Admit From & Discharged To

The Admit From value defines the location from where a patient was admitted from. The Discharged To value defines the location that a patient was discharged to.

Guidelines for the admit from source and discharge to location fields

It is important to obtain the correct location where the patient was prior to their ICU care and to distinguish between a pt that had been treated prior in any ICU or hospital ward as this can influence outcomes. The concept is that a pt that had prior inpatient care (ward or ICU) and still requires additional ICU care has a higher risk of death than someone who did not have prior care (coming from the community to ER). The following guidelines will apply:

• When ER is indicated as the admit from location, this implies that the pt originated in the community.
• If a pt was bounced around a lot, then use the last ward or ICU as the source.
• PARR and the OR at any location can be used as admit from sources. It is not necessary to put the previous hospital code for these patients.
• The OR can be used as a discharge to location only if the pt is not returning to your unit. (Discharge to a different inpatient location following surgery).

• If it is unclear what type of unit the patient is transferred to or discharged to outside city or province, put unknown. Unknown is coded as "X". See table below.
  • From a collection perspective, is it ever unclear inside the city where a pt came from. If not, we are good, but before the above was changed, it instructed to use *x even inside the city, and now it no longer has instructions for inside the city. Ttenbergen 11:50, 2012 November 15 (EST)
  • within city hospitals "x" as second letter is not an options. Is that a problem? Ttenbergen 17:18, 2012 October 19 (CDT)
    • Yes, it will be a problem in the linking of admissions across hospitals for those who have more than one admission. After appending, we will know eventually the unit where the patient was transferred when doing the linking and therefore we want the unit to be specified at the entry level than do the changes later. In addition, for the Critical Care, the Directors are monitoring the inter and intra facility transfers in the region so we need to be specific (no unknowns). Also for Critical Care, the specific location the patient went within the region is needed to determine if the patient's next admission is a readmission or not. JMojica 11:31, 2012 November 15 (EST)
      • Of course we want the data if available, but would we rather have a guess or have the collector spend time pursuing. And, what I meant was, has it been a problem for collectors to not have the "unknown" option in town, i.e. is there ever a legitimate reason to loose track? Ttenbergen 18:15, 2013 April 8 (EDT) Template:Discussion(never resolved...) Ttenbergen 15:26, 2014 January 26 (CST)

Deceased (Expired) patients

Discharge-to must be left blank for patients who has expired.

• this includes Braindead Organ Donors that go to operating room (OR) for organ donation.

Organ Donor/Braindead

Specific procedures apply, see Organ Donor article for details

OR Admissions

To be admitted from an OR (i.e. admit from = *P), the primary admit diagnosis must be the procedure they were in the OR for. See Check ORDx for more info.

from out-of-town via ER

• If a pt has been treated in one or more ER's PRIOR TO ICU or ward admit, the ADMIT FROM should be the ER the patient was in just PRIOR to ICU or ward admission.(reviewed by Task committee December 5,2012)GHall 17:21, 2012 December 5 (EST)-Trish Ostryzniuk 12:03, 2013 October 3 (CDT)
• If a pt has been treated at any hospital ward or ICU inside or outside the city or province, it is important to capture this information, even if the pt went to your unit via ER for assessment. Your hospital ER in this case is just a triage area and not the original place they presented. For example: if a pt has been on the ward in Selkirk and is transferred to HSC ER and then is sent to HSC MICU, the admit from is Selkirk Ward, even though it is not a direct transfer. -Trish Ostryzniuk 12:03, 2013 October 3 (CDT)

All my out-of-town patients who are directed straight from those ER's (or Nursing Stations) come through our ER unless they go directly to the OR. If I show all of these as HSC ER admissions, the other info will be lost. Is this what you want? Also, they are bringing in patients from the field by direct helicopter to the airport. I am only able to code these as admit from HSC ER, is that what you want? <who, when?> Template:Discussion

Internal Discharge-To locations we don't code

The following internal discharge-to locations cannot be used. If the patient goes to these locations, then code where they go afterward as discharge to field. If the patient dies at one of these locations, code patient as deceased.

• ER
• ACF
• the heart cath lab; see also #From other hospital via Angio

STEMIs at St Boniface

Occasionally a patient is picked up by paramedics at home and transferred directly to the heart cath lab at St. Boniface Hospital. They will not go to ER first to facilitate a very rapid "primary" PTCA. For these patient's admit-from code location prior to arriving at this hospital, not ER or OR. See STEMI for more information.

From other hospital via Angio

If a patient comes from another center to angiography in your center, then to your unit, please record which site the patient was from prior to angiogram and in Hospital previous put the center that they had been sent from.

From OR to other hospital via PACU

If a patient is admitted at site-A ER, transferred to site-B for a non-angio procedure, it is determined in site-B PACU that they need an ICU bed and they are transferred to site-C ICU, then code as admitted from site-B Recovery Room.

Direct to Medicine from Ambulatory Care

DIRECT to Medicine are patients who the medicine service attending Dr. has already accepted to their service, but the patient is sent to the ER to wait for a ward bed.

Example of Direct to medicine from ambulatory care clinic: Admit FROM: HA Medicine service Accept date (date and time admitted to medicine service): is the date and time patient came to ER MOVE 1 – date and time patient actually arrived on the ward Comment for MOVE 1– type in as follows: parked in ER

If a patient is sent to ER from ambulatory care to be assessed by Medicine Service in ER to see if he should or should not be admitted to a med ward bed, then this is not a direct admission to medicine. Admit from is HE.

Template:CCMDB Data Integrity Checks

• If medicine patient admit from ward, we need Med Var 1 - Admit-from Ward (implemented by Function AdFrom_Var1_reconcile())
• If medicine patient discharge to ward, we need Med Var 2 - Discharge-to Ward (implemented by Function DisTo_Var2_reconcile())
• For survived patients, Discharged-to should never be blank (implemented by Function DisTo_Dead()))
• For expired patients, Discharged-to should always be blank
• Admit-from or discharge-to should not be the same as current location. This can only be checked for ICU since individual wards are not included as destinations in medicine.

Data Structure and details

S AdmitDischarge is the table which contains the list of the most current values in CCMDB.mdb.

Acceptable Data

• It is important for data collectors to be aware that the letters used in the section below are not on the laptops and are only utilized by Julie, Trish, Pagasa and others who process the data.

These values always consist of two characters. The first letter designates the facility, the second letter the location in the facility.

The meanings for the codes are as follows.

• Special Note: For patients who were admitted from a hospital outside of Winnipeg, also see the entry for hospital previous.

First Letters / Hospitals

Hospital/Site	First Letter
HSC	H
St Boniface	B
Grace	G
Victoria	V
Concordia	C
7 Oaks	K
Children's Hospital	P

Second Letters / Locations

Location	Code Key	Notes
H6 ward at HSC	6	added: September 25, 2012 - is the only medicine ward in the Region at HSC that admits LTV, MD, AML, failure to wean patient, etc.
Ambulatory Care	A	added: November 24, 2004. Out patient dialysis, Day clinic, Day surgery, Cancer Clinic etc.
Lennox Bell Lodge	B	started: September 16, 2013
CCU	C	HSC and STB Hospitals only
Emerg	E
MICU	M
Operation Room	P
Recovery Room	R
SICU	S	HSC and STB only
IICU	U	HSC only
CICU	V	STB Hospital only
Ward	W
Location Unknown	X

Special Locations where only limited combinations are allowed

Misericordia Urgent Care	ME
Misericordia Ward	MW
Misericordia Recovery Room	MR (*added Trish Ostryzniuk 12:11, 2013 April 4 (EDT))
Misericordia Operating Room	MP (*added Trish Ostryzniuk 11:40, 2013 April 12 (EDT))
Nursing Home	NW
Nursing Home Ward at HSC	NH
Nursing Home Ward at Grace	NG
Deer Lodge	DW
Riverview Center	RW
St Amant	AW
HOME	ZZ

Any other KNOWN sites inside WRHA that are not included elsewhere

These apply, for example, to Maples Surgery Center, Pan Am Surgery Center Operating Room. Label in CCMDB.mdb does not include this because it would be way too long for the field.

Operating Room in known site inside WRHA	FP	added Trish Ostryzniuk 17:23, 2013 April 8 (EDT)
Recovery Room in known site inside WRHA	FR	added Trish Ostryzniuk 17:23, 2013 April 8 (EDT)

Non-Winnipeg Codes

• For any non-Winnipeg codes, the “hospital previous” number code must also be entered. (see Hosp number code table).

Outside City	X*
Outside Province	Y*

• Outside City Emergency XE
  • Outside City MICU XM
  • Outside City Operating XP
  • Outside City Recovery XR
  • Outside City Ward XW
  • Outside City Unknown unit XX
  • Outside Prov Emergency YE
  • Outside Prov MICU YM
  • Outside Prov Operating YP
  • Outside Prov Recovery YR
  • Outside Prov Ward YW
  • Outside Province-Unknown unit YX

Legacy

Discharge-to field

• Emailed Julie: "In setting up linking I came across 6762 old ICU patients who are listed as survived but don’t have a discharge-to. ... I suspect this is known and that the field was added later (just from where it is). Do we have a record when (or at what study #) coding this started." Ttenbergen 11:14, 2014 May 21 (CDT)
• As far as I know we have always put in a discharge to. I am surprised there are so many without this information, it sounds like a computer error, is this possible?--LKolesar 07:38, 2014 May 22 (CDT)
  • There are pts with a discharge-t from very early on, but there were much fewer error checks then. The affected patients are very early patients, the latest is from 1998/Aug/11. I flagged this to Julie partly to confirm if it's an import error.Ttenbergen 12:56, 2014 May 22 (CDT)
  • Prior to 1999 only HSC had the database. I only started as a data collector in April,1999 when STB and the other hospitals came on board. --LKolesar 09:14, 2014 May 26 (CDT)