EMIP

EMIP stands for Emergency Medicine "IN" patient. It is used for patients who are admitted to our internal medicine service and spend their entire admission under one of the medicine services we follow in the ER (emergency department). We are tracking this as VIC_EMIP, GRA_EMIP, STB_EMIP and HSC_EMIP.

Definition of EMIP

1. Pt has an order or some entry that medicine has accepted the patient while still in ER.
2. The patient leaves the ER to either
   • home or
   • any other out of hospital location or
   • the patient is transferred within the hospital to any service because Medicine decides that they will not take the pt but the patient needs different care or
   • dies in ER ("ED Death after Arrival" in Cognos)
   • leaves AMA ("ED Reg/Triaged/Assess LAMA" in Cognos)

Collection Instructions

See site specific collection guides for details on the collection process, papers, binders.

Identifying EMIPs in Cognos Admitter

Laptops in the PatientFollow Project

EMIPs show up in Cognos Admitter and are filtered by the "Mine! Mine!" button to limit to the subset collected on a laptop. Because they don't have a Unit Arrive DtTm they filter to the end of the list when sorted by date.

If a patient is listed who is still in the ER at the time the list is reviewed (i.e. it isn't clear if they will turn into a fully arrived patient or an EMIP), ...

What would be the best approach: Enter them as EMIP and change the location to a Ward later if the patient arrives on a ward; this would provide the most complete data but would cause Orphans in Centralized data.mdb when changed to a ward later delay entering them until it is clear whether they have become an EMIP or a fully arrived patient After discussion in the office we thought the best option would be to delay entering them until we know if they are an EMIP or a regular ward admission. We thought a pop up reminder when you "x" out of the admitter window would be helpful (you have un-entered admissions do you really want to close?) or something like that would be helpful. We all here read the pop-ups and find them helpful, ... This will likely be addressed by 2020-10 EMIP changes. If it has been addressed, please integrate and delete the discussion.

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...with the exception of the ER delay pop up which pops up 4 times, we check the first time but find the remaining 3 reminders slightly overkill... Can you confirm that this is the check Query ''check ER Delay not too big''? If so, then the problem should be gone now, since we can't run that check any more (will need to be replaced with a new check that goes between Boarding Loc entries eventually, but the mechanism that causes multiple errors won't be an issue any longer for those). This is also tracked in Multiple LOS errors. Ttenbergen 22:12, 2020 October 18 (CDT)

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laptops still collecting by location

EMIPs show up in Cognos Admitter and can be filtered for with the "EMIP" button.

Identifying patients (old way, in EPR)

EMIPs will show up under:

• the Transfer Register if they are sent to non-medicine units in your hospital.
• EMIP's in this list will be those under the medicine or internal medicine service that subsequently changed service before leaving ER and were transferred out of ER to a local hospital ward or unit. (not a medicine ward).
  • see instructions for Off ward field to also identify some EMIP patients. See this under the title "how to identify off-ward patients" in that article.

• the Discharge Register if they leave the hospital
  • When reviewing the discharge list generated by the instructions, the EMIP's are those that have medicine or internal medicine under the "service" heading.

For EMIP entry

Entering patients in dispo tab fields

• Service/Location field - your Generic HSC_Med, GRA_Med, STB_Med
• Previous Service field - likely emergency medicine, unless some other service accepted them prior to medicine, and was never able to get them out of the ER either, and medicine accepted the patient from them - in order for a pt to be an EMIP they must have been accepted by Medicine for admission otherwise they would just be an Emergency patient
• Accept DtTm field - the time Medicine accepted them, i.e. the time they became an EMIP
• Arrive DtTm field - same as Accept DtTm field
• Previous Location field - use normal instructions
• Dispo field - For EMIP pts, you cannot put discharge to an ER, so if that is where they went, put the place they went after ER (usually a ward).

Is that still true that we can't dispo to an ER? Should we be able to? EG if Emergency Medicine takes them back (does that happen?) or they get sent to another site's ER? Why should that not be allowed? Ttenbergen 21:59, 2020 October 18 (CDT)

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Follow the instructions in Boarding Loc, Service tmp entry, Transfer Ready DtTm tmp entry; if you do, none of these special instructions for EMIPs should be required. That's part of the point of going to the new scheme.

• In Tmp Boarding Loc enter ER with the same Date/Time as Accept DtTm field
• Service tmp entry - Enter the service that accepted the pt, eg. "HSC Internal Med / A Medicine" or "HSC Critical Care / General" with the same Date/Time as Accept DtTm field
• Transfer Ready DtTm / Transfer Ready DtTm tmp entry - only use this if the pt is going home. Otherwise use "not transfer ready".

Patients transferred to other locations

Collection includes patients who are discharged to a non-medicine location in the hospital.

• if an EMIP patient is transferred to an ICU, that ICU would use e.g. GRA_Med as Previous Location

That is an interesting point. GRA_Med is not really a location. Julie, if you can confirm that this is how you want these coded, please take out the question, else how should they be coded?

• SMW

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• • For Pre-admit Inpatient Institution = GRA_Med

Ditto.

• SMW

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• • For Previous Service = Medicine
• If a pt who starts out on the EMIP track turns into a medicine Boarding Loc patient, collect them as you would any other Boarding Loc patient.

EMIP scenario

• In ER under Medicine service and left your hospital to Home or died in ER
• In ER under Medicine service and transferred to other locations under different service in your hospital
• In ER under Medicine service and discharged to other locations in another hospital

NOT an EMIP

• In ER under Medicine service and then moved to a Medicine service ward (i.e. a regular Medicine admission)
• In ER under Medicine service and then moved to other ward but under Medicine service (i.e. a case of off ward patients).

EMIP to ICU

A patient who is accepted by the medicine service while in the ER, but who then goes to ICU without ever going to a medicine location or Boarding Loc should be collected as an EMIP.

Template:Guideline CAU vs Boarding Loc vs EMIP For STB_CAU, HSC_CAU, STB_CAU.

Patients in ER admitted under other services

Our definition of EMIP includes only patients that were followed by one of our services. So, patients who were followed by Family Medicine or Trauma while still in the ER are not EMIPs.

Serial numbers used

Patients in EMIP have their own serial numbers starting at number 150.

Related articles

Legacy Information

used to be a Service/Location field in the Medicine database until 2020-10 EMIP changes / Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry there used to not be a critical care counterpart, see ECIP for more info since the concept only applied to Med pts and we didn't collect those at CON and OAK, patients in Concordia ER or Oaks ER could not become EMIPs