EMIP

EMIP stands for Emergency Medicine "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.

Definition of EMIP

1. Pt has an order or some entry that medicine has accepted the patient while still in ER.
2. The patient is discharged/transferred from 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.

When reviewing the Cognos EPR Report I came across a few entries that were "ED Death after Arrival" (4 across sites between 2020-03-16 - 29) . Our current definition would exclude these from EMIP collection. Do we include or exclude them in practice? Is that intentional or have we just never thought about them?

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When reviewing the Cognos EPR Report I came across a few entries that were "ED Reg/Triaged/Assess LAMA" (6 across sites between 2020-03-16 - 29) . Our current definition would exclude these from EMIP collection. Do we include or exclude them in practice? Is that intentional or have we just never thought about them? In both of these cases we would capture these patients if they were accepted by the medicine service prior to them dying or leaving AMA, it would show up on the discharge register, if they were not accepted by medicine then we do not include them as they were never under the care of the medicine service. Yes they would show up. What I want to be sure about is whether we would collect them when we see them show up. If so, then we need one more bullet above, or we need to add the AMA option to the Home option, since they are kind of the same thing. As it stands now, if someone strictly follows the instructions they would exclude AMAs because they are not on our list.

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Collection Instructions

See site specific collection guides for details on the collection process, papers, binders.

identifying patients

EMIPs will show up under:

• 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
  • When reviewing the discharge list generated by the instructions, the EMIP's are those that have medicine or internal medicine under the "service" heading.

• • Run these reports at least once a week if possible.

For EMIP entry

• There is a separate paper log sheet that has its' own sequential numbers.

Entering patients in dispo tab fields

• Service/Location field - your EMIP (e.g. GRA_EMIP)
• 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
• 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".

Patients transferred to other locations

Collection includes patients who are discharged to a non-medicine location in the hospital.

• if an EMIP patient is transferred to an ICU, that ICU would use e.g. GRA_EMIP as Previous Location.
  • For Pre-admit Inpatient Institution = GRA EMIP
  • For Previous Service = Medicine
• If a pt who starts out on the EMIP track turns into a medicine off ward patient, collect them as you would any other off-ward patient.

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).

EMIP (?) to ICU

I have had a couple of scenarios in the past few months that I have not considered an EMIP, but I thought I should get a second opinion: The emergency notes state that a patient from another hospital/nursing station, etc. is a "direct for internal medicine". The patient gets to our ER, and is immediately deemed too sick for the ward, and ICU is consulted. The internal medicine doctor may or may not have even laid eyes on this patient, and there is no admission order. In these cases, although the medicine doctor may have written a note about seeing the patient in the ER, they never took over care/wrote orders for the patient. How are other collectors entering these patients?Mlagadi 11:38, 2019 October 1 (CDT) I think this scenario is not an EMIP since the Med doc did not took over. Did the patient go to ICU - if yes then this is an ICU admission? --JMojica 17:09, 2019 October 3 (CDT) This is an interesting case because the medicine service technically accepted the patient to begin with, as they came direct to medicine, and an ER physician did not see them. If medicine sees them, then it could be considered an EMIP? but if medicine doesn't see them, who decided that the patient was too sick for the ward? and consulted ICU? if it was the ER physician than I don't think it would be an EMIP. Just my two cents, it is definitely not clear cut Lisa Kaita 11:03, 2019 October 8 (CDT)

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CAU

For STB_CAU, HSC_CAU, STB_CAU.

In Sept 2017 Con investigated whether any patients in the CAU are ever EMIPs at HSC; she found that there should not be. If any collector comes across an EMIP from one of these locations, please update this.

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. --LKolesar 11:49, 2017 October 27 (CDT)

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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

Patients in EMIP have their own serial numbers starting at number 150.

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