Definition of a Critical Care Laptop Admission

The definition of an "ICU patient" for the Regional ICU Database is:

• EXCEPT for the exceptions immediately below, a patient admitted under Critical Care service, regardless of their physical location, even if it is a Boarding Loc such as PACU or ER. If patient doesn't meet this definition then we don't collect data and enter into the ICU database. What this DOES mean is that this begins at the time when the ICU service takes over primary care of the patient (see Service tmp entry)
• Exception HSC SICU: As SICU patients remain under the primary care of the surgical service, they do not fall under the rule directly above. Instead a SICU patient becomes an ICU laptop patient at the earlier of (a) actual arrival in SICU or (b) the patient is not yet in SICU (e.g. is in PACU, or ED or boarding elsewhere) but the SICU service has accepted them to come to SICU when there's a bed in SICU.
• Exception STB : STB_CICU, STB_MICU & STB_ACCU Admissions Arrive_DtTm is the time the patient physically enters the unit under the care of the ICU service and is taken from the ICU flowsheet. EPR times are unreliable as they are often entered long before the pt is actually in the unit or are entered when the pt is in a swing bed location; EPR times are reflected in the Cognos data.
• Exception for Cardiac Surgery patients coming from the OR & Cardiology/Cardiac Surgery patients coming from the Cath Lab the service accept time will be considered to be the time the patient starts being cared for by the ICU service in the ICU, not the time the patient is under the Cardiac Surgery service; the Arrive_DtTm & the Accept_DtTm will be the same. For Cardiac Surgery patients that are cared for on the unit (CR4) by the ICU team, the Accept_DtTm in tmp will be the time the ICU assumed care of the patient, and the Arrive_DtTm will be the time the patient physically enters the ICU. Cardiac Surgery patients coming from the ER will be regarded the same way as any other ICU patient.
• Exception for ICU patients coming from an internal unit the service accept time is when the ICU team has arrived to a code, if the patient is successfully resuscitated, and is transferred to the ICU; this time is found on the code record. Otherwise, in a situation without a code, the accept and arrive times will be the same
• Exception PACU: pts in PACU are to be included if they are under critical care, but not if they are under surgery

• Special case: Pts in ICU for procedures only: as per Bed borrow exclude patients brought into ICUs for procedures only; these would likely not show up in the Cognos reports because the service does not change to ICU for them

Entry of Admission Date to Critical Care Service and Reporting

See also STB CICU Admissions start at Arrive DtTm

• Since the definition varies from site and unit, for the Statistician to get the correct admission date time to the ICU which is to be used to calculate Length of Stay (ICU Report), the admission date and time must be entered in the Service tmp entry as its first service entry Start date and time.
• It would be hit and miss to get the correct date and time information to the first Boarding Loc because the first physical location may not be the unit but just a boarding location and by definition does not necessarily imply that the patient is already being taken over by the ICU service. Neither getting the correct admission date time to the succeeding boarding location which can also be a boarding location.
• The purpose of the Service tmp is to define the start dates the service takes over and the first start date time is the beginning date when the Critical Care service takes over regardless of the location it started (e.g. own ICU, other ICU unit, Off service unit, ER, RR, or other locations).