Previous Service field

Data Element (edit)
Field Name:	Previous_Service
CCMDB Label:	Previous Service
CCMDB tab:	Dispo
Table:	L_Log table
Data type:	number
Length:	long integer
Program:	Med and CC
Created/Raw:	Raw
Start Date:	2016-07-01
End Date:	2300-01-01
Sort Index:	38

The most recent "originating service" which sends the patients to their current service location.

• SMW

Legacy implementation right in the table

• Cargo

• Categories

• Forms

Collection Instruction

• For each patient enter the option that most closely matches
  • For medicine ward-to-ward moves, code "medicine" as previous service
  • For ICU-to-ICU moves, code "Critical Care" if no other specific service is documented
  • For pt from ER, code "Emergency Medicine" unless a different service had accepted them and is handing them off to Medicine
  • For pt direct from ambulatory not via ER, code "not applicable" if no other specific service is documented
• Patients admitted after having a problem during an outpatient procedure are more complicated:
  • Such procedures include outpatient: GI endoscopy, bronchoscopy, cardiac cath, invasive radiology, procedures done at surgicentres, etc.
  • If the patient goes DIRECTLY from the outpatient procedure area to a Medicine ward or an ICU, then code the type of physician who was doing the procedure:
    • if, for example, it was a GI endoscopy, then the previous service was "GI", but as GI is not specifically listed in the dropdown list of services, then list it as "other"
  • If before being admitted to hospital the patient was sent from the procedure area to the ED:
    • if the patient was actually an ED patient (under the care of the ED docs) then code "Emergency Medicine"
    • if, for example, it was a GI endoscopy and the patient was not actually under ED care, but instead was directly admitted to the ED on the Medicine ward service, then the previous service was "Medicine"
• If the service is not listed, code "other (known but not on list)"
  • in these cases we don't care about the details; if we see too many others we may add additional options in future (as of January 2022 we checked and these account for <1% of all previous services)

From HD / From hemodialysis

• Came to dialysis from being an outpatient:
  • Previous Location =dialysis
  • Previous Service=Nephrology
  • Pre-admit Inpatient Institution=n.a.
• Came to dialysis from ED:
  • Previous Location=dialysis
  • Previous Service=ED
  • Pre-admit Inpatient Institution=n.a.
• Came to dialysis from a prior, different, inpatient location:
  • Previous Location=dialysis
  • Previous Service=service of that prior inpatient location
  • Pre-admit Inpatient Institution=that prior inpatient location

From Cardiac Cath Lab

• A patient goes to emergency, then is sent to the cardiac cath lab for an angiogram. Julie would like the sending service to be Emergency Medicine in these cases (not cardiology). Discussed at the task group meeting on July 20, 2017.
• Most patients come to CCU or ICU via the heart cath as a code stemi, in which case the previous service is cardiology because they bypass ER and go direct to the heart cath lab.

• The previous service is who was looking after the pt before the heart cath in some situations. For example, if ECMO is done in the heart cath lab : If the pt was on a ward or unit prior to the procedure, the service is whatever ward or unit it was that sent the pt there. If ER sends a pt for a VV ECMO, the ER is the sending service, unless ICU takes over the pt prior to the ECMO. (They would need to consult cardiac surgery for the ecmo procedure but it would be the ICU that takes over the care ultimately).

This was discussed at the task group meeting on June 21, 2017.

from OR

If a patient comes from an OR/RR, code the responsible surgical service as previous service.

Nursing Home Wards (HSC/GRA)

We treat patients that went through the HSC/GRA Nursing Home as having been discharged. So, admission from there should be as if admitted from home, so put "not applicable" into the Previous Service field. This does not affect the Visit Admit DtTm field definition - remember, that is defined by EPR entry.

Admit from home

For an admission directly from home bypassing the ER enter Previous Service = 'Not applicable'.

from EMIP via ER

The case of VIC ER to STB EMIP to VIC ER to VIC Ward is a bit tricky because STB EMIP signify being an inpatient under Medicine service before going to VIC ER. WIKI defines Previous Service as the "originating service" for those patient's who where already in a prior inpatient location. It would be easier to define the previous service if this is a case of direct transfer to VIC Medicine service and parked only in VIC ER. This is a good question - which to use, Emergency Medicine or Medicine? Since it is known that there is prior inpatient service, I am more on the second one 'Medicine'. This can be a similar case when the previous location is Operating or Recovery and the responsible surgical service is coded as previous service. If coming from home to another ER to own ER to own Ward, then previous service is clearly Emergency medicine.

admission from a unit partly collected by us

see Previous_Location_field#from_a_unit_that_is_partly_collected_by_us.2C_and_partly_not.

admission from a nursing station

• For direct admission from a nursing station, put "other (known, but not on list)".
• If from a nursing station, patient dropped by ER , put "Emergency Medicine".

Direct admit

For a Direct admit via the ER, the Previous Service will be the primary service looking after the patient, prior to admission at your facility.

Example:

testcontent

I had always thought as Previous service only applying to local services, rather than services at a different site. #Data use only talks about inpatient locations. Do we really want to use these for services from outside? Ttenbergen 11:05, 2022 January 19 (CST) if known or obvious, let it be entered. For example from Brandon ICU, it is known as ICU, but if Brandon ward, this maybe Medicine or unknown. if from other outside city hospital ER, then that is Emergency Medicine. I have checked the database - some have entries and some are blanks for direct admits. --JMojica 11:19, 2022 January 19 (CST)

• SMW

• Cargo

• Categories

Urgent Care

For patients directly admitted from urgent care, code previous service as "Emergency Medicine".

Clinical Assessment Units

Specific instructions apply for coding previous service for the specific CAUs. See

• GRA CAU#Collection instructions
• HSC CAU#Collection instructions
• STB CAU#Collection instructions

Data Use

Sending service to ICU will be reported to the Critical Care Director whose interest is to determine the sending services for patients who where already in a prior inpatient location before coming to ICU (refer to minutes of Task Meeting dated 13 April 2015 and 11June 2015). The data to be reported will be filtered to include only those in-patients prior to ICU.

Data Integrity Checks (automatic list)

	App	Status
Query check previous location vs service inconsistent	CCMDB.accdb	retired
Function Validate previous service	CCMDB.accdb	retired

Implementation

The field is populated with options from the s_previous_service table.

Legacy

For medicine this concept is related to ER Wait.

For critical care this concept is related to Service Sending to ICU - refer to Task Meeting minutes dated June 11, 2015.

• see updated minutes dated August 24, 2017.