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''This field is currently being implemented, please check the instructions and put a discussion for anything that isn't clear. ''
Collection stopping as per [[Task_Team_Meeting_-_Rolling_Agenda_and_Minutes_2022#ICU_Database_Task_Group_Meeting_%E2%80%93_August_24,_2022]]. [[User:Ttenbergen|Ttenbergen]] 16:00, 2022 September 7 (CDT)


The [[Previous_Service field]] contains info about the service taking care of the patient prior to admission to the [[Service/Location field| current location]].
{{Data element
|field_name=Previous_Service
|CCMDB_label=Previous Service
|CCMDB_tab=Dispo
|in_table=L_Log table
|data_type=number
|datafield_length=long integer
|program_collecting=Med and CC
|created_raw=Raw
|data_element_start_date=2016-07-01
|data_element_end_date=2022-09-07
|data_element_sort_index=38
|element_description=The most recent "originating service" which sends the patients to their [[Service/Location field| current service location]].
}}


== Purpose ==
== Collection Instruction ==
The purpose of this field is integrate the "sending service" or "originating service" for those patients's who where already in a '''prior''' '''inpatient''' location before coming to the ICU and the patients coming from the Emergency Department and were accepted to Medicine service.
*For each patient enter the option that most closely matches
** For medicine ward-to-ward moves, code "medicine" as previous service  
** For ICU-to-ICU moves, code "Critical Care" if no other specific service is documented
** For pt from ER, code "Emergency Medicine" unless a different service had accepted them and is handing them off to Medicine
** For pt direct from '''ambulatory''' not via ER, code "not applicable" if no other specific service is documented
* Patients admitted after having a problem during an outpatient procedure are more complicated:
**Such procedures include outpatient:  GI endoscopy, bronchoscopy, cardiac cath, invasive radiology, procedures done at surgicentres, etc.
**If the patient goes DIRECTLY from the outpatient procedure area to a Medicine ward or an ICU, then code the type of physician who was doing the procedure:
***if, for example, it was a GI endoscopy, then the previous service was "GI", but as GI is not specifically listed in the dropdown list of services, then list it as "other"
**If before being admitted to hospital the patient was sent from the procedure area to the ED:
***if the patient was actually an ED patient (under the care of the ED docs) then code "Emergency Medicine"
***if, for example, it was a GI endoscopy and the patient was not actually under ED care, but instead was directly admitted to the ED on the Medicine ward service, then the previous service was "Medicine"
* If the service is not listed, code "other (known but not on list)"
** in these cases we don't care about the details; if we see too many others we may add additional options in future (as of January 2022 we checked and these account for <1% of all previous services)


===From HD / From hemodialysis===
* Came to dialysis from being an outpatient: 
** [[Previous Location]] =dialysis 
** [[Previous Service]]=Nephrology
** [[Pre-admit Inpatient Institution]]=n.a.
* Came to dialysis from ED: 
** [[Previous Location]]=dialysis
** [[Previous Service]]=ED
** [[Pre-admit Inpatient Institution]]=n.a.
* Came to dialysis from a prior, different, inpatient location:
** [[Previous Location]]=dialysis
** [[Previous Service]]=service of that prior inpatient location
** [[Pre-admit Inpatient Institution]]=that prior inpatient location


* the first part of the purpose is mainly used for the Critical Car Program (refer to Task Meeting Minutes April 13,2015).
===From Cardiac Cath Lab===
*A patient goes to emergency, then is sent to the cardiac cath lab for an angiogram. Julie would like the sending service to be Emergency Medicine in these cases (not cardiology). Discussed at the task group meeting on July 20, 2017.
*Most patients come to CCU or ICU via the heart cath as a code stemi, in which case the previous service is cardiology because they bypass ER and go direct to the heart cath lab.
 
*The previous service is who was looking after the pt before the heart cath in some situations. For example, if ECMO is done in the heart cath lab : If the pt was on a ward or unit prior to the procedure, the service is whatever ward or unit it was that sent the pt there. If ER sends a pt for a VV ECMO, the ER is the sending service, unless ICU takes over the pt prior to the ECMO. (They would need to consult cardiac surgery for the ecmo procedure but it would be the ICU that takes over the care ultimately).  


Note:  This is different to the "service of the attending" during the patient's stay in ICU or Ward.
This was discussed at the task group meeting on June 21, 2017.


=== from OR ===
If a patient comes from an OR/RR, code the responsible surgical service as previous service.


== Collection Instruction ==
=== Nursing Home Wards (HSC/GRA)===
For each patient,  
We treat patients that went through the HSC/GRA Nursing Home as having been discharged. So, admission from there should be as if admitted from home, so put "not applicable" into the [[Previous Service field]].
* enter the option that most closely matches
This does not affect the [[Visit Admit DtTm field]] definition - remember, that is defined by EPR entry.
* for medicine ward-to-ward moves, enter "medicine" as previous service (can't just omit because then we would not know if omitted intentionally")
 
* if the service is not listed, code “other”
===Admit from home===
** in these cases we don't care about the details; if we see too many others we may add additional options in future
For an admission directly from home bypassing the ER enter Previous Service = 'Not applicable'.
* if previous service is not applicable, enter '''not applicable'''
 
** {{discussion}} under what circumstances would that be? Ttenbergen 12:14, 2016 March 21 (CDT) Ttenbergen 20:08, 2016 April 18 (CDT)
=== from EMIP via ER ===
The case of VIC ER to STB EMIP to VIC ER to VIC Ward is a bit tricky because STB EMIP signify being an inpatient under Medicine service before going to VIC ER. WIKI defines Previous Service as the "originating service" for those patient's who where already in a prior inpatient location. It would be easier to define the previous service if this is a case of direct transfer to VIC Medicine service and parked only in VIC ER. This is a good question - which to use, Emergency Medicine or Medicine? Since it is known that there is prior inpatient service, I am more on the second one 'Medicine'. This can be a similar case when the previous location is Operating or Recovery and the responsible surgical service is coded as previous service. If coming from home to another ER to own ER to own Ward, then previous service is clearly Emergency medicine.


== Questions ==
=== admission from a unit partly collected by us ===  
=== Medicine Ward to Ward ===
see [[Previous_Location_field#from_a_unit_that_is_partly_collected_by_us.2C_and_partly_not]].
{{discussion}}
* because this field is related to ER wait in medicine it will be left blank when a pt is transfered for example from B3 to D4? Judy K
*Since this field is related to er wait in the medicine program do you want this field used when the pt transferes from D4 to A3 to D5 (medicine to surgery to medicine)? Judy april 13th, 2016.
*If it is medicine service sending the pt do you still need to fill this field in for the medicine program patients, or only if they come from a different service?--[[User:LKolesar|LKolesar]] 14:29, 2016 April 14 (CDT)
** updated the instructions above to address this, if now clear please remove this section. Ttenbergen 16:02, 2016 April 18 (CDT)


=== Medicine Patients Ward to Ward ===
=== admission from a nursing station ===
{{discussion}}
*For a direct admission to a collection unit from nursing stations, put "other (known, but not on list)".
*for Medicine pts ER to ward, would the previous service be Emergency Medicine or Medicine as pt was accepted to Medicine service in ER?
*If from a nursing station, patient dropped by ER , put "Emergency Medicine".
** good question, we need to find out Ttenbergen 19:34, 2016 April 25 (CDT)


=== ICU to ICU moves ===
=== Direct admit ===
{{discussion}}
For a direct admit via the ER, the [[Previous Service]] will be the primary service looking after the patient, prior to admission at your facility. 
* If a patient comes from the ICU to the ward, or ICU to ICU, are we still entering "not applicable", or are we supposed to start entering something more specific (surgical/medicine/etc.)[[User:Mlagadi|Mlagadi]] 15:31, 2016 April 18 (CDT)
{{Ex|
* "I do not see Critical Care Medicine?" Lou
* direct admit from Steinbach ER, [[Previous Service]] = emergency
** Julie, thoughts on how ICU-to-ICU should be collected in new scheme? I could add "not applicable" or "Critical Care Medicine" or something else. Thoughts? Ttenbergen 20:05, 2016 April 18 (CDT)
* direct admit from Steinbach ward, [[Previous Service]] = medicine or family medicine
}}


=== ICU to Medicine move ===
=== Urgent Care ===
{{discussion}}
For patients directly admitted from urgent care, code previous service as "Emergency Medicine".
* "I do not see Critical Care Medicine?" (Lou)
** emailing Julie to decide how we want to handle that... Ttenbergen 18:35, 2016 April 18 (CDT)


=== Direct Admission / from ACF ===
=== [[Clinical Assessment Unit]]s ===
{{discussion}}
Specific instructions apply for coding previous service for the specific CAUs. See
* there is the option of "direct admission" under the previous service, so if a patient comes from ambulatory care clinic direct to the ward do we select direct admission or the service they saw in amb care? [[User:Lkaita|Lisa Kaita]] 08:46, 2016 April 15 (CDT)
* [[GRA CAU#Collection instructions]]
* There is no option in the drop down for a patient coming from ACF.  Previously, we would just put "not an inpatient" but this option is not in the selection.  (This is for the ICU people).  --[[User:LKolesar|LKolesar]] 10:04, 2016 April 15 (CDT)
* [[HSC CAU#Collection instructions]]
*Can you add Cancer Care/Oncology and Infectious Disease as we get frequent admissions from them?--[[User:CMarks|CMarks]] 12:48, 2016 April 11 (CDT)
* [[STB CAU#Collection instructions]]
** Interesting question; the intent there was just to replace the "direct admit" from [[ER Wait]]. But what should be the right entry? Will need to look into this. Ttenbergen 16:02, 2016 April 18 (CDT)


== Data Use ==
== Data Use ==
Used to be:
Sending service to ICU will be reported to the Critical Care Director whose interest is to determine the sending services for patients who where already in a prior ''inpatient location'' before coming to ICU (refer to minutes of Task Meeting dated 13 April 2015 and 11June 2015).  The  data to be reported will be filtered  to include only those in-patients prior to ICU.
* [[ER_Wait#Reporting_and_Analysis]]
* {{discussion}} Julie, to whom and in what context does [[Service Sending to ICU]] get reported? Ttenbergen 12:35, 2016 March 21 (CDT)


== {{CCMDB Data Integrity Checks}} ==
== Integrity checks ==
None as of 11:58, 2016 March 21 (CDT).
{{Data Integrity Check List}}
* {{discussion}} Do we need any? Ttenbergen 11:58, 2016 March 21 (CDT)


== Implementation ==
== Implementation ==
Line 67: Line 102:
For '''medicine''' this concept is related to [[ER Wait]].  
For '''medicine''' this concept is related to [[ER Wait]].  


For '''critical care''' this concept is related to [[Service Sending to ICU]].
For '''critical care''' this concept is related to [[Service Sending to ICU]] - refer to Task Meeting minutes dated June 11, 2015.  
 
*see updated minutes dated August 24, 2017.
'' for tracking which service is taking care of a patient in STB CCU, see [[CCU Service Tracking]] instead
== COPY FROM SENDING SERVICE USING THIS TO UPDATE THIS ARTICLE ==
bELOW WILL GET REMOVED AS IT IS UPDATED INTO ARTICLE ABOVE.[[User:JMojica|JMojica]] 15:54, 2016 April 26 (CDT)
== Purpose ==
To identify the "sending service" or "originating service" for those patients's who where already in a '''prior''' '''inpatient''' location before coming to the ICU. (refer to Task Meeting Minutes April 13,2015). 
Note:  This is different to the "service of the attending" during the patient's stay in ICU.
 
== Data Collection Instructions ==
When you enter a new ICU patient a "Srv to ICU" will be automatically generated with item '''zz_enter'''. Before you can check the tmp checkbox this item has to be changed to one of the following:
* one of the sending services as per dropdown if applicable
* '''z_not an inpatient''' - if the patient was not an inpatient, eg came from home, usually only happens in CCU e.g. if STB cardiologist admits based on phone call; this is not for pts coming from angio, these would be from service cardiology
* '''z_not applicable''' - pt moving from one ICU to another (including from CCU, '''don't use cardiology'' for this)
* '''z_other''' - any others such as EENT surgery at STB
* '''z_unknown''' - if unknown service for patients coming from ward or OR or RR
*  - the entry automatically put in for new CC patients, not accepted as final entry when checking tmp checkbox
 
The other tmp fields are '''not used''' (except in "not applicable" scenario)
 
=== special case - ER -> OR -> ICU ===
* Scenario: The service is consulted in emergency, an OR or procedure is planned and an ICU stay is planned post-op but the patient was not on an inpatient ward.
* Collection: If the patient '''had been accepted to a service''', ie admitted and therefore now an inpatient, even if they were still physically in the ER, then code Service Sending with the specific service. 
{{discussion}} Would pt ever go to OR without having been accepted? Ttenbergen 17:39, 2016 March 21 (CDT)
 
=== How to determine? ===
Go and find out. Ask on the ward. Talk to people. In EPR there is a pt provider section that shows what service(s) the pt has been under, as well there is often an indication of service change in the EPR orders section.
 
== Start/End Dates ==
*Start: 2015-06-22
*End: there is no planned end date
 
=={{CCMDB Data Integrity Checks}}==
When you enter a new ICU patient a "Srv to ICU" will be automatically generated.
* If that record is missing, you can't checkbox tmp
* If that record has "enter" or "" as item, you can't checkbox tmp
 
=== currently impossible ===
* Query ''s_tmp_Service_Sending_to_ICU_duplicate'' - error if more than one entry per patient Ttenbergen 15:35, 2015 June 22 (CDT)
 
* Query ''s_tmp_Service_Sending_to_ICU'' - Error if:
** not admitted from inpatient location (([[S AdmitDischarge table|S AdmitDischarge]].inpatient = true)) but has "Srv to ICU" entry
** admitted from inpatient location and one of
*** no "Srv to ICU" entry
*** has "Srv to ICU" = "z_not applicable" and no comment
Right now our consistency check would not allow someone from other hosp via ER. We won't be able to do this check until we have [[Pre-admit Inpatient Institution field]]. I will take that check out for now. Ttenbergen 11:50, 2015 June 24 (CDT) {{discussion}}
 
== SAS Program ==
* The data is saved in table L_TmpV2 under project "Srv to ICU" of the centralized_data.mdb
* The SAS program that reads the data is in X:\Julie\SAS_CFE\CFE_macros\CFE_ServiceSendingtoICU.sas
 
== See also ==
* [[STB Cardiac Care patients]]
* [[Registry Patient Type]]
 
== to do before go live ==
* [[Registry_Patient_Type#C-Cardiac_Type]] - awaiting confirmation
** "Once this tmp study section is active we can go back to making the pt type relate to the type of diagnosis." (Laura K)
*** need to look into Ttenbergen 16:58, 2016 March 21 (CDT)
 
 
[[Category: L_TmpV2 Data]]
[[Category: Special Short Term Projects]]
[[Category: All Projects ICU only]]
[[Category: Dispo]]
 
[[Category: Site Specific Collection Guide]]
[[Category: St Boniface Hospital Office (Critical Care)]]
== why a STB CC topic? ==
{{discussion}} why would this be in the STB Critical Care category specifically? Or the Site Specific Collection Guide? If not answered by next review I will remove category. Ttenbergen 16:58, 2016 March 21 (CDT)
 


== Related articles ==
{{Related Articles}}




[[Category: 2016 Time and Place changes]]
[[Category:2016 Time and Place changes]]
[[Category: Admit/Discharge]]
[[Category:Admit/Discharge]]
[[Category:Data Collection Guide]]

Latest revision as of 11:55, 30 July 2025

Collection stopping as per Task_Team_Meeting_-_Rolling_Agenda_and_Minutes_2022#ICU_Database_Task_Group_Meeting_–_August_24,_2022. Ttenbergen 16:00, 2022 September 7 (CDT)


 
 
 
 

Legacy Content

This page contains Legacy Content.

  • Explanation: This is a legacy data field, its DataElementEndDate is in the past.
  • Successor: No successor was entered

Click Expand to show legacy content.

Data Element (edit)
Field Name: Previous_Service
CCMDB Label: Previous Service
CCMDB tab: Dispo
Table: L_Log table
Data type: number
Length: long integer
Program: Med and CC
Created/Raw: Raw
Start Date: 2016-07-01
End Date: 2022-09-07
Sort Index: 38
Data Dependencies(Reports/Indicators/Data Elements): No results

The most recent "originating service" which sends the patients to their current service location.

  • SMW

Legacy implementation right in the table

  • Cargo


  • Categories
  • Forms


Collection Instruction

  • For each patient enter the option that most closely matches
    • For medicine ward-to-ward moves, code "medicine" as previous service
    • For ICU-to-ICU moves, code "Critical Care" if no other specific service is documented
    • For pt from ER, code "Emergency Medicine" unless a different service had accepted them and is handing them off to Medicine
    • For pt direct from ambulatory not via ER, code "not applicable" if no other specific service is documented
  • Patients admitted after having a problem during an outpatient procedure are more complicated:
    • Such procedures include outpatient: GI endoscopy, bronchoscopy, cardiac cath, invasive radiology, procedures done at surgicentres, etc.
    • If the patient goes DIRECTLY from the outpatient procedure area to a Medicine ward or an ICU, then code the type of physician who was doing the procedure:
      • if, for example, it was a GI endoscopy, then the previous service was "GI", but as GI is not specifically listed in the dropdown list of services, then list it as "other"
    • If before being admitted to hospital the patient was sent from the procedure area to the ED:
      • if the patient was actually an ED patient (under the care of the ED docs) then code "Emergency Medicine"
      • if, for example, it was a GI endoscopy and the patient was not actually under ED care, but instead was directly admitted to the ED on the Medicine ward service, then the previous service was "Medicine"
  • If the service is not listed, code "other (known but not on list)"
    • in these cases we don't care about the details; if we see too many others we may add additional options in future (as of January 2022 we checked and these account for <1% of all previous services)

From HD / From hemodialysis

From Cardiac Cath Lab

  • A patient goes to emergency, then is sent to the cardiac cath lab for an angiogram. Julie would like the sending service to be Emergency Medicine in these cases (not cardiology). Discussed at the task group meeting on July 20, 2017.
  • Most patients come to CCU or ICU via the heart cath as a code stemi, in which case the previous service is cardiology because they bypass ER and go direct to the heart cath lab.
  • The previous service is who was looking after the pt before the heart cath in some situations. For example, if ECMO is done in the heart cath lab : If the pt was on a ward or unit prior to the procedure, the service is whatever ward or unit it was that sent the pt there. If ER sends a pt for a VV ECMO, the ER is the sending service, unless ICU takes over the pt prior to the ECMO. (They would need to consult cardiac surgery for the ecmo procedure but it would be the ICU that takes over the care ultimately).

This was discussed at the task group meeting on June 21, 2017.

from OR

If a patient comes from an OR/RR, code the responsible surgical service as previous service.

Nursing Home Wards (HSC/GRA)

We treat patients that went through the HSC/GRA Nursing Home as having been discharged. So, admission from there should be as if admitted from home, so put "not applicable" into the Previous Service field. This does not affect the Visit Admit DtTm field definition - remember, that is defined by EPR entry.

Admit from home

For an admission directly from home bypassing the ER enter Previous Service = 'Not applicable'.

from EMIP via ER

The case of VIC ER to STB EMIP to VIC ER to VIC Ward is a bit tricky because STB EMIP signify being an inpatient under Medicine service before going to VIC ER. WIKI defines Previous Service as the "originating service" for those patient's who where already in a prior inpatient location. It would be easier to define the previous service if this is a case of direct transfer to VIC Medicine service and parked only in VIC ER. This is a good question - which to use, Emergency Medicine or Medicine? Since it is known that there is prior inpatient service, I am more on the second one 'Medicine'. This can be a similar case when the previous location is Operating or Recovery and the responsible surgical service is coded as previous service. If coming from home to another ER to own ER to own Ward, then previous service is clearly Emergency medicine.

admission from a unit partly collected by us

see Previous_Location_field#from_a_unit_that_is_partly_collected_by_us.2C_and_partly_not.

admission from a nursing station

  • For a direct admission to a collection unit from nursing stations, put "other (known, but not on list)".
  • If from a nursing station, patient dropped by ER , put "Emergency Medicine".

Direct admit

For a direct admit via the ER, the Previous Service will be the primary service looking after the patient, prior to admission at your facility.

Example:   

testcontent

Urgent Care

For patients directly admitted from urgent care, code previous service as "Emergency Medicine".

Clinical Assessment Units

Specific instructions apply for coding previous service for the specific CAUs. See

Data Use

Sending service to ICU will be reported to the Critical Care Director whose interest is to determine the sending services for patients who where already in a prior inpatient location before coming to ICU (refer to minutes of Task Meeting dated 13 April 2015 and 11June 2015). The data to be reported will be filtered to include only those in-patients prior to ICU.

Integrity checks

Data Integrity Checks (automatic list)

 AppStatus
Query check previous location vs service inconsistentCCMDB.accdbretired
Function Validate previous serviceCCMDB.accdbretired

Implementation

The field is populated with options from the s_previous_service table.

Legacy

For medicine this concept is related to ER Wait.

For critical care this concept is related to Service Sending to ICU - refer to Task Meeting minutes dated June 11, 2015.

  • see updated minutes dated August 24, 2017.

Related articles

Related articles:
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