Boarding Loc: Difference between revisions

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*Use tmp fields:
*Use tmp fields:
** Project: '''{{PAGENAME}}'''
** Project: '''{{PAGENAME}}'''
** Enter start_dt: '''arrival date at physical location''', under column E.
** start_dt and start_tm:  
** Enter start_tm: '''arrival time at physical location''', under column M.
*** enter as per Cognos initially
*** '''Exception:''' '''[[#First Service tmp entry and the first Boarding Loc should be the same]]'''
*** 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 <!-- was used for cross checks in data before 2020-10-15 -->
** checkbox: not used for this project <!-- was used for cross checks in data before 2020-10-15 -->
** Item:  
** Item:  
*** '''no location entered''' is the default (that entry will not be allowed in a complete record)
*** 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]]
**** change the original entry to the first location the patient was during the admission in this record, e.g. ER, specific medicine ward etc
*** 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
**** for any physical move to another unit, enter an additional [[Boarding Loc]] entry:
**** 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
*** for all locations there is a specific entry listed in the dropdown (eg ER)
**** 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.  
**** item: the actual ward, e.g. STB_B5 or HSC_MICU
* '''no location entered''' is the default
****For new ward changes, please notify Julie, Tina and update the wiki when this occurs.  Tina can then add the new location to the dropdown, Julie will note this for her reports. eg. during the various COVID waves, many surgical wards were used for medicine overflow or COVID patients, if the ward is not available in the dropdown, please notify Tina and Julie.
** 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.
**** comment: leave what is automatically added; the main office doesn't use this part for anything for home locations, but it can be used to crosscheck accuracy.  
<!--
** '''No two different boarding locations should have same start_dt and start_tm.'''  
*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) -->


{{First Service and Boarding Loc same}}
==== 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. 
{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}
{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}


Line 42: Line 49:


=== Special Case - cross-program boarding ===
=== 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 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.  
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.  
{{Discuss|
what happens if a patient is accepted by your service and  '''remains at a location of a different service for some time'''  but '''not  being taken care of by your service'''  before moving to your service? will that originating and different service location still need to be enter as the first [[Boarding Loc]] entry ?  Example from Medicine service to ICU service, the location of the Medicine service  is <own site> ER (case of EMIP)  or <own site> Med we collect, will  the first boarding entry still be  <own ER> or <own site> Med?  Is the service taking care of the patient on that location of different service available and easy to know? --[[User:JMojica|JMojica]] 12:51, 2022 April 8 (CDT)}}
----
*How should we handle this with the new implementation of using the actual location?  we will add these to the critical care laptops?  or leave as per the instructions [[User:Lkaita|Lisa Kaita]] 18:16, 2022 January 26 (CST)
** Good question. I had hoped that [[Definition_of_a_Critical_Care_Laptop_Admission#From Code Blue]] would help, but all that says is that this should be rare. But clearly it could happen elsewhere. What do you mean by "leave as per the instruction"? Take to Task?
{{Todo
| who = Tina
| question = _dev_CCMDB
* Tina will add all options to the boarding loc list so we can enter what is actually true. [[User:Ttenbergen|Ttenbergen]] 10:59, 2022 February 17 (CST)
| todo_added = 2022-02-17 
| todo_action = 2022-02-17
}}


----
'''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 Critical Care collection, 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. The generic "<Site>_Med" entry would only be available on CC laptops.  
'''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.
   
 
For Medicine laptops this isn't an issue because all CC locations are explicitly included in Boarding Loc.
{{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.}}
 
===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]] ===
=== Special Case - Erroneous Unit information in [[Cognos EPR Report]] ===
See [[Process for bad data in Cognos]]
Use what you know to be correct from chart and your knowledge of your hospital.


=== further information ===
=== parked in ER ===
For further information please see  
For further information please see  
* [[Parked in ER]]  
* [[Parked in ER]]




Latest revision as of 14:09, 2024 August 27

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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