Overstay Predictor Project Collection Instructions

Changes coming July 31 2017 - stay tuned. 

Projects
Active?:	active
Program:	Med
Requestor:	Mary Ann Lynch and Dr Eberhard Renner
Collection start:
Collection end:

Instructions for admissions starting Jul 31 2017

This article documents what data collectors need to do to collect information for the Overstay project.

This project is one of the Vacation and staff shortage collection priorities!

No entries are required in the TMP section. (AutoEntry of DPST form in tmp will disappear.)

In addition to Minimal Data Set

The following items need to be entered before the generation of the chart colour in the next step because the algorithm uses this data:

• Date of Birth
• Province
• Accept DtTm if used, else Arrive DtTm
• Pre-admit Inpatient Institution
• ADL
• Glasgow Coma Scale
• important: List of diagnoses affecting Overstay Project

Generate colour

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.

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.

• 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; there are no gray stickers, gray is just a colour the laptop will give when it gets bad data for the algorithm.
• RED - significant risk for discharge delays
• YELLOW - anyone who is not red

Red Chart Stickers

If the colour is red place a 3/4" red round sticker on the spine of the patient chart. Template:Discussion Who is providing the stickers? Or who has in the past? Ttenbergen 14:44, 2017 July 18 (CDT)

Other coloured dots on charts?

There is currently a small red dot used to indicate long term chart. Template:Discussion

• Are these small red dots used at all sites? Ttenbergen 14:44, 2017 July 18 (CDT)

• Is there any risk of someone confusing these small red dots with our overstay ones? Ttenbergen 14:44, 2017 July 18 (CDT)

• Are you talking about the small dots that the ward staff use on the addressograghs?--CMarks 12:56, 2013 July 30 (CDT)
  • any dots that might be confused with ours, eg by new staff misunderstanding training. Do you think those might be? Ttenbergen 09:44, 2017 July 19 (CDT)

• At STB at this time the data collectors do not travel to the ward to review charts as they are able to retrieve all their information from EPR. Once this change is implemented, do they need to go to the ward every day to put stickers on the charts? Who will be looking at these stickers which are put on the charts here at STB? Are all sticker colors essential on the chart spine? If the unit manager is being notified of red ones perhaps this email notification is sufficient for the purposes of the overstay project? (instead of red sticker). Just checking to make sure we all understand this new change. --LKolesar 07:37, 2017 July 19 (CDT)
  • At this time the plan would be for all (incl STB) medicine collectors to put dots on physical charts. We discussed only notifying the manager by email with the requestor of the project, but they really want the dots. One thing we considered was the possibility of putting something equivalent to the red dot onto Medworxx. I am looking into that. Ttenbergen 09:44, 2017 July 19 (CDT)

Notifying the Unit Manager

If a patient is identified as red, send an email to the unit manager.

Template:Discussion We are going to automate that process at least partially, using something similar to the email buttons you already have. Details to come. Ttenbergen 14:44, 2017 July 18 (CDT)

Possible Scenarios

Possible Scenario - Patient transferred from other ward - admit ward was 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 original Yellow/Red designation is retained. Ensure that these charts have the appropriate colour dot on them. If they were pre-determined to be a "red" then the name and date of the patient transferred in should be written in the transition coordinator binder, indicating that they are a transfer in from another ward.

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 admitted to a participating ward, then transferred to a non-participating ward, and finally back to a participating ward, then use the colour on the original ward.

Template:Discussion Need to discuss with Julie how this will work. There will no longer be a form to travel along. What would happen if we just generated the colour again and stripped out values for transferred pts later? Ttenbergen 14:44, 2017 July 18 (CDT)

• If generating the color every time will simplify the instructions to the DC, this is fine with me. In the analysis, I will only use the color of the first ward admission and not the succeeding transfers. Tina, is it possible to have an article in WIKI about the Overstay model and the cut-off value that designate color? Thanks. --JMojica 16:15, 2017 July 18 (CDT)

Possible Scenario - Patient transferred from other ward - admit ward was NON-participating ward

If the patient is transferred either from or via any unit not participating in the Overstay project (e.g. an ICU) generate a colour.

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.

• Tina, how are these color changes being handled when sending the data - which color appears in the table L_TmpV2? Can we assume that the last color entry is the final color? JMojica 11:33, 2015 April 30 (CDT) Template:Discussion
  • I will need to review in the CCMDB.mdb... Ttenbergen 11:33, 2015 May 1 (CDT)
    • I still need to review... Ttenbergen 14:44, 2017 July 18 (CDT)

Possible Scenario - Patient died/discharged before data collection

Enter anyway and generate colour. Do not contact Unit Manager.

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

Enter anyway and generate colour. Do not contact Unit Manager.

Possible Scenario - Off ward patients

For patients with Off ward field = true, Enter anyway and generate colour. Template:Discussion Which unit manager do we contact? Ttenbergen 14:44, 2017 July 18 (CDT)

---

Current instructions admissions before Jul 30 2017

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!

For STB SITE: the Overstay Predictor Project is currently on hold. We do not collect at STB at this time because the medicine wards have all stopped filling out our Discharge Planning Screening Tool (DPST) forms. We do however, still generate a DPST color at the time of admission. Under the temp studies tab we change one line on the overstay project to "Overstay (column P)", and "DPST data missing (column I)". We then delete the remaining five lines from the Overstay Project. At that point the color can be generated by pressing the Overstay color generating button. DPageNewton 12:53, 2017 May 18 (CDT)

For HSC SITE: Go here as we continue do minimal collection of items that are required for Overstay. This changed occurred on Nov 25.15 Template:Discussion that link doesn't lead to any info helpful to an HSC collector, need cleanup. Ttenbergen 08:13, 2017 March 1 (CST)

when you have questions or problems with the overstay project

Please email Trish or Tina

• For HSC site: Please email Trish and Shellie Anderson.--CMarks

ensuring completeness within 24 hrs

The bedside nurses have 24 hours from the time of admission to the unit to fill out the 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) , if it took more than 2 days, yes fill it out but let me or the manager be aware if this is a consistent issue.

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

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 where 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
• Date of Birth
• Province
• Accept DtTm if used, else Arrive DtTm
  • Enter 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
• Pre-admit Inpatient Institution
• 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; there are no gray stickers, gray is just a colour the laptop will give when it gets bad data for the algorithm.

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 DPST 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 from the DPST form

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 ward - admit ward was 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. Ensure that these charts have the appropriate colour dot on them. If the form is not available, treat as missing form.

If they were pre-determined to be a "red" then the name and date of the patient transferred in should be written in the transition coordinator binder, indicating that they are a transfer in from another ward.

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 admitted to a participating ward, then transferred to a non-participating ward, and finally back to a participating ward, then use the colour on the original ward.

Possible Scenario - Patient transferred from other ward - admit ward was NON-participating ward

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.

• Tina, how are these color changes being handled when sending the data - which color appears in the table L_TmpV2? Can we assume that the last color entry is the final color? JMojica 11:33, 2015 April 30 (CDT) Template:Discussion
  • I will need to review in the CCMDB.mdb... Ttenbergen 11:33, 2015 May 1 (CDT)

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 form 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

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 EPR 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

Possible Scenario - Incorrect information

If the DPST has information on it that disagrees with documentation in the chart, do not correct it. For example it sometimes happens that a patient reports no falls but upon review of the home-care record it is clear that the patient has fallen in the past. While it seems important to correct the DPST the assumption is the DPST was filled out with information available in the first 24 hours and the things will be missed. The care team still needs to do their diligent discharge planning regardless of the colour assigned.--LHathout

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)