Allied Health Consults

Please do not discuss this project 
with other staff except collectors 
at your sites.  
This project will observe staff 
behaviour and we are concerned about a 
Hawthorne effect. 

Purpose

To determine how many allied health consults patients are getting, in part to determine the effect of the Overstay Predictor Project on this variable.

We want to collect whether a consult was requested, not what sort of delays happen. That is something we know we need to consider, but it is not part of this temporary collection. We assume that most patients get allied health consults but we need numbers to back up the assumption.

Audit Dates

• all medicine sites
• Starting: 2012-11-05
• Ending: 3 - 4 weeks after start date

Collection Instructions

Generate a tmp entry for the first relevant allied health discipline if they had a consult

- while admitted to your ward (ie after admission, before discharge)

- in the ER immediately prior to admission to your ward

• Project:AlliedHC
• Item (as appropriate):
  • Home Care
  • Physio
  • OT
  • Social work
• no other fields need to be filled, i.e. no times etc.
• if there are no consults there is nothing to do for this project, i.e. there is no "no consults" entry

Problems with collection instructions?

Template:Discussion Can you think of a scenario in which the instructions above are not clear and comprehensive? I am not concerned for the moment whether they are "right" or "wrong", just if they would leave you confused how to code, or if you think you might interpret them different from another collector. Ttenbergen 10:58, 2012 November 5 (EST)

Data use and analysis

The data will be analyzed as part of the Overstay project. Tina is involved with that and can provide it directly.

The plan for this data is to give a broad picture of consultation practices before and after the Overstay project. The data will be grouped and counted for comparison. We are not planning to use this data to get any detailed information on individual patients. We may use the data to trigger a chart review in special cases.

We are aware that the consult practices at the sites are complex, and our project is not aiming to get a full picture. Specifically, we need to simplify what we are investigating so we end up with data we can compare across patients, wards and hospitals.

Collector observations and comments that might help interpretation of this data

Why we didn't add dates to the collection

I have removed comments relating to this from the discussion below The tmp entries in CCMDB.mdb could accommodate date and time, but we decide 'not to collect this for the following reasons:

• We will primarily use this data in the form of counts, and there it would not help.
• If we wanted to add dates we would have to set rules around how to collect them in special cases (e.g. unknown, before admission, several consults, etc); this would make the collection more complicated, and it would mean that there would be too few of each case to combine them with any meaning.
• The dates might give an idea about what went wrong in a specific case, but if we wanted that level of detail there would need to be a chart review anyway, so having it in the database would add no value.
• also, see #Data use and analysis

Why don't we collect where a consult was generated, or by whom?

I have removed comments relating to this from the discussion below Consultes could be generated before patients arrive on the ward, and various parties can generate them. We decided not to collect this because it would complicate both the collection rules and aggregation of the data.

• also, see #Data use and analysis

Why collect only these four types of allied health consults?

They are the ones that will be directly affected by project Overstay.

Miscellaneous

I will treat these as comments only, unless you put a {{discussion}} tag and a question I could address. At the Vic, non-teaching medicine spends much of its time on discharge planning. PT and OT are often consulted in emerg and patients are usually assessed in emerg. If a patient does not pass the function assessment, the patient will be admitted to a ward. The patients here are sometimes admitted for failure to cope in the community. They are followed up on the ward usually the next day or when the patient's medical condition improves enough for the patient to participate. I notice that a patient may be medically stable but not able to perform ADL (activities of daily living)due to deconditioning. Discharge will be delayed till the patient has plateaued or gained a prior level of ADL functioning. This is the first significant delay in patient discharge that I see and holds up discharge planning for weeks. It can take weeks or more for the patient to regain strength. PT and OT work together and will consult each other on the patient's progress. Once PT feels that the patient is mobilizing well, OT will complete their assessment and determine the type of supported needed in the home if home is the goal. Home Care (HC) becomes involved once the patient has plateaued and makes the needed arrangements. The home care process seems fast and efficient in my opinion; usually a matter of 2-3 days approx. this is of course when the patient is returning to a prior living arrangement. When a patient fails to meet the criteria to return home or needs supportive housing a second delay begins. Paneling is the third time consuming process and waiting for placement seems to take months. These are the three main delays I see here at the Vic on my non-teaching units. What do others see happening? Jkublick Nov 1, 2012.

• Decided to include consults in ER immediately prior to ward admission. Ttenbergen 15:59, 2012 November 1 (EDT)
  • I agree with Judy. Just to let you know consults to physio and or occupational health can be filled out by a nurse /doctor /or allied health care service. Many patients who come to our wards are already receiving homecare which is cancelled and then has to be reviewed again to see if they require more treatments /adls at home. Do you want 1st timer to homecare services ? I have found out some services (Home care) are being delayed because information is not being relayed to them ie from ER They are not faxing the information to Home care and they are unaware that the pt needs follow up on the ward, until someone asks them what is happening? This just happened last week The pt wasnt seen for 7 days.
    • • I agree with all comments made. Maybe we could capture if consults were made in ER or on Ward.--FLindell 09:44, 2012 November 5 (EST)--FLindell 09:44, 2012 November 5 (EST)
      • Yes Tina your instructions are clear and comprehensive, no further comments will be made--PStein 08:49, 2012 November 6 (EST)