2020 GRA COVID unit transition

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This page is about the transition of collection units at GRA to accommodate the new COVID unit.

Background

Grace Medicine

  • Saturday March 28.20 – start date patients in GRA_N5 move to GRA_2S but not all. Moves are are on staggered basis in April.
    • Wednesday April 15.20 - the decided date as a cut-off for the service_location change
      • All admit dates before April 15, 2020 will have service_location = GRA_N5
      • All admit dates on or after April 15, 2020 and discharge before May 15,2020 will have service_location=GRA_2S
  • ?? April ?? .20 - 5S will be a new COVID-19 ward GRA_5S_C with ?? adult beds
  • Friday May15.20 - start date patients in GRA_2S move back to GRA_N5
    • All admit dates before April 15, 2020 and discharge after May 15, 2020 will have service_location = GRA_N5
    • All admit dates on or after April 15, 2020 and discharge after May 15, 2020 will have service_location = GRA_N5

GRA MICU

  • 2020-10-16 the PACU will not be used as the GRACE ICU COVID Unit unless absolutely necessary. Two NFA theatres in the SDC area next to the ICU are being renovated to accommodate four COVID Positive patients. I do not know how the beds will be numbered yet, but these 4 beds will be part of the 10 bed census for the GRA ICU, they are not extra beds, just extra isolation rooms.Gens 07:25, 2020 October 16 (CDT)gens}}
  • The GRACE ICU COVID UNIT in the SDC NFA Theatres will potentially be opened on November 6 or November 9, 2020. There will be 4 isolation beds for COVID-19 positive patients. They will be labelled as: ICU NFA 1,ICU NFA 2,ICU NFA 3 and ICU NFA 4.Gens 11:44, 2020 October 30 (CDT)
  • 2020-04-14 - GRA_PACU with 15 beds are added to Grace ICU for non-covid pts. The current GRA_MICU with 10 beds are for covid pts.

Medicine Situation

New COVID ward

  1. The new COVID ward is GRA_5S_C which has already been added to the s_dispo table.

Transition plan A - from N5 to 2S on and after April 15, 2020 and before May 15

  1. This transition plan is only for the patients on N5 who were moved to 2S or who remained on N5 under the N5 physicians.
  2. GRA_N5 patients discharged before April 15 remain GRA_N5
  3. All admission to N5 on or after April 15, 2020 and discharge before May15 will have service_location=GRA_2S
  4. All admission to N5 before April 15, 2020 and discharge after May15 will have service_location=GRA_N5 - refer to case#1 in Transition plan B

Collector Instructions for Transition Plan A

  1. change the Service/Location of the record to the new location (ie from GRA_N5 to GRA_2S )
  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 "GRA_N5" and enter the time the patient arrived in N5
      • add a line for "GRA - 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

Transition plan B - from 2S to N5 on and after May 15, 2020

  1. This transition plan is only for the patients with service_location= GRA_2S who were 1) moved back to GRA_N5 or 2) boarding on N5 under the N5 physicians.
    • Identify the patient who stayed the 1) whole time at 5N with service_location=GRA_2S
    • Identify the patient who stayed the 2) whole time at 2S with service_location=GRA_2S
    • Identify the patient who stayed 3) first in N5 and then moved to 2S with service_location=GRA_2S
    • Identify the patient who stayed 4) first in 2S and then moved to N5 with service_location=GRA_2S
  2. All new patients admitted after May 15, 2020 on N5 will have service_location= GRA_N5 and follow the usual guideline in tmp

Collector Instructions for Transition Plan B

  1. For patients Discharged before May 15, 2020
    • For cases in #1 - change the Service/Location from GRA_2S to GRA_N5 and in tmp change the line "GRA_N5" to "no borrow" and delete the date and time
    • For cases in #2 - keep the Service/Location= GRA_2S and in tmp "no borrow"
    • For cases in #3 - keep the Service/Location= GRA_2S and keep in tmp line "GRA_N5" and date/time the patient arrived in N5 and the line for "GRA - Home medicine ward" with the time that the patient was actually moved
  2. For patients Discharged on or after May 15, 2020
    • For cases in #1 - change the Service/Location from GRA_2S to GRA_N5 and in tmp change the line "GRA_N5" to "no borrow" and delete the date and time
    • For cases in #4 - change the Service/Location from GRA_2S to GRA_N5 and in tmp add line "GRA_2S" and date/time the patient arrived in 2S and the line for "GRA - Home medicine ward" with the time that the patient was actually moved to N5

N5 COVID suspect ward

This ward is a mix of different medicine patients ie. 3S, 2S, and 3N 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 N5
  3. if the patient's result is negative and they are moved back to their home ward then enter Boarding Loc GRA home medicine ward with the date and time they are transferred back
  4. if the patient's result is positive,and if they do not physically move to S5 and remain on N5 then no change is required, if they move to S5 create a new profile for using Service Location 5S_C

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 unit (ie. N5 to 2S or 2S to N5) use your continuous serial numbers
  2. For 5S_C start with serial number 150

Examples of Entries

If in the documentation from ER it says that a COVID swab was sent and they do NOT indicate the result, we assume they were admitted to whichever ward as COVID SUS

  • If they were admitted to 5N, service location= home ward location (3N, 3S or 2S), boarding loc in tmp= 5N
  • If they’re admitted to their home ward, Service Location = home ward (3N, 3S, 2S), no boarding loc in tmp is necessary, unless they are transferred to 5N at some point during their stay
  • If they’re swabbed positive, the initial profile will be discharged to 5S_C, and a new profile will be created Service Location= 5S_C, and if they’re physically anywhere other than 5S_C use their home ward location.
    • We do not follow surgery patients that are COVID suspect unless they are under the care of medicine

ICU Situation

  • The current Grace ICU will be the COVID unit. A new 15 bed ICU has been set up in the GRA_PACU area, this will be the non-covid ICU.

Reporting

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