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- At least some of these started, but does someone know when this actually got implemented?
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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).
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- 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.
- Allan confirmed that Hajidiacos is fine with this. Ttenbergen 12:01, 2020 October 27 (CDT)
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TISS
TISS starts from the off-ward bed and continues to PatientFollow Project locations; how does that need to be collected? Will one solution fix both pre and continue?
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- TISS starts in ER if the pt spends time in ER while under Medicine Service. There was a meeting 2020-10-29 to discuss how exactly this should work, outcomes will need to be documented and linked from here once available; will probably be documented elsewhere since it also affects pts that change location. Ttenbergen 11:53, 2020 October 29 (CDT)
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ADLs
See question at ADL General Collection Information#Timeframe
GCS
See question at Glasgow Coma Scale.
APACHE
The APACHE elements time frame will start in the off-ward bed location.
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- Does it really start in ER? since that's now one off-ward location? In any case, we should really only link to the definition in APACHE from here so this doesn't become inconsistent. If someone knows where that's documented, can you please confirm and fix? Ttenbergen 00:36, 2020 October 16 (CDT)
- I haven't been able to find it on the Wiki, but I was told to get my values for my Apache from the previous location. So for example a patient getting admitted to the ward from ER, the Apache values would be the ones just prior to their Accept Dt/Tm. Think "this was their condition when they were accepted by medicine". If it's a transfer to the ward from ICU, I take the last values before they left. Surbanski 11:14, 2020 October 19 (CDT)
- To confirm for patients admitted from ER, Apache vital signs are taken from closest to but prior to Accept Date/time?
- For medicine yes. I don't know if ICU does anything different. If I've been doing it wrong I expect someone from medicine at the other sites will say something :) Surbanski 10:31, 2020 October 20 (CDT)
- Dose ICU start there APACHE and TISS from the ER accept time or ICU admit time. Currently we collect from the ER accept time only when the patient is boarded in the ER for greater than 2 hours. Gthomson2 10:43, 2020 October 20 (CDT)
- Since Oct.15th, I have been using the 24 hour period after the accept time, which means that I am including the applicable Vitals from ER if the patient was from the ER. I wasn't at the task meeting yesterday, so I don't know if this was discussed, but this was my understanding of how we are supposed to collect apacheMlagadi 11:02, 2020 October 23 (CDT)
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Reporting
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