Dispo field: Difference between revisions

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* Enter:  
* Enter:  
{{PrePrevDispo listing}}
{{PrePrevDispo listing}}
* see [[Visits to temporary locations]] for dispo to temporary locations, ie. OR, dialysis, procedure suites of all types, imaging suites/radiology
* [[HSC Stepdown Units]]
* [[AMA]] see also [[BedHeldEnd DtTm]]


* see [[Visits to temporary locations]] for dispo to temporary locations, ie. OR, dialysis, procedure suites of all types, imaging suites/radiology
===Home===
* Includes:
**hotel
**rooming house
**boarding home


==== [[AMA]] ====
==== Additional options similar to "Home" ====
Enter "AMA (left against medical advice)" for patients who leave against medical advice (type "AMA" to open up drop down).
We have several "Home" like discharge options that may appear in [[Cognos2 Unit Starter]]. If the entry from ADT doesn't align with what is found in the chart then correct the entry to what you think is correct:
* '''Home with Support Services''' - Discharged to a private residence or apartment with support from the community at home or referred to services.  example home care, [[Alternative Integrated Accommodation (AIA) | AIA]].  '''Note''' a patient with instructions to return for follow-up or referral to a specialist (as part of a routine discharge order) is '''NOT''' considered discharge home with support service/referral
** includes people on Home O2, they are part of the Home Oxygen home care program
** includes CIVP
** excludes: GPAT/GMAT assessments
* '''TRSF Group/Supportive housing'''
** includes group home
** excludes [[Assisted Living]] facilities
{{Discuss | does this include patients who are discharged home with private nursing service? }}


AMA is used as follows:  
{{DiscussTask | JALT
# AMA is being excluded in the calculation of Readmission rate.  
I thought we had decided at [[JALT Meeting - Rolling Agenda and Minutes 2025#JALT 2025-03-11 |JALT]] to collect this as presented by EPR... do I remember this wrong? I had already added it in [[CCMDB.accdb Change Log 2025#2025-03-11-1]]. [[User:Ttenbergen|Ttenbergen]] 22:52, 11 March 2025 (CDT)
# AMA is being counted as HOME in reporting for the location the patient went after discharge.   
* Yes, I saw that, come to think of it I don't think we decided, not in my notes, but we can use it and I will change the wiki instructions [[User:Lkaita|Lisa Kaita]] 11:25, 13 March 2025 (CDT)
# AMA as itself for specific request. 
* If we are going to collect this detail for dispo, should we consider whether or not to also look at SH in preadmit living situation?, currently lumped with community facility with support. [[User:Lkaita|Lisa Kaita]] 14:45, 16 April 2025 (CDT)
* The entry name includes "TRSF" - is the entry for the previous location equivalent in EPR? [[User:Ttenbergen|Ttenbergen]] 23:30, 16 April 2025 (CDT)
* no because the previous location would usually be <site>_ER [[User:Lkaita|Lisa Kaita]] 09:53, 28 May 2025 (CDT)
** Sorry, I should have asked about "pre-hospital location in ADT". [[User:Ttenbergen|Ttenbergen]] 16:21, 28 May 2025 (CDT)
}}
* '''TRSF to Residential Care'''- Includes transfer to long-term care home (24 hour nursing), mental health and/or addiction treatment center or hospice/palliative care facility.   
** for PCH use [[Dispo]] PCH options
** for hospice, see [[Hospice]]
** for palliative care use the appropriate palliative care options
** for mental health or addiction treatment center use [[Dispo]] '''Home with Support Services'''


AMA should be entered whether the patient follows the WRHA AMA process (signing form etc) or just goes AWOL. This will lead to proper reporting for the first two points, and it will allow a chart review to exclude AWOL person depending on the data requirements in the third case.
===LAU (low acuity unity)===
see [[LAU]]


{{DiscussTask|
===Geri Rehab wards===
* For clarification, patients that leave with a known AWOL date/time and the bed is "held" for a period of time; is the dispo date/time inclusive of the bed hold time or is the dispo date/time the actual date/time the patient left AWOL? Thanks! (Pam) }}
see [[Geri Rehab]]


==== [[Homeless]] patients ====
==== [[Homeless]] patients ====
If a homeless patient is discharged, either to a place like Siloam Mission or even without a specific plan, then code them as discharged to '''home'''. Consider whether they might have left [[AMA]].
*If a homeless patient is discharged, either to a place like Siloam Mission, shelter or even without a specific plan, then code them as discharged to '''home'''. Consider whether they might have left [[AMA]].
* If discharged to an [[Alternative Integrated Accommodation (AIA)|Alternative Integrated Accommodation]] with services use '''home with support services'''


==== [[Prison / Jail / Correctional Institution]] ====
==== [[Prison / Jail / Correctional Institution]] ====
If a patient is '''discharged to prison, jail or a correctional institution''', code this as a '''Institution NOS'''.
If a patient is '''discharged to prison, jail or a correctional institution''', code this as "TRSF to Correctional Facility" as dispo to be consistent with EPR
*[[Pre acute living situation field]] should be coded as:  Jail/correctional institution.
 
See [[Prison / Jail / Correctional Institution]] for additional coding instructions that may apply.
 
 
==== [[Chronic Health Facility]] ====
This is somewhat messy and fluid, so see [[Chronic Health Facility]]


==== Discharged to ER or [[Urgent Care]] ====
==== Discharged to ER or [[Urgent Care]] ====
If you discharge a patient to the ER or Urgent Care, you can't enter this in the dispo field. The reason is that this should not happen. If it really does happen:
This is a case of [[Patients who appear to transfer from in-patient situation to Emergency Room]].
* enter '''Other Continents - unknown/other''' (this is a very rare entry so when we see it, we can question it. Put a note in to the [[Notes field]] so Pagasa can check there first.)
 
If a patient is discharged to the ER or Urgent Care at your own site you can't enter this in the dispo field. The reason is that this should not happen. If it really does happen:
* enter '''Not Canada or USA - unknown/other''' (this is a very rare entry so when we see it, we can question it. Put a note in to the [[Notes field]] so Pagasa can check there first.)
* email Pagasa so she can enter your ER / Urgent Care location as dispo.
* email Pagasa so she can enter your ER / Urgent Care location as dispo.


We don't want ER to be available in the dropdown because it had been mistakenly entered a number of times. If it turns out there are a lot of legitimate ''discharges'' to ER we will make the option available.
We don't want ER to be available in the dropdown because it had been mistakenly entered a number of times. If it turns out there are a lot of legitimate ''discharges'' to ER we will make the option available.


==== [[Visits to temporary locations]] ====
===Manitoba Nursing Station===
* use ''"Outside City - unknown/other"''
{{Discuss | If this is actually done then why don't we just make the nursing stations available? We already have [[s_dispo table]] entries for them. 35 entries since 2016, 6 in the last 12 months. Are there other things for which this entry is used? Checked for reasons for this decision but they don't appear documented [[User:Ttenbergen|Ttenbergen]] 19:42, 13 March 2025 (CDT)
}}


=== [[Deceased patients]] ===
=== [[Deceased patients]] ===
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{{Location dropdown cleanup}}
{{Location dropdown cleanup}}


== Data Use ==
== Data Use / [[Indicators]] ==
* [[Unit Mortality]]
* [[Unit Mortality]]
* Intra or Inter Transfer Rate
* [[ICU Interfacility Transfer]]/[[Length of Time for Transfer from ED to ICU within same facility]]/[[Transfer Delay (Critical Care)]]/[[Transfer Delay (Medicine)]]
* Discharges out of hospital
* Discharges out of hospital
* Organ donor rate
* Organ donor rate
* AMA Rate  
* AMA Rate  
* Linking admissions
* Linking admissions
* [[Readmission Rate to ICU]]/[[Readmission to MedWard]]


== Cross checks ==
== Cross checks ==
Line 75: Line 112:
{{Related Articles}}
{{Related Articles}}


== Legacy ==
== Log/Legacy ==
Also see info in the various [[CCMDB.accdb_Change_Log]]s over time.
* [[CCMDB.accdb_Change_Log_2025#2025-03-11-1 | 2025-03-11]]
** added granularity Discharged to community: "TRSF Group/Supportive housing", "TRSF to Correctional Facility", "Home with Support Services"
** one other option in EPR for discharge to was "TRSF to Residential Care" - we decided not to switch to this because we currently record more detailed information.
{{DL |
That more detailed info included things like [[HSC Lennox Bell]]; we discussed whether or not we need to document the details of this. If so, the following is likely a starting point:
* Home
* Home with support
* Institution NOS
* TRSF Group/Supportive housing
* TRSF to Correctional Facility
* any [[Hospice]]s
* GH-Transitional care
* HSC - Transitional care
* Misericordia  - Transitional care
* STB - Transitional care
* VIC - Transitional care
* HSC Lennox Bell
* Manitoba Adolescent Treatment Center - unknown/other
** what is this about again?  we already collect these with the exception of the transitional care units, which don't exist, at GH, HSC, SBGH and VIC, but there is a TCU at Miseri and DLC [[User:Lkaita|Lisa Kaita]] 21:18, 6 September 2025 (CDT)
*** we discussed whether we should shift to EPR's "TRSF to Residential Care" and decided not to because our data is more granular. But we should be able to compare to their TRSF, so should understand which of our data would compare to theirs, and how. I ''think'' the above is a list of what  we have in dispo, so which of those correspond do what listing in EPR? [[User:Ttenbergen|Ttenbergen]] 10:31, 8 September 2025 (CDT)
}}
** added locations for [[LAU Collection Project]]: VGH_LAU, VGH_Geriatrics, COH_LAU, SOH_LAU, SOH_Geriatrics
 
* 2025-03-07
** started to collect "TRSF to Correctional Facility" as dispo to be consistent with EPR; for [[Previous Location]] continue to use the old entry "Institution, NOS"
 
{{Change to collecting prison as "Institution NOS"}}
 
=== earlier legacy info ===
This field is part of the [[2016 Time and Place changes]] and was affected by the [[PatientFollow_Project]].
This field is part of the [[2016 Time and Place changes]] and was affected by the [[PatientFollow_Project]].


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[[Category:Dispo]]
[[Category:Dispo]]
[[Category:Data Collection Guide]]
[[Category:Data Collection Guide]]
[[Category:End-of-life related data]]

Latest revision as of 11:54, 23 October 2025

Data Element (edit)
Field Name: dispo
CCMDB Label: Dispo
CCMDB tab: Dispo
Table: L Log table
Data type: number
Length: long
Program: Med and CC
Created/Raw: Raw
Start Date: 2016-07-01
End Date: 2300-01-01
Sort Index: 41
Data Dependencies(Reports/Indicators/Data Elements): No results

The Dispo field contains information about what happens to the patient at the end of their admission.

  • SMW

Legacy implementation right in the table

  • Cargo


  • Categories
  • Forms


Collection Instruction

surviving patients

Home

  • Includes:
    • hotel
    • rooming house
    • boarding home

Additional options similar to "Home"

We have several "Home" like discharge options that may appear in Cognos2 Unit Starter. If the entry from ADT doesn't align with what is found in the chart then correct the entry to what you think is correct:

  • Home with Support Services - Discharged to a private residence or apartment with support from the community at home or referred to services. example home care, AIA. Note a patient with instructions to return for follow-up or referral to a specialist (as part of a routine discharge order) is NOT considered discharge home with support service/referral
    • includes people on Home O2, they are part of the Home Oxygen home care program
    • includes CIVP
    • excludes: GPAT/GMAT assessments
  • TRSF Group/Supportive housing 
does this include patients who are discharged home with private nursing service?
  • SMW


  • Cargo


  • Categories

JALT I thought we had decided at JALT to collect this as presented by EPR... do I remember this wrong? I had already added it in CCMDB.accdb Change Log 2025#2025-03-11-1. Ttenbergen 22:52, 11 March 2025 (CDT)

  • Yes, I saw that, come to think of it I don't think we decided, not in my notes, but we can use it and I will change the wiki instructions Lisa Kaita 11:25, 13 March 2025 (CDT)
  • If we are going to collect this detail for dispo, should we consider whether or not to also look at SH in preadmit living situation?, currently lumped with community facility with support. Lisa Kaita 14:45, 16 April 2025 (CDT)
  • The entry name includes "TRSF" - is the entry for the previous location equivalent in EPR? Ttenbergen 23:30, 16 April 2025 (CDT)
  • no because the previous location would usually be <site>_ER Lisa Kaita 09:53, 28 May 2025 (CDT)
    • Sorry, I should have asked about "pre-hospital location in ADT". Ttenbergen 16:21, 28 May 2025 (CDT)
  • SMW


  • Cargo


  • Categories
  • TRSF to Residential Care- Includes transfer to long-term care home (24 hour nursing), mental health and/or addiction treatment center or hospice/palliative care facility.
    • for PCH use Dispo PCH options
    • for hospice, see Hospice
    • for palliative care use the appropriate palliative care options
    • for mental health or addiction treatment center use Dispo Home with Support Services

LAU (low acuity unity)

see LAU

Geri Rehab wards

see Geri Rehab

Homeless patients

  • If a homeless patient is discharged, either to a place like Siloam Mission, shelter or even without a specific plan, then code them as discharged to home. Consider whether they might have left AMA.
  • If discharged to an Alternative Integrated Accommodation with services use home with support services

Prison / Jail / Correctional Institution

If a patient is discharged to prison, jail or a correctional institution, code this as "TRSF to Correctional Facility" as dispo to be consistent with EPR

See Prison / Jail / Correctional Institution for additional coding instructions that may apply.


Chronic Health Facility

This is somewhat messy and fluid, so see Chronic Health Facility

Discharged to ER or Urgent Care

This is a case of Patients who appear to transfer from in-patient situation to Emergency Room.

If a patient is discharged to the ER or Urgent Care at your own site you can't enter this in the dispo field. The reason is that this should not happen. If it really does happen:

  • enter Not Canada or USA - unknown/other (this is a very rare entry so when we see it, we can question it. Put a note in to the Notes field so Pagasa can check there first.)
  • email Pagasa so she can enter your ER / Urgent Care location as dispo.

We don't want ER to be available in the dropdown because it had been mistakenly entered a number of times. If it turns out there are a lot of legitimate discharges to ER we will make the option available.

Manitoba Nursing Station

  • use "Outside City - unknown/other"
If this is actually done then why don't we just make the nursing stations available? We already have s_dispo table entries for them. 35 entries since 2016, 6 in the last 12 months. Are there other things for which this entry is used? Checked for reasons for this decision but they don't appear documented Ttenbergen 19:42, 13 March 2025 (CDT)
  • SMW


  • Cargo


  • Categories

Deceased patients

See

"Can we remove the items that are no longer Service/Locations, Previous Locations, Pre-admit Inpatient Institutions or dispo locations from the dropdowns?"

We can and will remove them, but that can only happen once no more laptops use them. We will need to keep track of this and then remove them when ready. If I removed them now, then any box that currently has them enter would misbehave.

SQL query of what is currently available    
SELECT s_dispo.location_name, s_dispo.Site, s_dispo.active, s_dispo.inpatient, s_dispo.previous_location, s_dispo.s_location, s_dispo.dispo
FROM s_dispo
WHERE (((s_dispo.Site)>"") AND ((s_dispo.active)=True) AND ((s_dispo.inpatient)=True)) OR (((s_dispo.Site)>"") AND ((s_dispo.active)=True) AND ((s_dispo.previous_location)=True)) OR (((s_dispo.Site)>"") AND ((s_dispo.active)=True) AND ((s_dispo.s_location)=True)) OR (((s_dispo.Site)>"") AND ((s_dispo.active)=True) AND ((s_dispo.dispo)=True));
  • query of what is currently used: query z_s_dispo_inactivatable

Data Use / Indicators

Cross checks

Data Integrity Checks (automatic list)

 AppStatus
Check pre acute consistentCCMDB.accdbdeclined
Function Validate DispoCCMDB.accdbimplemented
Check function location NE dispoCCMDB.accdbimplemented
Query check ICD10 dx implying death must have appropriate dispoCCMDB.accdbimplemented
Query check dispo lower acuity than locationCCMDB.accdbretired
Link suspect dead then alive queryCentralized data front end.accdbimplemented
Link suspect mismatch to ours incomplete queryCentralized data front end.accdbimplemented
Link_suspect_not_same_visitAdmitDtTm queryCentralized data front end.accdbimplemented
Query cardiac arrest throughout admissionCentralized data front end.accdbready to implement
Link_suspect_visitAdmitDtTm_mult_to-from-home queryCentralized data front end.accdbready to implement

Implementation

The field is populated with options from the s dispo table.

Related Articles

Related articles:

Log/Legacy

Also see info in the various CCMDB.accdb_Change_Logs over time.

  • 2025-03-11
    • added granularity Discharged to community: "TRSF Group/Supportive housing", "TRSF to Correctional Facility", "Home with Support Services"
    • one other option in EPR for discharge to was "TRSF to Residential Care" - we decided not to switch to this because we currently record more detailed information.

That more detailed info included things like HSC Lennox Bell; we discussed whether or not we need to document the details of this. If so, the following is likely a starting point:

  • Home
  • Home with support
  • Institution NOS
  • TRSF Group/Supportive housing
  • TRSF to Correctional Facility
  • any Hospices
  • GH-Transitional care
  • HSC - Transitional care
  • Misericordia - Transitional care
  • STB - Transitional care
  • VIC - Transitional care
  • HSC Lennox Bell
  • Manitoba Adolescent Treatment Center - unknown/other
    • what is this about again? we already collect these with the exception of the transitional care units, which don't exist, at GH, HSC, SBGH and VIC, but there is a TCU at Miseri and DLC Lisa Kaita 21:18, 6 September 2025 (CDT)
      • we discussed whether we should shift to EPR's "TRSF to Residential Care" and decided not to because our data is more granular. But we should be able to compare to their TRSF, so should understand which of our data would compare to theirs, and how. I think the above is a list of what we have in dispo, so which of those correspond do what listing in EPR? Ttenbergen 10:31, 8 September 2025 (CDT)
  • SMW


  • Cargo


  • Categories
  • 2025-03-07
    • started to collect "TRSF to Correctional Facility" as dispo to be consistent with EPR; for Previous Location continue to use the old entry "Institution, NOS"

Change to collecting Prison as "Institution NOS"

Before 2018-12-21 we would have coded an admission from jail as previous location "Home". With CCMDB.mdb_Change_Log_2018#2018-12-21 we added the option "Institution NOS".

earlier legacy info

This field is part of the 2016 Time and Place changes and was affected by the PatientFollow_Project.

It a combination of our previous

Data from these fields has been back-populated to the this field so data is available from the beginning of the database.

Related articles:

Very early missing Discharge-tos

There were 6762 very old ICU records who are listed as survived but didn’t have a discharge-to. This is from HSC-only days when there simply were no checks.

When data was brought across from the old discharge to field the dispo fields of these records were set to 'survive(Legacy)'.

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