Admit From & Discharged To: Difference between revisions
Ttenbergen (talk | contribs) →Guidelines for the admit from source and discharge to location fields: link to new article Operating room visits and also pinging a question about unclear "admit from"s inside town |
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*** 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. [[User:JMojica|JMojica]] 11:31, 2012 November 15 (EST) | *** 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. [[User:JMojica|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) {{discussion}}(never resolved...) Ttenbergen 15:26, 2014 January 26 (CST)Ttenbergen 11:07, 2015 May 27 (CDT) | ****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) {{discussion}}(never resolved...) Ttenbergen 15:26, 2014 January 26 (CST)Ttenbergen 11:07, 2015 May 27 (CDT) | ||
==Direct Admissions== | |||
* DEFINITION: If a patient has been sent from a ward, ER or ICU to your hospital where the sending physician has discussed the case with the accepting physician and the accepting physician has accepted the pt to their service, this is a direct admission. These patients could still stop off in your ER, but are not seen by the ER doctors. Normally, when these direct admit patients arrive in ER, the accepting physician or service will be paged by ER and they will go down to assess the patient there and arrange for the pt admission. (this is usually the case with patients sent form other hospital ER's or wards). Patients that require ICU care and the ICU physician has accepted them will usually go directly to the ICU (without stopping in ER) | |||
===Deceased (Expired) patients === | ===Deceased (Expired) patients === | ||
'''Discharge-to''' must be left '''blank''' for patients who has expired. | '''Discharge-to''' must be left '''blank''' for patients who has expired. | ||
Revision as of 12:55, 11 June 2015
The Admit From value defines the hospital and ward from where a patient was admitted. The Discharged To value defines the hospital and ward 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.
- <hospital> Recovery and <hospital> Operating at any location can be used as admit from sources. It is not necessary to put the previous hospital code for these patients.
- see Operating room visits
- 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.
- Template:DiscussionFrom 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)Ttenbergen 11:07, 2015 May 27 (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)
Direct Admissions
- DEFINITION: If a patient has been sent from a ward, ER or ICU to your hospital where the sending physician has discussed the case with the accepting physician and the accepting physician has accepted the pt to their service, this is a direct admission. These patients could still stop off in your ER, but are not seen by the ER doctors. Normally, when these direct admit patients arrive in ER, the accepting physician or service will be paged by ER and they will go down to assess the patient there and arrange for the pt admission. (this is usually the case with patients sent form other hospital ER's or wards). Patients that require ICU care and the ICU physician has accepted them will usually go directly to the ICU (without stopping in ER)
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.
- Check OR from but not Surgical Type
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.
extract of S_AdmitDischarge via query S_AdmitDischarge_to_wiki
| location | code | surgical | active | old code | hosp | ward | notes
wiki_line |
|---|---|---|---|---|---|---|---|
| St Amant Center | AW | 0 | -1 | AW | |||
| STB Ambulatory Care | BA | 0 | -1 | BA | STB | added: November 24, 2004. Out patient dialysis, Day clinic, Day surgery, Cancer Clinic etc. | |
| STB CCU | BC | 0 | -1 | BC | STB | CCU | |
| STB Emergency | BE | 0 | -1 | BE | STB | ||
| STB MICU | BM | 0 | -1 | BM | STB | MICU | |
| STB Operating | BP | -1 | -1 | BP | STB | ||
| STB Recovery | BR | -1 | -1 | BR | STB | ||
| STB SICU (Legacy) | BS | 0 | 0 | BS | STB | ||
| STB Cardiac Surg Sciences | BV | 0 | -1 | BV | STB | CICU | |
| STB Ward | BW | 0 | -1 | BW | STB | ||
| STB x (Legacy) | BX | 0 | 0 | BX | STB | ||
| CON Ambulatory Care | CA | 0 | -1 | CA | CON | added: November 24, 2004. Out patient dialysis, Day clinic, Day surgery, Cancer Clinic etc. | |
| CON Emergency | CE | 0 | -1 | CE | CON | ||
| CON MICU | CM | 0 | -1 | CM | CON | MICU | |
| CON Operating | CP | -1 | -1 | CP | CON | ||
| CON Recovery | CR | -1 | -1 | CR | CON | ||
| CON Ward | CW | 0 | -1 | CW | CON | ||
| CON x (Legacy) | CX | 0 | 0 | CX | CON | ||
| Deer Lodge | DW | 0 | -1 | DW | |||
| Operating Room in known site inside WRHA | FP | -1 | -1 | FP | added Trish Ostryzniuk 17:23, 2013 April 8 (EDT) | ||
| Recovery Room in known site inside WRHA | FR | -1 | -1 | FR | added Trish Ostryzniuk 17:23, 2013 April 8 (EDT) | ||
| GRA Ambulatory Care | GA | 0 | -1 | GA | GRA | added: November 24, 2004. Out patient dialysis, Day clinic, Day surgery, Cancer Clinic etc. | |
| GRA Emergency | GE | 0 | -1 | GE | GRA | ||
| GRA MICU | GM | 0 | -1 | GM | GRA | MICU | |
| GRA Operating | GP | -1 | -1 | GP | GRA | ||
| GRA Recovery | GR | -1 | -1 | GR | GRA | ||
| GRA Ward | GW | 0 | -1 | GW | GRA | ||
| GRA x (Legacy) | GX | 0 | 0 | GX | GRA |
"|-|HSC H6 || H6 || 0 || -1 || H6 || HSC || || added: September 25, 2012 - is the only medicine ward in the Region at HSC that admits LTV, MD, AML, failure to wean patient, etc." | |
| HSC Lennox Bell | HB | 0 | -1 | HB | HSC | started: September 16, 2013 | |
| HSC CCU | HC | 0 | -1 | HC | HSC | CCU | |
| HSC Emergency | HE | 0 | -1 | HE | HSC | ||
| HSC MICU | HM | 0 | -1 | HM | HSC | MICU | |
| HSC Operating | HP | -1 | -1 | HP | HSC | ||
| HSC Recovery | HR | -1 | -1 | HR | HSC | ||
| HSC SICU | HS | 0 | -1 | HS | HSC | SICU | |
| HSC IICU | HU | 0 | -1 | HU | HSC | IICU | |
| HSC Ward | HW | 0 | -1 | HW | HSC | ||
| HSC x (Legacy) | HX | 0 | 0 | HX | HSC | ||
| OAK Ambulatory Care | KA | 0 | -1 | KA | OAK | added: November 24, 2004. Out patient dialysis, Day clinic, Day surgery, Cancer Clinic etc. | |
| OAK Emergency | KE | 0 | -1 | KE | OAK | ||
| OAK MICU | KM | 0 | -1 | KM | OAK | MICU | |
| OAK Operating | KP | -1 | -1 | KP | OAK | ||
| OAK Recovery | KR | -1 | -1 | KR | OAK | ||
| OAK Ward | KW | 0 | -1 | KW | OAK | ||
| OAK x (Legacy) | KX | 0 | 0 | KX | OAK | ||
| Misr Emergency | ME | 0 | -1 | ME | MIS | ||
| Misr M (Legacy) | MM | 0 | 0 | MM | MIS | ||
| Misr Operating | MP | -1 | -1 | MP | MIS | MR (*added Trish Ostryzniuk 12:11, 2013 April 4 (EDT)) | |
| Misr Recovery | MR | -1 | -1 | MR | MIS | (*added Trish Ostryzniuk 12:11, 2013 April 4 (EDT)) | |
| Misr Ward | MW | 0 | -1 | MW | MIS | ||
| Nursing Home Grace | NG | 0 | -1 | NG | |||
| Nursing Home HSC | NH | 0 | -1 | NH | |||
| Nursing Home | NW | 0 | -1 | NW | |||
| Other (Legacy) | OT | 0 | 0 | OTH | |||
| Children's Emergency | PE | 0 | -1 | PE | CH | ||
| Children's MICU | PM | 0 | -1 | PM | CH | ||
| Children's Operating | PP | -1 | -1 | PP | CH | ||
| Children's Recovery | PR | -1 | -1 | PR | CH | ||
| Children's S (Legacy) | PS | 0 | 0 | PS | CH | ||
| Children's Ward | PW | 0 | -1 | PW | CH | ||
| Riverview | RW | 0 | -1 | RW | |||
| VIC Ambulatory | VA | 0 | -1 | VA | VIC | added: November 24, 2004. Out patient dialysis, Day clinic, Day surgery, Cancer Clinic etc. | |
| VIC Emergency | VE | 0 | -1 | VE | VIC | ||
| VIC MICU | VM | 0 | -1 | VM | VIC | MICU | |
| VIC Operating | VP | -1 | -1 | VP | VIC | ||
| VIC Recovery | VR | -1 | -1 | VR | VIC | ||
| VIC Ward | VW | 0 | -1 | VW | VIC | ||
| VIC X (Legacy) | VX | 0 | 0 | VX | VIC | ||
| XA (Legacy) | XA | 0 | 0 | XA | |||
| XC (Legacy) | XC | 0 | 0 | XC | |||
| Outside City Emergency | XE | 0 | -1 | XE | |||
| Outside City MICU | XM | 0 | -1 | XM | |||
| Outside City Operating | XP | -1 | -1 | XP | |||
| Outside City Recovery | XR | -1 | -1 | XR | |||
| XS (Legacy) | XS | 0 | 0 | XS | |||
| Outside City Ward | XW | 0 | -1 | XW | |||
| Outside City | XX | 0 | -1 | XX | |||
| YA (Legacy) | YA | 0 | 0 | YA | |||
| YC (Legacy) | YC | 0 | 0 | YC | |||
| Outside Prov Emergency | YE | 0 | -1 | YE | |||
| Outside Prov MICU | YM | 0 | -1 | YM | |||
| Outside Prov Operating | YP | -1 | -1 | YP | |||
| Outside Prov Recovery | YR | -1 | -1 | YR | |||
| YS (Legacy) | YS | 0 | 0 | YS | |||
| Outside Prov Ward | YW | 0 | -1 | YW | |||
| Outside Province-Unknown unit | YX | 0 | -1 | YX | |||
| Hospice Care Center | ZH | 0 | -1 | ZH | |||
| Home | ZZ | 0 | -1 | ZZ |
Legacy
Very early missing Discharge-tos
There are 6762 very old ICU records who are listed as survived but don’t have a discharge-to. This is from HSC-only days when there simply were no checks. We will leave these be, just documenting here.