Boarding Loc

Projects
Active?:	planned
Program:	CC and Med
Requestor:	Critical Care program (Allan Garland)
Collection start:	TBA "TBA" contains an extrinsic dash or other characters that are invalid for a date interpretation.
Collection end:

Need to start page about contingency locations as discussed in team meeting. To take over from Project Borrow arrive. * Val mentioned that for borrowed bed, the term that is being used is 'Boarding Bed'. It seems more intuitive than off ward - Project Boarding Bed or Project Boarding or Project Boarding Loc. if all agree to use the term boarding, then we need to change the off ward to boarding bed in the Item of Tmp to be consistent. - --JMojica 16:39, 2019 July 5 (CDT)

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This project tracks where and when a patient arrives into a "borrowed bed".

A "borrowed bed" is when a patient is not physically located in the place designated by the Service/Location.

• Critical Care will track all instances of bed borrows and moves between beds
• Medicine will track all instances of bed borrows and moves between beds for one month period

This new project replaces Project Borrow arrive.

This project does not replace ICUotherService; we will still need this item in the event that both the bed and the service are both borrowed. Administration at STB want this data.

Data Collection Instructions

In TMP, a "no borrow" entry will automatically be added to every new Critical Care or Medicine patient's record.

If the patient never ends up in a "borrowed bed" during their stay then, leave the default in Item as no borrow and also put a check mark in the checkbox. (this is to verify that there was no bed borrow, otherwise no one is sure is missed or not). If the patient does end up in a "borrowed bed", change the item to the location of the borrow and enter the rest as per below: #How to enter this.

Add a new tmp entry for every additional move/borrow within your centre that a patient makes during their stay at your Service/Location; including moves from borrowed location to your actual unit.

How to enter this

• Use tmp fields:
  • Project: Boarding Loc
  • Item: no borrow is the default (check off the box under column B for all patients not borrowing a bed).
  • Item: borrow arrive (select the ward/unit where the bed was borrowed):
    • CON - recovery
    • GRA - recovery
    • GRA - ER (a strange thing they only do at Grace for now) - added May 2.19
    • HSC - recovery
    • HSC_CCU
    • HSC_IICU
    • HSC_MICU
    • HSC_SICU
    • OAK - recovery
    • STB - recovery
    • STB_ACCU
    • STB_CICU
    • STB_MICU
    • HSC-off ward
    • STB-off ward
    • GRA-off ward
      • For ICU, specify the actual location of the borrowed bed.
      • For Medicine, use off-ward and there is no need to specify the actual location of borrowed bed.
      • If a location borrowed from is not available in the drop down, email Tina and Trish to have them added.
  • Enter start_dt: arrival date at borrowed bed, under column E.
  • Enter start_tm: arrival time at borrowed bed, under column M.
  • checkbox: to be checked only in case of "no borrow"

• If the patient moves back to their "home unit", or "intended unit", make another borrow arrive entry and select your home unit. Enter the date/time for this move, as above.

• Dispo Tab
  • Service/Location field enter: home ward/unit

Special Case - original arrival is in "borrowed bed"

If pt is admitted to your physician service but the original location is from an off-ward bed, code that location Arrive DtTm = borrow date and time.

The APACHE elements time frame will start in the off-ward bed location and TISS starts from the off-ward bed as well.

Special Case - PACU

If a bed is borrowed in PACU / post-anesthesia care / recovery unit, code this as a borrow. (i.e. <hosp> - recovery, e.g. "HSC - recovery").

If the decision to accept to the service happens in PACU, the Arrive DtTm = the borrow date and time. The APACHE elements are collected at PACU stay and TISS starts at PACU.

Special Case - From ER

Not included in this project.

• The time spent/waiting in ER is done using Arrive DtTm vs Accept DtTm.
  • March 30.19: own ward, to own ER (under ICU physician care) then to own ICU when bed available. Started occurring at Grace- March 30.19

Special Case - Parked

Not included.

• For patients who are Parked in ER, no need an entry for these, since the ER delay will take care of them.

Special Case - ???

Any Medicine special cases we can think of?

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Start/End Dates

• End: there is no planned end date

considerations about continuing collection

Continue collection for now, just keeping you in the loop about discussions in main office.

• --JMojica 11:17, 2018 November 15 (CST) -- Added some more as shown by the data. Just a note - only 30 out of 1807 (2%) records have shown borrowed location while 98% have no borrow. This is expected since STB ACCU has stopped borrowing bed and instead, now borrowing service from ICMS /ICCS which is being collected in another tmp project. The site with most frequent borrower is HSC SICU (i.e. borrowing bed from PACU). How much work will it take to do all these integrity checks? Also with very few useful data, I think we should not collect this project for all admissions but restore the use of Off ward field checkbox and collect only for those with YES Off ward.
  • We are checking in with HSC_SICU to see how they use this data.

did they ever get back to us? no response from HSC SICU --JMojica 10:14, 2019 May 6 (CDT). will follow-up again. --JMojica 16:39, 2019 July 5 (CDT)

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Data Integrity Checks (automatic list)

	App	Status
Query check tmp ER Boarding Loc should exist if from ER	CCMDB.accdb	declined
Check if awaiting code is primary dx then Transfer Ready DtTm must be equal to Arrive DtTm	CCMDB.accdb	declined
Query s tmp check Boarding Loc and TransferReadyDtTm pairs	CCMDB.accdb	implemented
Query check tmp 2 BL TR S same tm	CCMDB.accdb	implemented
Query Check BL TR combiner null	CCMDB.accdb	implemented
Query check Transfer DtTm after paired BL and before later BL	CCMDB.accdb	implemented
Query s tmp Boarding Loc ER delay reasonable	CCMDB.accdb	implemented
Query check no consecutive same BL or Service	CCMDB.accdb	implemented
Query check CCI TISS matching BoardingLoc time	CCMDB.accdb	implemented
Query check tmp Boarding Loc Service first same	CCMDB.accdb	implemented
Query s tmp check combined Boarding Loc and TransferReadyDtTm	CCMDB.accdb	implemented
Query check transfer DtTm during admission	CCMDB.accdb	implemented
Query check tmp Service and Boarding Loc during admission timeframe	CCMDB.accdb	implemented
Query check tmp service or location duplicate	CCMDB.accdb	implemented
Query s tmp Boarding Loc date item	CCMDB.accdb	implemented
Query check minimal data set incomplete	CCMDB.accdb	implemented
Query check tmp Transfer Ready not before Boarding Loc	CCMDB.accdb	retired
Query s tmp check combined BL and TRDtTm nonsequential	CCMDB.accdb	retired
Query check transfer ready tmp for each Boarding Loc	CCMDB.accdb	retired
Query s tmp Boarding Loc no borrow but entry	CCMDB.accdb	retired

Data Use

Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.

SAS Program

The SAS program calculates the time spent in a borrowed bed at each ICU stay and summarize the total bed-days in a given interval that are taken up by boarders from elsewhere and how much a certain unit is boarding elsewhere.

Time spent in borrowed bed = Next Arrival Date_time - First Arrival Date_time

where Next Arrival Date_time = Dispo Date_time if there is no more next arrival date_time.

The SAS program is saved in X:\Julie\SAS_CFE\CFE_macros\Bed_Borrow.sas

Background

Will replace Off ward field to provide more meaningful data.

We used to collect Moves for Medicine but this was too much work because there are too many administrative moves. Also, the data wasn't being used.

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