Level of care hierarchy

We use the concept of a level of care hierarchy in the context of Transfer Delays. See Transfer Delay to understand how it is used. Level of care applies to a patient's combination of Boarding Loc item and comment entry (which together define a physical location). Which location has which level of care is stored in the s_level_of_care table.

Levels of Care

• 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)
  • Other MB RHA ICU or Other Province ICU
  • WRHA IICU
  • WRHA HOB Medicine ward (HSC_HOBS as of 2022-05)
  • WRHA regular Medicine ward (CTU or NTU)
  • WRHA non-Medicine (e.g. surgery, family med, OB, palliative, 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
    • To be clear here, we DO consider these locations "lower" levels than are Medicine wards, and the reason is that a major purpose of the levels is to be able to count up "wasted" bed-days in ICUs or Medicine wards. But of course the care provided in these other locations are not truly lower levels.
  • Ward outside WRHA
  • PCH or home

level of care of the ED

We consider the ER to be at the standard level of care for the Service taking care of the patient i.e. HOBS or regular med ward for Medicine service patients, and regular ICU (ie not IICU)

This definition is relevant for decisions about the Transfer Ready DtTm tmp entry and consequently about reporting Transfer Delay.

JALT We had discussed making this "the level of care of where the pt goes" but the problem in this definition is pts who are discharged or AMA from or die in ER. So I have instead made it about the patient's service. Would that work as a definition? This would also remove the concept of "where the patient actually went" from the definition and might finally eliminate some of the confusion that comes from that. Ttenbergen 12:37, 2022 August 3 (CDT) I agree. --JMojica 13:09, 2022 August 3 (CDT) Yes, but you added HOBS above, and that doesn't work if we do it by service: if the pt never makes it to a unit it would be impossible to find out whether it's HOBS or regular. So if you want to include the option of HOBS we are back to needing a special clause, either for EMIP or for HOBSers, depending how we define them. If we are ready to treat all pts as regular ward while in ER then no extra clause needed. The case not counting ER as HOBS is that, if they were transfer ready in the ER and then went to HOBS then they likely deteriorated from being transfer ready, so it's actually an escalation in care. Sorry I didn't catch this earlier, I can't believe that this sends this back yet again. Ttenbergen 17:21, 2022 August 3 (CDT) One option: how about for Medicine always treat ER as regular ward and therefore any delay in transfer is a bed wasted to regular ward. If it happens that the patient with transfer ready at ER went to HOBS, the TR Dttm until the start dttm at HOBS is bed wasted regular ward. If at HOBS, patient becomes transfer ready, then bed wasted to HOBS until the start of the different level of care. This case will have two wasted bed - one regular and one HOBS. Second option is to have 3 types of med bed wasted - 1) at ER only 2) Regular 3) HOBS. Third option -1) EMIPs with TR dttm - bed wasted regular 2) ER with TR dttm and went to regular - consider the ER TR dttm until start of diff level of care or dispo and this is bed wasted regular 3)ER with TR dttm and went to HOBS - consider the ER TR dttm until start of diff level of care or dispo and this is bed wasted HOBS. If first BL is ER - for both regular and HOBS bed wasted, Option 3 will have the highest value of cumulative bed wasted, then followed by Option 1 and the least is Option2. For option2, the question is what is the meaning of bed wasted at ER alone? shouldn't it be the whole stay considered as bed wasted at ER, not just when the patient became transfer ready to a lower level of care? I am more incline to separate the bed waste at ER but whether to report all or selected ones (say from EMIPs only or exclude those prior to HOBS) or not to report at all - I need to think more. we need to discuss at JALT.--JMojica 13:57, 2022 August 31 (CDT)

• SMW

• Cargo

• Categories

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.

Actual listing of care levels for different Boarding Locs

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.

Why are some non-med locations considered "lower"

We DO consider some non-medicine locations "lower" levels than are Medicine wards, and the reason is that a major purpose of the levels is to be able to count up "wasted" bed-days in ICUs or Medicine wards. But of course the care provided in some of these other locations are not truly lower levels.