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]].  


'''Be aware that this project is a [[Vacation and staff shortage collection priorities|Vacation and staff shortage collection priority]]!'''
'''This project was one of the Vacation and staff shortage collection priorities!'''


== when you have questions or problems with the overstay project ==
== In addition to [[Minimal Data Set]] ==
Please email Tina and Linda Hathout or post issue on Wiki rather phone calls. If phone call is getting you voice message than email Tina & CC Linda.  Thank you for your cooperation with this.[[User:TOstryzniuk|Trish Ostryzniuk]] 18:47, 2013 February 12 (EST)
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]]


== ensuring completeness within 24 hrs ==
== Generate colour ==
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.  
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 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.
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.  


See [[STB_Medicine_Collection_Guide#Overstay_Project]] for special considerations in gathering this data at StB Medicine.  
* '''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.


=== Possible Scenarios ===
== Red Chart Stickers ==
See
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.  
* [[#Possible Scenario - complete DPST Form missing or blank]]
* [[#Possible Scenario - colour change due to data entry error]]
* [[#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==
=== Other coloured dots on charts ===
'''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.  
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.  


=== 6 Questions Data ===
== Notifying the Unit Manager ==
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)".
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.  
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.  


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'''.
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.
 
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.
[[file:Overstay TMP - What you see in TMP.JPG |100px | what it looks like - click to see a bigger image]]
[[file:Overstay TMP-what you ENTER.JPG |100px| Overstay TMP What to ENTER - click to see a bigger image]]
 
=== "From" Data ===
When a new medicine patient is entered, a line "Enter "From"" is created in the tmp table.
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 ==
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)
***We @ sbgh were told quite some time ago, that we do not have to make copies of the dpst because our data base was large enough for analysis. I have not been making copies of the dpst since we were directed that we didn't have to. I seem to recall that this was not the case for every single site. [[User:DPageNewton|DPageNewton]] 12:29, 2013 August 12 (CDT)
****I was told that this was discussed at the Team Meeting June 19 and the collectors were told they no longer had to generate copies of the form.  Is this the case?
 
=== 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 ==
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''.
*{{discussion}}
*is there a copy of this form available online for photocopying purposes? I will need another one shortly and do not have a blank copy


== Possible Scenarios ==
== Possible Scenarios ==
=== Possible Scenario - complete DPST Form missing or blank ===
=== Possible Scenario - Patient transferred from other ward - admit ward was participating ward ===
If the entire form is missing, delete 5 of the questions and replace the remaining one with "DPST Data missing"
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.
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. If possible, 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.
It will be the responsibility of the manager of the originating ward to notify the manager of the receiving ward of any red patients.  
'''''Even if the form is missing you still need to generate a colour for the patient.'''''


==== entry instructions ====
==== Previous ward's collector ====
* ''erase'' the 6 questions
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.  
* enter an entry Project "Overstay", Item '''"DPST Data Missing"'''
** {{discussion}}I have been unable to generate a color if I follow the above instructions. In addition to entering a line that says "DPST Data Missing", I also have to enter a line that says "From location missing". Only after BOTH lines are entered, will a color be generated. [[User:DPageNewton|DPageNewton]] 16:59, 2013 August 12 (CDT)
*** The "from" topic is completely separate of this, and there are separate answers for it above. Ttenbergen 14:59, 2013 August 13 (CDT)


=== Possible Scenario - individual questions missing ===
==== New ward's collector ====
If the answer to an individual question is missing, replace the "Enter (x)" for that question with "DPST Data missing". The algorithm will treat this as if a problem was identified, but by entering it like this we can identify in the data whether the colour escalated because of known problems or because of missing information.
Ensure that these charts have the appropriate colour dot on them as communicated to you.  
'''''Even if the answer to a question is missing you still need to generate a colour for the patient.'''''


==== entry instructions ====
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.
Replace "Enter (x)" for the missing answer with "DPST Data missing".


=== Possible Scenario - Patient transferred from other participating ward ===
=== Possible Scenario - Patient transferred from other ward - admit ward was '''NON'''-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 the '''DPST form does not need to be filled out''' and and the original Green/Yellow/Red designation is retained.  
If the patient is transferred either '''from''' or '''via''' any unit not participating in the Overstay project (e.g. an ICU) generate a colour.


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.
=== 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 the patient is transferred either '''from''' or '''via''' any unit not participating in the Overstay project (e.g. an ICU) then the form needs to be filled out; if it is not, treat it as a [[#Possible Scenario - complete DPST Form missing or blank]].  
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 - colour change due to data entry error ===
=== Possible Scenario - Patient died/discharged before data collection ===
After 24 hours all information required to make the assessment as to if the patient is at risk should be available (or not known to the nurse within the first 24 hours and thus considered a risk). The only case where the colour should be changed is if the data-collector knew they had made an error on data entry. In that case, click the button again and answer "yes" to the question whether this is the final entry; this will overwrite the previous entry in the tmp table, and it will add the new entry to the beginning of the Notes field. This means you may have multiple colours in notes, the first one being the current one.
Enter anyway and generate colour. Do not contact Unit Manager.  
It is '''not be necessary to document''' when a sticker colour changes. Just change the colour.


If the change results in the patient no longer needing a transition coordinator, then the data coordinator needs to notify the transition coordinator to ensure they are ware of the change.
=== 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.


=== Possible Scenario - Patient died/discharged before assessment ===
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.
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.
* At sbgh we no longer make copies of the dpst. [[User:DPageNewton|DPageNewton]] 12:34, 2013 August 12 (CDT)
==== 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
*{{discussion}}
*if the pt is admitted and discharged prior to the collector seeing the form, but the form has been completed, should a colour be generated?  Or just record the From missing entered?
 
=== Possible Scenario - EMIP patient that never made it to the ward ===
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.  
==== entry instructions ====
* ''erase'' the 6 questions
* enter an entry Project "Overstay", Item '''"Form Data Missing"'''; put "EMIP" into the notes field


===Possible Scenario - HSC overflows to RR5 & RR6===
== Start/Stop/Site participation ==
As of May 13, 2013 HSC medicine data collection will follow all OVERFLOW patient that are going to RR5 & RR. These are patients 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)
see [[Overstay Project Start Stop dates]]


Medical records will auto print patient list for RR5 & RR6 directly 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).
{{Data Integrity Check List}}
* is this info in any way special for the overstay project? If not it should be stored on a more appropriate page on the wiki. Ttenbergen 17:56, 2013 August 8 (CDT) {{discussion}}


== Legacy Info ==
= 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.


=== Legacy Info - red for PCH or out-of-province patients ===
== even at STB ==
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.
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.  


=== Legacy Info - multiple colour entries ===
== DPST form - STOP July 31.17 ==
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.  
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.  


Trish's note at the time:
Collectors can ignore the form and just collect the minimal data set outlined above to generate a colour.
* Every time 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 multiple color generation show up in TMPV2.mdb every time data is sent in. Because of this, it is a challenge to analyses because it is not always clear what the final color was posted on a chart. This is especially the case when a new color is generate each day after admission.  [[User:TOstryzniuk|Trish Ostryzniuk]] 19:00, 2013 July 23 (CDT)
*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.
}}


[[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.