ward bed as well.
=== Special Case - Erroneous Unit information in [[Cognos EPR Report]] ===
Use what you know to be correct from chart and your knowledge of your hospital.


=== Special Case - PACU ===
=== parked in ER ===
If a bed is borrowed in PACU / post-anesthesia care / recovery unit, code this as a '''borrow'''. (i.e. <hosp> - recovery, e.g. "HSC - recovery").
For further information please see
* [[Parked in ER]]


If the decision to accept to the service happens in PACU, the [[Arrive DtTm]] = the borrow date and time.  The APACHE elements are collected at PACU stay and TISS starts at PACU.


=== Special Case - From ER ===
=== sources for Boarding Loc DtTm ===
Not included in this project. 
Sometimes the times are not when people really show up at a boarding loctation.  
*The time spent/waiting in ER is done using [[Arrive DtTm]] vs [[Accept DtTm]].
**March 30.19: own ward, to own ER (under ICU physician care) then to own ICU when bed available.  Started occurring at Grace- March 30.19


=== Special Case - Parked ===
==== Cognos Unit Listing ====
Not included.
Usually the Cognos Unit start time can be used as [[Boarding Loc]].
*For patients who are [[Parked in ER]], no need an entry for these, since the ER delay will take care of them.


=== Special Case - ??? ===
==== First set of vital signs ====
{{Discuss|Any Medicine special cases we can think of?}}
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 ==
== 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
*End: there is no planned end date
=== considerations about continuing collection ===
Continue collection for now, just keeping you in the loop about discussions in main office.
* --[[User:JMojica|JMojica]] 11:17, 2018 November 15 (CST)  --  Added some more as shown by the data.  Just a note - only 30 out of 1807 (2%) records have shown borrowed location while 98% have no borrow. This is expected since STB ACCU has stopped borrowing bed and instead, now borrowing service from ICMS /ICCS which is being collected in another tmp project. The site with most frequent borrower is HSC SICU (i.e. borrowing bed from PACU). How much work will it take to do all these integrity checks?  Also with very few useful data, I think we should not collect this project for all admissions but restore the use of [[Off ward field]] checkbox and  collect only for those with YES Off ward.
** We are checking in with [[HSC_SICU]] to see how they use this data.
{{Discuss |who=Julie | question= did they ever get back to us?  no response from HSC SICU --[[User:JMojica|JMojica]] 10:14, 2019 May 6 (CDT)}}


{{Data Integrity Check List}}
{{Data Integrity Check List}}


== Data Use ==
== Data Use ==
Critical care program wants to know this to better understand patient flow and bed utilization.
Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.


=== SAS Program ===
=== SAS Program ===
Line 112: Line 98:
::: 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 ==
Will replace [[Off ward field]] to provide more meaningful data.
See [[Bed borrow]] as aggregator page for other boarding and borrow related concepts.


We used to collect [[Moves for Medicine]] but this was too much work because there are too many administrative moves. Also, the data wasn't being used.
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)


==Related articles ==
==Related articles ==
Line 125: Line 112:
[[Category:Project]]
[[Category:Project]]
[[Category:Overflow]]
[[Category:Overflow]]
[[Category:EMIP]]
[[Category:PatientFollow Project]]
[[Category:Admit/Discharge]]

Latest revision as of 11:50, 18 November 2024

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:
    • 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

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.

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


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

Data Integrity Checks (automatic list)

 AppStatus
Query check tmp ER Boarding Loc should exist if from ERCCMDB.accdbdeclined
Check if awaiting code is primary dx then Transfer Ready DtTm must be equal to Arrive DtTmCCMDB.accdbdeclined
Query s tmp check Boarding Loc and TransferReadyDtTm pairsCCMDB.accdbimplemented
Query check tmp 2 BL TR S same tmCCMDB.accdbimplemented
Query Check BL TR combiner nullCCMDB.accdbimplemented
Query check Transfer DtTm after paired BL and before later BLCCMDB.accdbimplemented
Query s tmp Boarding Loc ER delay reasonableCCMDB.accdbimplemented
Query check no consecutive same BL or ServiceCCMDB.accdbimplemented
Query check CCI TISS matching BoardingLoc timeCCMDB.accdbimplemented
Query check tmp Boarding Loc Service first sameCCMDB.accdbimplemented
Query s tmp check combined Boarding Loc and TransferReadyDtTmCCMDB.accdbimplemented
Query check transfer DtTm during admissionCCMDB.accdbimplemented
Query check tmp Service and Boarding Loc during admission timeframeCCMDB.accdbimplemented
Query check tmp service or location duplicateCCMDB.accdbimplemented
Query s tmp Boarding Loc date itemCCMDB.accdbimplemented
Query check minimal data set incompleteCCMDB.accdbimplemented
Query check tmp Transfer Ready not before Boarding LocCCMDB.accdbretired
Query s tmp check combined BL and TRDtTm nonsequentialCCMDB.accdbretired
Query check transfer ready tmp for each Boarding LocCCMDB.accdbretired
Query s tmp Boarding Loc no borrow but entryCCMDB.accdbretired

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)

Related articles

Related articles:
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