Level of care hierarchy: Difference between revisions

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== Levels of Care ==

The list of levels of care from highest to lowest are:

*The list of levels of care from highest to lowest are:

* WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU (also for PACU or OR)

**WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU (also for PACU or OR)

* Other MB RHA ICU or Other Province ICU

**Other MB RHA ICU or Other Province ICU

* WRHA IICU

**WRHA IICU

* WRHA HOB Medicine ward (examples: [[HSC_HOBS]], [[STB_IMCU]] as of 2020-10)

**WRHA HOB Medicine ward (examples: [[HSC_HOBS]], [[STB_IMCU]] as of 2020-10)

* WRHA regular Medicine ward (CTU or NTU)

**WRHA regular Medicine ward (CTU or NTU)

* WRHA non-Medicine (e.g. surgery, family med, OB, etc) AND lower acuity ward in acute care hospital, whatever flavour of the month word they use for this, incl. rehab, geri-rehab, palliative care unit, etc

**WRHA non-Medicine (e.g. surgery, family med, OB, etc) AND lower acuity ward in acute care hospital, whatever flavour of the month word they use for this, incl. rehab, geri-rehab, palliative care unit, etc

* ~~ward~~ outside WRHA

**Ward outside WRHA

* PCH or home

**PCH or home

*Regarding the level of care of the ED

**The ED is unique in this regard as it can take on various different levels of care

**When the patient’s care is taken over in ED (either Medicine or ICU) and then the patient goes to Medicine or ICU --> consider the time in ED as being the SAME level of care as where the person goes to (i.e. Medicine or ICU).

**In the unusual circumstance that Medicine ward team takes over care while the patient is still in the ED, but before going to a Medicine ward the decision is made to send the person to a level of care lower than Medicine wards (e.g. home, back to PCH, etc) then consider the time in ED as being that of a Medicine ward.

=== When to use the Levels of Care ===

When the intent is to move the patient from a higher level of care to a lower level of care, transfer ready date and time has to be entered corresponding to the physical location where the decision was made. The entries are done following the guidelines in the [[Boarding Loc]] and [[Transfer Ready DtTm tmp entry]].

~~=== Special case - ER, OR and PACU ===~~

~~These are considered the highest level of care collected by that program. So,~~

* for a medicine patient on a med laptop, an ER/OR/PACU location is considered the same level of care as a HOBS unit

* for a critical care patient on a cc laptop, an ER/OR/PACU location is considered the same level of care as an MICU/SICU

~~~~

~~=== Hierarchy and Transfer Ready Dt/Tm Entries ===~~

A Transfer Ready Dt/Tm is entered when a patient has been declared medically stable and/or ready to be transferred to a lower level of care (for example, a patient has been made ACP-C, deemed stable and ready for discharge home/to PCH, ready to be transferred from ICU to medicine, etc). For patients who present to ER and then are admitted to the medicine ward, they do NOT need a Transfer Ready date and time entry leaving ER because they are not going to a lower level of care (even though listed above indicates ER is a higher level of care). The care they will be receiving on medicine is considered to be equivalent to the level of care they received in ER. The line still needs to be entered/associated with the ER Boarding Loc, but follow the direction used when the patient is moved with a Transfer Ready date and time that is not available, or if they were not transfer ready.

=== Actual listing of care levels for different [[Boarding Loc]]s ===

The [[s_level_of_care table]] in [[CCMDB.accdb]] (and automatically linked into [[CFE]] contains a mapping of our Boarding Locs to their level of care.

{{Discuss| Should Special case - ER, OR and PACU entry (see above) and what is written directly above need to be somehow be better reconciled? Otherwise apt to differing interpretation(s) for example, if ER is to be considered a "higher" level of care than a medicine unit a collector could enter a comment of "not available" as the patient did transfer to a "lower" level of care so theoretically was "transfer ready" based on special case above (as appears to be an exception) but a date/time was not available, or alternatively enter a comment of "not transfer ready" as the transfer to a medicine unit is not a lower level of care unless indicated otherwise while the patient is in ER (ie. change to ACP C). If left as is, would this be confusing to a new collector? }}

{{Discuss | who = Julie |

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 == Levels of Care ==
-The list of  levels of care from highest to lowest are:
+*The list of  levels of care from highest to lowest are:
-* WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU (also for PACU or OR)
+**WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU (also for PACU or OR)
-* Other MB RHA ICU or Other Province ICU <!--(confirmed by Dr. Allan Garland 2Oct2017)-->
+**Other MB RHA ICU or Other Province ICU <!--(confirmed by Dr. Allan Garland 2Oct2017)-->
-* WRHA IICU
+**WRHA IICU
-* WRHA HOB Medicine ward (examples: [[HSC_HOBS]], [[STB_IMCU]] as of 2020-10)
+**WRHA HOB Medicine ward (examples: [[HSC_HOBS]], [[STB_IMCU]] as of 2020-10)
-* WRHA regular Medicine ward (CTU or NTU)
+**WRHA regular Medicine ward (CTU or NTU)
-* WRHA non-Medicine (e.g. surgery, family med, OB, etc) AND lower acuity ward in acute care hospital, whatever flavour of the month word they use for this, incl. rehab, geri-rehab, palliative care unit, etc
+**WRHA non-Medicine (e.g. surgery, family med, OB, etc) AND lower acuity ward in acute care hospital, whatever flavour of the month word they use for this, incl. rehab, geri-rehab, palliative care unit, etc
-* ward outside WRHA
+**Ward outside WRHA
-* PCH or home
+**PCH or home
+*Regarding the level of care of the ED
+**The ED is unique in this regard as it can take on various different levels of care
+**When the patient’s care is taken over in ED (either Medicine or ICU) and then the patient goes to Medicine or ICU --> consider the time in ED as being the SAME level of care as where the person goes to (i.e. Medicine or ICU).
+**In the unusual circumstance that Medicine ward team takes over care while the patient is still in the ED, but before going to a Medicine ward the decision is made to send the person to a level of care lower than Medicine wards (e.g. home, back to PCH, etc) then consider the time in ED as being that of a Medicine ward.
 === When to use the Levels of Care ===
 When the intent is to move the patient from a higher level of care to a lower level of care, transfer ready date and time has to be entered corresponding to the physical location  where the decision was made.  The entries are done following the guidelines in the [[Boarding Loc]] and [[Transfer Ready DtTm tmp entry]].
-=== Special case - ER, OR and PACU ===
-These are considered the highest level of care collected by that program. So,
-* for a medicine patient on a med laptop, an ER/OR/PACU location is considered the same level of care as a HOBS unit
-* for a critical care patient on a cc laptop, an ER/OR/PACU location is considered the same level of care as an MICU/SICU
-<!-- as per meeting with Allan 2020-10-27 -->
-=== Hierarchy and Transfer Ready Dt/Tm Entries ===
-A Transfer Ready Dt/Tm is entered when a patient has been declared medically stable and/or ready to be transferred to a lower level of care (for example, a patient has been made ACP-C, deemed stable and ready for discharge home/to PCH, ready to be transferred from ICU to medicine, etc). For patients who present to ER and then are admitted to the medicine ward, they do NOT need a Transfer Ready date and time entry leaving ER because they are not going to a lower level of care (even though listed above indicates ER is a higher level of care). The care they will be receiving on medicine is considered to be equivalent to the level of care they received in ER. The line still needs to be entered/associated with the ER Boarding Loc, but follow the direction used when the patient is moved with a Transfer Ready date and time that is not available, or if they were not transfer ready.
 === Actual listing of care levels for different [[Boarding Loc]]s ===
 The [[s_level_of_care table]] in [[CCMDB.accdb]] (and automatically linked into [[CFE]] contains a mapping of our Boarding Locs to their level of care.
-{{Discuss| Should Special case - ER, OR and PACU entry (see above) and what is written directly above need to be somehow be better reconciled? Otherwise apt to differing interpretation(s) for example, if ER is to be considered a "higher" level of care than a medicine unit a collector could enter a comment of "not available" as the patient did transfer to a "lower" level of care so theoretically was "transfer ready" based on special case above (as appears to be an exception) but a date/time was not available, or alternatively enter a comment of "not transfer ready" as the transfer to a medicine unit is not a lower level of care unless indicated otherwise while the patient is in ER (ie. change to ACP C). If left as is, would this be confusing to a new collector? }}
 {{Discuss |  who = Julie |