|
|
| (53 intermediate revisions by 8 users not shown) |
| Line 1: |
Line 1: |
| '''This project is still active as defined below, and does not stop as [[Overstay]] starts at a site. '''
| | {{Project |
| | |ProjectActive=legacy |
| | |ProjectProgram=Med |
| | |ProjectRequestor=Linda Hathout |
| | |ProjectCollectionStartDate=2012-11-05 |
| | |ProjectCollectionStopDate=2013-09-30 |
| | |Project={{PAGENAME}} |
| | }} |
| | Legacy only, see history for details |
|
| |
|
| '''Please do not discuss this project
| |
| with other staff except collectors
| |
| at your sites. '''
| |
| This project will observe staff
| |
| behaviour and we are concerned about a
| |
| [https://secure.wikimedia.org/wikipedia/en/wiki/Hawthorne_effect Hawthorne effect].
| |
|
| |
|
| ==Purpose==
| |
| To determine "how many" allied health consults patients are getting, in part to determine the effect of the [[Overstay Predictor Project]] on this variable.
| |
|
| |
|
| We want to collect ''whether a consult was requested'', not what sort of delays happen. That is something we know we need to consider, but it is not part of this temporary collection. We assume that most patients get allied health consults but we need numbers to back up the assumption.
| |
|
| |
|
| ==Project Dates==
| |
| * '''all medicine wards''' at: (HSC, STB, GRA, VIC)
| |
| * Starting: 2012-11-05
| |
| * Ending: To be reviewed 2013-02-28 (booked with Tina and Trish)
| |
|
| |
|
| == Collection Instructions ==
| |
| Generate a tmp entry when a '''first/initial''' consult" for '''any''' of the '''four''' allied health disciplines is generated
| |
| :: - while admitted to your ward (ie after admission, before discharge)
| |
| :: - in the ER immediately prior to admission to your ward
| |
| * Project:AlliedHC
| |
| * Item (as appropriate):
| |
| #Home Care
| |
| #Physio
| |
| #OT
| |
| #Social work
| |
| * '''''no other fields need to be filled''''', i.e. no times etc.
| |
| * if there are no consults there is nothing to do for this project, i.e. there is no "no consults" entry
| |
| {{discussion}}
| |
| *I just want to clarify I've encountered a couple of cases where pts are coming from non-collection units where a first consult is generated and then the patient is transferred to my unit and the pt continues to be followed by the allied health services. These cases fall under the project goals and will be included in my data collection. Clarify the collection instructions to include consults generated elsewhere but not previously documented in the pts profile(ie coming from a data collection site).
| |
| ** No, don't collect these, they only should be collected on the ward where they are initiated. The instructions were always meant to say that, that was why we put "first" there. I hope it is clear now. If it is not clear, ''please'' update the instructions above to make it clear. Please delete the discussion after you do; the change will invite me to have a look.Ttenbergen 11:59, 2012 December 21 (EST)
| |
| *** So just to clarify Tina you dont want us to collect Allied Health Consults from a ward we are not collecting on for example S2 (WE DONT COLLECT FROM S2 )comes to S4/S5/N5 they started the consult on S2 and continue with them on S4S5N5 We dont enter the consults Correct? Also does this apply to pts coming from Vic ICU the consults start there and cont to the wards? Is this not the same situation as a pt coming from emerg? Thanks Please let us know .
| |
| **** Only collect Allied Health consults generated on your ward on in ER immediately prior to admission. As the instructions said. I am really curious - are the instructions still unclear, or is it more a case of you collectors being concerned that the instructions are not what you would like them to be? We are aware that this will exclude total workload generated for Allied Health, but we just want to know workload generated by "our" wards. Further, we want to use this to generate a baseline, and then to see the change in that baseline performance once we change something. So, even if the baseline doesn't include all cases, the ''change'' in numbers compared to the baseline will still tell us what we want to know. Does that help? Ttenbergen 16:45, 2012 December 21 (EST)
| |
|
| |
| === Care Map generated consults ===
| |
| If a consult is generated because a patient is put on a care map (e.g. ACS caremap), '''do code'' those allied health consults, because if a consult is generated, it will affect Allied Health workload and availability.
| |
|
| |
| ===EMIP===
| |
| '''Include''' [[EMIP]] patients in this project, because if a consult is generated, it will affect Allied Health workload and availability.
| |
|
| |
| === Problems with collection instructions? ===
| |
| Can you think of a scenario in which the instructions above are '''not clear and comprehensive'''? I am not concerned for the moment whether they are "right" or "wrong", just if they would leave you confused how to code, or if you think you might interpret them different from another collector. Ttenbergen 10:58, 2012 November 5 (EST)
| |
| *Yes there was. The initial instruction was misinterpreted. Was not clear if first consult of any of the four allied health consults, or the first consult '''for each''' of the four allied health consults: [[User: DPagenewton | Deb]]. Dec 17.12
| |
|
| |
| ==== Self referrals ====
| |
| {{discussion}}
| |
| * I have encountered several pts where the Home Care nurse has self referred; in other words, a consult was not generated by the ward but was done by the HC dept themselves. Do these get included?
| |
| **our home care nurse at the VIC will often self-refer in emerg because the patient is known to the system and will need services on return home. Yes I include this referral in the study.[[User:Jkublick|Jkublick]] Dec 12,2012
| |
| ** To what degree can it be determined from chart whether a referral is a self-referral, and would it be extra work to find out? If it can be determined clearly and easily, we will create separate entry options for self-referrals. Please comment here so we can update this ASAP. (as per discussion with Linda) Ttenbergen 18:20, 2012 December 19 (EST)
| |
| * at the Grace it is easy to establish as the HC Coordinator writes self referral on a consult sheet and then puts the sheet in the chart
| |
|
| |
| == Data use and analysis ==
| |
| The data will be analyzed as part of the Overstay project. Tina is involved with that and can provide it directly.
| |
|
| |
| The plan for this data is to give a '''broad picture''' of consultation practices before and after the Overstay project. The data will be grouped and counted for comparison. We are not planning to use this data to get any detailed information on individual patients. We may use the data to trigger a chart review in special cases.
| |
|
| |
| We are aware that the consult practices at the sites are complex, and our project is not aiming to get a full picture. Specifically, '''we need to simplify what we are investigating so we end up with data we can compare across patients, wards and hospitals'''.
| |
|
| |
| === Considerations when analyzing this data ===
| |
| * At the Vic we have been double coding the allied health consults: for example if a pt is transferred from one ward to another the allied health tmp. entry has been re-entered on those pt's. in their new location because the allied health will follow the pts on the new unit. As of today Dec 6th when a pt moves from one unit to another unit the allied health tmp area will be left blank unless a new consult has been filed. Julie, the pts admitted to N5, S5, or S4 will have their first consult generated there (if they came from emerg) When those pts are transferred to S3 (or to N5/S5 from S4) they are still followed by allied health but I'll leave the allied health tmp entry blank.
| |
|
| |
| ==Collector observations and comments that might help interpretation of this data==
| |
| === Why we didn't add dates to the collection ===
| |
| '' I have removed comments relating to this from the discussion below ''
| |
| The tmp entries in CCMDB.mdb could accommodate date and time, but we decide '''not to collect'' this for the following reasons:
| |
| * We will primarily use this data in the form of counts, and there it would not help.
| |
| * If we wanted to add dates we would have to set rules around how to collect them in special cases (e.g. unknown, before admission, several consults, etc); this would make the collection more complicated, and it would mean that there would be too few of each case to combine them with any meaning.
| |
| * The dates might give an idea about what went wrong in a specific case, but if we wanted that level of detail there would need to be a chart review anyway, so having it in the database would add no value.
| |
| * also, see [[#Data use and analysis]]
| |
|
| |
| === Why don't we collect where a consult was generated, or by whom? ===
| |
| '' I have removed comments relating to this from the discussion below ''
| |
| Consultes could be generated before patients arrive on the ward, and various parties can generate them. We decided not to collect this because it would complicate both the collection rules and aggregation of the data.
| |
| * also, see [[#Data use and analysis]]
| |
|
| |
| === Why collect only these four types of allied health consults? ===
| |
| They are the ones that will be directly affected by project Overstay.
| |
|
| |
| === Miscellaneous ===
| |
| '' I will treat these as comments only, unless you put a <nowiki>{{discussion}}</nowiki> tag and a question I could address. ''
| |
| At the Vic, non-teaching medicine spends much of its time on discharge planning. PT and OT are often consulted in emerg and patients are usually assessed in emerg. If a patient does not pass the function assessment, the patient will be admitted to a ward. The patients here are sometimes admitted for failure to cope in the community. They are followed up on the ward usually the next day or when the patient's medical condition improves enough for the patient to participate. I notice that a patient may be medically stable but not able to perform ADL (activities of daily living)due to deconditioning. Discharge will be delayed till the patient has plateaued or gained a prior level of ADL functioning. This is the first significant delay in patient discharge that I see and holds up discharge planning for weeks. It can take weeks or more for the patient to regain strength. PT and OT work together and will consult each other on the patient's progress. Once PT feels that the patient is mobilizing well, OT will complete their assessment and determine the type of supported needed in the home if home is the goal. Home Care (HC) becomes involved once the patient has plateaued and makes the needed arrangements. The home care process seems fast and efficient in my opinion; usually a matter of 2-3 days approx. this is of course when the patient is returning to a prior living arrangement. When a patient fails to meet the criteria to return home or needs supportive housing a second delay begins. Paneling is the third time consuming process and waiting for placement seems to take months. These are the three main delays I see here at the Vic on my non-teaching units. What do others see happening? [[User:Jkublick|Jkublick]] Nov 1, 2012.
| |
| * Decided to include consults in ER immediately prior to ward admission. Ttenbergen 15:59, 2012 November 1 (EDT)
| |
| ** I agree with Judy. Just to let you know consults to physio and or occupational health can be filled out by a nurse /doctor /or allied health care service. Many patients who come to our wards are already receiving homecare which is cancelled and then has to be reviewed again to see if they require more treatments /adls at home. Do you want 1st timer to homecare services ? I have found out some services (Home care) are being delayed because information is not being relayed to them ie from ER They are not faxing the information to Home care and they are unaware that the pt needs follow up on the ward, until someone asks them what is happening? This just happened last week The pt wasnt seen for 7 days.
| |
| ****I agree with all comments made. Maybe we could capture if consults were made in ER or on Ward.--[[User:FLindell|FLindell]] 09:44, 2012 November 5 (EST)--[[User:FLindell|FLindell]] 09:44, 2012 November 5 (EST)
| |
|
| |
|
| |
| [[Category: Special_Short_Term_Projects]]
| |
| [[Category: L_TmpV2 Data]] | | [[Category: L_TmpV2 Data]] |
| [[Category: All Projects Medicine Only]]
| |