Change to start collection at accept rather than arrive time

Page to track required and completed tasks to move to collecting data from Accept DtTm. If and when any of these things are changed there would be further discussion and documentation.

• SMW

• Cargo

• Categories

We have not started to actually do this, this page just tracks a discussion, anything that is implemented will be documented so.

This is actually related to PatientFollow Project - a lot of the things we need to work out for each are the same.

mixed bag, not yet broken out, copied from Task meetings

• For Medicine and ICU patients we begin our record when our service takes over care, NOT when the patient reaches their designated “home” location. This means that procedure codes, and counts of things (e.g. transfusions) will start when our service takes over, including any/all time spent on that service (e.g. time in ED or PACU, or other “boarding” location).

STB_ICCS patients are generally admitted under the service Cardiac Surgery. Cardiac surgery patients are admitted into ward beds on CR4 & become pre-op patients on 5A sometimes many days prior to their OR date. Will these patients become CICU patients to be entered pre-op? Or will we just continue to consider their accept time as when their care is assumed by the ICU team? (steph)

• SMW

• Cargo

• Categories

• • For ICU patients we will decide on a Minimum data set of TISS items to be collected when patients are boarding. These will have to be recorded by collectors.
  • Of note, Tina reports that the DSM data we’re getting DOES include labs from the time in ED, so she will simply need to include the lab data from the time when our service takes over care.
• Regarding the “machinery” for this -- discuss next time expanding the “Boarding Location” machinery to initial admission and all moves thereafter. In this schema, the name would be changed to something like “Physical Locations”, and the initial one would be wherever the patient was when he/she first began to be cared for by the service/team. This machinery can then easily be used by Julie to report on boarding, lengths of stay and every other aspect of location and timing of care. Because such moves are much more frequent and confusing for Medicine than ICU, as suggested by Michelle, for Medicine patients we would have only 3 possible physical locations: ED, their service location, or a generic boarding location which is not further subdivided.
• We began to discuss that with the above changes, and the increased boarding that will likely become the norm, it would be simpler to keep track of database records not as we do now (i.e. by home location) but rather by home service. The machinery discussed above will allow Julie to write SAS code to slice and dice the information in any way desired -- e.g. time in each physical location (including high obs). After we discuss this more next time, Allan will talk to Drs. Renner/Hajadiacos if they see any major problems with such a change in process.

Identification of patients - how do we make sure we capture everyone

Right now our process for identifying patients is poorly documented and defined. This needs to be brought to a useful current state before we change any of it.

• Identifying ICU admissions
• Identifying patients in boarding locations

If we use Cognos EPR Report exclusively we should be able to catch this, but while some sites use other methods those methods (which are not always documented) would need to be adjusted.

This ties into many things:

• Definition of a Medicine Service admission
• Definition of an ICU admission
• there may be more

Coding if patients - which laptop, and when does something turn into two records

• When a person in ED has a change of service while still in ED, this WILL mandate starting a new record.
• For a person admitted but with “Service Unspecified” (which is an ADT/COGNOS designation) we will assign that person to what we will call the “X Service”
  • Do you mean Service/Location? And will we then make a new record when their sl changes? Who will collect this?
• For Medicine patients, Locations options will be: Each specific dedicated medicine ward, high obs, COVID ward, ED, other boarding location.

CCMDB.accdb

• Boarding Loc and the many places that is automated into (e.g. New patient generator, Patient Viewer Tab Cognos ADT, etc.
• cross checks that only allow Accept DtTm for ER pts (this may already be gone? )
• are Admit Diagnosis Dx Dates checked?
• any chronological checks that deal with accept vs arrive

TISS

• need a way for collectors to enter pre-arrive TISS data
• possibly this will replace how we do TISS in the first place, there are discussions about this