Definition of a Medicine Laptop Admission: Difference between revisions
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* Internal med-nephrology has always been collected at STB [[User:Ppiche|Pamela Piche]] 11:49, 2023 August 22 (CDT) | * Internal med-nephrology has always been collected at STB [[User:Ppiche|Pamela Piche]] 11:49, 2023 August 22 (CDT) | ||
* are nephrology patients at SBGH co-managed by an internal med service? so you would have two services listed? We only collect nephro patients that are on one of our medical wards, not overflow wards and we do not collect nephro EMIP [[User:Lkaita|Lisa Kaita]] 11:03, 2023 August 24 (CDT) | * are nephrology patients at SBGH co-managed by an internal med service? so you would have two services listed? We only collect nephro patients that are on one of our medical wards, not overflow wards and we do not collect nephro EMIP [[User:Lkaita|Lisa Kaita]] 11:03, 2023 August 24 (CDT) | ||
* Currently majority of time "nephrology" patients are admitted to medicine and are followed by nephrology service via consult, very occasionally nephrology may assume primary care on B5; STB does not follow nephrology patients once transferred from a collection unit. Looking through my EPR lists, I see STB did follow and collect Nephro EMIPs prior to patient follow, but this very rarely if ever occurred. [[User:Ppiche|Pamela Piche]] 11:22, 2023 August 24 (CDT)}} | * Currently majority of time "nephrology" patients are admitted to medicine and are followed by nephrology service via consult, very occasionally nephrology may assume primary care on B5; STB does not follow nephrology patients once transferred from a collection unit. Looking through my EPR lists, I see STB did follow and collect Nephro EMIPs prior to patient follow, but this very rarely if ever occurred. If STB was collecting nephro EMIPs prior to patient follow, then overflow nephrology patients were likely collected as well, though rarely occurred. [[User:Ppiche|Pamela Piche]] 11:22, 2023 August 24 (CDT)}} | ||
*For these inclusions based on location, once pt is transferred out of the Medicine ward location, we no longer follow the patient. (see [[#excluded patients]]) | *For these inclusions based on location, once pt is transferred out of the Medicine ward location, we no longer follow the patient. (see [[#excluded patients]]) | ||
Revision as of 10:54, 24 August 2023
This page defines what would be a profile in the Medicine portion of the database (see also Definition of a Critical Care Laptop Admission); it is relevant for Using Cognos2 to keep track of patients general data use.
Each Medicine profile constitutes all care in any Internal Medicine location (see Boarding Loc) or Service (see Service tmp entry) at a given hospital with certain exceptions (see #Excluded patients further below in this article). Thus once a patient is admitted to an Internal Medicine service at a given hospital (regardless of where they are physically), a profile begins -- and the same profile includes all continuous direct transfers among Internal Medicine services and locations while under Medicine at that same hospital. For a transfer between hospitals a new database profile is started.
Included patients
- Collection starts at Service tmp entry DtTm, ie possibly while still in ER.
- The following situations ARE included for the Regional Medicine Database.
Inclusion based on service
- Admitted under a Medicine service attending physician anywhere in the hospital (including, for example, if they are remaining in ED because there is no medicine ward bed yet). (see #excluded patients)
- includes "HSC Oncology / Medicine"
Inclusion based on location
- Admitted to a Medicine ward location but rather than being cared for by the regular ward team, the primary care service is
- Nephrology
- Neurology (includes "HSC Internal Med / Neurology" patients admitted to HSC HOBS)
- Oncology -- EXCEPT if admitted ONLY for chemotherapy (if complications occur and Medicine service takes over, admit the pt starting at medicine service acceptance)
- For this purpose, we INCLUDE Nephro, Neuro or Onc patients who are located on one of the mixed wards (i.e. wards that have both Medicine and non-Medicine [e.g. surgery] beds; an example of such wards are the mixed COVID wards). The rationale is that what we are seeking to capture is patients who use Medicine "resources". So by this criterion, Nephro, Neuro or Onc who are in ED are NOT included in the Medicine database as ED beds are not a Medicine resource.
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How should we handle those patients that are admitted under nephro in the ED and then a medicine service takes over, while still in ED? Do we capture the portion of stay while they were under nephro or do we only count the medicine portion as the first service? Both nephro and medicine care for the patient. If we ignore the nephrology portion would the previous location be HSC_ward? Lisa Kaita 11:37, 2023 August 22 (CDT)
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- For these inclusions based on location, once pt is transferred out of the Medicine ward location, we no longer follow the patient. (see #excluded patients)
Excluded patients
- The following situations ARE NOT included for the Regional Medicine Database:
- Oncology patients admitted only for chemotherapy. These are short stay patients with only nursing IPN entries.
- Nephrology, Oncology or Neurology patients whose primary care service is (respectively) nephrology, oncology or neurology -- who are NOT on a Medicine ward location.
- Patients admitted to HSC_H6 or HSC_H7S (High OBs) under "HSC Internal Med / Respiratory"
- Patients who use a ward bed for a procedure but are NOT admitted to the Medicine service, and indeed these patients are usually not formally inpatients at all. Examples include a patient who is using a ward bed for: insertion of a central line; diagnostic endoscopy; dialysis.
- "HSC Internal Med / Neurology" -- on HSC_H6, actually this fits into the above rules, as HSC_H6 is not a Medicine ward location.
- Interventional radiology pts admitted for an overnight procedure (not on Cognos EPR Report so easy to exclude)
- Exclude "HSC Oncology / Radiation"
- Exclude "IV infusion Administration"
- Exclude patients admitted to STB Internal Medicine/Respiratory service
Excluded service admissions can lead to missed records
There are scenarios in which a legitimate admission may be missed when Using Cognos2 to keep track of patients. If a patient's first location upon admission is one where we don't collect, the patient would be excluded from CSS. If the patient then moves to a location where we would collect them without changing services, this change will not show up in Cogonos since we already excluded the service admission. We have occasionally found these records when looking for other things, but some are likely getting through. We discussed this and could not think of a way to overcome this, so this is only to document that this can happen.
End of a database profile
Bed holds
To see when a profile should continue vs new profile, see Bed holds.