Overstay Predictor Project Collection Instructions

This article explains how to collect data in the CCMDB.mdb for the Overstay Predictor Project.

For every medicine patient admitted to the Grace 5N, as soon as possible, but definitely within 48 business hrs of admission the data collector will need to enter the data in the Nursing Discharge Screening Tool form into the CCMDB.mdb, enter a certain amount of regular data early to generate a colour, put a sticker of that colour onto the chart, and in case of certain colours notify the transition coordinator.

Entering the Nursing Discharge Screen Tool data into CCMDB.mdb

Find the white Nursing Discharge Screening Tool form with the admission documentation on the patient chart and check if there is either a yes or no for all the first 6 questions. The form is to be completed within 24 hours of admission; if it is not possible at time of admission, the admitting nurse will pass the responsibility for completion to the next duty nurse

ensuring completeness within 24 hrs

If you can't find the form or an answer is still missing 24 hrs after admission:

• enter the "form data missing" entry into the tmp table
• check with the bedside nurse and remind them to complete it; still the remaining data into CCMDB.mdb if it now becomes available.

The nurse can update the form within the first 24 hours after admission if, for example they receive information from the patients family that contradicts the patients answers. It is possible that depending on when you review that document these changes are not captured. This a known risk that has to be accepted.

entering the data

For the first 6 questions on the form, create a record for each in tmp entries and check the check box if the answer is Yes.

Question 4 consists of several sub-questions re. the patient's inability to manage daily activities. If even one of the activities raises a concern then summary answer for the question needs to be "no".

Take answers to questions directly from the form, no interpretation, even if you disagree after reading the chart. We will be testing the answers provided by the nurses to determine if they are a better predictor of transition support needs or can be used in conjunction with existing admission data to improve the effectiveness of the prediction tool. If the data were interpreted by the collector it would introduce another factor and make this test less valid.

• If the patient is transferred from one medical unit to another within the facility, is their overstay predictor redone or do they carry the one from the original admitting ward with them? Template:Discussion As it stands once the patient has been identified they will continue to be monitored by a Transition Coordinator till the time of discharge. So only one Discharge Screening Tool is required.

Changes to regular data entry required for the Overstay Project

A number of items in addition to the regular Minimal Data Set needs to be entered before the generation of the chart colour in the next step because the algorithm uses this data:

• DOB
• Admit Date
  • The time we use as the time of admission will be different than the time of admission to the unit, and often significant time has passed between the 2 times so the information collected is different e.g. pt is confused at our admission time but by the time the patient goes to the unit, the patient is now A & O etc or vice versa. Will this affect the algorithm?
    • Use the data as you would have entered before as that is what the algorithm was based on. I hope that helps, since I know some collectors used to collect this much later. Pls let me know if you need more info.--Ttenbergen 12:47, 2012 April 27 (CDT)
    • Which admit date should be used as the 24hr cut-off for the form, the official one or "ours"? Ttenbergen 14:29, 2012 July 13 (CDT) Template:Discussion
• ADL
• any Overstay Predictor Diagnosis Code Used (note exclusion of most comorbids and all acquireds/complications)
  • if a dx is entered as a working diagnosis but not yet confirmed, do enter that diagnosis
  • only dxs as listed in Overstay Predictor Diagnosis Code Used need to be entered early, i.e. the rest can be entered as they were before

• will these next 3 cause collection problems? Ttenbergen 16:36, 2012 July 19 (CDT)
  • province, since out-of-province patients are excluded
  • admit-from location, since admits from nursing homes will be excluded (ie AW,NW,RW,DW)
  • admit diagnosis of "Palliative Care", since palliative patients will be excluded
• Right now incomplete data will cause the sticker color to be gray in ccmdb.mdb. What should the sticker colour be if form data is not available? Ttenbergen 14:29, 2012 July 13 (CDT) Template:Discussion

Chart Stickers

Once the required information has been entered click the new “Overstay” button on the patient viewer form next to the notes field and it will turn a colour based on an underlying algorithm

• GREEN - low/no risk for discharge issues
• YELLOW - some risk for discharge issues
• RED - significant risk for discharge issues assign a transition coordinator.
• GRAY - if some needed data is missing

Based on the color displayed put that colored sticker on the spine of the patient chart. The sticker 3/4 inch stickers will be located adjacent to the transition coordinator binder at the unit clerk desk.

Note: There is currently a small red dots used to indicate long term chart. There is also a small yellow dot used to indicate VRE.

no need to document sticker colour changes

1. Will it be necessary to document a difference in sticker colours if we need to change the colour once the algorithm has run?
   • No need. The original colour is based on the items you enter into tmp, so we can go back from that if needed. Ttenbergen 12:47, 2012 April 27 (CDT)

test scenarios for colours

1. How can I test the yellow colour?-I can only get the overstay button to be red or green using multiple different combinations of the check boxes
   • Yellow would be based on a combination of comorbids and ADLs and age. Make a patient a little less sick and they will become yellow. Sorry, can't give you exact instructions, the algorithm is pretty messy. Ttenbergen 12:47, 2012 April 27 (CDT)

Notifying the Transition Coordinator

If the patient has been designated as "red" for purposes of overstay prediction, the data collector will notify a Transition Coordinator by placing the patients name beside the transition coordinator on call for the time period of the patients admission. The transition coordinators will be assigned to cover between Friday to Monday, the next shift will go to Wednesday, the last will be Wednesday to Friday. If the designation is made after 1500 on the day of entry, the assignment will be deferred to the next day's coordinator. The rotation of Coordinators is made up of Home Care, Social Work, Physio, And OTs. After assignment, that service is responsible for following that patient throughout their hospital stay.

Programming Stuff

testing for consistent data

Template:Discussion I intentionally left out one of the overstay questions in the temp file expecting to get a gray overstay predictor score indicating missing information but am getting yellow-is this correct?

• should be fixed in CCMDB.mdb_Change_Log_2012#ver_2012-07-13Ttenbergen 16:25, 2012 July 13 (CDT)

button colour persistence

Every time I exit the Database and then reenter, I have to repress the overstay button as it has gone gray; reported on May 8.12.-- Stephanie Cortilet.

• This is by design. The button starts out gray when the form opens and only changes when it is pressed. The colour is only used once, so there is no need to keep it. Also, to keep it a variable would be required to store it and we don't have one. Ttenbergen 16:31, 2012 July 13 (CDT)

violent behaviour dx

Is the DX code for violent behaviour secondary to dementia included in the list?

• I would say yes. Linda will check with Julie Mojica--Trish Ostryzniuk 13:03, 2012 July 6 (CDT)Template:Discussion

pt from nursing home

Does the algorithm include age, and/or whether the patient originally came from a nursing home? Patients from an existing nursing home bed will not overstay as frequently as those from home.

• All these factor have been considered. See Media:Two_Stage_Predictive_Model_of_Patients_in_Need_of_a_Transition_Coordinator.pdf Twostagepredictivemodel.pdf] for details--Linda Hathout 21:51, 2012 July 5 (CDT)

automatic generation of tmp entries

Is it possible for the 6 overstay requirements in the temp file to be generated automatically like the postal code is rather than having to add the 12 items manually? we then would just have to check the box to answer each question

• not for now. I am hoping to move to a pre-entered model for all tmp studies in the future but can't get to it at this time. Ttenbergen 16:29, 2012 July 13 (CDT)