Multiple Encounter

Patients may show up in our database repeatedly. Because our records are patient-ward-stay based, we do not have an inherent link to reflect this.

For patients encountered repeatedly some data should be consistent between stays. The data processor runs a set of checks during vetting that attempts to find and make consistent the records for patients encountered previously. See which article?

If a patient is never discharged in between encounters, patient may be a Continuous Stay. See that article for definitions.

If a patient is discharged and then admitted again at a later time, but soon after the last hospital stay, they may qualify as Re-admission. See that article for definitions.

Terminology and definitions

temporary parking during clean-up

Encounter vs admission vs record

• Continuous Admission: patients that move between ICU's and wards within their own center or to other centers in the city during the same hospital admission. (Trish)
• New encounter: when a patient is discharged from the hospital system in the city back to the community and he then returns to the hospital from the community (generally through the ER), this is a new encounter to the hospital system in the city. (Trish)
  • So, does "same encounter" mean the same as "same hospital admission"? We really can't use that since we don't collect on all wards. I was asking Julie about this before, but we didn't finish the discussion. Ttenbergen 14:53, 29 October 2008 (CDT)
    • Isn't this going off onto a tangent? Depend on how you are looking at the data. Same encounter to one hospital or same encounter to hospital system in the city or new encounter to a hospital or new encounter to the hospital system in the city.
      • We are using the terms, and I need to be sure we are all using them in the same way. I don't think that's a tangent, is it? We are using "encounter" to mean different things at different times.Ttenbergen 14:24, 30 October 2008 (CDT)

• Example of one patient:
• 1. From Home to HSC transf to CON, transf back to HSC discharged home:
  • HSC enc 1
  • CON enc 1
  • HSC enc 2
  • this is the first encounter to hospital system in city.
• 2. same patient
• From home to HSC transf to VIC transf to CON transf back to HSC discharged home
  • HSC enc 1
  • VIC enc 1
  • CON enc 2
  • HSC enc 3
  • this is the second encounter to hospital system in city.

(Tina says: this doesn't help. When qualified as "hospital encounter" or "hospital system encounter" it is all clear. I am concerned because "encounter" by itself could mean either unless apparent from the context. For a query I need to know which is meant, especially if the query then goes on to specify earlier and later encounters...)

THEREFORE (i.e. with reference to encounter definitions):

1. if a patient is diagnosed with ARF (350) which means newly dialyzed and not on chronic outpatient dialysis prior to this admission (no 351 in comorbid) AND if during this encounter to hospital system, he continues to receive dialysis as he is moved around between hospitals and icu or medicine programs then he is still considered to be in ARF.(Trish)
   • How would someone who didn't receive dialysis before continue to receive dialysis? Ttenbergen 14:53, 29 October 2008 (CDT)
   • Julie's directions had been: "If having more than 1 encounter (i.e.: continuous or same hospital admission), then ARF(350) and CRF (351) should not appear together in at least one of the encounters." That's different from what Trish says now. Are we all on the same page? Ttenbergen 14:53, 29 October 2008 (CDT)
   • The definition that this patient would remain an ARF patient once they leave our ward, possibly are admitted somewhere where we don't collect, then maybe goes to the ICU, etc. is problematic since I don't think we can automatically assess that as the same hospital stay. More importantly, from what I hear about the quality of records travelling along with a patient, this is not something a DC at location 2 would be able to find out in any other way than by talking to the corresponding DC at location 1. This is an error prone, time consuming process, and I think we should re-consider the definition. Ttenbergen 14:53, 29 October 2008 (CDT)
2. patients don't flip between (350)ARF and CRF (351) in the same encounter. (Trish)
   • so if someone enters hospital as ARF and stays here for 365 days on various wards with some icu stays, they should still be considered ARF during the last 3 day stay on a ward before they are discharged? I realize we don't flip back and forth but how about one way?Ttenbergen 14:53, 29 October 2008 (CDT)
3. If the patient is discharged into the community, and will continue to receive outpatient dialysis, then the next time he is re admitted to a hospital in the city, he will be coded as CRF (351) in comorbid and admit or complication DX of ARF (350)cannot be used.(Trish)
   • as is true for anyone, so we can remove this point... Ttenbergen 14:53, 29 October 2008 (CDT)

Need to address

• check for inconsistencies like brain dead and ARF