This page is about the transition of collection units at GRAto accommodate the new COVID unit.
Background
The dates are not yet finalized.
- Saturday March 28.20 – start date patients in GRA_N5 move to GRA_2S but not all. Moves are are on staggered basis in April.
- ?? April ?? .20 - 5S will be a new COVID-19 ward GRA_5S_C with ?? adult beds
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- Patients that were on GRA N5 began moving to GRA 2S on March 28. It was a staggered move, and because we're not going to the wards to review charts, I can't say for sure if there was a reason why that was. For example, one patient was admitted to GRA N5 in February and was moved to GRA 2S on March 28. Another was admitted Jan 14 and was moved April 7. EPR doesn't give any clues as to why they were staggered this way (if there was a medical reason why they stayed behind).
- We have confirmed with one of the doctors that GRA 2S IS a non-teaching medicine ward with the 2 doctors that previously covered GRA N5. So yes, GRA 2S is what GRA N5 was pre-COVID.
- I don't know what bed capacity GRA N5 and GRA_5S_C will have but I do know that
- everyone COVID SUS or COVID POS will default to GRA N5]
- If they have more than 2 POS admissions, they will open GRA_5S_C
- We're assuming if a COVID SUS is swabbed negative, they will be moved to GRA 2S. Currently there is 1 admission on GRA N5 that are not labelled COVID in EPR, so again, I don't know if there's another medical reason why they stayed behind.
- The COVID POS patients are usually under the internist that admitted them unless they are coming from ICU (COVID POS patients are under internal medicine).
- The COVID SUS patients are under the medicine doctor that admitted them (general medicine) Surbanski 09:09, 2020 April 15 (CDT)
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- Julie wrote: Tina, Trish – we need to decide how to handle the COVID suspects admitted at N5 -
- 1. If the result is negative and patient moves to 2S – a case of transition, Service_location change from GRA_N5 to GRA_2S
- Tina- If we change the service location Pagasa will get orphans
- 2. If the result is negative and patient did not move to 2S but somewhere else - ??? Service_location = GRA_N5 - keep as is
- 3. If the result is positive and patient moves to 5S – new record Service_location= GRA_5S
- Tina- If we change the service location Pagasa will get orphans.
- 4. If the result is positive and patient remains in N5 - ??? Service_location=GRA_N5_C – added _C to denote covid positive
- Tina- Unless other collectors also get this right, this will cause linking errors
- Items 1 and 3 - no issue. Items 2 and 4 – need to decide, do you agree with the red entry. If so, need to add item 4 entry (was added already because I thought we had decided to use it) OR you have other thoughts?
- DC - will it be easy to distinguish the negative and positive at N5?
- Sherry-we won’t know until their charts are physically in medical records. Cadham does not put the swab results on EPR and we have no way of knowing the results. As of right now, Trish has given us the direction to NOT go to the wards to view charts.
- Tina-We would not likely be able to use eChart for this. When we looked into this before the answer was that eChart is only allowed to be used for direct patient care activities. I have contacted Allan to see if there is another option.
- Lisa
- 1. If Sherry and Mindy are dividing workload on 5N by provider (so it can be and is currently a mix of 5N patients, one 3S patient and one 3N patient) , then a negative covid (moved to its home location) is just an extension of the same admission. by transition Julie do you mean use the transition instructions on the wiki for the moves from 5N to 2S? Would Mindy do the same for a negative that then transfers back to 3N? or a patient that goes back to 3S? (BTW we are not doing any of this at HSC for our COVID suspects we enter our home location and just put the D2 in the tmp boarding and if they transfer back to our home ward we use the medicine home ward option in the tmp, we have not been instructed otherwise)
- 2. If the result is negative and the patient and moves somewhere else wouldn't that be boarding?, if they stay under medicine but not on a medicine ward
- 3. if positive and move to 5S I think Julie means create a new profile with service location 5S
- 4. Makes sense to add a new location 5N_c but how will they handle those cases if 5S opens up because there are more than 2 patients and the patient then moves from 5N_C to 5S, is this a new profile? or track in tmp? Lisa Kaita 11:28, 2020 April 15 (CDT)
- Mindy
- 5North is NOT a boarding location. It's still a regular sub acute medicine ward. Yes the patients are Covid suspects we think due to being Exposed but this is not confirmed. No boarders here Mcrawley 15:15, 2020 April 14 (CDT)
- Are there new patients admitted at N5 (primarily as COVID suspects)? --JMojica 16:01, 2020 April 14 (CDT)
- On closer inspection the new people being admitted to this ward are all Covid suspects, was hard to tell at first because patients that stayed on this ward were 5 North patients. So it looks like the new patients on the ward are boardersMcrawley 08:01, 2020 April 15 (CDT)
Transition plan
- There is no transition plan for the new COVID ward GRA_5S_C which has already been added to the s_dispo table.
- This transition plan is only for the patients in N5 who were moved to 2S or who remained on N5 under the N5 physicians.
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- Maybe we need to add GRA_2S as a s_tmp of Project BoardingLoc as well since there are random medicine patients there like from 3South?Mcrawley 12:22, 2020 April 15 (CDT
- is this case also started at 5N as suspect or started at 2S? the date gives the clue. if date is before the move of N5 to 2S, then enter generic GRA boarding. let us know before we decide to add it as another tmp item. --JMojica 13:53, 2020 April 15 (CDT))
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collector instructions
- change the Service/Location of the record to the new location (ie from GRA_N5 to GRA_2S )
- enter the actual location as part of Boarding Loc:
- for patients who had no location borrowing during transition:
- change the "no borrow" line to "GRA_N5" and enter the time the patient arrived in N5
- add a line for "GRA - Home medicine ward" with the time that the patient was actually moved
- if there were patients who actually were in a borrow location during the transition, let's talk about how we would enter those
N5 COVID suspect ward
This ward is a mix of different medicine patients ie. 3S, 2S, and 3N patients, therefore each data collector will enter their own patients
- the Service/Location will be your home ward location
- in the tmp the Boarding Loc will be N5
- if the patient's result is negative and they are moved back to their home ward then enter Boarding Loc GRA home medicine ward with the date and time they are transferred back
- if the patient's result is positive, create a new profile using S5 as Service/Location if they do not physically move to S5 and remain on N5 then enter Boarding Loc N5 with the date and time closest to the positive result, if or when they move to S5 enter Boarding Loc Gra home medicine ward with the date and time they are transferred to S5
Outstanding issues
I have spoken with Richard Q the manager on the 5th floor today and this is what he has told me:
- As of right now, they still don't have confirmation on the designated COVID units, but at this time, 5N is being used for COVID SUS and 5S is being used for COVID POS admissions. Currently according to EPR there are 2 positive cases admitted to 5S.
- Over the past week, there has been a lot of movement from 5N to 2S, which in the past was where our boarders were moved to. When I asked Richard, he indicated that 2S has become the "clean" medicine unit. Again, this is all yet to be confirmed by GH and/or WRHA.
- Currently, there is 1 doctor who has taken on the COVID patients, but again, this could be temporary and may change over time depending on what the demand is.
- Unless they are labeled COVID POS in EPR, there is no way for us to know what the swab results return as. This information will only be gathered once the chart is available in Medical Records. If you would like to grant us the ability to go to eChart to review, I'll leave that to the powers that be to decide. My understanding is in this Data Collector role, we are no to review records in eChart.
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- For the patients who have been moved from GRA N5 to GRA 2S - I have been tracking these as boarders. Do you want me to continue in this manner? Surbanski 14:42, 2020 April 8 (CDT)
- Julie? Ttenbergen 14:59, 2020 April 14 (CDT)
- refer to the transition instruction. --JMojica 16:02, 2020 April 14 (CDT)
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- For the POS patients who have moved from 5N to 5S - How do we want to track these? There is a dispo location to this unit, but I don't yet see a Service Location for this unit (unless Tina/Julie are still working on this step and it is yet to come). Surbanski 14:42, 2020 April 8 (CDT)
- Made GRA_5S_C available for collection now. Sorry, I missed a step earlier for this. If you van now enter this please delete the question, otherwise put a comment that this is still an issue. Ttenbergen 14:59, 2020 April 14 (CDT)
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- I would like some direction on how to proceed - I didn't know that my medicine unit (5N) was transitioned into a COVID floor. I've been entering and tracking the 5N admissions and 2S boarders. I know it's difficult to make decisions when no one really knows what's going on, but before I get too deep in COVID I'd like to have some direction to avoid duplication of work (i.e. having a profile for a 5N admission and a second profile for a 5S admission if we decide to track them).Surbanski 14:42, 2020 April 8 (CDT)
- do you mean both N5 and 5S are COVID wards, please confirm because we need to distinguish the N5 as acute med unit vs N5 as covid ward. Covid ward(s) will be reported separately from the other med wards. thanks. --JMojica 16:23, 2020 April 14 (CDT)
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- I have another question - currently I am recording data and admissions on 5N (as per the current process), which we are assuming is the COVID SUS ward. Some of these patients are discharged from the ward after a couple of days once (I assume) their swab results are back negative. If we're not interested in collecting for COVID SUS, then we need to change the process for data entry on this unit. Technically, my 5N medicine patients are admitted on 2S, which are now all being labelled as "Boarders". I'm not sure what that would look like but I'm open to a discussion with whoever it would be who would decide this. Surbanski 08:57, 2020 April 9 (CDT)
- are these covid suspects under the medicine service? this will be a bit tricky if being taken care by medicine service. should it be considered as 2S medicine service borrowing bed at 5N, so it will not be missed? --JMojica 16:30, 2020 April 14 (CDT)
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- This just in .... as we're going through our admissions guess what we've found on 2S? Patients admitted under 3S doctors! Are we having fun yet?
- I'll be admitting these folks on 3S and have them boarding on 2S. There are no COVID flags on their EPR accounts.
Surbanski 11:30, 2020 April 15 (CDT)
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Reporting
service location GRA_N5 before move date to GRA_2S and GRA_2S can be reported together.
Cross checks
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- Have not yet checked how this will impact CFE Data Integrity Checks. Pagasa, of the top of your head which would be impacted and how?
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