Bed borrow

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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).

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.

collection instructions

Exception: EMIP

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

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:

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:
        1. Bed-days in the given interval that patients assigned to UnitA had Flag1=1 +
        2. 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:
        1. Bed-days in the given interval that patients assigned to UnitB had Flag2=1 +
        2. Bed-days in the given interval that patients assigned to any other unit had Flag1=1 AND the FlaggedUnitCode for Flag2 was UnitB

Background

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

The concept is the counterpart of an Off ward - 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

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

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.

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