Bed borrow: Difference between revisions

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A bed borrow is when a patient is located in one place while admitted under the physician of a different location (the home location).  
A bed borrow is when a patient is located in one place (e.g. a boarding location, [[Boarding Loc]]) while admitted under the physician of a different location (the home location).  


If a patient overflows into another unit, they are still patient of the unit where they are admitted and in the location on the laptop. Return to the unit is not a transfer.  
Over time we have had various incarnations of collecting this data, this page is an aggregator for the info, and specific collection info for old projects lives on the respective pages.  


{{DiscussTask | we want to unify this concept; started discussion today
== Currently collected concepts ==
* pre-admission bed borrow vs post-admission bed borrow (vs current [[Off ward field]] check box
(soon!)
* also consider [[ECIP]] Ttenbergen 14:33, 2019 April 9 (CDT)
* [[Boarding Loc]]
* also related is our ''old'' concept [[Moves for Medicine]]}}
* [[Accept DtTm]]  


== Proposed new concept ==
{{DA | we want to unify this concept; started discussion today Ttenbergen 14:33, 2019 April 9 (CDT)
*we are seeing at Grace, a number of patients that are admitted from a GRA ward into the GRA ER under ICU care until bed is available in Grace ICU.  Unlike CON or OAKs, that if patient needs ICU, and no bed, they go to ER, under ER service care until ICU bed available. At Grace, this is a bed borrow by ICU service in ER dept, but our TMP project does not have to ITEM for GRA ER for this purpose. As discussed in Task, we will likely be seeing more of this and we need to find out if ICU would like to know how much time patients spends in ER like this.  We need to decide how we are going to capture this. 
*GRA_MICU-10422
*GRA_MICU-10458
*UPDATE: on May 2.19 we added GRA ER as item in TMP for [[Project Borrow arrive]]. At a later time we also added GRA_MICU
*UPDATE: June 12.19 - planned changes - not yet active - [[Boarding Loc]]
*UPDATE: July 18.19 - target start date - Sept 1.19 for new admits.  Please see [[Boarding Loc]] article.}}


=== collection instructions ===
== Soon-to-be legacy concepts ==
* If a patient comes from arrives on your ward from a bed borrow location, code [[Pre-admit Inpatient Institution field]]/[[Previous Location field]] as the home location, not the bed borrow one.
As of 2019-08-26 we are in the process of phasing out:
* If a patient you collect is currently in a borrowed bed somewhere off-ward, collect the [[Service/Location field]] as the home ward.
* [[Off ward field]]
* If you discharge a patient to a bed borrow location, code [[Dispo field]] as the home location.
* [[Project Borrow arrive]]
 
== Legacy concepts, or considered but never implemented ==
* [[ECIP]]
* [[Moves for Medicine]]}}


=== Exception: [[EMIP]] ===
=== Exception: [[EMIP]] ===
{{Discuss | is this about to change with [[Boarding Loc]]? }}
EMIP patients are essentially bed borrows in the Emergency Room, but we collect and are specifically interested in this group, so follow the [[EMIP]] collection instructions for these patients.  
EMIP patients are essentially bed borrows in the Emergency Room, but we collect and are specifically interested in this group, so follow the [[EMIP]] collection instructions for these patients.  


=== [[Parked in ER]] ===  
=== [[Parked in ER]] ===  
{{Discuss | is this about to change with [[Boarding Loc]]? }}
A patient is considered parked in ER if they are a direct admit but when they arrive a bed is borrowed in the ER. The location they came from is encoded as [[Accept Loc Park]].
A patient is considered parked in ER if they are a direct admit but when they arrive a bed is borrowed in the ER. The location they came from is encoded as [[Accept Loc Park]].
=== [[Project Borrow arrive]] ===
For all bed borrows for ICU patients only.  We are not using for medicine.
This new project replaces:
*[[ACCU borrow]]
*[[ICUotherService]]
**We are still using ACCU borrow as it has not been replaced by borrow/arrive on the laptop. --[[p:Lois Bilesky-retire Jan 10, 2019 | Lois Bilesky]]-- 11:23, 2018 November 5 (CST)
==== Allan’s Suggestion for Bed Borrow Coding ====
*There are 2 sorts of bed borrowing when a TypeA patient should be in UnitA but is boarded in UnitB
**(1) Patient is in Unit B but still under the care of TeamA -- this is coded in the database as a UnitA patient
**(2) Patient is in Unit B and under the care of TeamB -- this is coded in the database as a UnitB patient
*Here’s what they’re borrowing:
**For ‘1’ the patient is just borrowing a bed
**For ‘2’ the patient is borrowing a bed AND the service, i.e. TeamB
*To capture all of this, we need to create 2 PAIRS of parameters -- that should be coded separately for each day, if applicable.  Each pair comprises a binary Flag combined with FlaggedUnitcode
**(a) Flag1 indicates that on the given day the patient is borrowing a bed -- the FlaggedUnitCode indicates WHERE that bed is. 
**(b) Flag2 indicates that on the given day the patient is borrowing a bed & service -- the FlaggedUnitCode code indicates WHERE that patient would otherwise be located
*Example:  A=ACCU  B=ICMS
**In situation#1, set Flag1=1 and FlaggedUnitCode=ICMS
**In situation#2, set Flag2=1 and FlaggedUnitCode=ACCU
*THUS, here is how the 2 kinds of pieces of data sought by administrators related to bed borrows would each be calculated:
**Administrators for UnitA want to know how many bed-days in a given interval that they had TypeA patients boarding elsewhere.  This number is the sum of the following 2 things:
***#Bed-days in the given interval that patients assigned to UnitA had Flag1=1 +
***#Bed-days in the given interval that patients assigned to any other unit had Flag2=1 AND the FlaggedUnitCode for Flag2 was UnitA
**Administrators for UnitB want to know how many bed-days in a given interval were taken up by boarders from elsewhere.  This number is the sum of the 2 following things:
***#Bed-days in the given interval that patients assigned to UnitB had Flag2=1 +
***#Bed-days in the given interval that patients assigned to any other unit had Flag1=1 AND the FlaggedUnitCode for Flag2 was UnitB
==== Allan's new suggestion for bed borrow coding ====
(as discussed [[Task_Team_Meeting_-_Rolling_Agenda_and_Minutes_2019#ICU_Database_Task_Group_Meeting_.E2.80.93_April_9.2C_2019]] and in email the next day)


== Background ==
== Background ==
The concept is important because it affects the [[Previous Location field]], [[Service/Location field]], [[Dispo field]], various cross-checks, and concepts like [[EMIP]], [[Boarding Loc]], [[Definition of an ICU admission]] and [[Definition of a Medicine Service admission]].  
The concept is important because it affects the [[Previous Location field]], [[Service/Location field]], [[Dispo field]], various cross-checks, and concepts like [[EMIP]], [[Boarding Loc]], [[Definition of an ICU admission]] and [[Definition of a Medicine Service admission]].  
The concept is the counterpart of an [[Boarding Loc
] - a patient who is counted as an off-ward by one site could be seen as a bed borrow by the site where they actually are.


=== Circumstances leading to bed borrows ===
=== Circumstances leading to bed borrows ===
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=== Implication: mis-estimation of workload ===
=== Implication: mis-estimation of workload ===
Our decision to code borrowed beds according to their attending rather than to their physical location means we will underestimate work load in some places and overestimate it in others. There is no way to not have this problem in one direction or the other, so we decided on this one.
Our decision to code borrowed beds according to their attending rather than to their physical location means we will underestimate work load in some places and overestimate it in others. There is no way to not have this problem in one direction or the other, so we decided on this one.
{{DT | When I change this page back to a general aggregator for borrow related info I need to deal with:
* [[Accept DtTm]] vs [[Arrive DtTm]]
* [[Moves for Medicine]]
}}


==Related articles ==
==Related articles ==

Revision as of 20:19, 2019 August 26

A bed borrow is when a patient is located in one place (e.g. a boarding location, Boarding Loc) while admitted under the physician of a different location (the home location).

Over time we have had various incarnations of collecting this data, this page is an aggregator for the info, and specific collection info for old projects lives on the respective pages.

Currently collected concepts

(soon!)


Soon-to-be legacy concepts

As of 2019-08-26 we are in the process of phasing out:

Legacy concepts, or considered but never implemented

Exception: EMIP

is this about to change with Boarding Loc?
  • SMW


  • Cargo


  • Categories

EMIP patients are essentially bed borrows in the Emergency Room, but we collect and are specifically interested in this group, so follow the EMIP collection instructions for these patients.

Parked in ER

is this about to change with Boarding Loc?
  • SMW


  • Cargo


  • Categories

A patient is considered parked in ER if they are a direct admit but when they arrive a bed is borrowed in the ER. The location they came from is encoded as Accept Loc Park.

Background

The concept is important because it affects the Previous Location field, Service/Location field, Dispo field, various cross-checks, and concepts like EMIP, Boarding Loc, Definition of an ICU admission and Definition of a Medicine Service admission.

Circumstances leading to bed borrows

Examples of circumstances leading to bed borrows are:

  • Own ward to own ER under ICU the care of ICU Service Physicians, then move to ICU, when bed available (Grace-started end of March 2019)
  • ER borrows a ICU bed to do hemodialysis and then the pt goes back to ER.
  • medicine borrows a ICU bed for central line insertion or for dialysis or for a bronchoscopy, etc.
  • post angio monitoring because pre and post procedure in angio is closed in late evening and night shifts.
  • medicine borrows a ICU bed for Cardioversion
  • (does anyone have additional bed borrow scenerios?)
  • (any examples for borrowed med beds?)
    • These are not situations we can code and these are not units we code in our database eg. ER. If someone wants this data we are unable to code it now without changes to the database. --LBilesky 11:27, 2018 November 5 (CST)

Considerations

Bed-borrowing in other locations has always occurred but appear to becoming more common.

In the meantime, our definition of ICU patient stands and excludes bed borrows.

Implication: mis-estimation of workload

Our decision to code borrowed beds according to their attending rather than to their physical location means we will underestimate work load in some places and overestimate it in others. There is no way to not have this problem in one direction or the other, so we decided on this one.

Related articles

Related articles:
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