2020-10 EMIP changes: Difference between revisions

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*** now for EMIP.  the accept datetime is the same as arrive datetime.  but these same dates also happen in NON_EMIP.  so how will I identify the EMIP's in the new rule - there must be an entry ER in the boarding loc.  OR Option2,  no more  entry ER in the boarding loc, we keep the ACCEPT datetime the same definition but the  ARRIVE datetime is DISPO datetime - since actually there was no arrival in the home unit.  I think I like Option2.  -- (Julie)
*** now for EMIP.  the accept datetime is the same as arrive datetime.  but these same dates also happen in NON_EMIP.  so how will I identify the EMIP's in the new rule - there must be an entry ER in the boarding loc.  OR Option2,  no more  entry ER in the boarding loc, we keep the ACCEPT datetime the same definition but the  ARRIVE datetime is DISPO datetime - since actually there was no arrival in the home unit.  I think I like Option2.  -- (Julie)
****  I am not quite following your thinking for option 2.  I was proposing that if they are NOT an EMIP there should be nothing in the TMP for them.  But if they are an EMIP then we leave as per the current instructions which is to put the home unit location for the service admitting and in the tmp put the ER  boarding accept date and time.  To have arrive date and time the same as the disposition time does not make sense to me.  What other other nonEMIP cases are there where the accept and arrival time are the same? (Lisa)
****  I am not quite following your thinking for option 2.  I was proposing that if they are NOT an EMIP there should be nothing in the TMP for them.  But if they are an EMIP then we leave as per the current instructions which is to put the home unit location for the service admitting and in the tmp put the ER  boarding accept date and time.  To have arrive date and time the same as the disposition time does not make sense to me.  What other other nonEMIP cases are there where the accept and arrival time are the same? (Lisa)
***** Yes I am clear that you mean non-EMIP and I agree with you.  I am adding another issue about EMIP -  when doing report, I have to look at the whole database and there are some entries where accept and arrive are the same (e.g. from other site ER, cath lab, radiology, ward etc.) even though the rule is only enter accept if coming from own ER. For EMIP, if we set the arrived dttm to be dispo dttm, not only we are consistent with the definition of datetime of physical arrived on the unit (or boarding loc) but the calculation of time spent in ER is consistent too (Arrive - Accept) and become simple.  the reality is there was '''no''' physical arrival on the unit although we can argue that ER is considered as a boarding loc.  Just trying to reduce duplication of entries in boarding loc.  --[[User:JMojica|JMojica]] 12:18, 2020 October 9 (CDT)
* One of the reasons for this change was to be able to enter a patient who is under Med service but still in ER before we know if they will become admitted or EMIP. With the old method, we would not be able to enter a service location until that is settled, or would need to change it later. We would not accomplish that if we changed the service location.  Also, an EMIP really is just a special case of boarding, and we would like to unify how that data is encoded so we can eventually eliminate the accept and arrive dttms and their strange set of rules. Hope that explanation makes sense... Ttenbergen 11:43, 2020 October 9 (CDT)
* One of the reasons for this change was to be able to enter a patient who is under Med service but still in ER before we know if they will become admitted or EMIP. With the old method, we would not be able to enter a service location until that is settled, or would need to change it later. We would not accomplish that if we changed the service location.  Also, an EMIP really is just a special case of boarding, and we would like to unify how that data is encoded so we can eventually eliminate the accept and arrive dttms and their strange set of rules. Hope that explanation makes sense... Ttenbergen 11:43, 2020 October 9 (CDT)
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Revision as of 12:18, 2020 October 9

  • Trish, Julie and Tina discussed 2020-10-08, we will roll this out shortly but wait until Trish gives go-ahead before you change practices. Please comment inline if you see problems, or clarify things if I could have written them up better. Ttenbergen 22:05, 2020 October 8 (CDT)
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Collection instructions

Identifying EMIPs for laptops using PatientFollow model

Identifying EMIPs for laptops using location based identification of pts

  • same person/laptop as before will collect these
  • find them as you have in the past

Entering an EMIP

  • Service/Location: based on which Service covers the patient, use that service's main unit as the Service/Location
  • Boarding Loc: for any pt from ER enter your site's ER as the first Boarding Loc entry; in case of an EMIP it will be the only entry; for other pts it will simply be the first entry before other Boarding Loc entries
    • use the time of acceptance to service as Boarding Loc date and time (yes, that makes it the same as the Accept DtTm - we may address that duplication later once we are comfortable that this change has settled in
    • this means that if the patient is later moved to a unit we collect (ie turns out to not be an EMIP after all), you can just enter that next location as an additional Boarding Loc entry, with that one having the same Boarding Loc Dt Tm as our Arrive DtTm
  • For those that do move to a unit where we collect can we not just take out all the tmp boarding entries and just treat it as a regular admission? i.e. have an accept and arrive time to the home unit location, is there a reason why we need all the tmp boarding entries in these cases? Lisa Kaita 07:40, 2020 October 9 (CDT)
    • I agree with Lisa. if the physical locations of patient are ER followed by home unit location, the accept and arrive date time will imply the corresponding arrival at ER and arrival at home unit. the tmp boarding is the default no borrow.
      • now for EMIP. the accept datetime is the same as arrive datetime. but these same dates also happen in NON_EMIP. so how will I identify the EMIP's in the new rule - there must be an entry ER in the boarding loc. OR Option2, no more entry ER in the boarding loc, we keep the ACCEPT datetime the same definition but the ARRIVE datetime is DISPO datetime - since actually there was no arrival in the home unit. I think I like Option2. -- (Julie)
        • I am not quite following your thinking for option 2. I was proposing that if they are NOT an EMIP there should be nothing in the TMP for them. But if they are an EMIP then we leave as per the current instructions which is to put the home unit location for the service admitting and in the tmp put the ER boarding accept date and time. To have arrive date and time the same as the disposition time does not make sense to me. What other other nonEMIP cases are there where the accept and arrival time are the same? (Lisa)
          • Yes I am clear that you mean non-EMIP and I agree with you. I am adding another issue about EMIP - when doing report, I have to look at the whole database and there are some entries where accept and arrive are the same (e.g. from other site ER, cath lab, radiology, ward etc.) even though the rule is only enter accept if coming from own ER. For EMIP, if we set the arrived dttm to be dispo dttm, not only we are consistent with the definition of datetime of physical arrived on the unit (or boarding loc) but the calculation of time spent in ER is consistent too (Arrive - Accept) and become simple. the reality is there was no physical arrival on the unit although we can argue that ER is considered as a boarding loc. Just trying to reduce duplication of entries in boarding loc. --JMojica 12:18, 2020 October 9 (CDT)
  • One of the reasons for this change was to be able to enter a patient who is under Med service but still in ER before we know if they will become admitted or EMIP. With the old method, we would not be able to enter a service location until that is settled, or would need to change it later. We would not accomplish that if we changed the service location. Also, an EMIP really is just a special case of boarding, and we would like to unify how that data is encoded so we can eventually eliminate the accept and arrive dttms and their strange set of rules. Hope that explanation makes sense... Ttenbergen 11:43, 2020 October 9 (CDT)
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Background

We encode EMIPs as a Service/Location for legacy reasons - it is not really a location as much as a special case. Under our current infrastructure we would more likely encode these as a special case of Boarding Loc. Now that we are moving to a PatientFollow model where patient load is split by chart number, we are running into patients in ER where we are not yet sure if they will end up EMIPs or ward patients. Leaving Service/Location blank is not allowed, so we either need to delay entering or come up with a new solution. We decided this was a good trigger to finally make encoding them like other Boarding Locs.

Cleanup and integration still required

Will need to reconcile the following:

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