EMIP: Difference between revisions

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EMIP stands for '''E'''mergency '''M'''edicine "'''IN'''" patient. It is used for patients who are admitted to our internal medicine service and spend their entire '''admission under one of the medicine services we follow''' in the ER (emergency department). We are tracking this as [[VIC_EMIP]], [[GRA_EMIP]], [[STB_EMIP]] and [[HSC_EMIP]].
EMIP stands for '''E'''mergency '''M'''edicine "'''I'''n" '''P'''atient. It is used for patients who are admitted to our internal medicine service and spend their entire '''admission under one of the medicine services we follow''' in the ER (emergency department).  


==Definition of EMIP==  
==Definition of EMIP==  
An EMIP is a Patient who has a record in [[EPR]]/[[Cognos Report Integrator]] for a [[Service tmp entry | Service]] we collect while in ER, and who does not then end up on one of the wards/units that correspond with that service, regardless where they go instead.
{{Ex |
# Pt has an order or some entry that medicine has accepted the patient while still in ER.
# Pt has an order or some entry that medicine has accepted the patient while still in ER.
# The patient leaves the ER to either  
# The patient leaves the ER to either  
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#* dies in ER ("ED Death after Arrival" in [[Cognos]])
#* dies in ER ("ED Death after Arrival" in [[Cognos]])
#* leaves [[AMA]] ("ED Reg/Triaged/Assess LAMA" in [[Cognos]])
#* leaves [[AMA]] ("ED Reg/Triaged/Assess LAMA" in [[Cognos]])
== Collection Instructions ==
See [[:Category:Site Specific Collection Guide|site specific collection guides]] for details on the collection process, papers, binders.
=== Identifying EMIPs in [[Cognos Admitter]] ===
[[EMIP]]s show up in [[Cognos Admitter]]. Because they don't have a Unit Arrive DtTm they filter to the end of the list when sorted by date.
If a patient is listed who is still in the ER at the time the list is reviewed (i.e. it isn't clear if they will turn into a fully arrived patient or an EMIP), ...
{{Discuss |
* What would be the best approach:
** Enter them as EMIP and change the location to a Ward later if the patient arrives on a ward; this would provide the most complete data but would cause [[Orphans in Centralized data.mdb]] when changed to a ward later
** delay entering them until it is clear whether they have become an EMIP or a fully arrived patient
*** After discussion in the office we thought the best option would be to delay entering them until we know if they are an EMIP or a regular ward admission.  We thought a pop up reminder when you "x" out of the admitter window would be helpful (you have un-entered admissions do you really want to close?)  or something like that would be helpful.  We all here read the pop-ups and find them helpful, ...
**** This will likely be addressed by [[2020-10 EMIP changes]]. If it has been addressed, please integrate and delete the discussion.
}}
}}


{{Discuss |
=== Patients in ER admitted under other services are not EMIPs ===
* ...with the exception of the ER delay pop up which pops up 4 times,  we check the first time but find the remaining 3 reminders slightly overkill...
Our definition of EMIP includes only patients that were followed by one of '''''our''''' services. So, patients who were followed by Family Medicine or Trauma while still in the ER are '''not EMIPs'''.
** Can you confirm that this is the check [[Query ''check ER Delay not too big'']]? If so, then the problem should be gone now, since we can't run that check any more (will need to be replaced with a new check that goes between [[Boarding Loc]] entries eventually, but the mechanism that causes multiple errors won't be an issue any longer for those). This is also tracked in [[Multiple LOS errors]]. Ttenbergen 22:12, 2020 October 18 (CDT)
}}


=== Identifying patients (old way, in EPR) ===
== Identifying EMIPs ==
EMIPs will show up under:
=== Identifying EMIPs in [[Cognos2 Service Starter]] ===
* the [[Transfer Register]] if they are sent to non-medicine units in your hospital.
[[EMIP]]s show up in [[Cognos2 Service Starter]]. They can't be identified there as EMIPs, but that's OK, since they really are just like any other patient now and should just be entered.  
*EMIP's in this list will be those under the medicine or internal medicine service that subsequently changed service before leaving ER and were transferred out of ER to a local hospital ward or unit. (not a medicine ward). 
** see instructions for [[Off ward field]] to also identify some EMIP patients. See this under the title "how to identify off-ward patients" in that article.


* the [[Discharge Register]] if they leave the hospital
There has been some discussion whether or not a patient accepted by our service but still in ER when Cognos first lists them should actually be entered then, or only after they either leave from ER or become an inpatient. People have been leaving these un-entered both out of old habit (when EMIPs were entered following different rules you first had to know if a pt would need to be entered as EMIP or as regular) and to be able to enter the unit at the same time, rather than having to remember to go back to the record later to enter the unit. There really is no longer a reason to delay these, especially starting with [[Using Cognos2 to keep track of patients]], instead they become something for which we would need to add tools to CSS to identify them. Please enter them as they show up on [[Cognos2 Service Starter]]o.  
**When reviewing the discharge list generated by the instructions, the EMIP's are those that have medicine or internal medicine under the "service" heading.


==For EMIP entry==  
== Entering data for EMIPs ==
=== Entering patients in dispo tab fields ===
=== Entering patients in dispo tab fields ===
* [[Service/Location field]] - your Generic [[HSC_Med]], [[GRA_Med]], [[STB_Med]]
* [[Service/Location field]] - your Generic [[HSC_Med]], [[GRA_Med]], [[STB_Med]]
* [[Previous Service field]] - likely emergency medicine, unless some other service accepted them prior to medicine, and was never able to get them out of the ER either, and medicine accepted the patient from them - in order for a pt to be an EMIP they must have been accepted by Medicine for admission otherwise they would just be an Emergency patient
* [[Accept DtTm field]] - the time Medicine accepted them, i.e. the time they became an EMIP
* [[Arrive DtTm field]] - same as [[Accept DtTm field]]
* [[Previous Location field]] - use normal instructions
* [[Previous Location field]] - use normal instructions
* [[Dispo field]] - For EMIP pts, you cannot put discharge to an ER, so if that is where they went, put the place they went after ER (usually a ward).
{{Discuss |
* Is that still true that we can't dispo to an ER? Should we be able to? EG if Emergency Medicine takes them back (does that happen?) or they get sent to ''another'' site's ER? Why should that not be allowed? Ttenbergen 21:59, 2020 October 18 (CDT) }}


'''Follow the instructions in [[Boarding Loc]], [[Service tmp entry]], [[Transfer Ready DtTm tmp entry]]; if you do, none of these special instructions for EMIPs should be required. That's part of the point of going to the new scheme. '''
'''Follow the instructions in [[Boarding Loc]], [[Service tmp entry]], [[Transfer Ready DtTm tmp entry]]; if you do, none of the old special instructions for EMIPs should be required. That's part of the point of going to the new scheme. '''
* In Tmp [[Boarding Loc]] enter '''ER''' with the same Date/Time as [[Accept DtTm field]]
* [[Service tmp entry]] - Enter the service that accepted the pt, eg. "HSC Internal Med / A Medicine" or "HSC Critical Care / General" with the same Date/Time as [[Accept DtTm field]]
* [[Transfer Ready DtTm]] / [[Transfer Ready DtTm tmp entry]] - only use this if the pt is going home.  Otherwise use "not transfer ready".


=== Collecting an EMIP who has been transferred to your location ===
=== Collecting an EMIP who has been transferred to your location ===
Collection includes patients who are discharged to another service's location in the hospital. (eg Med to CC or CC to Med)
Collection includes patients who are discharged to another service's location in the hospital. (eg Med to CC or CC to Med)
*if an EMIP patient is transferred to an ICU, that ICU would use e.g. [[GRA_Med]] as [[Previous Location]]
*if an EMIP patient is transferred to an ICU, that ICU would use e.g. [[GRA_Med]] as [[Previous Location]] for the new scheme.  Before start date of new scheme,[[Previous Location]] is '''site_EMIP'''
{{Discuss | who = Julie |
** For [[Pre-admit Inpatient Institution field | Pre-admit Inpatient Institution]] = GRA_Med for the new scheme. Before start date of new scheme,[[Previous Location]] is '''site_EMIP'''
* That is an interesting point. [[GRA_Med]] is not really a location. Julie, if you can confirm that this is how you want these coded, please take out the question, else how should they be coded? And same for ECIPs?
** for the new scheme, yes  [[Previous Location]] is [[GRA_Med]].  Before start date of new scheme,[[Previous Location]] is '''site_EMIP'''.}}
** For [[Pre-admit Inpatient Institution field | Pre-admit Inpatient Institution]] = GRA_Med
{{Discuss | who = Julie |
*Ditto.  
**see above.
}}
** For [[Previous Service]] = Medicine
** For [[Previous Service]] = Medicine
*If a pt who starts out on the EMIP track turns into a medicine [[Boarding Loc]] patient, collect them as you would any other [[Boarding Loc]] patient.  
*If a pt who starts out on the EMIP track turns into a medicine [[Boarding Loc]] patient, collect them as you would any other [[Boarding Loc]] patient.  
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* In ER under '''Medicine service''' and then moved to other ward but under '''Medicine service''' (i.e. a case of [[Off_ward_field|off ward patients]]).
* In ER under '''Medicine service''' and then moved to other ward but under '''Medicine service''' (i.e. a case of [[Off_ward_field|off ward patients]]).


=== Patients in ER admitted under other services ===
{{Ex|
Our definition of EMIP includes only patients that were followed by one of '''''our''''' services. So, patients who were followed by Family Medicine or Trauma while still in the ER are '''not EMIPs'''.
*(1) Internal Med answered consult but deferred and admitted under Critical Care service. Consults do not count as admissions, the patient has to be accepted to Internal med service, and in this scenario would be considered an admission to Critical care only.
 
*(2) Rural Patient accepted by Internal Med service but deteriorated enroute to Winnipeg. Transport team transferred to ER resus room and Critical care consulted, admitted, and assumed care of the patient. This should only be collected as a Critical care service profile, as the patient was assumed by CC service upon arrival at the hospital. (Just as we would not collect for any other patient who died before they ever made it to the hospital).
== Serial numbers used ==
}}
Patients in EMIP have their own [[serial number]]s starting at number 150.


== Related articles ==  
== Related articles ==  
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| always= Legacy Information
| always= Legacy Information
| full=   
| full=   
* used to be a [[Service/Location field]] in the Medicine database until [[2020-10 EMIP changes]] / [[Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry]]  
* [[VIC_EMIP]], [[GRA_EMIP]], [[STB_EMIP]] and [[HSC_EMIP]] used to be [[Service/Location field]] entries in the Medicine database until [[2020-10 EMIP changes]] / [[Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry]]  
* there used to not be a critical care counterpart, see [[ECIP]] for more info
* there used to not be a critical care counterpart, see [[ECIP]] for more info
* since the concept only applied to Med pts and we didn't collect those at CON and OAK, patients in Concordia ER or Oaks ER could not become EMIPs
* since the concept only applied to Med pts and we didn't collect those at CON and OAK, patients in Concordia ER or Oaks ER could not become EMIPs

Latest revision as of 13:40, 2023 November 3

EMIP stands for Emergency Medicine "In" Patient. It is used for patients who are admitted to our internal medicine service and spend their entire admission under one of the medicine services we follow in the ER (emergency department).

Definition of EMIP

An EMIP is a Patient who has a record in EPR/Cognos Report Integrator for a Service we collect while in ER, and who does not then end up on one of the wards/units that correspond with that service, regardless where they go instead.

Example:   
  1. Pt has an order or some entry that medicine has accepted the patient while still in ER.
  2. The patient leaves the ER to either
    • home or
    • any other out of hospital location or
    • the patient is transferred within the hospital to any service because Medicine decides that they will not take the pt but the patient needs different care or
    • dies in ER ("ED Death after Arrival" in Cognos)
    • leaves AMA ("ED Reg/Triaged/Assess LAMA" in Cognos)

Patients in ER admitted under other services are not EMIPs

Our definition of EMIP includes only patients that were followed by one of our services. So, patients who were followed by Family Medicine or Trauma while still in the ER are not EMIPs.

Identifying EMIPs

Identifying EMIPs in Cognos2 Service Starter

EMIPs show up in Cognos2 Service Starter. They can't be identified there as EMIPs, but that's OK, since they really are just like any other patient now and should just be entered.

There has been some discussion whether or not a patient accepted by our service but still in ER when Cognos first lists them should actually be entered then, or only after they either leave from ER or become an inpatient. People have been leaving these un-entered both out of old habit (when EMIPs were entered following different rules you first had to know if a pt would need to be entered as EMIP or as regular) and to be able to enter the unit at the same time, rather than having to remember to go back to the record later to enter the unit. There really is no longer a reason to delay these, especially starting with Using Cognos2 to keep track of patients, instead they become something for which we would need to add tools to CSS to identify them. Please enter them as they show up on Cognos2 Service Startero.

Entering data for EMIPs

Entering patients in dispo tab fields

Follow the instructions in Boarding Loc, Service tmp entry, Transfer Ready DtTm tmp entry; if you do, none of the old special instructions for EMIPs should be required. That's part of the point of going to the new scheme.

Collecting an EMIP who has been transferred to your location

Collection includes patients who are discharged to another service's location in the hospital. (eg Med to CC or CC to Med)

EMIP scenario

  • In ER under Medicine service and left your hospital to Home or died in ER
  • In ER under Medicine service and transferred to other locations under different service in your hospital
  • In ER under Medicine service and discharged to other locations in another hospital

NOT an EMIP

  • In ER under Medicine service and then moved to a Medicine service ward (i.e. a regular Medicine admission)
  • In ER under Medicine service and then moved to other ward but under Medicine service (i.e. a case of off ward patients).
Example:   
  • (1) Internal Med answered consult but deferred and admitted under Critical Care service. Consults do not count as admissions, the patient has to be accepted to Internal med service, and in this scenario would be considered an admission to Critical care only.
  • (2) Rural Patient accepted by Internal Med service but deteriorated enroute to Winnipeg. Transport team transferred to ER resus room and Critical care consulted, admitted, and assumed care of the patient. This should only be collected as a Critical care service profile, as the patient was assumed by CC service upon arrival at the hospital. (Just as we would not collect for any other patient who died before they ever made it to the hospital).

Related articles

Related articles:
Legacy Information   
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