Service Sending to ICU

for tracking which service is taking care of a patient in STB CCU, see CCU Service Tracking instead

Purpose

To identify the "sending service" or "originating service" for those who came to ICU from a prior inpatient location (refer to Task Meeting Minutes April 13,2015). This is different to the "service of the attending" during the patient's stay in ICU.

Data Collection Instructions

For each patient who meets the following conditions:

• critical care patient
• was an inpatient before coming to ICU (even if arrived via temp location such as ER, procedure suite, OR or RR)
• doesn't arrive from another ICU or CCU(ie not an inter or intra transfer)

Template:Discussion If they were not on an inpatient unit(ward) prior to ER,procedure suite,OR or recovery room you wouldn't put the service sending? Can anyone who knows the answer clear this up for us?

add a single tmp entry with the following:

• project: Srv to ICU
• item: the sending service, in case of OR, the service of the OR physician:
  • Medicine
  • Cardiology
  • Psych
  • Ob/Gyne
  • Family Medicine (only relevant at sites that have family medicine)
  • General surgery (including ACSS and Trauma surgery)
  • Cardiac surgery
  • Thoracic surgery
  • Urologic surgery
  • Ortho surgery
  • Neurosurgery
  • Vascular surgery
  • Plastic surgery
  • z_other - any others such as EENT surgery at STB
  • z_not applicable - in this case an entry to the comment field in tmp will be required. (z_ to sort to bottom)
• the other tmp fields are not used (except in "not applicable" scenario)

How to determine?

We want to know what service the physician who sent the patient worked for at the time. Some physicians wear multiple hats, so name of physician is no good. Some locations have patients from multiple services, so location is no good. Template:Discussion

• How are collectors determining this? How often would you be not sure which service is sending a patient - Ttenbergen 14:54, 2015 June 25 (CDT) Ttenbergen 16:52, 2015 July 13 (CDT)
  • I have not been looking at the service information on a regular basis, but do know that the initial service for the SICU admission may be changed very soon after admission to the unit.--Jpeterson 09:57, 2015 July 15 (CDT)
    • hasn't been a problem thus far, in EPR there is a pt provider section that shows what service(s) the pt has been under, as well there is often an indication of service change in the EPR orders section Lisa Kaita 12:22, 2015 July 15 (CDT)
      • Is it always the service where a patient was most recently that is the "sending" one? IE, are there scenarios where a "consultant from other service" of some sort is called to the ward where a patient is, and that consultant sends to ICU. In that case, do we want the ward where the pt was, or the consultant? Ttenbergen 11:46, 2015 July 16 (CDT)

family medicine?

Our concern is not about previous ward, but about 
the service of the physician to transferred to ICU.
Leaving here for now but no sense discussing further
along this... 

• What is the difference between family medicine and medicine?
  • we only admit medicine patients which have CTU and VMU doctors looking after them . Family medicine has a list of FM doctors who we do not follow these patients.We at the Vic do not go to 4North which contains all FM patients. The Vic follows patients on S4 (CTU) S3 /S5/N5 (VMU)
    • this is an ICU project, so not about whom we admit, I think this thread is off topic... Ttenbergen 14:54, 2015 June 25 (CDT)
  • only relevant at sites that have family medicine. I think that's Oaks and Vic? Could one of those sites clarify? Ttenbergen 10:41, 2015 June 24 (CDT)
    • SBGH also has family medicine, HSC has Geriatric medicine, I think its referred to as this, Louise can confirm, are we including Rehab? ie. there are are some inpatients from HSC, Deer Lodge, Riverview that are part of stroke rehab or Geri rehab? Lisa Kaita 10:34, 2015 June 25 (CDT)
      • I don't understand... are you just explaining that Family Medicine is happening at more places, or do we need to add other options for this tmp collection? Ttenbergen 11:38, 2015 June 25 (CDT)
      • I think it would be helpful to put a list of the family medicine wards on the wiki for people who are unfamiliar and are covering. I know for STB that 6AS is family medicine, not sure if other wards have some family medicine. --LKolesar 11:52, 2015 June 25 (CDT)
      • B4 is also family medicine at SBGH, E4 is geriatric rehab medicine, 6AS has both family medicine and internal medicine overflow, My other point/question is are we lumping all the different types of medicine (geriatric rehab, stroke rehab under "medicine" or should there be other options for sending service? Lisa Kaita 12:09, 2015 June 25 (CDT)

other options required?

If other options are required, please comment here.

• Someone suggested we might need "Emergency" but since this is only for patients coming from other inpatient locations we won't include it for now. Can add later if it becomes an issue. (Tina)
  • We could go either way. Might NOT code unless came from an inpatient location, but this isn't perfect because then the people admitted to a service while still in ED wouldn't appear to qualify even tho they DID come from another service. Alternatively, change that entry, include options of 'ED' and 'unknown'. This latter option has the advantage of including 'unknown' which should take care of the situation when it's apparently not collectable. We should discuss this I suppose at next task group. What do you think? (email from Allan Garland)

Start/End Dates

• Start: 2015-06-22
• End: there is no planned end date

Template:CCMDB Data Integrity Checks

• Query s_tmp_Service_Sending_to_ICU - Error if:
  • not admitted from inpatient location ((S AdmitDischarge.inpatient = true)) but has "Srv to ICU" entry
  • admitted from inpatient location and one of
    • no "Srv to ICU" entry
    • has "Srv to ICU" = "z_not applicable" and no comment

Template:Discussion Right now our consistency check would not allow someone from other hosp via ER. We won't be able to do this check until we have PrevInptLocation field. I will take that check out for now. Ttenbergen 11:50, 2015 June 24 (CDT)

• Query s_tmp_Service_Sending_to_ICU_duplicate - error if more than one entry per patient Ttenbergen 15:35, 2015 June 22 (CDT)

See also

• STB Cardiac Care patients
• Registry Patient Type

to do before go live

• Registry_Patient_Type#C-Cardiac_Type - awaiting confirmation
  • "Once this tmp study section is active we can go back to making the pt type relate to the type of diagnosis." (Laura K)