Definition of a Critical Care Laptop Admission: Difference between revisions

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The definition of an "ICU patient" for the Regional ICU Database is:
This page defines what would be a profile (aka "record") in the Critical Care portion of the database (see also [[Definition of a Medicine Laptop Admission]]).  
*EXCEPT for the exceptions immediately below, a patient admitted under Critical Care service, regardless of their physical location, even if it is a [[Boarding Loc]] such as PACU or ER. If patient doesn't meet this definition then we don't collect data and enter into the ICU database.  What this DOES mean is that this begins at the time when the ICU service takes over primary care of the patient (see [[Service tmp entry]])
* '''Exception HSC SICU:''' As SICU patients remain under the primary care of the surgical service, they do not fall under the rule directly above.  Instead a SICU patient becomes an ICU laptop patient at the earlier of (a) actual arrival in SICU or (b) the patient is not yet in SICU (e.g. is in PACU, or ED or boarding elsewhere) but the SICU service has accepted them to come to SICU when there's a bed in SICU.
* '''Exception STB :''' STB_CICU, STB_MICU & STB_ACCU Admissions start at [[Arrive_DtTm]] unless the Cognos data is within a reasonable time frame. EPR times are unreliable as they are ofter entered long before the pt is actually in the unit or are entered when the pt is in a swing bed location; EPR times are reflected in the Cognos data.
* '''Exception PACU:''' pts in PACU are to be included if they are under critical care, but not if they are under surgery


* '''Special case: Pts in ICU for procedures only''': as per [[Bed borrow]] exclude patients brought into ICUs for procedures only; these would likely not show up in the Cognos reports because the service does not change to ICU for them
A Critical Care profile constitutes all care under a given ICU service team. Thus when a patient changes service, a new record is begun. If a patient moves locations, but remains on the same ICU service, no new record is begun.


== Entry of Admission Date to Critical Care Service and  Reporting ==
 
Since the definition varies from site and unit, for the Statistician to get the correct admission date time to the ICU which is to be used to calculate [[Length of Stay (ICU Report)]], the admission  date and time must be entered in the  [[Service Tmp entry]] as its  first service entry  '''Start date and time'''.  It would be hit and miss to get the correct date and time information to the first Boarding Loc because the first physical location may not be the unit but just a boarding location and by definition does not necessarily imply that the patient is already being taken over by the ICU service. Neither getting the correct admission date time  to the succeeding boarding location which can also be a boarding location. The purpose of the Service tmp is to define the start dates the service takes over and the first start date time is the beginning date when the Critical Care service takes over.
 
It is relevant for [[Using Cognos2 to keep track of patients]] general data use.
 
* '''The GENERAL RULE''' is that a patient becomes a Critical Care Laptop patient at the date/time that the ICU team takes over being their primary care team -- regardless of their physical location, even if it is a [[Boarding Loc]] such as ED or PACU. Thus, this relates to the first relevant [[Service tmp entry]].
**We define ''the ICU takes over being their primary care team'' as occurring when there is clear indication (usually a progress note) to this effect.  That note may be by the ward team or by the ICU team.
*Each critical care service that a patient is admitted to will have a separate profile. For HSC, this means [[HSC_MICU]], [[HSC_SICU]], and [[HSC_IICU]] admissions will all be collected as separate profiles. The same rule applies to St Boniface for ICMS, ACCU, and ICCS admissions. Grace only has one critical care service so this is not relevant there.
**The profiles are by service, not by location. So for example, if an MICU patient is transferred to SICU for bed management reasons and remains under the MICU service, this remains one profile and is not divided into two. Conversely, if an MICU patient is accepted by the SICU service and transfers to SICU, this stay would be separated into two profiles by service.
* There are a small number of tricky situations (not really exceptions) for this general rule:
*# [[HSC_SICU]]: As SICU patients remain under the primary care of the surgical service (technically, the SICU team is a consulting service even though much of the daily ICU care is guided by the SICU team), the general rule is modified such that the patient becomes a Critical Care Laptop patient at the date/time that the SICU team agrees to take over care of the patient (in SICU or equivalent SICU boarding location such as ER or PACU). This is thus a "partial exception" in that the only difference with the general rule is that the ICU team isn't officially the primary care team of SICU patients.
*# Some Cardiac Surgery patients ([[STB CICU]]) are tricky in regards to this, even though as per the general rule, the patient becomes a Critical Care laptop patient at the date/time when he/she transitions to be under the care of the CICU team. The tricky issue here is related to the fact that there are cardiac surgeons who are CICU attendings, cardiac surgery ward attendings, and operating surgeons guiding care in PACU. Thus it can sometimes be tricky to figure out ''which'' cardiac surgery service is caring for the patient before they actually arrive in [[STB CICU]] (or equivalent boarding location).
*# Pts in ICU for procedures only who are never actually under the ICU service: These patients are, by definition, not ICU patients, and clearly DO fall under the general rule.  But they may be tricky if it is not recognized that they were never under the care of the ICU team.
 
=== From Code Blue / [[Respiratory arrest]] ===
* The ICU team '''does not take over main/overall care of a patient DURING a code on the ward'''. When the ICU team runs a ward code, they are just performing a procedure (ACLS) for the ward team. We only consider the ICU team as taking over care IF once the patient has survived the code (or possibly in between arrests), the ICU team has agreed to do so.  So, this is not automatic. The main way this will be noted is that the Medicine ward resident will almost certainly write a note indicating this.
 
== Dates of service vs location starts ==
See [[Admit DtTm]] for how the starting time of a record is encoded.
 
==ICU Service Attendings and Admissions==
There is an "A', "B" and "C or outreach physician" The outreach physician is responsible for rounding on JJ3 patients and new consults are seen by A, B, C or housestaff depending on how busy the unit is. As per Bojan for those that are '''ECIP''': If the patient was to be admitted to initial site ICU but there was a lack of bed capacity then I would consider that an admission that then was transferred however if there was no intention to admit to site unit because patient needed services at another site ICU then I would not consider them an admit
 
== End of a database profile ==
=== Bed holds ===
To see when a profile should continue vs new profile, see [[Bed holds]].  


== Related Articles ==
== Related Articles ==
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|explanation=xxx
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[[Category: Admit/Discharge]]
[[Category: Admit/Discharge]]

Latest revision as of 09:07, 20 November 2023

This page defines what would be a profile (aka "record") in the Critical Care portion of the database (see also Definition of a Medicine Laptop Admission).

A Critical Care profile constitutes all care under a given ICU service team. Thus when a patient changes service, a new record is begun. If a patient moves locations, but remains on the same ICU service, no new record is begun.


It is relevant for Using Cognos2 to keep track of patients general data use.

  • The GENERAL RULE is that a patient becomes a Critical Care Laptop patient at the date/time that the ICU team takes over being their primary care team -- regardless of their physical location, even if it is a Boarding Loc such as ED or PACU. Thus, this relates to the first relevant Service tmp entry.
    • We define the ICU takes over being their primary care team as occurring when there is clear indication (usually a progress note) to this effect. That note may be by the ward team or by the ICU team.
  • Each critical care service that a patient is admitted to will have a separate profile. For HSC, this means HSC_MICU, HSC_SICU, and HSC_IICU admissions will all be collected as separate profiles. The same rule applies to St Boniface for ICMS, ACCU, and ICCS admissions. Grace only has one critical care service so this is not relevant there.
    • The profiles are by service, not by location. So for example, if an MICU patient is transferred to SICU for bed management reasons and remains under the MICU service, this remains one profile and is not divided into two. Conversely, if an MICU patient is accepted by the SICU service and transfers to SICU, this stay would be separated into two profiles by service.
  • There are a small number of tricky situations (not really exceptions) for this general rule:
    1. HSC_SICU: As SICU patients remain under the primary care of the surgical service (technically, the SICU team is a consulting service even though much of the daily ICU care is guided by the SICU team), the general rule is modified such that the patient becomes a Critical Care Laptop patient at the date/time that the SICU team agrees to take over care of the patient (in SICU or equivalent SICU boarding location such as ER or PACU). This is thus a "partial exception" in that the only difference with the general rule is that the ICU team isn't officially the primary care team of SICU patients.
    2. Some Cardiac Surgery patients (STB CICU) are tricky in regards to this, even though as per the general rule, the patient becomes a Critical Care laptop patient at the date/time when he/she transitions to be under the care of the CICU team. The tricky issue here is related to the fact that there are cardiac surgeons who are CICU attendings, cardiac surgery ward attendings, and operating surgeons guiding care in PACU. Thus it can sometimes be tricky to figure out which cardiac surgery service is caring for the patient before they actually arrive in STB CICU (or equivalent boarding location).
    3. Pts in ICU for procedures only who are never actually under the ICU service: These patients are, by definition, not ICU patients, and clearly DO fall under the general rule. But they may be tricky if it is not recognized that they were never under the care of the ICU team.

From Code Blue / Respiratory arrest

  • The ICU team does not take over main/overall care of a patient DURING a code on the ward. When the ICU team runs a ward code, they are just performing a procedure (ACLS) for the ward team. We only consider the ICU team as taking over care IF once the patient has survived the code (or possibly in between arrests), the ICU team has agreed to do so. So, this is not automatic. The main way this will be noted is that the Medicine ward resident will almost certainly write a note indicating this.

Dates of service vs location starts

See Admit DtTm for how the starting time of a record is encoded.

ICU Service Attendings and Admissions

There is an "A', "B" and "C or outreach physician" The outreach physician is responsible for rounding on JJ3 patients and new consults are seen by A, B, C or housestaff depending on how busy the unit is. As per Bojan for those that are ECIP: If the patient was to be admitted to initial site ICU but there was a lack of bed capacity then I would consider that an admission that then was transferred however if there was no intention to admit to site unit because patient needed services at another site ICU then I would not consider them an admit

End of a database profile

Bed holds

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

Related Articles

Related articles:

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