Intended1stSrvc

Projects
Active?:	planned
Program:	CC
Requestor:	Bojan Paunovic
Collection start:
Collection end:

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• This project is not live yet, do not follow the instructions to stop the old collection yet
• Planned go-live is 2025-01-01
• For now, continue to use the instructions in ICUotherService

Data Collection Instructions

When to code

• Collect this if the initial service, as encoded in Service/Location for records under the Definition of a Critical Care Program Admission, is not the service the patient "should" have been on
• No consistency or "not applicable" entry is required when applicable
• Reconsider this for each new ICU record for the same patient

Changes during the ICU stay

• only consider initial intent per record (see #Changes within an ICU service admission)
• apply a new consideration for each new record (see #Changes between successive ICU service admissions)

Data Entry Instructions

• Use tmp fields:
• Project: Intended1stSrvc
• Item: one of (HSC-MICU, HSC-SICU, HSC-IICU, STB-MICU, STB-CICU, STB-ACCU, GH-CC)
• all other fields are not used for this project

Data Integrity Checks (automatic list)

none found

Background

• Usually Boarding Loc and Service/Location fully explain a patient's admission's impact on bed capacity; Service tmp entry contents from Cognos2 do not actually contain data that is relevant for our use
• When demand exceeds capacity a patient may end up cared for by a different critical care service than the one they would have usually been assigned to.
• Without an additional signal, it would appear as if the capacity was sized right and accommodated the load, when really the sending service was over capacity, and the receiving service had (possibly excess) capacity to absorb the admission.
• This project encodes when the ICU service a patient is actually on (as encoded in Service/Location: MICU, SICU, IICU, ICMS, CICU, Grace ICU) is different from the service the patient should be on.

Example:

e.g. patient admitted from ED ventilated with severe pneumonia, should go to MICU but it is full, so goes to SICU and is taken care of by the SICU service. Here Service/Location is SICU and Intended1stSrvc is MICU e.g. patient in ED at Grace and should go to Grace ICU but it's full, so goes to HSC MICU. Here Service/Location is MICU and Intended1stSrvc is Grace ICU. This example shows that the Intended1stSrvc can be at a different hospital altogether.

Possible Responsibility/Location Scenarios

Group	Service should be on	Actual service	Actual location	Meaning
A	mine	mine	my ICU	my natural patients
B	mine	mine	different ICU	my boarders elsewhere
C	different	different	my ICU	somebody else's boarders in my ICU
D	mine	different	different	my "double boarders" elsewhere
E	different	mine	my ICU	somebody else's "double boarders" in my ICU

Changes within an ICU service admission

• As per Definition of a Critical Care Program Admission the same ICU profile (record) is maintained if a patient changes Boarding Loc while remaining under the care of the same service
• It is possible that the notion who "should" have cared for the patient changes over the course of the admission
• Sometimes such a change might be clear-cut (e.g. due to occurrence of a surgical procedure) but other times the fact that the service the patient should be on changes is just within the heads of the attending physicians.
• The notion may not have been recorded at all, and would be hard to abstract from charts consistently even if it was implied
• Adding the ability to maintain multiple entries for this relatively rare event would significantly increase reporting complexity
• We explicitly decided NOT to try and track the service a patient should be on as time goes by, but only upon initiation of an ICU profile, which is why this variable is called "Intended1stSrvc"

Example:

Patient with acute MI admitted via ED. He should have been under the ACCU service in ACCU but ACCU was full. So he was admitted to ICMS instead under the ICMS Service. Thus here Intended1stSrvc = ACCU.

• If the patient was initially on a service they should not have been on, and is then changes status such that the present service is the intended one, there is no change in service (so no new record), and the initial status for the record as Intended1stSrvc stays.

Example:

Intended1stSrvc is STB ICSM taken care by ACCU service (May 24,2023 13:17) boarding at ACCU bed , then by May 26,2023 15:40 became an ACCU patient taken care by ACCU in same ACCU bed until discharge to ward June 5,2023 16:22.

Changes between successive ICU service admissions

• As per Definition of a Critical Care Program Admission we create a new ICU profile (record) when the ICU service changes
• We considered carrying over the prior value of Intended1stSrvc when a patient is transferred ICU-to-ICU, but decided against this as it creates other ambiguities
• The decision of whether this project applies will have to be re-assessed for each new record under the Definition of a Critical Care Program Admission

Terminology for services inconsistent with EPR

• We recognize that the drop-downs we chose are different from the standardized terms in EPR; it was decided that this is OK because the perception is that our terms are what leadership actually wants

JALT 2025-12-18 JALT - We may want to discuss the discrepancy of our naming and its implications with the recipients of our reports and possibly the team that reports similar out of EPR. Ttenbergen 14:44, 23 December 2025 (CST)

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Left to resolve

need to resolve before we can start collecting

Could you confirm that there are no changes required to the following pages? We discussed that details about them might change as part of all this. Ttenbergen 14:44, 23 December 2025 (CST) Service/Location field Service tmp entry

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can be left until later but may complicate analysis or degrade data

There is a question that may be related to this on ICUotherService for you, could you have a look? Ttenbergen 14:44, 23 December 2025 (CST)

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Indicator page ICU Service Location Discrepancy will need to be updated.

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JALT Can these entries only be at the same site as the record (eg would "Gra ICU" be a legit entry for a patient at HSC MICU)? If only same siet that may be a relevant cross-check.

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We need to confirm that the change is properly linked and contextualized on 2025-05 Revision of concept around ICUotherService (one of the Change Explainer Pages) to allow a user of our data to reconstruct a continuous conceptual timeline. Someone other than me should review that page to confirm that the change is explained fully enough to make sense of the before and after data Ttenbergen 14:44, 23 December 2025 (CST)

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resolved

• just for tracking
  • TT reviewed and resolved "what links here" for ICUotherService

Data Use

• see ICU Service Location Discrepancy
• for legacy context also consider ICUotherService, a similar concept that used to be collected; see 2025-05 Revision of concept around ICUotherService for details

Log

• -> 2026-01-01 - this entry essentially replaces ICUotherService
• 2025-12-18 JALT - decision that dropdown listings for this should be the same as for Boarding Loc
• 2025-12-23 - broke out ICU Service Location Discrepancy to document how indicators and metrics will be derived from this
• 2025-09-25 - change of ICUotherService to this way of coding the concept was first discussed, page generated for Allan to update.
• See 2025-05 Revision of concept around ICUotherService for decisions leading up to implementation

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