Bed borrow: Difference between revisions

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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.
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.


== 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.


LOS is generally 2-4hrs then they go back to there original department bed.


== Question - HSC Neurology H4H patients ==
== Question - HSC Neurology H4H patients ==
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In the meantime, our definition of ICU patient stands and '''excludes''' bed borrows.
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.
LOS is generally 2-4hrs then they go back to there original department bed.

Revision as of 17:33, 2016 June 6

A bed borrow is when a patient is located in one place while admitted under the physician of a different location.

more to come, this is being split out because it affects a bunch of things.

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.


Question - HSC Neurology H4H patients

moved here from Definition of a Medicine Service admission, depending on resolution it might need to go back there.

Template:Discussion

  • On H4H we get a few patients admitted to the high obs from other hospitals for neuro consults. The direction I have been given is to include them in my data if they are there for more than 24 hours. These short stays have occurred infrequently on my ward. We do however have lots of patients who are admitted under neurology and I have been including these as Medicine Admits.
  • Has anything been done to implement Dr. Robert's instructions to flag these neurology short stay patients? Or, for that matter, to flag the neurology patients? Now that they are staying longer we might want to review whether he wants to collect them. If we want to implement this, I would suggest doing it as a Category:Special Short Term Projects, and with limited duration and a plan to analyze and act. Ttenbergen 16:38, 11 September 2009 (CDT) Ttenbergen 22:23, 2014 October 6 (CDT)
  • How are these patients different from other bed borrows, and does this have any impact on our decision not to collect other bed borrows? Ttenbergen 18:09, 10 September 2009 (CDT) Ttenbergen 22:23, 2014 October 6 (CDT)
    • According to the definition of a Medicine pt, a good percentage of H4H pts would be excluded. The Stroke pts that are admitted to the unit are admitted under NEURO attendings not Medicine Atendings. To my understanding we were to included all pts that were admitted to the High Obs unit no matter what service the pt was, because high obs beds were considered to be medicine beds. We have not been instructed to Flag the non medicine ones.--PStein 08:01, 2014 October 7 (CDT)
      • flag how? If there is an article on the wiki about this, please link... Ttenbergen 09:52, 2014 October 9 (CDT)


Background

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

Some procedures like Cardioversion or hemodialysis can happen in a bed borrow situation.

According to HSC_Critical_Care_Collection_Guide#STB_CCU_transfers a bed there is sometimes borrowed before a pt is sent on to HSC CCU. Is that still true? Do we ever collect that pt while at STB_CCU?

The concept is the counterpart of an OVER - a patient who is counted as an OVER by one site would be seen as a bed borrow by the site where they actually are.

Circumstances leading to bed borrows

Examples of circumstances leading to bed borrows are:

  • 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?)

Considerations

Apparently the bed-borrow practice is getting more and more common. By not collecting these patients we not accounting for ICU nursing work load caused by them.

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.

LOS is generally 2-4hrs then they go back to there original department bed.