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EMIP stands for '''E'''mergency '''M'''edicine "'''IN'''" patient and is used as a [[Service/Location field]] in the Medicine database. It is used for patients who are admitted to our internal medicine service and spend their entire '''admission under one of the medicine services we follow''' in the ER (emergency department). We are tracking this as [[VIC_EMIP]], [[GRA_EMIP]], [[STB_EMIP]] and [[HSC_EMIP]].
EMIP stands for '''E'''mergency '''M'''edicine "'''I'''n" '''P'''atient. It is used for patients who are admitted to our internal medicine service and spend their entire '''admission under one of the medicine services we follow''' in the ER (emergency department).  


==Definition of EMIP==
==Definition of EMIP==  
# Pt has an order or some entry that medicine has accepted the patient while still in ER. 
An EMIP is a Patient who has a record in [[EPR]]/[[Cognos Report Integrator]] for a [[Service tmp entry | Service]] we collect while in ER, and who does not then end up on one of the wards/units that correspond with that service, regardless where they go instead.
# The patient either is discharged from ER to home or any other out of hospital location
*'''OR'''....
*the patient is transferred within the hospital directly to a different service because Medicine decides that they will not take the pt but the patient needs different care.  Examples:  Palliative care take over the care;  ICMS takes over the care;  Surgery takes over the care; Gynecology takes over care; etc. 
** These patients are only under medicine while they reside in ER.  Once they leave ER they are either going out of hospital or going to a different service within the hospital.


== Collection Instructions ==
{{Ex |
See [[:Category:Site Specific Collection Guide|site specific collection guides]] for details on the collection process, papers, binders.
# Pt has an order or some entry that medicine has accepted the patient while still in ER.
# The patient leaves the ER to either
#* home or
#* any other '''out of hospital location''' or
#* the patient is transferred '''within the hospital to any service''' because Medicine decides that they will not take the pt but the patient needs different care or
#* dies in ER ("ED Death after Arrival" in [[Cognos]])
#* leaves [[AMA]] ("ED Reg/Triaged/Assess LAMA" in [[Cognos]])
}}


=== identifying patients ===
=== Patients in ER admitted under other services are not EMIPs ===
EMIPs will show up under:
Our definition of EMIP includes only patients that were followed by one of '''''our''''' services. So, patients who were followed by Family Medicine or Trauma while still in the ER are '''not EMIPs'''.
* the [[Transfer Register]] if they are sent to non-medicine units in your hospital.
*EMIP's in this list will be those under the medicine or internal medicine service that subsequently changed service before leaving ER and were transferred out of ER to a local hospital ward or unit. (not a medicine ward).
** see instructions for [[Off ward field]] to also identify some EMIP patients.  See this under the title "how to identify off-ward patients" in that article.


* the [[Discharge Register]] if they leave the hospital
== Identifying EMIPs ==
**When reviewing the discharge list generated by the instructions, the EMIP's are those that have medicine or internal medicine under the "service" heading.
=== Identifying EMIPs in [[Cognos2 Service Starter]] ===
[[EMIP]]s show up in [[Cognos2 Service Starter]]. They can't be identified there as EMIPs, but that's OK, since they really are just like any other patient now and should just be entered.  


**Run these reports at least once a week if possible.  
There has been some discussion whether or not a patient accepted by our service but still in ER when Cognos first lists them should actually be entered then, or only after they either leave from ER or become an inpatient. People have been leaving these un-entered both out of old habit (when EMIPs were entered following different rules you first had to know if a pt would need to be entered as EMIP or as regular) and to be able to enter the unit at the same time, rather than having to remember to go back to the record later to enter the unit. There really is no longer a reason to delay these, especially starting with [[Using Cognos2 to keep track of patients]], instead they become something for which we would need to add tools to CSS to identify them. Please enter them as they show up on [[Cognos2 Service Starter]]o.  
 
==For EMIP entry==
*There is a separate paper log sheet that has its' own sequential numbers.


== Entering data for EMIPs ==
=== Entering patients in dispo tab fields ===
=== Entering patients in dispo tab fields ===
* [[Service/Location field]] - your EMIP (e.g. GRA_EMIP)
* [[Service/Location field]] - your Generic [[HSC_Med]], [[GRA_Med]], [[STB_Med]]
* [[Previous Service field]] - likely emergency medicine, unless some other service accepted them prior to medicine, and was never able to get them out of the ER either, and medicine accepted the patient from them  -in order for a pt to be an EMIP they must have been accepted by Medicine for admission otherwise they would just be an Emergency patient
* [[Accept DtTm field]] - the time Medicine accepted them, i.e. the time they became an EMIP
* [[Arrive DtTm field]] - same as [[Accept DtTm field]]
* [[Previous Location field]] - use normal instructions
* [[Previous Location field]] - use normal instructions
*[[Dispo field]] - For EMIP pts, you cannot put discharge to an ER, so if that is where they went, put the place they went after ER (usually a ward).
*[[Transfer Ready DtTm]] -only use this if the pt is going home.  Otherwise use "not transfer ready".
* See [[Overstay_Predictor_Project_Collection_Instructions#Possible_Scenario_-_EMIP_patient_that_never_made_it_to_the_ward]] for how to code overstay for these patients.


=== Patients transferred to other locations ===
'''Follow the instructions in [[Boarding Loc]], [[Service tmp entry]], [[Transfer Ready DtTm tmp entry]]; if you do, none of the old special instructions for EMIPs should be required. That's part of the point of going to the new scheme. '''
Collection includes patients who are discharged to a non-medicine location in the hospital. So, if an EMIP patient is transferred to an ICU, that ICU would use e.g. GRA_EMIP as [[Previous Location]].
 
If a pt who starts out on the EMIP track turns into a medicine [[off ward field |off ward]] patient, collect them as you would any other off-ward patient.  
=== Collecting an EMIP who has been transferred to your location ===
Collection includes patients who are discharged to another service's location in the hospital. (eg Med to CC or CC to Med)
*if an EMIP patient is transferred to an ICU, that ICU would use e.g. [[GRA_Med]] as [[Previous Location]] for the new scheme. Before start date of new scheme,[[Previous Location]] is '''site_EMIP'''
** For [[Pre-admit Inpatient Institution field | Pre-admit Inpatient Institution]] = GRA_Med for the new scheme.  Before start date of new scheme,[[Previous Location]] is '''site_EMIP'''
** For [[Previous Service]] = Medicine
*If a pt who starts out on the EMIP track turns into a medicine [[Boarding Loc]] patient, collect them as you would any other [[Boarding Loc]] patient.  


'''EMIP scenario'''   
'''EMIP scenario'''   
Line 48: Line 46:
* In ER under '''Medicine service''' and then moved to other ward but under '''Medicine service''' (i.e. a case of [[Off_ward_field|off ward patients]]).
* In ER under '''Medicine service''' and then moved to other ward but under '''Medicine service''' (i.e. a case of [[Off_ward_field|off ward patients]]).


=== [[CAU]] ===
{{Ex|
For [[STB_CAU]], [[HSC_CAU]], [[STB_CAU]]. [[Category:CAU]]
*(1) Internal Med answered consult but deferred and admitted under Critical Care service. Consults do not count as admissions, the patient has to be accepted to Internal med service, and in this scenario would be considered an admission to Critical care only.  
 
*(2) Rural Patient accepted by Internal Med service but deteriorated enroute to Winnipeg. Transport team transferred to ER resus room and Critical care consulted, admitted, and assumed care of the patient. This should only be collected as a Critical care service profile, as the patient was assumed by CC service upon arrival at the hospital. (Just as we would not collect for any other patient who died before they ever made it to the hospital).
In Sept 2017 Con investigated whether any patients in the CAU are ever [[EMIP]]s at HSC; she found that there should not be. If any collector comes across an EMIP from one of these locations, please update this.
}}
{{discussion}}
*need to resolve [[EMIP]] and figure out where that info will live. Ttenbergen 11:30, 2016 December 29 (CST)
**If a patient is still considered an ER patient in a CAU, they can potentially be an EMIP if they get accepted by internal medicine but subsequently are discharged or sent to another hospital.
***At STB CAU  contains inpatients under family Medicine (they are not under the ER physician).  
****If the CAU is considered part of ER then I guess patients that are accepted by internal medicine and go out elsewhere could be EMIP's.  It depends how you view the area.
*****Is the CAU considered the same as ER or not?  Management will have to determine how they want this done.  Currently no one at STB collects data at all on the patients in the CAU. --[[User:LKolesar|LKolesar]] 11:49, 2017 October 27 (CDT)
 
=== Patients in ER admitted under other services ===
Our definition of EMIP includes only patients that were followed by one of '''''our''''' medicine services. So, patients who were followed by Family Medicine or Trauma while still in the ER are '''not EMIPs'''. This means patients in Concordia ER or Oaks ER can not become EMIPs. Code them as regular ER patients.
 
== No ICU counterpart ==
see [[ECIP]] for more info


== Serial numbers used ==
== Related articles ==  
Patients in EMIP have their own [[serial number]]s starting at number 150.
{{Related Articles}}


== Related Articles ==
{{Collapsable
* [[Site and Location table]]
| always= Legacy Information
* [[OVER]]
| full=
* [[Bed borrow]]
* [[VIC_EMIP]], [[GRA_EMIP]], [[STB_EMIP]] and [[HSC_EMIP]] used to be [[Service/Location field]] entries in the Medicine database until [[2020-10 EMIP changes]] / [[Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry]]  
* there used to not be a critical care counterpart, see [[ECIP]] for more info
* since the concept only applied to Med pts and we didn't collect those at CON and OAK, patients in Concordia ER or Oaks ER could not become EMIPs
}}


[[Category: Site and Location]]
[[Category: Overflow]]
[[Category: Overflow]]
[[Category: EMIP|*]]
[[Category: EMIP| *]]
[[Category: Collection Location Service Type]]

Latest revision as of 13:40, 2023 November 3

EMIP stands for Emergency Medicine "In" Patient. It is used for patients who are admitted to our internal medicine service and spend their entire admission under one of the medicine services we follow in the ER (emergency department).

Definition of EMIP

An EMIP is a Patient who has a record in EPR/Cognos Report Integrator for a Service we collect while in ER, and who does not then end up on one of the wards/units that correspond with that service, regardless where they go instead.

Example:   
  1. Pt has an order or some entry that medicine has accepted the patient while still in ER.
  2. The patient leaves the ER to either
    • home or
    • any other out of hospital location or
    • the patient is transferred within the hospital to any service because Medicine decides that they will not take the pt but the patient needs different care or
    • dies in ER ("ED Death after Arrival" in Cognos)
    • leaves AMA ("ED Reg/Triaged/Assess LAMA" in Cognos)

Patients in ER admitted under other services are not EMIPs

Our definition of EMIP includes only patients that were followed by one of our services. So, patients who were followed by Family Medicine or Trauma while still in the ER are not EMIPs.

Identifying EMIPs

Identifying EMIPs in Cognos2 Service Starter

EMIPs show up in Cognos2 Service Starter. They can't be identified there as EMIPs, but that's OK, since they really are just like any other patient now and should just be entered.

There has been some discussion whether or not a patient accepted by our service but still in ER when Cognos first lists them should actually be entered then, or only after they either leave from ER or become an inpatient. People have been leaving these un-entered both out of old habit (when EMIPs were entered following different rules you first had to know if a pt would need to be entered as EMIP or as regular) and to be able to enter the unit at the same time, rather than having to remember to go back to the record later to enter the unit. There really is no longer a reason to delay these, especially starting with Using Cognos2 to keep track of patients, instead they become something for which we would need to add tools to CSS to identify them. Please enter them as they show up on Cognos2 Service Startero.

Entering data for EMIPs

Entering patients in dispo tab fields

Follow the instructions in Boarding Loc, Service tmp entry, Transfer Ready DtTm tmp entry; if you do, none of the old special instructions for EMIPs should be required. That's part of the point of going to the new scheme.

Collecting an EMIP who has been transferred to your location

Collection includes patients who are discharged to another service's location in the hospital. (eg Med to CC or CC to Med)

EMIP scenario

  • In ER under Medicine service and left your hospital to Home or died in ER
  • In ER under Medicine service and transferred to other locations under different service in your hospital
  • In ER under Medicine service and discharged to other locations in another hospital

NOT an EMIP

  • In ER under Medicine service and then moved to a Medicine service ward (i.e. a regular Medicine admission)
  • In ER under Medicine service and then moved to other ward but under Medicine service (i.e. a case of off ward patients).
Example:   
  • (1) Internal Med answered consult but deferred and admitted under Critical Care service. Consults do not count as admissions, the patient has to be accepted to Internal med service, and in this scenario would be considered an admission to Critical care only.
  • (2) Rural Patient accepted by Internal Med service but deteriorated enroute to Winnipeg. Transport team transferred to ER resus room and Critical care consulted, admitted, and assumed care of the patient. This should only be collected as a Critical care service profile, as the patient was assumed by CC service upon arrival at the hospital. (Just as we would not collect for any other patient who died before they ever made it to the hospital).

Related articles

Related articles:
Legacy Information   
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