2020 GRA COVID unit transition

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

Background

The dates are not yet finalized.

• 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.
• ?? April ?? .20 - 5S will be a new COVID-19 ward GRA_5S_C with ?? adult beds
• 2020 Apr 14 - Grace ICU - PACU has now been converted to be ready for non covid ICU pts (15 beds) - ready to go but no admissions. The Current GRA ICU (10 beds) will become the covid ICU

Medicine Situation

Collection instruction summary for now

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 anywhere on 5 or on 2S, their service location will be 2S
• If they’re admitted anywhere else, their service location will be their home ward, and will be boarding on 5N, with the Home Medecine Ward entry being the date/time of the swab negative result
• If they’re swabbed positive, the initial profile will be discharged and a new one will be created for them under 5S, and if they’re physically anywhere other than 5S we will add a boarding loc entry.

A couple weeks ago I had I believe 2 random surgery patients that were admitted to 5N. I entered them what I thought was in error, I talked with Pagasa and the profiles were deleted and a valid gap was made for those serial numbers. I believe they were on 5N because they were swabbed for COVID. Do we care about tracking cases like this? Because to be honest, if we see a surgery service patient on our EPR reports, we don’t view it (unless of course they’re a long recovery and need to be moved to medicine for PT/OT, etc). Surgery patients admitted under surgeons don’t get viewed by us. Surgery patients admitted under our regular medicine docs will get viewed.

• SMW

• Cargo

• Categories

Random bits from crazy email stream, need to be integrated

Collection

• COVID POS: label with Service/Location of GRA_5S_C regardless of their physical location; enter physical location as Boarding Loc
• COVID SUS: on 3S as well but under a 3S doctor, not a 2S/5N doctor
  • use GRA S3 profile and Boarding Loc=GRA_N5
  • GRA N5 is a mixed of GRA S3 and GRA N3 too. So these will be entered in S3 or N3, also with tmp Boarding Loc = GRA_N5

Transition

• GRA_N5 patients discharged before April 15 remain GRA_N5
• GRA_N5 patients discharged after April 15:
  • if pt is COVID POS change Service/Location to GRA_5S_C
  • otherwise change Service/Location to GRA 2S regardless if they move physically there
  • enter Boarding Loc=GRA_N5 for the time they were on that unit

Earlier content

• Patients that were on GRA N5 began moving to GRA 2S on March 28. It was a staggered move, and because we're not going to the wards to review charts, I can't say for sure if there was a reason why that was. For example, one patient was admitted to GRA N5 in February and was moved to GRA 2S on March 28. Another was admitted Jan 14 and was moved April 7. EPR doesn't give any clues as to why they were staggered this way (if there was a medical reason why they stayed behind).
• We have confirmed with one of the doctors that GRA 2S IS a non-teaching medicine ward with the 2 doctors that previously covered GRA N5. So yes, GRA 2S is what GRA N5 was pre-COVID.
• I don't know what bed capacity GRA N5 and GRA_5S_C will have but I do know that
  • everyone COVID SUS or COVID POS will default to GRA N5]
  • If they have more than 2 POS admissions, they will open GRA_5S_C
  • We're assuming if a COVID SUS is swabbed negative, they will be moved to GRA 2S. Currently there is 1 admission on GRA N5 that are not labelled COVID in EPR, so again, I don't know if there's another medical reason why they stayed behind.
• The COVID POS patients are usually under the internist that admitted them unless they are coming from ICU (COVID POS patients are under internal medicine).
• The COVID SUS patients are under the medicine doctor that admitted them (general medicine) Surbanski 09:09, 2020 April 15 (CDT)

* something goes wrong with following discussion it becomes invisible, need to troubleshoot.

• SMW

• Cargo

• Categories

1. Julie wrote: Tina, Trish – we need to decide how to handle the COVID suspects admitted at N5 -
   • 1. If the result is negative and patient moves to 2S – a case of transition, Service_location change from GRA_N5 to GRA_2S
     • Tina- If we change the service location Pagasa will get orphans
   • 2. If the result is negative and patient did not move to 2S but somewhere else -  ??? Service_location = GRA_N5 - keep as is
   • 3. If the result is positive and patient moves to 5S – new record Service_location= GRA_5S
     • Tina- If we change the service location Pagasa will get orphans.
   • 4. If the result is positive and patient remains in N5 - ??? Service_location=GRA_N5_C – added _C to denote covid positive
     • Tina- Unless other collectors also get this right, this will cause linking errors
   • Items 1 and 3 - no issue. Items 2 and 4 – need to decide, do you agree with the red entry. If so, need to add item 4 entry (was added already because I thought we had decided to use it) OR you have other thoughts?
   • DC - will it be easy to distinguish the negative and positive at N5?
2. Sherry-we won’t know until their charts are physically in medical records. Cadham does not put the swab results on EPR and we have no way of knowing the results. As of right now, Trish has given us the direction to NOT go to the wards to view charts.

1. Lisa
   • 1. If Sherry and Mindy are dividing workload on 5N by provider (so it can be and is currently a mix of 5N patients, one 3S patient and one 3N patient) , then a negative covid (moved to its home location) is just an extension of the same admission. by transition Julie do you mean use the transition instructions on the wiki for the moves from 5N to 2S? Would Mindy do the same for a negative that then transfers back to 3N? or a patient that goes back to 3S? (BTW we are not doing any of this at HSC for our COVID suspects we enter our home location and just put the D2 in the tmp boarding and if they transfer back to our home ward we use the medicine home ward option in the tmp, we have not been instructed otherwise)
   • 2. If the result is negative and the patient and moves somewhere else wouldn't that be boarding?, if they stay under medicine but not on a medicine ward
   • 3. if positive and move to 5S I think Julie means create a new profile with service location 5S
   • 4. Makes sense to add a new location 5N_c but how will they handle those cases if 5S opens up because there are more than 2 patients and the patient then moves from 5N_C to 5S, is this a new profile? or track in tmp? Lisa Kaita 11:28, 2020 April 15 (CDT)
2. Mindy
   • 5North is NOT a boarding location. It's still a regular sub acute medicine ward. Yes the patients are Covid suspects we think due to being Exposed but this is not confirmed. No boarders here Mcrawley 15:15, 2020 April 14 (CDT)
     • Are there new patients admitted at N5 (primarily as COVID suspects)? --JMojica 16:01, 2020 April 14 (CDT)
       • On closer inspection the new people being admitted to this ward are all Covid suspects, was hard to tell at first because patients that stayed on this ward were 5 North patients. So it looks like the new patients on the ward are boardersMcrawley 08:01, 2020 April 15 (CDT)

Transition plan

1. There is no transition plan for the new COVID ward GRA_5S_C which has already been added to the s_dispo table.
2. This transition plan is only for the patients in N5 who were moved to 2S or who remained on N5 under the N5 physicians.
   • GRA_2S needs to be added to the s_dispo table.
   • GRA_N5 needs to be added to s_tmp of Project BoardingLoc

Maybe we need to add GRA_2S as a s_tmp of Project BoardingLoc as well since there are random medicine patients there like from 3South?Mcrawley 12:22, 2020 April 15 (CDT is this case also started at 5N as suspect or started at 2S? the date gives the clue. if date is before the move of N5 to 2S, then enter generic GRA boarding. let us know before we decide to add it as another tmp item. --JMojica 13:53, 2020 April 15 (CDT))

• SMW

• Cargo

• Categories

collector instructions

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

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, create a new profile using S5 as Service/Location if they do not physically move to S5 and remain on N5 then enter Boarding Loc N5 with the date and time closest to the positive result, if or when they move to S5 enter Boarding Loc Gra home medicine ward with the date and time they are transferred to S5

I want to make sure I have everything correct so please provide your feedback if anything is incorrect. Please keep in mind that we are not going to the wards to review charts and will not be able to see swab results until their charts are available in medical records because currently the results are NOT available in EPR. The only exception to this would be a situation where someone was in ER long enough that their swab results come in and the ER docs document a note in EPR. People who are swabbed are indicated as COVID SUS in EPR and the positive results are indicated as COVID POS. PATIENT PRESENTS TO GH AND IS SWABBED UPON ADMISSION TO ER This patient is admitted to 5N, and will have a 5N profile created for them using the 5N serial numbers We're assuming if the result is negative they are moved to 2S (2S has been transitioned from surgery to a non-teaching medicine unit) The Service Location will be changed from GRA_N5 to GRA_2S The arrive date and time will remain their original arrive date/time, in this case, when they were admitted to 5N A Tmp Boarding Loc will be added to be boarding on 5N for their admission date/time, and a Home Medicine Ward will be added for their admission to 2S A second profile will NOT be created for these patients that is correct Lisa Kaita 10:28, 2020 April 16 (CDT) If this patient's swab results come back as COVID POS and patient remains on 5N A second profile will be created The Service Location will be GRA_5S_C. The arrive date/time will be the date/time of the swab POS results. A Tmp Boarding Loc will be added to be boarding on 5N again with the swab POS date/time If they do not leave 5N and are discharged from 5N, there will be no Home Medicine Ward entry If they are transferred to 5S, there will be a Home Medicine Ward entry for the date/time of the transfer This is correct, I believe they will also be under a new physician so you could you use the date and time the provider is changed, use your best clinical judgment or what is available Lisa Kaita 10:28, 2020 April 16 (CDT) If this patient's swab results come back as COVID POS and patient is transferred to 5S A second profile will be created for the 5S admission The arrive date/time will be the date/time of the swab POS results There is no need to add a Tmp boarding loc This is correct with the same comment as above Lisa Kaita 10:28, 2020 April 16 (CDT) PATIENT PRESENTS TO GH AND IS KNOWN TO BE COVID POS UPON TRANSFER TO THE WARD We know that 5N has the capacity for 2 POS patients. If they need capacity beyond this they will open 5S If this patient is admitted to 5N and remains on 5N The Service Location will be GRA_5S_C. The arrive date/time will remain as their original arrive date/time to 5N. A Tmp Boarding Loc will be added to be boarding on 5N for their admission date/time If they are not transferred to 5S and are discharged from 5N, there will be no Home Medicine Ward entry If they are transferred to 5S, there will be a Home Medicine Ward entry for the date/time of the transfer This is correct Lisa Kaita 10:28, 2020 April 16 (CDT) If this patient is admitted to 5S and remains on 5S Profile will be created in the usual fashion for an admission to 5S No Tmp boarding loc required as part of the admission process This is correct Lisa Kaita 10:28, 2020 April 16 (CDT) If this patient is transferred to 5N, a Tmp boarding loc will be entered to reflect the boarding on 5N and another profile will not be created This is correct provided they are still an active covid + patient under the same provider, if they are recovered and just transferred to 5N because there are no beds on 2S/3S then a new profile would be created Lisa Kaita 10:28, 2020 April 16 (CDT) If this patient is transferred to any other unit that is not on the 5th floor (i.e. 2S, ICU, etc) this profile will be discharged and a new profile will be created by whomever collects data for the new ward Correct

• SMW

• Cargo

• Categories

Currently I do not have a 5N boarding location. Was one going to be created or did we decide against this? Tina should add this in tmp. --JMojica 09:43, 2020 April 16 (CDT) done for next version Ttenbergen 11:24, 2020 April 16 (CDT)

• SMW

• Cargo

• Categories

Which serial numbers should be used

I want to confirm, are we using serial numbers starting at 150 for all 5S admissions? Surbanski 09:10, 2020 April 16 (CDT) I think you just have to continue your serial number. do you agree, Trish and Tina? --JMojica 09:43, 2020 April 16 (CDT) At HSC we are continuing using the same serial numbers, please let us know if we should be doing something different Lisa Kaita 10:28, 2020 April 16 (CDT) The new Serial Number helper will give you highest current of that service/location + 1; so we should use different series for each service location. If you end up trying to enter a serial while that serial is already on your laptop, you will get an error. So if we made more than one new location for someone we should start new serials in a staggered way, with the unit with expected higher throughput having the higher number. Eg. start slower unit with 150, and faster unit with 1150. Alternatively, we could move to a system where each laptop uses a single serial number pool; I would need to update the helper for this. Ttenbergen 11:12, 2020 April 16 (CDT) Before we clean this out, this above info needs to be moved to Serial number. Ttenbergen 11:12, 2020 April 16 (CDT)

• SMW

• Cargo

• Categories

Outstanding issues

I have spoken with Richard Q the manager on the 5th floor today and this is what he has told me:

• As of right now, they still don't have confirmation on the designated COVID units, but at this time, 5N is being used for COVID SUS and 5S is being used for COVID POS admissions. Currently according to EPR there are 2 positive cases admitted to 5S.
• Over the past week, there has been a lot of movement from 5N to 2S, which in the past was where our boarders were moved to. When I asked Richard, he indicated that 2S has become the "clean" medicine unit. Again, this is all yet to be confirmed by GH and/or WRHA.
• Currently, there is 1 doctor who has taken on the COVID patients, but again, this could be temporary and may change over time depending on what the demand is.
• Unless they are labeled COVID POS in EPR, there is no way for us to know what the swab results return as. This information will only be gathered once the chart is available in Medical Records. If you would like to grant us the ability to go to eChart to review, I'll leave that to the powers that be to decide. My understanding is in this Data Collector role, we are no to review records in eChart.

For the POS patients who have moved from 5N to 5S - How do we want to track these? There is a dispo location to this unit, but I don't yet see a Service Location for this unit (unless Tina/Julie are still working on this step and it is yet to come). Surbanski 14:42, 2020 April 8 (CDT) Made GRA_5S_C available for collection now. Sorry, I missed a step earlier for this. If you van now enter this please delete the question, otherwise put a comment that this is still an issue. Ttenbergen 14:59, 2020 April 14 (CDT)

• SMW

• Cargo

• Categories

I would like some direction on how to proceed - I didn't know that my medicine unit (5N) was transitioned into a COVID floor. I've been entering and tracking the 5N admissions and 2S boarders. I know it's difficult to make decisions when no one really knows what's going on, but before I get too deep in COVID I'd like to have some direction to avoid duplication of work (i.e. having a profile for a 5N admission and a second profile for a 5S admission if we decide to track them).Surbanski 14:42, 2020 April 8 (CDT) do you mean both N5 and 5S are COVID wards, please confirm because we need to distinguish the N5 as acute med unit vs N5 as covid ward. Covid ward(s) will be reported separately from the other med wards. thanks. --JMojica 16:23, 2020 April 14 (CDT)

• SMW

• Cargo

• Categories

I have another question - currently I am recording data and admissions on 5N (as per the current process), which we are assuming is the COVID SUS ward. Some of these patients are discharged from the ward after a couple of days once (I assume) their swab results are back negative. If we're not interested in collecting for COVID SUS, then we need to change the process for data entry on this unit. Technically, my 5N medicine patients are admitted on 2S, which are now all being labelled as "Boarders". I'm not sure what that would look like but I'm open to a discussion with whoever it would be who would decide this. Surbanski 08:57, 2020 April 9 (CDT) are these covid suspects under the medicine service? this will be a bit tricky if being taken care by medicine service. should it be considered as 2S medicine service borrowing bed at 5N, so it will not be missed? --JMojica 16:30, 2020 April 14 (CDT)

• SMW

• Cargo

• Categories

This just in .... as we're going through our admissions guess what we've found on 2S? Patients admitted under 3S doctors! Are we having fun yet? I'll be admitting these folks on 3S and have them boarding on 2S. There are no COVID flags on their EPR accounts. Surbanski 11:30, 2020 April 15 (CDT)

• SMW

• Cargo

• Categories

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 clean ICU.

as far as I can tell no additional tmp entries will be required for this; Julie, if you agree pls delete this discussion point. If we do need tmp entries pls tell what they are.

• SMW

• Cargo

• Categories

Reporting

service location GRA_N5 before move date to GRA_2S and GRA_2S can be reported together.

Cross checks

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?

• SMW

• Cargo

• Categories

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?

• SMW

• Cargo

• Categories

Related articles

Related articles:

GRA ICU Collection Guide ‎ (← links) GH-N5 ‎ (← links) GH-MICU ‎ (← links) CCMDB.accdb Change Log 2020 ‎ (← links) 2020 COVID unit transition ‎ (← links) GH-2S ‎ (← links) GH-Recovery Room ‎ (← links)