Overstay Predictor Project Collection Instructions: Difference between revisions

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This article explains how to collect data in the [[CCMDB.mdb]] for the [[Overstay Predictor Project]].
{{LegacyContent
|explanation=we stopped [[Overstay]]
|successor=
|content=
This article documents what data collectors need to do to collect information for the [[Overstay Predictor Project]].  


== Instructions ==
'''This project was one of the Vacation and staff shortage collection priorities!'''
For every '''medicine''' patient admitted to the Grace 5N, '''as soon as possible''', but definitely '''within 48 business hrs of admission''':
#Find the new white [[Media:Nursing_Discharge_Screening_Tool Nursing_Discharge_Screening_Tool.pdf|Nursing Discharge Screening Tool form]] on the chart. It will be with the admission documentation.
#*the form is to be dated and time stamped
#*For the first 6 check boxes on the form, create a record for each in tmp entries and check the check box if the answer is Yes.  (one to one from the form, no interpretation necessary)indicated if no answer is provided.
#*re question 4 (managing independently), if any of the boxes within question 4 are checked "no" or "x", the answer to question 4 should be checked "no"; all boxes within the question must be unmarked or given a check mark in order for question 4 to be checked "yes".
#**{{discussion}}'''the above instructions are very unclear''': '''should the boxes be checked if the pt is independent or not independent?'''
#*** When I look at [[Media:Nursing_Discharge_Screening_Tool Nursing_Discharge_Screening_Tool.pdf|the form]], the statement seems clear to me: if they have support, check. if they have supports for all, then the main box becomes a "y" checked. Are you maybe referring to an earlier version of the form? [[User:Ttenbergen|Ttenbergen]] 16:45, 2012 July 12 (CDT){{discussion}}
#the form is to be completed within 24 hours of admission; if it is not possible at time of admission, the admitting nurse will pass the responsibility for completion to the next duty nurse
#*The nurse can update the form within the first 24 hours after admission if, for example they receive information from the patients family that contradicts the patients answers. It is possible that depending on when you review that document these changes are not captured. This a known risk that has to be accepted.
#*If the form is '''not completed''' within the first 24 hours the data collector is to check with the bedside nurse and remind them to complete it; also, there will be a tmp table entry added to track this (Tina To Do) {{Question IT}}
#The information used in the predictor calculation is based on the minimal data set plus a handful of diagnostic codes that need to be checked for within the first 24 hours. The following as part of minimal data set:
##'''DOB'''
##'''Admit Date'''
##'''ADL'''
##'''CVA''' know or speculated as the admitting
##'''Dementia''' as an admitting reason or comorbid
##''whether there was a [[Overstay Predictor Diagnosis Code Used | permanent & severe neurological or spinal]] insult as an admitting diagnosis       
#Once this information has been entered click the new “Overstay” button on the patient viewer form next to the notes field and it will turn a colour (colours based on an underlying algorithm too complicated to get into here, but based on tmp entries, age, comorbids, admit dxs and ADLs):
#* GREEN - low/no risk for discharge issues
#* YELLOW - some risk for discharge issues
#* RED - significant risk for discharge issues assign a transition coordinator.
#* GRAY - if some needed data is missing
# Based on the color displayed put that colored sticker on the patients chart. Stickers will be located adjacent to the transition coordinator binder at the unit clerk desk.
# If the patient has been designated as "red" for purposes of overstay prediction, the data collector will assign a Transition Coordinator by placing the patients name beside the transition coordinator on call for the time period of the patients admission. The transition coordinators will be assigned to cover between Friday to Monday, the next shift will go to Wednesday, the last will be Wednesday to Friday. If the designation is made after 1500 on the day of entry, the assignment will be deferred to the next day's coordinator. The rotation of Coordinators is made up of Home Care, Social Work, Physio, And OTs.  After assignment, that service is responsible for following that patient throughout their hospital stay.


== In addition to [[Minimal Data Set]] ==
The following items need to be entered '''before the generation of the chart colour in the next step''' because the algorithm uses this data:
* [[Date of Birth]]
* [[Province]]
* "Accept DtTm" if used, else "Arrive DtTm"
* [[Pre-admit Inpatient Institution]]
* [[ADL]]
* [[Glasgow Coma Scale]]
* '''important:''' [[List of diagnoses affecting Overstay Project]]


If you can't find data
== Generate colour ==
'''Clarify with the bedside nurse.'''
Once the required information has been entered click the "Overstay" button on the patient viewer screen next to the [[Notes field]] and it will turn a colour based on an [[Overstay Predictor Project Algorithm | algorithm]].  


The program will ask you if this is the final colour you will submit. If so, it will be stored and sent. The colour will also be automatically added to the beginning of the Notes field, since most collectors were manually putting it there anyways.


If occasionally there is a working diagnosis written by the MD as "CVA" but this has not been confirmed by CT, then record the DX as CVA if it is suspected even if not confirmed.'''--[[User:LHathout|Linda Hathout]] 21:48, 2012 July 5 (CDT)
* '''Red''' - significant risk for discharge delays
** email to notify unit manager - see [[#Notifying_the_Unit_Manager]]
**put red stick on chart - see [[#Red Chart Stickers]]
* '''Yellow''' - anyone who is not red
**no email to manager
**no sticker on chart
* '''Gray''' -  there are no gray stickers, gray is just a colour the laptop will give when it gets bad data for the algorithm.one of two scenarios:  
** data needed to generate the colour is missing; you will not be able to generate a colour; there will be a specific error, please act on it
** the patient is transferred from a ward where the colour should have been generated already.


=== location of form and sticker ===
== Red Chart Stickers ==
If the colour is '''red''' place a 3/4" red round sticker on the spine of the patient chart. Ward clerks will need to order these. Collectors will tell ward clerks when supplies are getting low.


#Where on the chart will this new form be and will it be a colored form?--[[User:TOstryzniuk|Trish Ostryzniuk]] 10:43, 2012 April 24 (CDT)
=== Other coloured dots on charts ===
#*''The form will be in the same section as the nursing database. Not sure about the colour. The sticker is 3/4 inch in diameter and needs to be placed on the spine of the chart. There is currently a small red dots used to indicate long term chart. This practice is being phased out''.--[[User:LHathout|Linda Hathout]] 22:04, 2012 July 5 (CDT)
There is currently a small red dot used to indicate long term chart. These are not ours and users of the chart who use these ought to be aware of them.  
#What is the purpose of putting the sticker on the chart; will this be looked for by other disciplines to identify the need for their intervention?
#*''see'' [[#Purpose]] ''at top of this article''. --[[User:Ttenbergen|Ttenbergen]] 11:56, 2012 May 2 (CDT)


=== no need to document sticker colour changes ===
== Notifying the Unit Manager ==
#Will it be necessary to document a difference in sticker colours if we need to change the colour once the algorithm has run?
If a patient is identified as red, [[CCMDB.accdb]] will populate an email subject line with the name of the patient and that they have been identified as overstay colour red. The collector must send the email to the unit manager (see [[List of Unit Managers]]). It should not be necessary to add additional information to the body, this way all info is visible when the manager sees the email arrive, and they don't have to open it.
#* ''No need. The original colour is based on the items you enter into tmp, so we can go back from that if needed''. [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)


=== test scenarios for colours ===
If we find that additional info is required, let's talk about it and add it to the program, rather than add anything manually, so we know this is done consistently.
#How can I test the yellow colour?-I can only get the overstay button to be red or green using multiple different combinations of the check boxes
#* ''Yellow would be based on a combination of comorbids and ADLs and age. Make a patient a little less sick and they will become yellow. Sorry, can't give you exact instructions, the algorithm is pretty messy''. [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)


=== admission times and conditions at admission ===
== Possible Scenarios ==
#The time we use as the time of admission will be different than the time of admission to the unit, and often significant time has passed between the 2 times so the information collected is different e.g. pt is confused at our admission time but by the time the patient goes to the unit, the patient is now A & O etc or vice versa.  Will this affect the algorithm?
=== Possible Scenario - Patient transferred from other ward - admit ward was participating ward ===
#*''Use the data as you would have entered before as that is what the algorithm was based on. I hope that helps, since I know some collectors used to collect this much later''.--[[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
If the patient was admitted from a another '''medicine''' ward at the same location that also participates in the Overstay project, then the original Yellow/Red designation is retained.
#**''Pls let me know if you need more info''.--[[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
It will be the responsibility of the manager of the originating ward to notify the manager of the receiving ward of any red patients.
#What if our assessment differs from that of the admitting nurse e.g. they ask the pt/family on admission if they have fallen within the past 6 months and are told no or the information is not available, and we see from looking through the chart that falls have been documented within this timeframe?
#*''Use the answer the nurse provides even if you disagree. We will be testing the answers provided by the nurses to determine if they are a better predictor of transition support needs or can be used in conjunction with existing admission data to improve the effectiveness of the prediction tool''.--[[User:LHathout|Linda Hathout]] 22:11, 2012 July 5 (CDT)
#Is the admission information the only source used or will the complications be taken into consideration e.g. if the pt develops a new cva as a complication do we redo the overstay predictor?
#*''Only data upon admission to the unit should be used''.--[[User:LHathout|Linda Hathout]] 22:11, 2012 July 5 (CDT)
#If the patient is transferred from one medical unit to another within the facility, is their overstay predictor redone or do they carry the one from the original admitting ward with them?


==== Previous ward's collector ====
When you find out that your patient has been discharged to another ward where we collect please notify that collector. There seem to be different informal methods used by different collectors for this right now. We will test if that is good enough, and only formalize it if there are problems.


*so will these no longer be coded in comorbids? [[User:SCortilet | Stephanie]]
==== New ward's collector ====
**you will still continue to code comorbid conditions the same way as you do now. The list of admit and acquired complications is only for the the predictor algorithm.  [[User:TOstryzniuk|Trish Ostryzniuk]] 14:29, 2012 June 12 (CDT)
Ensure that these charts have the appropriate colour dot on them as communicated to you.  
===Programming Stuff===
==== testing for consistent data ====
{{Discussion}}
I intentionally left out one of the overstay questions in the temp file expecting to get a gray overstay predictor score indicating missing information but am getting yellow-is this correct?
* Program should not have let this through, I'll need to look into that. [[User:Ttenbergen|Ttenbergen]] 12:02, 2012 May 2 (CDT)


==== button colour persistence ====
Enter the patient as normal and click the overstay button. It will give you a message ''"Patient comes from participating ward, use their overstay colour on charts. CCMDB will list gray."''. We will match the data to the original ward behind the scenes.
#Every time I exit the Database and then reenter, I have to repress the overstay button as it has gone gray; reported on May 8.12.--[[User: SCortilet | Stephanie Cortilet]].
 
#*Will confirm process.--[[User:Ttenbergen|Ttenbergen]] 12:02, 2012 May 2 (CDT)
=== Possible Scenario - Patient transferred from other ward - admit ward was '''NON'''-participating ward ===
#**''This still an issue as of July 6.12''. [[User: SCortilet | Stephanie]]. {{Discussion}}
If the patient is transferred either '''from''' or '''via''' any unit not participating in the Overstay project (e.g. an ICU) generate a colour.
#Is the DX code for '''violent behaviour secondary to dementia''' included in the list?
 
#*I would say yes. '''Linda will check with Julie Mojica'''--[[User:TOstryzniuk|Trish Ostryzniuk]] 13:03, 2012 July 6 (CDT){{Discussion}}
=== Possible Scenario - colour change due to data entry error ===
#Would it be helpful for us to note the reason the patinet has stayed past the date it is noted they are medically stable somewhere; the chart usually notes whether the pt is being panelled, waiting for services or assessments etc. or whether the pt becomes "unstable" again while waiting for d/c (discharge).
'''The only case where the colour should be changed is if the data-collector made a error on data entry. We don't want you to change colour because data becomes available after the initial assessment window.'''
#*The [[media:!Transition_Coordinator_June_27th.pdf|Transition Coordinator]] will be documenting reasons for overstay.--[[User:LHathout|Linda Hathout]] 21:51, 2012 July 5 (CDT)
 
#**Trish is getting and internet explorer run time error when she tries to open above link.[[User:TOstryzniuk|Trish Ostryzniuk]] 15:51, 2012 July 12 (CDT) {{Discussion}}.
If you realize you made a data entry error and you have fixed it, you can click the Overstay button again. It will ask you again if this is final, and if you click yes the original entry will be '''overwritten''' and the new colour be added to the beginning of the Notes field. This means you may have multiple colours in notes, the first one being the current one.
#Does the algorithm include age, and/or whether the patient originally came from a nursing home? Patients from an existing nursing home bed will not overstay as frequently as those from home.
 
#*'''All these factor have been considered. See [[Media:Two_Stage_Predictive_Model_of_Patients_in_Need_of_a_Transition_Coordinator.pdf]] Twostagepredictivemodel.pdf] for details'''--[[User:LHathout|Linda Hathout]] 21:51, 2012 July 5 (CDT)
It is '''not necessary to document''' when a colour changes. Just change the colour.
#Is it possible for the 6 overstay requirements in the temp file to be generated automatically like the postal code is rather than having to add the 12 items manually? we then would just have to check the box to answer each question
 
#*''? Can I get this resolved or answered please''?--[[User: SCortilet | Stephanie]].{{Discussion}}
=== Possible Scenario - Patient died/discharged before data collection ===
#**?????
Enter anyway and generate colour. Do not contact Unit Manager.
 
=== Possible Scenario - EMIP patient that never made it to the ward ===
Enter anyway and generate colour. Do not contact Unit Manager.  
 
=== Possible Scenario - Off ward patients ===
Almost all of these will be [[#Possible Scenario - Patient transferred from other ward - admit ward was participating ward]], so use those collection instructions. It will be the responsibility of that manager to notify the next manager.  
 
For the rare patient admitted to an off-ward location without hitting one of our regular wards first, generate a colour and put it on the chart, but don't worry about contacting a manager. This was discussed as a special case not worth following up on. It Is OK.
 
== Start/Stop/Site participation ==
see [[Overstay Project Start Stop dates]]
 
{{Data Integrity Check List}}
 
= Clarification of difference to previous process=
The following documentation is relevant to pre-empt questions only until the transition to the new process is complete.  
 
== even at STB ==
For a while STB medicine collectors stopped putting red dots on the charts. They will now be required to put dots on the charts again. We discussed only notifying the manager by email with the requestor of the project, but they really want the dots. One thing we considered was the possibility of putting something equivalent to the red dot onto [[Medworxx]]. I am looking into that.
 
== DPST form - STOP July 31.17 ==
Collectors will '''no longer''':
*collect any information from the DPST forms or be responsible for them (tmp file for the questions will be gone)
*post information in the Transition Coordinator binders or  
*notify and assign allied Health.   


Collectors can ignore the form and just collect the minimal data set outlined above to generate a colour.
*wards may continue to fill out the DPST form at admission ''For their own purposes.'' 


{{Discussion}}
== Transition Coordinator Binder - Stop July 31.17 ==
Collectors will '''no longer''':
*post any kind of information in the Transition Coordinator binder 
*notify and assign reds to allied Health team 


*    where to find the Discharge planning screening tool
= Instructions admissions before Jul 30 2017 =
*  implementing the sticker code on the charts
see [[Pre-2017-07-30 Overstay Predictor Project Collection Instructions]]
* documenting the patients name on the transition coordinators assignment sheet
   
* time frames for chart reviews
* All reds generated prior to July 31st are already in our data, just leave them as they were.
}}


[[Category: OverstayProject]]
[[Category: OverstayProject| *]]

Latest revision as of 13:16, 2022 April 19

Legacy Content

This page contains Legacy Content.
  • Explanation: we stopped Overstay
  • Successor:

Click Expand to show legacy content.

This article documents what data collectors need to do to collect information for the Overstay Predictor Project.

This project was one of the Vacation and staff shortage collection priorities!

In addition to Minimal Data Set

The following items need to be entered before the generation of the chart colour in the next step because the algorithm uses this data:

Generate colour

Once the required information has been entered click the "Overstay" button on the patient viewer screen next to the Notes field and it will turn a colour based on an algorithm.

The program will ask you if this is the final colour you will submit. If so, it will be stored and sent. The colour will also be automatically added to the beginning of the Notes field, since most collectors were manually putting it there anyways.

  • Red - significant risk for discharge delays
  • Yellow - anyone who is not red
    • no email to manager
    • no sticker on chart
  • Gray - there are no gray stickers, gray is just a colour the laptop will give when it gets bad data for the algorithm.one of two scenarios:
    • data needed to generate the colour is missing; you will not be able to generate a colour; there will be a specific error, please act on it
    • the patient is transferred from a ward where the colour should have been generated already.

Red Chart Stickers

If the colour is red place a 3/4" red round sticker on the spine of the patient chart. Ward clerks will need to order these. Collectors will tell ward clerks when supplies are getting low.

Other coloured dots on charts

There is currently a small red dot used to indicate long term chart. These are not ours and users of the chart who use these ought to be aware of them.

Notifying the Unit Manager

If a patient is identified as red, CCMDB.accdb will populate an email subject line with the name of the patient and that they have been identified as overstay colour red. The collector must send the email to the unit manager (see List of Unit Managers). It should not be necessary to add additional information to the body, this way all info is visible when the manager sees the email arrive, and they don't have to open it.

If we find that additional info is required, let's talk about it and add it to the program, rather than add anything manually, so we know this is done consistently.

Possible Scenarios

Possible Scenario - Patient transferred from other ward - admit ward was participating ward

If the patient was admitted from a another medicine ward at the same location that also participates in the Overstay project, then the original Yellow/Red designation is retained. It will be the responsibility of the manager of the originating ward to notify the manager of the receiving ward of any red patients.

Previous ward's collector

When you find out that your patient has been discharged to another ward where we collect please notify that collector. There seem to be different informal methods used by different collectors for this right now. We will test if that is good enough, and only formalize it if there are problems.

New ward's collector

Ensure that these charts have the appropriate colour dot on them as communicated to you.

Enter the patient as normal and click the overstay button. It will give you a message "Patient comes from participating ward, use their overstay colour on charts. CCMDB will list gray.". We will match the data to the original ward behind the scenes.

Possible Scenario - Patient transferred from other ward - admit ward was NON-participating ward

If the patient is transferred either from or via any unit not participating in the Overstay project (e.g. an ICU) generate a colour.

Possible Scenario - colour change due to data entry error

The only case where the colour should be changed is if the data-collector made a error on data entry. We don't want you to change colour because data becomes available after the initial assessment window.

If you realize you made a data entry error and you have fixed it, you can click the Overstay button again. It will ask you again if this is final, and if you click yes the original entry will be overwritten and the new colour be added to the beginning of the Notes field. This means you may have multiple colours in notes, the first one being the current one.

It is not necessary to document when a colour changes. Just change the colour.

Possible Scenario - Patient died/discharged before data collection

Enter anyway and generate colour. Do not contact Unit Manager.

Possible Scenario - EMIP patient that never made it to the ward

Enter anyway and generate colour. Do not contact Unit Manager.

Possible Scenario - Off ward patients

Almost all of these will be #Possible Scenario - Patient transferred from other ward - admit ward was participating ward, so use those collection instructions. It will be the responsibility of that manager to notify the next manager.

For the rare patient admitted to an off-ward location without hitting one of our regular wards first, generate a colour and put it on the chart, but don't worry about contacting a manager. This was discussed as a special case not worth following up on. It Is OK.

Start/Stop/Site participation

see Overstay Project Start Stop dates

Data Integrity Checks (automatic list)

 AppStatus
Query check tmp generate allowedCCMDB.accdbimplemented
Query check overstay no colourCCMDB.accdbretired
Query check overstay pt from our medCCMDB.accdbretired
Query check overstay not enteredCCMDB.accdbretired

Clarification of difference to previous process

The following documentation is relevant to pre-empt questions only until the transition to the new process is complete.

even at STB

For a while STB medicine collectors stopped putting red dots on the charts. They will now be required to put dots on the charts again. We discussed only notifying the manager by email with the requestor of the project, but they really want the dots. One thing we considered was the possibility of putting something equivalent to the red dot onto Medworxx. I am looking into that.

DPST form - STOP July 31.17

Collectors will no longer:

  • collect any information from the DPST forms or be responsible for them (tmp file for the questions will be gone)
  • post information in the Transition Coordinator binders or
  • notify and assign allied Health.

Collectors can ignore the form and just collect the minimal data set outlined above to generate a colour.

  • wards may continue to fill out the DPST form at admission For their own purposes.

Transition Coordinator Binder - Stop July 31.17

Collectors will no longer:

  • post any kind of information in the Transition Coordinator binder
  • notify and assign reds to allied Health team

Instructions admissions before Jul 30 2017

see Pre-2017-07-30 Overstay Predictor Project Collection Instructions

  • All reds generated prior to July 31st are already in our data, just leave them as they were.
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