PatientFollow Project

Our database collects patient ward stays, which means the data of a patient may be processed by several collectors during the admission. This leads to extra, wasted work of different collectors familiarizing themselves with the same patient. We are looking at ways to reduce this waste.

Specifically, we are looking into having a single collector/laptop follow a patient for their whole admission, and how our processes would need to change to accommodate this, and what extra tools we might need.

Pilot

• one or two collectors at HSC will do collection like this for specific patients in coordination with main office to better understand how this would work

prerequisites for pilot participation

For a collector to be able to follow to another ward and enter that as a Service/Location we need to add the additional wards to the laptop's S locations allowed collection table entries in CCMDB.mdb, and assign a reasonable order in the dropdown for the locations. This has been done for:

• HSC H4 laptop

Identifying admissions / Starting collection

Currently patients are assigned to collectors/laptops based on where they are admitted. To change to the new system, we would need to identify patients who enter a given site and then assign them to the collector pool equitably.

Currently, our thought is that this will be done based on the last two digits of the chart number. We think chart numbers would work because

• determine if those last digits are equally distributed
• determine total EFT per site, and percentage of total of a given collector
• assign a portion of last digits of charts to each collector
• for example, if a site has 3 collectors that are each a .5EFT, each collector would get 33% of that site's new admissions, so collector A might get charts ending in 00-33, collector B 34-66, and collector C 67-99

Discussion

• Tina has taken a basic look at the distribution of these numbers and emailed Julie and Trish for feedback. Ttenbergen 17:31, 2019 August 1 (CDT)
  • Julie did additional analysis by looking at the distribution of the last two digits numbers from last 5 years 2014 to 2018 as follows: 1) all sites together, 2) each site separately 3) each year from all sites separately and 4) each site and year - the distributions showed similarity with few peaks in some numbers. She grouped the last two digits numbers into a) 10 subgroups (e.g. 0-9,10-19,20-29, …, 90-99 ) and b) 20 subgroups (e.g. 0-4, 5-9, 10-14, 15-19, …, 95-99) and their distributions showed uniformly across subgroups. Each of the 10 subgroups showed counts close to 10% while each of the 20 subgroups showed counts close to 5%. The histograms are in X:\CCMDB_Special_Projects\Project_PatientFollow_ChartNumberDistribution. The results support the viability of using the last two digits of the chart number in allocating patients among the data collectors.
  • Julie also did the distribution of the first two digits numbers and found out that the distribution was skewed to the right. Therefore, this cannot be used as a tool for allocating patients. The distribution is in X:\CCMDB_Special_Projects\Project_PatientFollow_ChartNumberDistribution .
• I think this is a good starting strategy to allocate patients among the data collectors proportionately in each site. The one thing which is unclear yet to me is how to make sure we will not miss any patient in a given ward(Med/ICU) using this strategy. Who will be responsible to check or monitor that all patients who were admitted in a given ward are already entered in all laptops? How long will the DC run after that patient who left the ward but still in the hospital? How easy to catch those transfers from other service who haven't been in ICU/Med and now have been admitted to ICU/Med service? For now, these are my thoughts. --JMojica 15:32, 2019 August 6 (CDT)
• We discussed whether different LOS will cause problems with this distribution of patients. We would expect LOS to be equally distributed across Chart Numbers; if it is we should be able to ignore it in distributing patients, since the “average” patient with an “average” chart number would have an “average” LOS.
• The process of picking up patients would need to be very clear, and would need to change from what it is currently. We started this discussion with Val. They now get all of their pts off the EPR. That listing includes Chart numbers. So instead of looking at their ward, they can look at their chart number. The only thing is, we can’t sort that by “last two digits of chart number” to make it easy. I hope we can still do better than that. I think it might be good to chat with someone like Laura or Lisa or someone from Med Records about what else we might be able to do with those lists – if we could export them we could filter them to laptops by last two digits.
• Val showed us that she uses EPR patient lists; this mechanism allows the user to manually put individual patients on their list to follow them during their stay. This would be a good way to track pts on one laptop (as opposed to per site), but since the list would be based on collector login it would not work for shared loations or coverage. Michelle investigated whether it is possible to share patient lists between collectors and the EPR specialist informed her that it is not possible

Entering into the laptop

The initial ward would need to be entered as usual. For stays on subsequent wards the Patient copier button can be used to create the next record.

Additional things we might be able to copy in the future are (not implemented now to allow general use of the copier button):

• Visit Admit Date and time
• import dispo and dispo_dttm (+ 5 min) into the previous location and arrive_dttm automatically

Thoughts?

As usual, if you have thoughts or ideas about this, please post them here.