Definition of a Medicine Program Admission: Difference between revisions

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~~''For~~ Critical Care, see [[~~Definition_of_an_ICU_admission~~]]''

This page defines what would be a profile in the [[Medicine program]] portion of the database (see also [[Definition of a Critical Care Program Admission]]); it is relevant for [[Using Cognos2 to keep track of patients]] general data use. There are some differences in CC and Med collection, see [[ICU Curriculum]]/[[Medicine Curriculum]].

~~The definition of~~ a ~~"Medicine~~ patient~~" for the Regional Medicine Database~~ is:

Each Medicine profile constitutes all care in ''any'' Internal Medicine location (see [[Boarding Loc]]) or Service (see [[Service tmp entry]]) at a given hospital with certain exceptions (see [[#Excluded patients]] further below in this article). Thus once a patient is admitted to an Internal Medicine service at a given hospital (regardless of where they are physically), a profile begins -- and the same profile includes all continuous direct transfers among Internal Medicine services and locations while under Medicine at that same hospital. For a transfer between hospitals a new database profile is started.

*admitted ~~under a~~ Medicine service ~~attending physician. If patient doesn't meet this definition then we don't collect data~~ and ~~enter into~~ the Medicine database.

== Included patients ==

* Collection starts at [[Service tmp entry]] DtTm, ie possibly while still in ER.

~~== Bed Borrows are~~ '''~~not~~''' ~~Medicine admissions ==~~

* The following situations '''ARE''' included for the Regional Medicine Database.

~~There are circumstances where other services "borrow" a Medicine bed~~ for ~~procedures or monitoring or testing but patient is not admitted under~~ Medicine ~~attending.~~

~~Do not collect these patients~~.

=== Inclusion based on service ===

*Admitted under a Medicine service attending physician anywhere in the hospital (including, for example, if they are remaining in ED because there is no medicine ward bed yet). (see [[#excluded patients]])

** includes "HSC Oncology / Medicine"

== ~~Short Stay Neuro Patients~~ on ~~H4H~~ ==

=== Inclusion based on location ===

~~Dec 08 Gail Hall reported short stay patients on HSC H4H who were admitted under neurology euro and may be receiving diagnostic testing or procedures~~ but cared for by ~~H4H nurses. Wanted~~ to ~~know~~ if ~~these~~ should ~~be collected~~, ~~possibly with a tag so we can identify them later~~.

*Admitted to a core Medicine ward '''location''' but rather than being cared for by the regular ward team, the primary care service is

~~On 5 Feb 09 Dr Roberts answered to include~~ the patients ~~and label them as short stay.~~

** Nephrology

** Neurology (includes "HSC Internal Med / Neurology" patients admitted to [[HSC HOBS]])

** Oncology -- ''EXCEPT'' if admitted ONLY for chemotherapy (if complications occur and Medicine service takes over, admit the pt starting at medicine service acceptance)

*When you enter such a patient into the Medicine Database, you should include the time in ED when they were on that service (Nephro, Neuro, Onc).

*For these inclusions based on location, once pt is transferred out of the Medicine ward location, we no longer follow the patient. (see [[#excluded patients]])

==~~=Discussion=~~==

== Excluded patients ==

~~{{Discussion}}~~

* The following situations '''ARE NOT''' included for the Regional Medicine Database:

* ~~Gail~~, is ~~this still going~~ on ~~on H4H? [[User:TOstryzniuk|TOstryzniuk]] 14:30~~, ~~11 March 2009~~ (~~CDT~~)

** Oncology patients admitted only for chemotherapy. These are short stay patients with only nursing IPN entries.

* ~~Has anything been done~~ to ~~implement Dr~~. ~~Robert's instructions? If we want to implement~~ this, ~~I would suggest doing it~~ as a [[~~:Category:Special Short Term Projects~~]]~~, and with limited duration and a plan~~ to ~~analyze and act. [[User:Ttenbergen|Ttenbergen]] 18:09, 10 September 2009 (CDT~~)

** Nephrology, Oncology or Neurology patients whose primary care service is (respectively) nephrology, oncology or neurology -- who are NOT on a core Medicine ward location, ie they are admitted to an overflow medicine location

* ~~How are these~~ patients ~~different from other bed borrows, and does this have any impact on our decision not~~ to ~~collect other bed borrows? [[User:Ttenbergen|Ttenbergen]] 18:09, 10 September 2009 (CDT)~~

** Patients admitted to HSC_H6 or HSC_H7S (High OBs) under "HSC Internal Med / Respiratory"

** Patients who use a ward bed for a procedure but are NOT admitted to the Medicine service, and indeed these patients are usually not formally inpatients at all. Examples include a patient who is using a ward bed for: insertion of a central line; diagnostic endoscopy; dialysis.

** "HSC Internal Med / Neurology" -- on HSC_H6, actually this fits into the above rules, as HSC_H6 is not a Medicine ward location.

** Interventional radiology pts admitted for an overnight procedure (not on [[Cognos EPR Report]] so easy to exclude)

** Exclude "HSC Oncology / Radiation"

** Exclude "IV infusion Administration"

** Exclude patients admitted to STB Internal Medicine/Respiratory service

=== Excluded service admissions can lead to missed records ===

There are scenarios in which a legitimate admission may be missed when [[Using Cognos2 to keep track of patients]]. If a patient's first location upon admission is one where we don't collect, the patient would be excluded from [[CSS]]. If the patient then moves to a location where we would collect them without changing services, this change will not show up in Cogonos since we already excluded the service admission. We have occasionally found these records when looking for other things, but some are likely getting through. We discussed this and could not think of a way to overcome this, so this is only to document that this can happen.

== End of a database profile ==

=== Bed holds ===

To see when a profile should continue vs new profile, see [[Bed holds]].

[[Category: ~~Medicine Elements~~]]

== Definitions relevant for historical data ==

Definitions over time are available at

* [[Special:History/{{PAGENAME}}]]

{{Discuss |

* We need to extract a summary of the definition details from the page history.

* We should set up a [[Record definition query in CFE]] to provide a clear way in [[CFE]] to treat historical, pre [[PatientFollow Project]], records in a way that is consistent with our current definition.

}}

== Related Articles ==

[[Category:Admit/Discharge | *]]

[[Category:Overflow]]

@@ Line 1: / Line 1: @@
-''For Critical Care, see [[Definition_of_an_ICU_admission]]''
+This page defines what would be a profile in the [[Medicine program]] portion of the database (see also [[Definition of a Critical Care Program Admission]]); it is relevant for [[Using Cognos2 to keep track of patients]] general data use. There are some differences in CC and Med collection, see [[ICU Curriculum]]/[[Medicine Curriculum]].
-The definition of a "Medicine patient" for the Regional Medicine Database is:
+Each Medicine profile constitutes all care in ''any'' Internal Medicine location (see [[Boarding Loc]]) or Service (see [[Service tmp entry]]) at a given hospital with certain exceptions (see [[#Excluded patients]] further below in this article). Thus once a patient is admitted to an Internal Medicine service at a given hospital (regardless of where they are physically), a profile begins -- and the same profile includes all continuous direct transfers among Internal Medicine services and locations while under Medicine at that same hospital. For a transfer between hospitals a new database profile is started.
-*admitted under a Medicine service attending physician.  If patient doesn't meet this definition then we don't collect data and enter into the Medicine database.
+== Included patients ==
+* Collection starts at [[Service tmp entry]] DtTm, ie possibly while still in ER.
-== Bed Borrows are '''not''' Medicine admissions ==
+* The following situations '''ARE''' included for the Regional Medicine Database.
-There are circumstances where other services "borrow" a Medicine bed for procedures or monitoring or testing but patient is not admitted under Medicine attending.
-Do not collect these patients.
+=== Inclusion based on service ===
+*Admitted under a Medicine service attending physician anywhere in the hospital (including, for example, if they are remaining in ED because there is no medicine ward bed yet). (see [[#excluded patients]])
+** includes "HSC Oncology / Medicine"
-== Short Stay Neuro Patients on H4H ==
+=== Inclusion based on location ===
-Dec 08 Gail Hall reported short stay patients on HSC H4H who were admitted under neurology euro and may be receiving diagnostic testing or procedures but cared for by H4H nurses. Wanted to know if these should be collected, possibly with a tag so we can identify them later.
+*Admitted to a core Medicine ward '''location''' but rather than being cared for by the regular ward team, the primary care service is
-On 5 Feb 09 Dr Roberts answered to include the patients and label them as short stay.
+** Nephrology
+** Neurology (includes "HSC Internal Med / Neurology" patients admitted to [[HSC HOBS]])
+** Oncology -- ''EXCEPT'' if admitted ONLY for chemotherapy (if complications occur and Medicine service takes over, admit the pt starting at medicine service acceptance)
+*When you enter such a patient into the Medicine Database, you should include the time in ED when they were on that service (Nephro, Neuro, Onc).
+*For these inclusions based on location, once pt is transferred out of the Medicine ward location, we no longer follow the patient. (see [[#excluded patients]])
-===Discussion===
+== Excluded patients ==
-{{Discussion}}
+* The following situations '''ARE NOT''' included for the Regional Medicine Database:
-* Gail, is this still going on on H4H? [[User:TOstryzniuk|TOstryzniuk]] 14:30, 11 March 2009 (CDT)
+** Oncology patients admitted only for chemotherapy. These are short stay patients with only nursing IPN entries.
-* Has anything been done to implement Dr. Robert's instructions? If we want to implement this, I would suggest doing it as a [[:Category:Special Short Term Projects]], and with limited duration and a plan to analyze and act. [[User:Ttenbergen|Ttenbergen]] 18:09, 10 September 2009 (CDT)
+** Nephrology, Oncology or Neurology patients whose primary care service is (respectively) nephrology, oncology or neurology -- who are NOT on a core Medicine ward location, ie they are admitted to an overflow medicine location
-* How are these patients different from other bed borrows, and does this have any impact on our decision not to collect other bed borrows? [[User:Ttenbergen|Ttenbergen]] 18:09, 10 September 2009 (CDT)
+** Patients admitted to HSC_H6 or HSC_H7S (High OBs) under "HSC Internal Med / Respiratory"
+** Patients who use a ward bed for a procedure but are NOT admitted to the Medicine service, and indeed these patients are usually not formally inpatients at all.  Examples include a patient who is using a ward bed for: insertion of a central line; diagnostic endoscopy; dialysis.
+**  "HSC Internal Med / Neurology" -- on HSC_H6, actually this fits into the above rules, as HSC_H6 is not a Medicine ward location.
+** Interventional radiology pts admitted for an overnight procedure (not on [[Cognos EPR Report]] so easy to exclude)
+** Exclude "HSC Oncology / Radiation"
+** Exclude "IV infusion Administration"
+** Exclude patients admitted to STB Internal Medicine/Respiratory service
+=== Excluded service admissions can lead to missed records ===
+There are scenarios in which a legitimate admission may be missed when [[Using Cognos2 to keep track of patients]]. If a patient's first location upon admission is one where we don't collect, the patient would be excluded from [[CSS]]. If the patient then moves to a location where we would collect them without changing services, this change will not show up in Cogonos since we already excluded the service admission. We have occasionally found these records when looking for other things, but some are likely getting through. We discussed this and could not think of a way to overcome this, so this is only to document that this can happen.
+== End of a database profile ==
+=== Bed holds ===
+To see when a profile should continue vs new profile, see [[Bed holds]].
-[[Category: Medicine Elements]]
+== Definitions relevant for historical data ==
+Definitions over time are available at
+* [[Special:History/{{PAGENAME}}]]
+{{Discuss |
+* We need to extract a summary of the definition details from the page history.
+* We should set up a [[Record definition query in CFE]] to provide a clear way in [[CFE]] to treat historical, pre [[PatientFollow Project]], records in a way that is consistent with our current definition.
+}}
+== Related Articles ==
+{{Related Articles}}
+[[Category:Admit/Discharge | *]]
+[[Category:Overflow]]