BedHeldEnd DtTm

Projects
Active?:	planned
Program:	CC and Med
Requestor:	???
Collection start:	2023-01-01
Collection end:

Data Collection

Collect for all patients where beds are held due to AMA or procedure at other sites. This will only be recorded in the following situations when:

• patient leaves AMA

or

• patient Visits to temporary locations, we expect them to return so bed is held but they never do come back

Collection Instructions

• Project :BedHeldEnd DtTm
• Items:
  • AMA (AWOL) - leaving without consent discussion or permission; The date and time for AMA (AWOL) will be the discharge date and time as per COGNOS/EPR ie. the date and time that the held bed was given up.
  • AMA (Protocol) - when a consent discussion regarding the patient's choice to leave before a recommended time has been done and the patient is being asked to sign a form that he/she understands the risks of such decision ; The date and time for AMA (Protocol) will be the same as the Dispo DtTm, we are collecting it only for completeness and cross-checks.
  • Procedure - patient went elsewhere for proedure and bed was held and patient did not return
  • Weird Reason - reason not covered above
• Date (field E): Discharge date as per ADT (ie when the bed was released)
• Time (field M): Discharge time as per ADT (ie when the bed was released)
• Not used: Integer, Real, Checkbox, Comment

Special Scenario

• A patient in the ER admitted under medicine service leaves AMA from the ER, A bed on the ward is assigned to the patient (boarding location appears in COGNOS) however the patient never returns to occupy the bed on the ward. As per the Boarding Loc instructions, do not enter the second boarding location

This is very rare, but if we do start to notice this happening more frequently we will discuss further.

Sources

Use the discharge dttm as per Cognos2 Ender/ADT.

Background

As discussed at JALT, the frequency of people leaving AMA (esp from ward) is not low. And, per Lisa, most of these are without notice. Thus it is not a trivial issue that there is a nontrivial difference between when the patient actually stops being under care vs. when the bed is released for reassignment.

Our previous instructions were to note in the Dispo DtTm field when the person left AMA, or was noted to be gone and assumed AMA. If a bed is "held" and the patient indeed returns, goes back into that bed without being readmitted (because the bed was held), then this isn't to be considered to be an AMA. This follows the same kind of reasoning as Visits to temporary locations. This meant we had no way to report bed times lost to AMA.

We then realized that this issue is the same for bed times lost to beds held when a patient is sent to another hospital for a procedure, expecting to return (so the bed from the sending site is held) but then does not return.

These 2 situations are easy for the DCs to identify and they always do so anyway, so we decided to track this to allow us to report on this more meaningfully.

So we will distinguish between:

• (a) Actual time under care, which is from Admit DtTm to the patient's Dispo DtTm -- we'll call this the patient's length of stay **use for indicators LOS Per Record or LOS Per Service
• (b) What we'll call "Bed Assigned Time", i.e. from Admit DtTm to the time when the bed is released for reassignment, which we will call "BedHeldEndTime". This latter is generally available from Cognos (ADT)

Visit to temporary locations and died

Follow the guidelines in Visits to temporary locations for collection of Dispo DtTm and BedHeldEnd DtTm in case of a death.

Collection parameters

• End Date: planned as continuous collection without an end date

Data Use

• LOS Per Record
• LOS Per Service
• Bed occupancy
• Occupancy For Bed Held

Consistency Checks

We will collect this data for a month or so to have an idea what it looks like after that, we might add a cross check for complete and undeleted records such that if AMA is entered for this, Dispo must be AMA.

With the current data, the converse is not true in case of AMA who signs out, as BedHeld will not be entered if pt signs out AMA following WRHA process. Once we see data we will decide if we want to add a counterpart so we can cross-check that the entry wasn't just forgotten if there is an AMA entry in Dispo. We might add an entry like AMA (protocol) to be able to ensure completion. Data for those would either have no dttm, or the same dttm as [[Dispo DtTm ], we'd have to decide.

No entry for AMA following sign-out protocol

We don't have a special entry for patients who leave AMA following the sign out protocol. For these, no bed hold times are incurred, and we already track that they are leaving AMA in the Dispo field, so nothing would be gained by adding an entry for them here.

Data Integrity Checks (automatic list)

	App	Status
Query check tmp BedHeld	CCMDB.accdb	implemented

Log

• 2023-01-25 added "Weird Reason"
• 2023-01-10 Julie identified data problems in preliminary data and defined required checks, see Query check_tmp_BedHeld
• 2023-01-01 collection start
• 2022-12-08 made page to validate