Change to start collection at accept rather than arrive time
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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. |
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).
{{Discuss | who = Allen |
- 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
- STB ICCS/CICU Cardiac Surgery patients will have an accept time starting when the pt. arrives in the ICU. If a Cardiac Surgery patient is accepted back to the ICU after they have already been transferred to the ward (CR4), then the accept time is when the ICU has agreed to take them to the ICU, and they are considered a boarded pt. from that time (TISS will be required for the boarded time)
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
TISS
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ADLs
See question at ADL General Collection Information#Timeframe
GCS
See question at Glasgow Coma Scale.
Reporting
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