Overstay Predictor Project Collection Instructions

This article documents what data collectors need to do with the Discharge Planning Screening Tool form (DPST Form). This is the latest generic form as of January 2014. Each hospital nurse education coordinator took the generic form and replaced the WRHA logo with the hospital logo. HSC also applied a form number.

Be aware that this project is a Vacation and staff shortage collection priority!

when you have questions or problems with the overstay project

Please email Tina and Linda Hathout or post issue on Wiki rather phone calls. If phone call is getting you voice message than email Tina & CC Linda. Thank you for your cooperation with this.Trish Ostryzniuk 18:47, 2013 February 12 (EST)

ensuring completeness within 24 hrs

The bedside nurses have 24 hours from the time of admission to the unit to fill out the bedside nurse DPST Form. This time frame allows for the nurse to clarify unanswered questions with the patient or caregivers during the day. Question 2: If the DPST form is filled out by the nurse but it took more than 2 days say 5 days for the nurse to do it do you still want this data entered or do you say (form data missing)

The nurse can update the DPST form within the first 24 hours after admission if, for example they receive information from the patients family that contradicts the patients answers. It is possible that depending on when you review that document these changes are not captured. This a known risk that we are accepting.

See STB_Medicine_Collection_Guide#Overstay_Project for special considerations in gathering this data at StB Medicine.

Special situations

• Admitted as a palliative patient: treat as any other patient: a DPST sheet is completed. The computer can generate any color for these patients.
  • This is not true. Palliative status no longer has any bearing on Overstay colour. It used to be a factor, but has not been since 2013-07-03. We were going to refine the palliative dx to distinguish between services received and bad outcome expected, but that was never finished. This is an outstanding thing being looked into by the ICU task group. Some info is in Palliative Care. Ttenbergen 14:36, 2013 September 5 (CDT) Template:Discussion

• (When I have time, I will try to revamp the section below (scenarios) to put them into this special situations section just putting in the rules instead and then I will delete the scenarios section entirely. Simply having the rules listed for special situations will condense this section.) --LKolesar 11:01, 2013 September 5 (CDT)
  • careful with that, has caused confusing before. Ttenbergen 14:36, 2013 September 5 (CDT) Template:Discussion

Possible Scenarios

See

• #Possible Scenario - complete DPST Form missing or blank
• #Possible Scenario - colour change due to data entry error
• #Possible Scenario - individual questions missing
• #Possible Scenario - Patient transferred from other participating ward
• #Possible Scenario - Patient died/discharged before assessment
• #Possible Scenario - EMIP patient that never made it to the ward
• #Possible Scenario - HSC overflows to RR5 & RR6
• any others? Think first whether they really are not addressed in these instructions...

entering the data in TMP

Within two business days after the bedside nurse has completed the DPST Form the rest of the predictor data must be collected & entered into laptop by data collector.

6 Questions Data

When a new medicine patient is entered, 6 rows for questions are generated for them in the tmp table. They are labelled "Enter(1)" through "Enter (6)". You need to change the "Enter (x)" for each to the corresponding entry, i.e. "Enter (1)" becomes "1 Alert ad Orientated". Then you need to check the checkbox in column B if the answer on the DPST form is "yes". Leave the box blank to indicate no.

Question "4 managing independently" consists of several sub-questions. If even one of the activities raises a concern then the summary answer for the question needs to be no'.

Take answers to questions directly from the DPST form, no interpretation, even if you disagree after reading the chart. We will be testing the answers provided by the nurses to determine if they are a better predictor of transition support needs or can be used in conjunction with existing admission data to improve the effectiveness of the prediction tool. If the data were interpreted by the collector it would introduce another factor and make this test less valid. If you identify a discrepancy please note it in the Temp Comments field also known as column Q. what it looks like - click to see a bigger image Overstay TMP What to ENTER - click to see a bigger image

"From" Data

When a new medicine patient is entered, a line "Enter "From"" is created in the tmp table. Change this entry to indicate where the patient was admitted from. If the information is not indicated on the DPST form, but you can identify it easily from the chart, enter that; i.e. you may interpret this one. If information where the patient is from is unavailable, enter "From location missing".

Changes to regular minimal data collection and entry required for the Overstay Project

A number of items in addition to the regular Minimal Data Set needs to be entered before the generation of the chart colour in the next step because the algorithm uses this data:

• "from" and "questions" tmp entries, or else "transferred" entry if applicable
• DOB
• province
• Admit Date
  • Enter admit date as before; we are aware that this can be different from the time of admission to the unit and the algorithm takes that into account
• admit-from
• ADL
• Glasgow Coma Scale
• Charlson Comorbids
  • still working on list for the wiki; in the meantime, please just code all comorbids for the patient
  • will be here: List of diagnoses affecting Overstay Project
• admit diagnoses important to code if applicable:
  • Dementia or Violent 2nd to dementia

Colored Chart Stickers

Once the required information has been entered click the "Overstay" button on the patient viewer screen next to the Notes field and it will turn a colour based on an underlying algorithm.

• GREEN - low/no risk for discharge issues
• YELLOW - some risk for discharge issues
• RED - significant risk for discharge issues assign a transition coordinator.
• GRAY - if some needed data is missing you will not be able to generate a colour; there will be a specific error, please act on it

The program will ask you if this is the final colour you will submit. If so, it will be stored and sent. The colour will also be automatically added to the beginning of the Notes field, since most collectors were manually putting it there anyways.

Based on the color displayed circle the colour on the DPST Form. Also place a colored sticker on the spine of the patient chart. The 3/4 inch stickers will be located in the transition coordinator binder at the unit clerk desk.

copies of forms?

No copy of the NDST is required.

Other coloured dots on charts?

• There is currently a small red dot used to indicate long term chart. There is also a small yellow dot used to indicate VRE.
  • Are you talking about the small dots that the ward staff use on the addressograghs?--CMarks 12:56, 2013 July 30 (CDT)
  • Are these other dots relevant to the overstay project? Is there any risk of someone confusing these? Ttenbergen 17:50, 2013 August 8 (CDT)

Notifying the Transition Coordinator

If the patient has been designated as "red" for purposes of overstay prediction, the data collector will notify a Transition Coordinator by placing the patients name on the Transition Coordinator Assignment Sheet.

Possible Scenarios

Possible Scenario - complete DPST Form missing or blank

If the entire form is missing, delete 5 of the questions and replace the remaining one with "DPST Data missing" If the bedside nurse's DPST Form is incomplete the patient will be evaluated as if they had identified a problem, i.e. the patient will become yellow or red; the program will give a message that data had been missing. If possible, check with the bedside nurse and remind them to complete it or notify the medicine ward unit manager; enter the remaining data into CCMDB.mdb if it now becomes available. Even if the form is missing you still need to generate a colour for the patient.

entry instructions

• erase the 6 questions
• enter an entry Project "Overstay", Item "DPST Data Missing"
  • I have been unable to generate a color if I follow the above instructions. In addition to entering a line that says "DPST Data Missing", I also have to enter a line that says "From location missing". Only after BOTH lines are entered, will a color be generated. DPageNewton 16:59, 2013 August 12 (CDT)
    • The "from" topic is completely separate of this, and there are separate answers for it above. Ttenbergen 14:59, 2013 August 13 (CDT)

Possible Scenario - individual questions missing

If the answer to an individual question is missing, replace the "Enter (x)" for that question with "DPST Data missing". The algorithm will treat this as if a problem was identified, but by entering it like this we can identify in the data whether the colour escalated because of known problems or because of missing information. Even if the answer to a question is missing you still need to generate a colour for the patient.

entry instructions

Replace "Enter (x)" for the missing answer with "DPST Data missing".

Possible Scenario - Patient transferred from other participating ward

If the patient was admitted from a another medicine ward at the same location, and if that ward also participates in the Overstay project, then the DPST form does not need to be filled out and and the original Green/Yellow/Red designation is retained.

The completed form, with colour written on it, should arrive on the new unit with the patient. The designated colour should be written on the form.

If the patient is transferred either from or via any unit not participating in the Overstay project (e.g. an ICU) then the form needs to be filled out; if it is not, treat it as a #Possible Scenario - complete DPST Form missing or blank.

Possible Scenario - colour change due to data entry error

After 24 hours all information required to make the assessment as to if the patient is at risk should be available (or not known to the nurse within the first 24 hours and thus considered a risk). The only case where the colour should be changed is if the data-collector knew they had made an error on data entry. In that case, click the button again and answer "yes" to the question whether this is the final entry; this will overwrite the previous entry in the tmp table, and it will add the new entry to the beginning of the Notes field. This means you may have multiple colours in notes, the first one being the current one. It is not be necessary to document when a sticker colour changes. Just change the colour.

If the change results in the patient no longer needing a transition coordinator, then the data coordinator needs to notify the transition coordinator to ensure they are ware of the change.

Possible Scenario - Patient died/discharged before assessment

If the patient was discharged/died before a colour could be assigned write "not assessed" and write the discharge date on the Discharge Planning Screening Tool. If the DPST is filled out, enter the data and generate a colour even after the fact - this scenario applies only if the paper form was filled out. Question 1: The patient is admitted on the Friday the nurse completes the discharge planning screening tool (DPST) then the patient is discharge home on Sunday. I am in on Tuesday and complete the patient profile in medical records. Do you want us to complete and enter the 6 questions in the computer and generate a color or do you want us to put (EARLY DISCHARGE) and not fill in the 6 questions and put form missing? The answer is above.

entry instructions

• erase the 6 questions
• enter an entry Project "Overstay", Item "Form Data Missing"; put "early death" or "early discharge" into the notes field

Possible Scenario - EMIP patient that never made it to the ward

If a pt was an EMIP and never got as far as the ward, then enter "Form Data Missing" in the temp field. We will know from the patient data why this patient does not have any Overstay information.

entry instructions

• erase the 6 questions
• enter an entry Project "Overstay", Item "Form Data Missing"; put "EMIP" into the notes field

Possible Scenario - HSC overflows to RR5 & RR6

As of May 13, 2013 HSC medicine data collection will follow all OVERFLOW patient that are going to RR5 & RR. These are patients that are under a medicine attending service while on RR5 or RR6. They are sent there from medicine wards we are collecting on at HSC. They are also admitted there under Internal medicine service attending physicians from the ER department.Trish Ostryzniuk 16:20, 2013 June 14 (EDT)

Medical records will auto print patient list for RR5 & RR6 directly to the printer in GF216. HSC collector should now have access to ADT (Admit/Transfer/Discharge) for patient wards list via KEA/ Reflections also. If not, please contact Denise Felbel (she is in global address in your email).

• is this info in any way special for the overstay project? If not it should be stored on a more appropriate page on the wiki. Ttenbergen 17:56, 2013 August 8 (CDT) Template:Discussion

Legacy Info

Legacy Info - red for PCH or out-of-province patients

The original implementation of the Overstay colouring algorithm used between project start and 2013-Feb-08 would never assign a red to palliative, out-of-province or PCH patients. As of 2013-Feb-09 the algorithm has moved consideration of PCH and out-of-province status into the logistic regression analysis; the two are still a factor, but a minor one, and both types of patients could now become red in the right circumstances. Palliative patients continue to be evaluated such that they can not be assigned a red.

Legacy Info - multiple colour entries

Until version [[]] a new colour was added to the dataset each time the button was pressed. We thought this would be OK because it should only be pressed once, maybe a second time shortly after to fix a mistake, but it turned out to be pressed at all odd times.

Trish's note at the time:

• Every time collector presses the Color generating button, the color generated is show and is stored. If they keep pressing button every time they add data, and press the button again, this event is stored. If they exit profile and go back later the last color they generated is not visible to collect, only when pressed button again then they can see the color. So if they press 3 times, then it is stored 3 times. Color can be generated numerous times when staff update data, or are waiting for data that they are following up or generate color just to check if changes to color after when they added data even after posting sticker on chart. These multiple color generation show up in TMPV2.mdb every time data is sent in. Because of this, it is a challenge to analyses because it is not always clear what the final color was posted on a chart. This is especially the case when a new color is generate each day after admission. Trish Ostryzniuk 19:00, 2013 July 23 (CDT)