HSC Virtual Ward: Difference between revisions

Line 5:

Even if we don't collect the actual records, we need to decide how we will code patients who come from or go there:

* [[Pre-admit Inpatient Institution]] are these in-patients for the purpose of

* [[Previous Location]] /

* [[Previous Location]]

* [[Dispo field]] (already started talking about this)

If we ~~were~~ to collect this we ~~would~~ need to ~~decide~~

== Do we consider these inpatients? ==

* how/if to ~~include~~ these in reports

Discussed at the CCMDB Monthly meeting 2025-07-08; my notes say the consensus was that these are not in-patients. I searched today to find out how the rest of the system will collect these, and it appears the do consider these in-patients:

* how would ~~collectors access~~ the ~~charts (is charting done~~ in ~~EPR like at STB?)~~

* p32 of [https://wrhasp.manitoba-ehealth.ca/hospitals/hsc/decs/his2/Coding Analysis/Abstracting 2022-2023/Manuals/4-2025 26 HSC Abstracting Manual.pdf#search=virtual%20ward 2025-26 HSC Abstracting Manual] instructs to code transfer to virtual ward as “transferred to inpatient care”.

* [https://wrhasp.manitoba-ehealth.ca/hospitals/hsc/decs/his2/Admitting Patient Registration/Quick Reference Guides (QRGs)/Virtual Ward/Admitting Virtual Ward.pdf#search=virtual%20ward HIS - Virtual Ward Inpatient Registration] says right in the title that this is an inpatient registration.

How we consider these has a lot of implications:

* [[indicators]]

** will a hospitalization that includes a virtual ward stay be considered a continuous admission?

*** affects [[Readmission]]s

** will we group them with the site for aggregates like [[LOS Medicine per hospital admission]], occupancy, [[Medicine Primary Diagnosis Rate]]

** some scores should only be calculated on the initial service encounter during an admission; how we treat virtual ward will impact how we need to consider these

** how would we treat the from the perspective of [[Transfer Ready DtTm]] / [[Transfer Delay (Medicine)]]

* would we consider the virtual ward as an [[Pre-admit Inpatient Institution]]

** this field is part of risk estimation, since patients who are previously inpatients have a higher risk for bad outcomes

** hospital administrators use this field to find out from which sites patients are coming to their sites

* [[reports]]

** [[Mortality and readmission report]] - is a patient who dies on the virtual ward part of HSC's mortality?

** [[Directors Quarterly and Annual Report (Medicine)]] -

** any other reports who consider a patient to remain in hospital, be associated with a specific institution, group together records as a continuous admission, etc, would also be affected

* other

** We will need to decide if things like how to group a transfer to virtual ward from the perspective of where a patient was sent geographically; for "home" we have a postal code, for specific site dispo we have a facet table that provides an RHA, etc. A lot of these are deeply buried assumptions in our reports - we have a good listing of what fields are used, but the structured data in our documentation was not set up to track at this level.

* if we ''don't'' code them as inpatients, will this affect how our numbers compare to other data sources used by our data users?

== Recommendation ==

* we should immediately break "HSC Virtual Ward" out as a specific entry in our [[s_dispo table]] and permit collection as [[Previous Location]] and [[Dispo]]

** this is relatively quick to do, but we will likely encounter curve balls, such as collectors asking for instructions for unexpected scenarios, or [[Data Integrity Checks]] triggering because this doesn't fit into historical assumptions; we would need to know how to get answers quickly when that happens, and we would need direction on how to validate any changed assumptions

* as soon as possible, but definitely before the next quarterly report, we need to decide whether to treat these as inpatients

* if yes need to collect patients coming from virtual ward in [[Pre-admit Inpatient Institution]]

* Julie will need direction which of the indicators and reports should include these and how

== Log ==

* 2025-10-30 - additional questions re. implications of inpatient status

* 2025-10-23 - initial question in [[Dispo field]] re how to code discharge to this location

* 2025-09-23 - initial records showed up in [[Cognos data import]]. We don't collect these, but added the following as required for so we added

@@ Line 5: / Line 5: @@
 Even if we don't collect the actual records, we need to decide how we will code patients who come from or go there:
 * [[Pre-admit Inpatient Institution]] are these in-patients for the purpose of
-* [[Previous Location]] /
+* [[Previous Location]]
 * [[Dispo field]] (already started talking about this)
-If we were to collect this we would need to decide
+== Do we consider these inpatients? ==
-* how/if to include these in reports
+Discussed at the CCMDB Monthly meeting 2025-07-08; my notes say the consensus was that these are not in-patients. I searched today to find out how the rest of the system will collect these, and it appears the do consider these in-patients:
-* how would collectors access the charts (is charting done in EPR like at STB?)
+* p32 of [https://wrhasp.manitoba-ehealth.ca/hospitals/hsc/decs/his2/Coding Analysis/Abstracting 2022-2023/Manuals/4-2025 26 HSC Abstracting Manual.pdf#search=virtual%20ward 2025-26 HSC Abstracting Manual] instructs to code transfer to virtual ward as “transferred to inpatient care”.
+* [https://wrhasp.manitoba-ehealth.ca/hospitals/hsc/decs/his2/Admitting Patient Registration/Quick Reference Guides (QRGs)/Virtual Ward/Admitting Virtual Ward.pdf#search=virtual%20ward HIS - Virtual Ward Inpatient Registration] says right in the title that this is an inpatient registration.
+How we consider these has a lot of implications:
+* [[indicators]]
+** will a hospitalization that includes a virtual ward stay be considered a continuous admission?
+*** affects [[Readmission]]s
+** will we group them with the site for aggregates like [[LOS Medicine per hospital admission]], occupancy, [[Medicine Primary Diagnosis Rate]]
+** some scores should only be calculated on the initial service encounter during an admission; how we treat virtual ward will impact how we need to consider these
+** how would we treat the from the perspective of [[Transfer Ready DtTm]] / [[Transfer Delay (Medicine)]]
+* would we consider the virtual ward as an [[Pre-admit Inpatient Institution]]
+** this field is part of risk estimation, since patients who are previously inpatients have a higher risk for bad outcomes
+** hospital administrators use this field to find out from which sites patients are coming to their sites
+* [[reports]]
+** [[Mortality and readmission report]] - is a patient who dies on the virtual ward part of HSC's mortality?
+** [[Directors Quarterly and Annual Report (Medicine)]] -
+** any other reports who consider a patient to remain in hospital, be associated with a specific institution, group together records as a continuous admission, etc, would also be affected
+* other
+** We will need to decide if things like how to group a transfer to virtual ward from the perspective of where a patient was sent geographically; for "home" we have a postal code, for specific site dispo we have a facet table that provides an RHA, etc. A lot of these are deeply buried assumptions in our reports - we have a good listing of what fields are used, but the structured data in our documentation was not set up to track at this level.
+* if we ''don't'' code them as inpatients, will this affect how our numbers compare to other data sources used by our data users?
+== Recommendation ==
+* we should immediately break "HSC Virtual Ward" out as a specific entry in our [[s_dispo table]] and permit collection as [[Previous Location]] and [[Dispo]]
+** this is relatively quick to do, but we will likely encounter curve balls, such as collectors asking for instructions for unexpected scenarios, or [[Data Integrity Checks]] triggering because this doesn't fit into historical assumptions; we would need to know how to get answers quickly when that happens, and we would need direction on how to validate any changed assumptions
+* as soon as possible, but definitely before the next quarterly report, we need to decide whether to treat these as inpatients
+* if yes need to collect patients coming from virtual ward in [[Pre-admit Inpatient Institution]]
+* Julie will need direction which of the indicators and reports should include these and how
 == Log ==
+* 2025-10-30 - additional questions re. implications of inpatient status
 * 2025-10-23 - initial question in [[Dispo field]] re how to code discharge to this location
 * 2025-09-23 - initial records showed up in [[Cognos data import]]. We don't collect these, but added the following as required for  so we added