Pre-admit Inpatient Institution field

This field is currently being implemented, please check the instructions and put a discussion for anything that isn't clear. 

The Pre-admit Inpatient Institution field identifies the previous inpatient location of patients who were already inpatients elsewhere and who have been under medical care continuously before coming to our unit. This does not include patients who just arrived at an ER elsewhere and were not admitted as inpatient there.

For example, a patient arriving from Selkirk Hospital ward via the local ER would have the ER coded in the Previous Location field and Selkirk ward coded in the Pre-admit Inpatient Institution field.

Collection Instruction

For each patient,

• enter the option that most closely matches
• if you know the situation but nothing on the list matches closely, enter other - known but not listed
• if the situation is unknown, enter location missing/unknown
• if the patient did not come from an inpatient location, enter "not applicable", for example if they came from home or a clinic. The ER is not an inpatient location.

If you know how we code the location exactly, you can type it. Otherwise press the "?" button to take you to the S dispo chooser‎ to help filter options if desired.

Where to find this information

If patient came from a different Winnipeg hospital this will be recorded in the “Visit History” on the EPR.

EMIP

If pt goes from Medicine EMIP to an ICU, use the EMIP location in Pre-admit Inpatient Institution field.

Ambiguous locations

The following are considered inpatient locations in this context:

• day-surgery patients ending up on our unit directly

The following are not considered inpatient locations, enter "NA / not applicable"

• care homes, including units with higher levels of care at Deer Lodge or Riverview

intra-facility and inter-facility transfers

If a patient gets transferred to another ward on the same or different hospital, enter the previous ward as both the Previous Location field and the Pre-admit Inpatient Institution field.

Cath lab confusion

We did not use to collect cath lab and would instead code the location before, usually ER. We will now allow cath lab. If a patient comes from the cath lab it does not result in any other exceptional collection instructions. If they were an inpatient before, without interruption, code that location as Pre-admit Inpatient Institution field. If they were not an inpatient code it as not available.

Code Readmission from Grace/HSC Nursing Home as NA

We consider admissions from there as re-admissions, so would be coded as if they had come from home. Consistent with that we will consider these not inpatient locations, so code them as "NA / not applicable". (As per meeting with Dr Roberts 2016-05-05)

Example

• ICU Vic---family medicine ward at the Vic---ED HSC---ED STB---cath lab---ICU HSC.
  • The PrevInptLocation field is: VIC_Ward

Question - VIC_ER->STB_EMIP->VIC_ER->VIC_Ward

Template:Discussion I am posting the following scenario for feedback please, is this correct? Thanks! Pamela Piche 15:43, 2016 May 20 (CDT)

• VIC ER under ER Medicine Service---STB ER admitted as inpatient under B Service Medicine received thrombolytic for CVA, did not leave ER Department---VIC ER; accepted by Medicine Service and transferred to inpatient unit.
  • The PrevInptLocation field is: STB EMIP
  • The Previous Service is: Emergency Medicine
    • I think the Previous Service is Medicine, nor Emergency Medicine. JMojica 10:15, 2016 May 24 (CDT)
      • OK, to clarify........a patient discharged as STB EMIP returning to VIC ER and cared for under ER physican/service until Medicine consulted and accepts patient....the most recent Previous Service caring for the patient in the example is Emergency Medicine not Medicine? Or is this wrong? Thanks, Pamela Piche 11:36, 2016 May 24 (CDT)
      • 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. Let us discuss, any suggestions/thoughts by anyone? JMojica 13:44, 2016 May 24 (CDT)

several pre-admit locations

If a patient travels through several pre-admit inpatient locations we will only have data on the last one. We understand that. Just to be clear.

Data Use / Purpose

To document where those patients who were inpatients immediately before arriving on our ward/unit came from.

The detailed information will allow us also to distinguish between patients who were or were not inpatients before arrival. This is relevant to a patient's risk of bad outcomes.

The information will also give our administrators a better idea of which other hospitals are sending us patients, which they will use for planning.

Template:CCMDB Data Integrity Checks

• Can not be blank
• preAdmit_NE_Location() - Pre-admit Inpatient Institution field can't be same as Service/Location field

Following might still need to be implemented: Template:Discussion

• if Previous Location is within the WRHA then Pre-admit Inpatient Institution field needs to be the same as it. But what is the appropriate filter for s_dispo? Julie, would the following work: if geog = "WPG" and (loc_type = "Ward" or loc_type = "ICU")?
  • (loc_type = "Ward" or loc_type = "ICU") will do. Both out-of-WPG or WPG are included. JMojica 10:55, 2016 May 27 (CDT)

Reports

• The information will be part of the Inter-facility transfer report (i.e. inpatients coming from other facility outside the region or within the region). Also the information will be useful for research projects where a patient will be tagged if already an inpatient before arrival to the unit or ward. JMojica 11:45, 2016 June 6 (CDT)

Implementation

The field is populated with options from the s_dispo table.

Legacy

This field is part of the 2016 Time and Place changes and did not previously exist.

Nursing stations

We used to collect nursing stations in hospital previous but would not include them under the new scheme because they are not inpatient locations. Julie and Tina met with Randy Martin 2016-04 and he confirmed he doesn't need them.