Service Sending to ICU

for tracking which service is taking care of a patient in STB CCU, see CCU Service Tracking instead

Purpose

To identify the "sending service" or "originating service" for those patients's who where already in a prior inpatient location before coming to the ICU. (refer to Task Meeting Minutes April 13,2015). Note: This is different to the "service of the attending" during the patient's stay in ICU.

Data Collection Instructions

for which patients to code

For each patient who meets the following conditions:

• critical care patient
• was an inpatient before coming to ICU (even if arrived via temp location such as ER, procedure suite, OR or RR)
• doesn't arrive from another ICU (i.e. not an inter or intra transfer)
• The service is consulted in emergency, an OR or procedure is planned and an ICU stay is planned post-op but the patient was not on an inpatient ward.We need to know are we including patients from emergency or not in these cases? Collectors are doing this differently so we need to know.
  • If the patient had been accepted to a service, ie admitted and therefore now an inpatient, even if they were still physically in the ER, then 'yes, do code Service Sending with the specific service. However, if the pt was in ER but not accepted by any service and then they are sent up to the ICU, (or to another ICU in the city), then put in "not an inpatient" in service sending. --LKolesar 13:35, 2015 December 14 (CST)

• • For patients moving from one ICU to another ICU, use only the "z_not applicable" in the service sending tmp. --LKolesar 13:35, 2015 December 14 (CST)
  • For patients coming from a ward, use any in the ITEM except "z_not applicable", "z_not an inpatient", "zz_enter" in the sending service tmp. -- JMojica 14:40, 2016 March 11 (CST)

why no nephrology?

• Just wondered why Nephrology is not listed in the services? I know we can put "other" but it would seem that this particular service is important and should perhaps be on the list??--LKolesar 13:37, 2016 February 19 (CST)
  • they didn't ask for it... Ttenbergen 16:39, 2016 February 22 (CST)
  • who made or provided the list? could it be that it was just overlooked? JMojica 16:16, 2016 March 2 (CST)
    • I believe it was provided by Allan Garland at a task meeting. Not sure where he got it. Laura, could you bring this to the next task meeting so we can discuss? Ttenbergen 09:21, 2016 March 3 (CST) Template:Discuss@task

Service from Home?

• Is it possible to have a sending service for patients who were admitted from HOME - say, Cardiology service admitted from home to CCU? -- JMojica 14:51, 2016 March 11 (CST)
  • Would that not be entered as "z_not an inpatient"? I could add home if needed. Laura/Trish, any collection concerns around it? However, in your example, would that not actually mean admitted from Cardiology? I guess it also depends on what we want to do with this data; would the recipients want to know "home" in this case, or what would they want to know? Ttenbergen 15:39, 2016 March 16 (CDT)
  • When one is admitted from home and the sending service is Cardiology (n=17 cases found in TmpV2), does it mean that a cardiologist phoned the hospital's CCU (HSC/STB) and requested for the patient's admission to the unit? If indeed happening and from home, is there a need to distinguish those "z_not an inpatient" with those having a sending service? - a question to ask to the TASK Group? JMojica 15:36, 2016 March 18 (CDT)

Service unknown?

• Is it possible to have an unknown service for patients coming from ward or OR or RR? what is being entered when you do not know the service? z_Other? -- JMojica 16:19, 2016 March 11 (CST)
  • I could add that. Laura/Trish, any collection concerns around it? Would we want an option other than "z_other" and "z_not applicable"? Ttenbergen 15:39, 2016 March 16 (CDT)

how to code

add a single tmp entry with the following:

• Project: Srv to ICU
• item: the sending service, in case of OR, the service of the OR physician:
  • Cardiac surgery
  • Cardiology
  • Family Medicine (only relevant at sites that have family medicine)
  • General surgery (including ACSS and Trauma surgery)
  • Medicine
  • Neurosurgery
  • Ob/Gyne
  • Ortho surgery
  • Plastic surgery
  • Psych
  • Thoracic surgery
  • Urologic surgery
  • Vascular surgery
  • Nephrology (added 21 March 2016)
  • z_not an inpatient
  • z_not applicable - in this case an entry to the comment field in tmp will be required. (z_ to sort to bottom)
  • z_other - any others such as EENT surgery at STB
  • zz_other - the entry automatically put in for new CC patients, not accepted as final entry when checking tmp checkbox

The other tmp fields are not used (except in "not applicable" scenario)

How to determine?

Go and find out. Ask on the ward. Talk to people. And: "in EPR there is a pt provider section that shows what service(s) the pt has been under, as well there is often an indication of service change in the EPR orders section Lisa Kaita 12:22, 2015 July 15 (CDT)"

Start/End Dates

• Start: 2015-06-22
• End: there is no planned end date

Template:CCMDB Data Integrity Checks

When you enter a new ICU patient a "Srv to ICU" will be automatically generated.

• If that record is missing, you can't checkbox tmp
• If that record has "enter" or "" as item, you can't checkbox tmp

currently impossible

• Query s_tmp_Service_Sending_to_ICU - Error if:
  • not admitted from inpatient location ((S AdmitDischarge.inpatient = true)) but has "Srv to ICU" entry
  • admitted from inpatient location and one of
    • no "Srv to ICU" entry
    • has "Srv to ICU" = "z_not applicable" and no comment

Right now our consistency check would not allow someone from other hosp via ER. We won't be able to do this check until we have PrevInptLocation field. I will take that check out for now. Ttenbergen 11:50, 2015 June 24 (CDT)

• Query s_tmp_Service_Sending_to_ICU_duplicate - error if more than one entry per patient Ttenbergen 15:35, 2015 June 22 (CDT)

SAS Program

• The data is saved in table L_TmpV2 under project "Srv to ICU" of the centralized_data.mdb
• The SAS program that reads the data is in X:\Julie\SAS_CFE\CFE_macros\CFE_ServiceSendingtoICU.sas

See also

• STB Cardiac Care patients
• Registry Patient Type

to do before go live

• Registry_Patient_Type#C-Cardiac_Type - awaiting confirmation
  • "Once this tmp study section is active we can go back to making the pt type relate to the type of diagnosis." (Laura K)