Overstay Predictor Project Collection Instructions: Difference between revisions

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This article documents what data collectors need to do with the [[Media:Discharge Planning Screening Tool.pdf | Discharge Planning Screening Tool form (DPST Form)]]
{{LegacyContent
|explanation=we stopped [[Overstay]]
|successor=
|content=
This article documents what data collectors need to do to collect information for the [[Overstay Predictor Project]].


== ensuring completeness within 24 hrs ==
'''This project was one of the Vacation and staff shortage collection priorities!'''
The bedside nurses have 24 hours from the time of [[Admit,_Transfer_and_Discharge_date_and_time#Definition_for_Medicine | admission to the unit]] to fill out the bedside nurse DPST Form. This time frame allows for the nurse to clarify unanswered questions with the patient or caregivers during the day.


The nurse can update the DPST 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 we are accepting.
== 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]]


=== Possible Scenarios ===
== Generate colour ==
See
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]].  
* [[#Possible Scenario - complete DPST Form missing or blank]]  
* [[#Possible Scenario - individual questions missing]]
* [[#Possible Scenario - Patient transferred from other participating ward]]
* [[#Possible Scenario - Patient died/discharged before assessment]]
* [[#Possible Scenario - EMIP patient that never made it to the ward]]
* [[#Possible Scenario - HSC overflows to RR5 & RR6]]
* any others? Think first whether they ''really'' are not addressed in these instructions...


== entering the data in TMP==
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.  
'''Within two business days''' after the bedside nurse has completed the DPST Form the rest of the predictor data must be collected & entered into laptop by data collector.  


=== 6 Questions Data ===
* '''Red''' - significant risk for discharge delays
When a new medicine patient is entered, 6 rows for questions are generated for them in the tmp table. They are labelled "Enter(1)" through "Enter (6)".  
** email to notify unit manager - see [[#Notifying_the_Unit_Manager]]
You need to change the "Enter (x)" for each to the corresponding entry, i.e. "Enter (1)" becomes "1 Alert ad Orientated". Then you need to check the checkbox in column B if the answer on the DPST form is "yes". Leave the box blank to indicate no.  
**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.


Question "4 managing independently" consists of several sub-questions. If '''even one'' of the activities raises a concern then the summary answer for the question needs to be '''no'''.
== 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.  


Take answers to questions directly from the DPST form, no interpretation, even if you disagree after reading the chart. 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. If the data were interpreted by the collector it would introduce another factor and make this test less valid. If you identify a discrepancy please note it in the Temp Comments field also known as column Q.
=== Other coloured dots on charts ===
[[file:Overstay TMP - What you see in TMP.JPG |100px | what it looks like - click to see a bigger image]]
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.  
[[file:Overstay TMP-what you ENTER.JPG |100px| Overstay TMP What to ENTER - click to see a bigger image]]


=== "From" Data ===
== Notifying the Unit Manager ==
When a new medicine patient is entered, a line "Enter "From"" is created in the tmp table.  
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.  
Change this entry to indicate where the patient was admitted from. If the information is not indicated on the DPST form, but you can identify it easily from the chart, enter that; i.e. '''you may interpret this one'''. If information where the patient is from is unavailable, enter "From  location missing".  


== Changes to regular minimal data collection and entry required for the Overstay Project ==
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.
A number of items in addition to the regular [[Minimal Data Set]] needs to be entered '''before the generation of the chart colour in the next step''' because the algorithm uses this data:
 
* "from" and "questions" tmp entries, or else "transferred" entry if applicable
* DOB
* province
* Admit Date
** Enter admit date as before; we are aware that this can be different from the time of admission to the unit and the algorithm takes that into account
* admit-from
* ADL
* Glasgow Coma Scale
* Charlson Comorbids
** still working on list for the wiki; in the meantime, please just code all comorbids for the patient
** will be here: [[List of diagnoses affecting Overstay Project]]
* admit diagnoses important to code if applicable:
** '''[[Dementia]]''' or '''[[Violent 2nd to dementia]]'''
 
== Colored Chart Stickers ==
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 [[Media:Two_Stage_Predictive_Model_of_Patients_in_Need_of_a_Transition_Coordinator.pdf | underlying algorithm]].
* 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 you will not be able to generate a colour; there will be a specific error, please act on it
 
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.
 
Based on the color displayed circle the colour on the DPST Form. Also place a colored sticker on the spine of the patient chart. The 3/4 inch stickers will be located in the transition coordinator binder at the unit clerk desk. 
 
=== copies of forms? ===
*Take a copy of all DPST forms and leave the copy on the Transition Coordinator binder. We will be collecting these forms for the time being to evaluate the form.
** {{discussion}} is this still true? Ttenbergen 17:42, 2013 August 8 (CDT)
 
=== Other coloured dots on charts? ===
* There is currently a small red dot used to indicate long term chart. There is also a small yellow dot used to indicate VRE.
** Are you talking about the small dots that the ward staff use on the addressograghs?--[[User:CMarks|CMarks]] 12:56, 2013 July 30 (CDT)
** Are these other dots relevant to the overstay project? Is there any risk of someone confusing these? Ttenbergen 17:50, 2013 August 8 (CDT)
 
== Notifying the Transition Coordinator ==
''see also [[#Special Case - Patient transferred from other participating ward]]
If the patient has been designated as "red" for purposes of overstay prediction, the data collector will notify a Transition Coordinator by placing the patients name on the ''Transition Coordinator Assignment Sheet''.


== Possible Scenarios ==
== Possible Scenarios ==
==Possible Scenario - HSC overflows to RR5 & RR6==
=== Possible Scenario - Patient transferred from other ward - admit ward was participating ward ===
As of May 13, 2013 HSC medicine data collection will follow all OVERFLOW patient that are going to RR5 & RR. These are patient that are under a medicine attending service while on RR5 or RR6.  They are sent there from medicine wards we are collecting on at HSC. They are also admitted there under Internal medicine service attending physicians from the ER department.[[User:TOstryzniuk|Trish Ostryzniuk]] 16:20, 2013 June 14 (EDT)
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.  
Medical records will auto print patient list for RR5 & RR6 direclty to the printer in GF216.  HSC collector should now have access to ADT (Admit/Transfer/Discharge) for patient wards list via [[KEA]]/ [[Reflections]] also.  If not, please contact Denise Felbel (she is in global address in your email).
 
== Possible Scenario - Patient transferred from other participating ward ==
If the patient was admitted from a another '''medicine''' ward at the same location, and if that ward also participates in the Overstay project, then '''no''' DPST form needs to be filled out and and the original Green/Yellow/Red designation is retained.  
 
The completed form, with colour written on it, should arrive on the new unit with the patient. The designated colour should be written on the form.
 
If the patient is transferred either '''from''' or '''via''' any other unit, the form needs to be filled out; if it is not, enter it as a missing form.
 
=== entry instructions for form missing ===
* ''erase'' the 6 questions
* enter an entry Project "Overstay", Item '''"Transferred form" '''
* ensure that the new chart has a dot of the right colour
* if '''red''' add the patients name to the assignment sheet
 
 
*{{discussion}}
I have had several pts readmitted to my ward after a stay in ICU, but whose original Screening Tools were never completed; should this still be recorded as a "transferred form" or should we attempt to have a form filled out to generate a colour this admission?
*'''Form missing'''.
 
== Possible Scenario - Patient died/discharged before assessment ==
If the patient was discharged/died before a colour could be assigned write "not assessed" and write the discharge date on the Discharge Planning Screening Tool, take a copy and put it in the Transition Coordinator Binder.
=== entry instructions ===
* ''erase'' the 6 questions
* enter an entry Project "Overstay", Item '''"Form Data Missing"'''; put "early death" or "early discharge" into the notes field


== Possible Scenario - EMIP patient that never made it to the ward ==
==== Previous ward's collector ====
If a pt was an EMIP and never got as far as the ward, then enter "Form Data Missing" in the temp field. We will know from the patient data why this patient does not have any Overstay information.  
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.  
=== entry instructions ===
* ''erase'' the 6 questions
* enter an entry Project "Overstay", Item '''"Form Data Missing"'''; put "EMIP" into the notes field


== Possible Scenario - complete DPST Form missing or blank ==
==== New ward's collector ====
== Possible Scenario - individual questions missing ==
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 - DPST Form or questions missing ==
=== Possible Scenario - Patient transferred from other ward - admit ward was '''NON'''-participating ward ===
Tina still needs to sort this, in process... Ttenbergen 17:19, 2013 August 8 (CDT)
If the patient is transferred either '''from''' or '''via''' any unit not participating in the Overstay project (e.g. an ICU) generate a colour.
=== DPST FORM completely missing ===
'''If the data collector can not find the DPST Form or if answers to any or all the questions are still missing 24 hrs after admission:'''
* in [[L_TmpV2 | TMP]] enter the project "Overstay" "form data missing" entry into the [[L_TmpV2 | TMP]] table for all 7 items.
** If the bedside nurse's DPST Form is incomplete the patient will be evaluated as if they  had identified a problem, i.e. the patient will become yellow or red; the program will give a message that data had been missing.
** check with the bedside nurse and remind them to complete it or notify the medicine ward unit manager; enter the remaining data into CCMDB.mdb if it now becomes available.
***'''IMPORTANT NOTE''': '''Even if the form is missing you still need to generate a colour for the patient.'''


Entry instruction in TMP when DPST form is completely missing:
=== Possible Scenario - colour change due to data entry error ===
#Project Overstay
'''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.'''
#*Item: FROM LOCATION
#**If available from another source, record it, if unknown, choose ''FROM LOCATION MISSING''
#ProjectOverstay
#*Items: 1-6 choose: ''DPST data missing'' for each item
#**press button to generate a color (collector would be able to see the color if follows steps above.[[User:TOstryzniuk|Trish Ostryzniuk]] 18:27, 2013 July 31 (CDT)


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.


== Special Collection Instructions - Colour Generation during collection staff shortages ==
=== Possible Scenario - EMIP patient that never made it to the ward ===
Staff have the option to pick up posted vacation shift as before.  Also staff will also have some of their shifts assigned to the area were there is the highest project priority during vacation time. Overstay Project is currently the priority project and HSC, STB, GRA and VIC.
Enter anyway and generate colour. Do not contact Unit Manager.  


=== specific SBGH medicine ===
=== Possible Scenario - Off ward patients ===
SBGH has now gone to paperless charting or [[EPR]]. This means that we can now review almost the entire chart on the computer. The exceptions to this are:
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.  
#the DPST Form. The information found on this form is one part of the information we need for the overstay predictor project (opp).
#the medicine apache score. These elements are usually found in the ER nurses notes, or the MICU flowsheet (for those patients transferred to medicine from MICU). Both of these forms are still paper.


The priority for medicine data collection at this point in time is this:
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.
#minimal data entry and assignment of serial #'s to all admissions.
#overstay predictor project with color assignment, i.e. keeping current and up to date with same. For instructions on what to do with entering reds into the transition coordinator binder, and where to put the colored stickers on the chart see the wiki opp collection instructions.
#completing oldest discharge charts for patients discharged while collector on vacation, starting with oldest first. Pay particular attention to those charts that are still incomplete if it is just prior to quarterly report time.  
#last priority would be the current admissions and discharges.


For those collectors who are doing vacation relief for the regular collectors who are away, catch up from time off can be expedited for the returning collector if the following things are priorized.
== Start/Stop/Site participation ==
#do opp and color generation. (ADL's are a component of the opp and can be found on the epr. They are in "initial assessment" form under the documents tab.) Everything needed for minimal data will be included if the opp is done.
see [[Overstay Project Start Stop dates]]
#medicine apache score. This can only be found in the regular paper chart, as the ER nurses notes and the MICU flow sheet are still paper.


The only things that need to be taken from the paper chart are the dpst info and the apache score info. If the opp is kept current and up to date then charts would not have to be pulled from medical records by the person returning from vacation. This would help tremendously in catching up from time off for the returning collector.[[User:DPageNewton|DPageNewton]] 14:40, 2013 February 20 (EST)
{{Data Integrity Check List}}


== Legacy Info - red for PCH or out-of-province patients ==
= Clarification of difference to previous process=
The original implementation of the Overstay colouring algorithm used between project start and 2013-Feb-08 would never assign a red to palliative, out-of-province or PCH patients. As of 2013-Feb-09 the algorithm has moved consideration of PCH and out-of-province status into the logistic regression analysis; the two are still a factor, but a minor one, and both types of patients could now become red in the right circumstances. Palliative patients continue to be evaluated such that they can not be assigned a red.
The following documentation is relevant to pre-empt questions only until the transition to the new process is complete.  


== Legacy Info - multiple colour entries ==
== even at STB ==
Until version [[]] a new colour was added to the dataset each time the button was pressed. We thought this would be OK because it should only be pressed once, maybe a second time shortly after to fix a mistake, but it turned out to be pressed at all odd times.  
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.  


Trish's note at the time:
== DPST form - STOP July 31.17 ==
* Everytime collector presses the Color generating button, the color generated is show and is stored. If they keep pressing button every time they add data, and press the button again, this event is stored. If they exit profile and go back later the last color they generated is not visible to collect, only when pressed button again then they can see the color.  So if they press 3 times, then it is stored 3 times.    Color can be generated numerous times when staff update data, or are waiting for data that they are following up or generate color just to check if changes to color after when they added data even after posting sticker on chart. These mulitple color generation show up in TMPV2.mdb every time data is sent in. Because of this, it is a challenge to anylyse because it is not alway clear what the final color was posted on a chart. This is epecially the case when a new color is generate each day after admission.  [[User:TOstryzniuk|Trish Ostryzniuk]] 19:00, 2013 July 23 (CDT)
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.  


== when you have a problem ==
Collectors can ignore the form and just collect the minimal data set outlined above to generate a colour.
*Reminder to all staff.........please email Tina or post issue on Wiki rather phone calls. If phone call is getting you voice message than email her & CC LindaThank you for your cooperation with this.[[User:TOstryzniuk|Trish Ostryzniuk]] 18:47, 2013 February 12 (EST)
*wards may continue to fill out the DPST form at admission ''For their own purposes.''  
{{discussion}}  I understand that we are no longer photocopying the screening tools to forward to the office; do you want any we have previously copied or should they be destroyed?


== 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.
}}


[[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.