Bed borrow

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

• 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.
• If a patient you collect is currently in a borrowed bed somewhere off-ward, collect the Service/Location field as the home ward.
• If you discharge a patient to a bed borrow location, code Dispo field as the home location.

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.

ACCU borrow

See ACCU borrow for borrows involving STB ICU patients.

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

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.