2020-05 HSC COVID unit transition

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This page is about the May transition of collection units at HSC to accommodate the new COVID unit. See 2020-03 HSC COVID unit transition, 2020-04 HSC COVID unit transition about earlier transitions.

Background

Dates

  • May 12.20 - "HSC D2 C" will now be ortho patients.
  • May 12, 2020 "HSC D2 C" converted back to ortho and HSC D4 C is now a mixed unit of COVID positive and suspect patients
  • May 26th.20 D4 started transitioning to accept all D medicine patients, no longer a dedicated COVID positive or suspect ward. By May 28th, this transition was completed, and all patients from D5 were moved back to D4.
  • 2020-03-20 to 2020-05-25 - HSC D4 C is the designated COVID positive ward.

Medicine specifics

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  • Julie wrote - We should have a cut-off date for the additional covid ward D2 and MS3. As I understand these new wards are for covid positives. Once dates are confirmed, then we start collecting at D2 and MS3.
    • Currently D2 is still a suspect ward, D4 is still our only COVID + ward Lisa Kaita 17:01, 2020 April 16 (CDT)
      • May 12.20 D2 C is no longer suspect ward. will now be ortho pts. D4 will house both suspect and +ve covid
      • May 26th.20 D4 started transitioning to accept all D medicine patients, no longer a dedicated COVID positive or suspect ward. By May 28th, this transition was completed, and all patients from D5 were moved back to D4.
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If all the covid wards are operational, how to handle the case where the patient stayed in 2 official covid wards consecutively - 1) separate records or 2)one continuous record? I think we should consider (2) as continuous.

ICU specifics

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what is STB ICU doing for suspect or positive covid patients? Will they be in the ICMS along with nocovid?Trish Ostryzniuk 17:27, 2020 May 7 (CDT)
  • Suspects are on units ICSM, ICCS and ACCU. COVID+ are in ICMS together with the nonCovid as shown in the database.--JMojica 10:33, 2020 June 11 (CDT)
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  • April 2020 HSC_MICU will admitted both SICU and MICU physician Service patients that are either suspect or confirmed COVID patients. No suspect or positive covid will be admitted to HSC SICU. Though MICU is a close unit the SICU patient in this unit will be under the SICU attending service physician. Depending on skill set required, sometime may be a SICU nurse or just MICU nurse. The nurse bit we will not be able to track. We need to ask Randy and Bojan how they want this tracked in Database in terms of service occupancy. Put service Loc as HSC SICU and tag in TMP as boarding location? Julie would some of the logic applied to bed board apply to how we tag this.
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Wards involved:

    • "HSC D2 C" - stopped May 12.20
    • HSC_B2
    • HSC_MS3
    • HSC_A7_MI
    • HSC_A7_SI
    • HSC_H7_MI
    • HSC_H7_SI

originals:

Service Locations

Tmp entries

  • The following should be added to Tmp entries :
    • HSC_D5_P
    • HSC_D4_P
    • HSC_H4H
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  • Does that mean all those should be removed as s_dispo table entries? If we keep them in both linking will mess up.
    • are you using the tmp entries in linking? I use the s_dispo when I do linking. I use the tmp entries to calculate time spent in each boarding loc and home ward. --JMojica 11:03, 2020 April 15 (CDT)
      • No, not using tmp entries for linking, but if info is kept in tmp instead of new record added then the dispo entry in previous record or previous entry in next record may not match with the service location.
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Transition plan

  1. There is no transition plan for the new COVID wards and the additional ICUs. Just need to add in the s_dispo table
  2. This transition plan is only for the patients in H4H who were moved to HSC_B2
    • "HSC_H4H" needs to be added to s_tmp of Project BoardingLoc

collector instructions

  1. change the Service/Location of the record to the new location (ie from HSC_H4H to HSC_B2 )
    • Multi DC are collecting the H4H patients
      • HSC_H4H_a to HSC_B2
      • HSC_H4H_b to HSC_B2
      • HSC_H4H_d to HSC_B2
      • HSC_H4H_h to HSC_B2
    • the new ward B2 does not need a subscript anymore because the Laptop identifier replaces it.
  2. enter the actual location as part of Boarding Loc:
    • for patients who had no location borrowing during transition:
      • change the "no borrow" line to "HSC_H4H" and enter the time the patient arrived in H4H
      • add a line for "HSC - Home medicine ward" with the time that the patient was actually moved
    • if there were patients who actually were in a borrow location during the transition, let's talk about how we would enter those
      • The move from H4H to B2 happened April 14th.

D2 COVID Suspect Ward "HSC D2 C"

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what needs to change on laptops? Trish Ostryzniuk 18:00, 2020 May 12 (CDT)
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  • Stopped May 12.20. will be Ortho.

This ward is a mix of different medicine patients ie. H, D, A, unkknown, and nephrology patients, therefore each data collector will enter their own patients

  1. the Service/Location will be your home ward location
  2. in the tmp the Boarding Loc will be generic boarding and in Q column enter D2
  3. if the patient's result is negative and they are moved back to their home ward then enter Boarding Loc HSC home medicine ward with the date and time they are transferred back
  4. if the patient's result is positive, create a new profile using D4_C or whichever COVID + ward they are transferred to, if they remain on D2 no changes are required

Special Circumstances

When Reviewing a chart in MR and you find a COVID positive or COVID suspect patient that occurred BEFORE the new COVID positive/suspect wards were opened, use Service Location home ward location and use the appropriate COVID-19 (SARS-COV-2) or Observation for suspected infection NOS code.

When reviewing a chart in MR and you find a COVID suspect patient on your home ward and the patient is transferred to another location where the diagnosis of COVID positive is made, check the date/time the swab was sent. If it was sent less than 48 hours after admission code this as an Admit Diagnosis, if the swab was sent greater than 48 hours after admission code this as an Acquired Diagnosis

Serial Number

  1. For transition units ie. D5 to WRS3, D4 to D5, H4H to B2, use your continuous serial numbers
  2. For D4_C start with serial number 150


data processor instructions

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Depending on how we do this with tmp vs service location we may end up with linking issues and orphans; need to review. 
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Reporting

  • service location HSC_H4H before April 14,2020 and HSC_B2 can be together.
  • all COVID wards namely HSC_D4_C, "HSC D2 C", HSC_MS3 can be together.
  • HSC_MICU, HSC_A7_MI, HSC_H7_MI can be together.
  • HSC_SICU, HSC_A7_SI, HSC_H7_SI can be together.

Transition plan B

D Service Patients from HSC D5 to HSC D4 on or after May 27, 2020

  1. This transition plan is only for the patients with service_location= HSC D5 who moved back to HSC D4
  2. The label pre-COVID HSC D4 P will be restored back to HSC D4
  3. All new patients admitted on or after May 29, 2020 on D4 will have service_location= HSC D4 and follow the usual guideline for boarding loc in tmp
  4. The COVID suspect/positive patients who were at D4 during the move will remain with service_location=HSC_D4_C.
    1. if the result is negative and the patient stays at D4, the patient will be discharged from service_location=HSC_D4_C and a new profile will be done with service_location= HSC D4
    2. if the COVID suspect/positive patients move to another location, the patient will be discharged from service_location=HSC_D4_C.

collector instructions for D Service patients from D5 to D4

  1. For patients discharged before May 29,2020, keep the Service/Location= HSC D5 and in tmp "no borrow" or as appropriate.
  2. For patients discharged on or after May 29,2020, change the Service/Location from HSC D5 to HSC_D4 and in tmp, add the "HSC- boarding" and 'D5' in comment (or "HSC_D5" if available), date/time the patient arrived in D5 and the line for "HSC - Home medicine ward" with the time that the patient was actually moved to D4.
  3. After the last D service patient from D5 has been completed and submitted to the master database, the label for HSC D5 will be changed to HSC D5 D to denote 'D service patient physically in D5 from March 20 to May 28, 2020 during the COVID season' .

Patients From WRS3 to HSC D5 on or after ??

  1. This transition plan is only for the patients with service_location= HSC WRS3 who moved back to HSC D5
  2. All new patients admitted on or after ?? 2020 on D5 will have service_location= HSC D5 P and follow the usual guideline for boarding loc in tmp

collector instructions for patients from WRS3 to D5

  1. For patients discharged before ?? 2020, keep the Service/Location= HSC WRS3 and in tmp "no borrow" or as appropriate.
  2. For patients discharged on or after ?? 2020, change the Service/Location from HSC WRS3 to HSC D5 P and in tmp, add the "HSC- boarding" and 'WRS3' in comment (or "HSC_WRS3" if available), date/time the patient arrived in WRS3 and the line for "HSC - Home medicine ward" with the time that the patient was actually moved to D5
  3. After the last D service patient from D5 has been completed and submitted to the master database and the label for HSC D5 has been changed from HSC D5 to HSC D5 D,the label pre-COVID HSC D5 P will be restored back to HSC D5. This change will create orphans to the master database which will be deleted by the Data Processor.

Cross checks

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  • We have no CCMDB.accdb Data Integrity Checks yet for Boarding Loc , so that won’t limit our options. Is this the time to add cross-checks?
    • Yes, I think we need to add now the integrity checks. See below and check if I have missed anything:
      • 1. Date_var and Time_var must not be before Accept DtTm/Arrive DtTm
      • 2. Date_var and Time_var must not be on or after Dispo DtTm
      • 3. Item should not be the same as the service_location for Medicine profile
      • 4. Item should be either ‘no borrow’ or with boarding item but must not have both
      • 5. When having a boarding location, both date and time must be present. Should not have missing time.

---JMojica 08:52, 2020 May 28 (CDT)

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  • Have not yet checked how this will impact CFE Data Integrity Checks. Pagasa, of the top of your head which would be impacted and how?
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