| Data Element (edit)
|
| Field Name:
|
off_ward
|
| CCMDB Label:
|
Off Ward
|
| CCMDB tab:
|
Dispo
|
| Table:
|
L_Log table
|
| Data type:
|
number
|
| Length:
|
long integer
|
| Program:
|
Med and CC
|
| Created/Raw:
|
Raw
|
| Start Date:
|
2016-07-01
|
| End Date:
|
2020-01-29
|
| Sort Index:
|
39
|
Checked/true if the patient who meets the Definition of a Medicine Program Admission or Definition of a Critical Care Program Admission spent any time in a bed that is not at their actual collection location between "Arrive DtTm" and Dispo DtTm. The patient must be covered by the attending of the service of the home unit that is credited with the "off ward" designation.
Legacy implementation right in the table
Legacy
- Allan suggested this OFFWARD field for some reasons related to outcome. you are right the tmp Boarding will indicate patients staying in offward locations. Offward started July 2016. CC started tmp Boarding July 2018 while Med on Sept2019. since offward start date was before any of these BL dates, we need to keep those data in prior dates. --JMojica 16:18, 2022 August 12 (CDT)
- Here is a query with counts by send time:
TRANSFORM Count(L_Log.D_ID) AS CountOfD_ID
SELECT Format([SentDtTm],"yy-mm") AS send_month
FROM L_Log
GROUP BY Format([SentDtTm],"yy-mm")
ORDER BY Format([SentDtTm],"yy-mm"), L_Log.off_ward
PIVOT L_Log.off_ward;
- It actually looks like we used this from 2014 onward, even if the data definition on this page says from 2016.
There is a weird spike in Jan 2018, other than that numbers in a similar range between 16-07 and 20-03. So from when until when would we consider this data reliable? We should likely clean up values outside that range so no one thinks records are reliably tagged outside that range. Ttenbergen 11:23, 2022 August 23 (CDT)
- For the pre2016 profiles, the OFFWARD field is pre-populated by the old VAR3, ICU Var 4 - Parked in ER , VAR5 (see below) and therefore they are reliable. Actually Var3 to Var5 specify the units they are overflowing (similar with tmp Boarding but only with location and no start dates). If I remember right, when Allan introduced OFFWARD, he was thinking of the specific location but the idea was not received well and so decided just to be binary code YES/NO. For research project needing historical data, I think binary data would still be useful. we can either keep it AS IS or be saved as tmp project. --JMojica 15:38, 2022 August 29 (CDT)
Old instructions
This includes patients who spend part or all of their admission located on an off service ward, but not #EMIPs.
How to enter patient into CCMDB
Collection Instructions - current ward
If the patient meets the definition at the top, check the "off ward" checkbox located underneath the Service/Location field.
Enter the laptop's regular collection location into the Service/Location field, not the off-ward location.
Collection Instructions - next ward (if applicable)
The Pre-admit Inpatient Institution field and Previous Location field of the next encounter would use the Service/Location field of the previous collection location where available, not the off-ward location.
Collection Instructions - previous ward (if applicable)
The Dispo field of the previous encounter would use the Service/Location field of the next collection location where available, not the off-ward location.
Not intended for off-ward tests
see Bed holds
EMIP
EMIPs are in their collection location, e.g. GRA_EMIP, so they are not off ward. Don't check the field.
Parked in ER
Parked in ER is before Arrive DtTm, so they are not "off ward". Don't check the field.
- find patients as per off ward field article
- Write down a list of these patients with their chart numbers on a paper.
- Place this list on the bulletin board in the medicine office so that both medicine data collectors are aware that there are medicine service patients on off-service wards in the hospital.
Entering off ward patients
- If these patients ultimately get transferred to one of the medicine wards, then the data collector that does that ward will enter those patients on their laptop, reflecting their entire stay from the admission from ER. In the dispo tab the Off ward field must be ticked off as they were off ward for part of their stay.
- If these patients get discharged from the off service ward to home or out of hospital location, then these are considered Off ward field that must be entered on one of the medicine laptops, because their entire stay was on an off service ward.(There may be individual hospital differences on which laptop is used for these entries).
- This patient list can be posted on the bulletin board of the medicine office. If they are admitted to one of the medicine wards, then that data collector will cross that person off the list. Once a week check if the pt is still in the hospital, if they have left and were never admitted to one of the medicine wards, then a designated data collector will enter them on her laptop. --LKolesar 12:54, 2017 March 2 (CST)
Patients who are on a off wards for part of their stay only
- When a pt comes to one of the medicine wards from an off-service ward, the data collector must go to the original presentation of the pt to see if this pt was accepted to medicine on the off-service ward prior to their arrival on their own ward. If you see that the pt was looked after by internal medicine prior to their arrival from the other ward, make sure you start your profile on the original date that medicine accepted them (usually in ER).
- On occasion, medicine patients are transferred to off service wards, but are still admitted under the internal medicine service. ie. patient transferred from a medical ward to a surgical ward but still are admitted under internal medicine service. The attending may be different than the admitting service but it is still an internal medicine attending. Please continue to follow these patients (new profile is not required) until they are discharged or transferred to an off service ward under family medicine or any other service other than internal med. Please note the location in the RECORD box to indicate where the pt is currently located. --LKolesar 13:05, 2017 March 2 (CST)
How to determine when a patient is no longer under an internal medicine service
In the EPR the patient list will show the "provider" which should identify which service the attending physicians is from. However, because this is not always consistently kept up to date when services change, the following checks can help to determine if a patient remains under internal medicine or switches to another service.
1. In EPR,Check the orders under transfers/care directives, to see if there has been an order to switch from internal medicine to another service. Use the time transferred to the other ward as the discharge time or use the time in the order when the other service took over care if the pt remains on the off-service ward. (orders are currently only available to view at STB).
2. In EPR, go to the patient info tab, select care providers from the left hand column, a list should come up with providers and their discipline with a date. If you see that the most recent attending is no longer an internal medicine physician then there has likely been a change of service. You may be able to confirm this by checking under the documents tab, sort by discipline, and then check the medicine notes that correspond to the date found in the care providers list. The progress notes from different services will be identified as such in the notes section. If you determine that they are in fact now under a new service (with no corresponding order), use the date and time of the attending switch in the care provider list as your discharge date and time.
Data Use
Relevant to Bed occupancy and some patient risks.
As of 17:13, 2017 November 9 (CST) we don't use it in reports but it is used to explain such things as over-census situations.
See also
Cross Checks
Legacy but still implemented: ACCU_borrow#If_ACCU_entry_then_off-ward_should_be_checked
Legacy
initial mis-connection
From 2016-07-01 to 2016-08-?? the control for this field had been incorrectly connected to the pharm_complete field. Since medicine doesn't use that field we could reclaim data for medicine from there. CC uses the field so could not reclaim data for them. Data for CC will be reported starting 2016-09-01.
pre-2016 fields for similar content
We used to collect related information in multiple places. Once we are comfortable with the new dispo fields we want to stop collection of the old fields. The fields are:
Old data would be transferred to new fields where the translation is not ambiguous. We can keep a snapshot of Centralized with the data pre-translation in case we ever want to go back to it.
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