Boarding Loc

Projects
Active?:	active
Program:	CC and Med
Requestor:	internal
Collection start:	2019-Sep-20
Collection end:

This isn't so much a project as way to track how patients physically move around the hospital. See Change to GRA Med, HSC Med, STB Med Service Location for information about it and why we needed to change it to this model.

This project tracks where and when a patient arrives into a new physical location.

Data Collection Instructions

and this is where I realized we may need to do this for CC and Med, rather than just cc. Sent out email for input...

• SMW

• Cargo

• Categories

In TMP, a "no borrow" entry will automatically be added to every new Critical Care or Medicine patient's record.

If the patient never ends up in a "borrowed bed" during their stay then, leave the default in Item as no borrow and also put a check mark in the checkbox. (this is to verify that there was no bed borrow, otherwise no one is sure is missed or not). If the patient does end up in a "borrowed bed", change the item to the location of the borrow and enter the rest as per below: #How to enter this.

Add a new tmp entry for every additional move/borrow within your centre that a patient makes during their stay at your Service/Location; including moves from borrowed location to your actual unit.

How to enter this

• Use tmp fields:
  • Project: Boarding Loc
  • Item: no location entered is the default (that entry will not be allowed in a complete record)
    • change the original entry to the first location the patient was during the admission in this record, e.g. ER, specific medicine ward etc
    • for any physical move to another unit, enter an additional boarding loc entry
  • Enter start_dt: arrival date at borrowed bed, under column E.
  • Enter start_tm: arrival time at borrowed bed, under column M.
  • checkbox: not used for this project
  • comment field:
    • see #Special Case - moving from one borrowed ward bed to another
    • There are now additional circumstances where we use comment field for Borrow Loc, to do with COVID moves. Documented in pages in Category:2020 COVID unit transition and some info below in #COVID

Are the following two cases not the same? Ttenbergen 09:34, 2020 September 23 (CDT)

• SMW

• Cargo

• Categories

Special Case - Moved to a Borrow Location PRIOR to being moved to your Unit or ward

• If moved into a borrowed location prior to coming your unit or ward, then the Arrive DtTm field in Dispo tab should be the same the arrive DtTm in TMP of your first borrowed location.

Special Case - original arrival is in "borrowed bed"

If pt is admitted to your physician service but the original location is from an off-ward bed, code that location Arrive DtTm = borrow date and time.

The APACHE elements time frame will start in the off-ward bed location and TISS starts from the off-ward bed as well.

Special Case - Return from boarding Loc to own unit during same stay

• If the patient moves back to their "home unit", or "intended unit", make another borrowed bed location entry and select your home unit, e.g. HSC - Home medicine ward. Enter the date/time for this move, as above.
• Dispo Tab
  • Service/Location field enter: home ward/unit.

Wouldn't the service/location field equals the generic HSC_Med, and the HSC_Home medicine ward in the tmp would specify this as H4, A4, etc? Same for ICU would it be a generic HSC_ICU and home ICU would be specified in the tmp boarding?

• SMW

• Cargo

• Categories

Special Case - moving from one borrowed ward bed to another

If there are two consecutive boarding locations in the same type of Boarding Loc entry (e.g. "HSC - boarding"), just have one entry with the first date and add in the comment the other locations.

For Julie's reports on occupancy, does she need this separated out with a unique date/tm for each move?

• SMW

• Cargo

• Categories

Special Case - PACU

If a bed is borrowed in PACU / post-anesthesia care / recovery unit, code this as a borrow. (i.e. <hosp> - recovery, e.g. "HSC - recovery").

If the decision to accept to the service happens in PACU, the Arrive DtTm = the borrow date and time. The APACHE elements are collected at PACU stay and TISS starts at PACU.

Special Case - From ER

Not included in this project.

• The time spent/waiting in ER is done using Arrive DtTm vs Accept DtTm.
  • March 30.19: own ward, to own ER (under ICU physician care) then to own ICU when bed available. Started occurring at Grace- March 30.19
    • See GRA ER use as borrow location

we have two entries "GRA_ER" and "GRA - ER". The "- ER" one is same format as the STB and HSC ones. We should probably consolidate the GRA_ER entry into GRA - ER. For now, collectors please use "GRA - ER", and when the last "GRA_ER" is gone I will get rid of the option and we can consolidate them. Ttenbergen 19:26, 2020 October 15 (CDT)

• SMW

• Cargo

• Categories

Special Case - Parked

Not included.

• For patients who are Parked in ER, no need an entry for these, since the ER delay will take care of them.

Special Case - EMIP/ECIP

ECIP - these are now happening, so how would we enter them? EMIP - this structure could accommodate EMIPs, but the problem is how do we identify them (right now people take turns at some sites... which collector would collect them what service/location do we collect them as? Right now we have a special service location for these... how about that "service x" at HSC? Wouldn't the chart number determine which collector enters any given EMIP/ECIP? COGNOS should show all patients under medicine, including those still sitting in the ER. If we enter them all with a service/location of HSC_MED and the tmp boarding location HSC_ER, some may be discharged (EMIP) and some will arrive to their intended unit, which would then require another entry in the tmp "HOme medicine ward with date/tm and specific physical location in Q or to another boarding location if they are overflow. At HSC we have unknown medicine, neuro and nephro services that we admit, in the case of neuro their home medicine ward is HOBS(H7) because we only enter neuro patients admitted to that specific unit, however nephro and unknown service can admit anywhere, so I am not sure what we would put for their home medicine service location.

• SMW

• Cargo

• Categories

Special Case - CAU

If the patient ends up moving to a ward from CAU, why would we treat the CAU as a boarding loc? We don’t collect data on CAU patients so wouldn’t it be a new profile? I know at one time the CAU was considered an extension of the ER, but I believe that may have changed now, as I believe all of the CAU’s are located away from the ER’s and are considered an inpatient location, under family medicine service E.g at HSC the CAU is now located on WRS3, At Grace it is located in the old ER and are under a grace HMO. At SBGH I think CAU is located on 6AS. I will double check with our admitting girls. If it is an inpatient location then this would not be an EMIP

• SMW

• Cargo

• Categories

Special Case - COVID

See 2020-10 COVID unit collection.

earlier info

During the COVID-19 pandemic there were a lot of movements of entire wards (see Category:2020 COVID unit transition for related pages). The Boarding Loc project was a convenient place to store this information, so we added some specific locations for this purpose: HSC_D4_P HSC_D5 HSC_D5_p HSC_H4H STB_E6_B GRA_5N

Start/End Dates

• Start: 2019-Sep-01: new admissions on and after this date.
• End: there is no planned end date

Loose ends

Query ''check ER Delay not too big'' needs to be changed to include the new Boarding Loc schema .

• SMW

• Cargo

• Categories

Which if any of Project_Borrow_arrive#Data_Integrity_Checks_.28SMW.29 will need to be moved over to this instead?

• SMW

• Cargo

• Categories

Data Integrity Checks (automatic list)

	App	Status
Query check tmp ER Boarding Loc should exist if from ER	CCMDB.accdb	declined
Check if awaiting code is primary dx then Transfer Ready DtTm must be equal to Arrive DtTm	CCMDB.accdb	declined
Query s tmp check Boarding Loc and TransferReadyDtTm pairs	CCMDB.accdb	implemented
Query check tmp 2 BL TR S same tm	CCMDB.accdb	implemented
Query Check BL TR combiner null	CCMDB.accdb	implemented
Query check Transfer DtTm after paired BL and before later BL	CCMDB.accdb	implemented
Query s tmp Boarding Loc ER delay reasonable	CCMDB.accdb	implemented
Query check no consecutive same BL or Service	CCMDB.accdb	implemented
Query check CCI TISS matching BoardingLoc time	CCMDB.accdb	implemented
Query check tmp Boarding Loc Service first same	CCMDB.accdb	implemented
Query s tmp check combined Boarding Loc and TransferReadyDtTm	CCMDB.accdb	implemented
Query check transfer DtTm during admission	CCMDB.accdb	implemented
Query check tmp Service and Boarding Loc during admission timeframe	CCMDB.accdb	implemented
Query check tmp service or location duplicate	CCMDB.accdb	implemented
Query s tmp Boarding Loc date item	CCMDB.accdb	implemented
Query check minimal data set incomplete	CCMDB.accdb	implemented
Query check tmp Transfer Ready not before Boarding Loc	CCMDB.accdb	retired
Query s tmp check combined BL and TRDtTm nonsequential	CCMDB.accdb	retired
Query check transfer ready tmp for each Boarding Loc	CCMDB.accdb	retired
Query s tmp Boarding Loc no borrow but entry	CCMDB.accdb	retired

Data Use

Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.

SAS Program

The SAS program calculates the time spent in a borrowed bed at each ICU stay and summarize the total bed-days in a given interval that are taken up by boarders from elsewhere and how much a certain unit is boarding elsewhere.

Time spent in borrowed bed = Next Arrival Date_time - First Arrival Date_time

where Next Arrival Date_time = Dispo Date_time if there is no more next arrival date_time.

The SAS program is saved in X:\Julie\SAS_CFE\CFE_macros\Bed_Borrow.sas

Background

See Bed borrow as aggregator page for other boarding and borrow related concepts.

The concept is similar to EMIPs but we will keep the EMIP separate from this project. The current EMIP will stay the same.--JMojica 10:37, 2019 September 20 (CDT)

Related articles