Bed holds

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  • Before we had access to hospital admit/discharge/transfer information (available both from COGNOS and EMR), we had to manually deal with the situation where a patient is sent away from the current hospital (A), to a different hospital (B) almost always for specific procedures, with the expectation they will return after the procedure. While this is usually the case, sometimes the patient remains after the procedure for an extended period, and (rarely) gets admitted to hospital B due to complications; but if that admission is to a location where we do not collect data, we have no way of knowing. This is a "bed hold".
  • But now we have better way of dealing with this, and here are the guidelines:
    • If the patient did, at some point, return to hospital A from hospital B, and ADT indicates that the patient was NOT discharged from hospital A during the say in hospital B -- then we consider the entire stay (time in A, then B, then back in A) as a single record in hospital A, including all the procedures done during the time at hospital B.
    • If the patient did, at some point, return to hospital A from hospital B, and ADT indicates that the patient WAS discharged from hospital A during the time at hospital B -- then we will consider this as TWO records in hospital A, with the first one ending when the patient physically left to go to hospital B (i.e. not when ADT shows the patient was discharged from A), and the second one starting when the patient returned to hospital A. In this case, the procedures that occurred during the time in hospital B are not included in either record for hospital A unless they include an Admit Procedure for the 2nd admission to hospital A.
    • If the patient did NOT return to hospital A from hospital B then there will be an indication in ADT of the discharge from hospital A, and our single hospital A record is taken to end on the date of ADT discharge.

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      • NOTE for Julie -- if such a patient was admitted in hospital B to a location where we collect, then the hospital A and B records will be flagged in the data check as having overlapping times. In that case the end of the hospital A record should be taken as the time of the hospital B admission.
        • That's not so much a note for Julie as an instruction for a cross-check. Not sure if that's a cross check we have in CFE or something she does in SAS...
  • added: 2021-07-15
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duplication on wiki needs to be cleaned up once we are on same page , e.g. LOS Medicine per hospital admission and other LOS pages would use this concept as well and other details are duplicated at articles in "what links here", should get rid of details elsewhere and only have them here, but need to discuss with Julie.

There are likely three parts:

  • How this should be collected - almost trivial now since Using Cognos2 to keep track of patients should address it, but since collectors don't necessarily follow that, we should probably leave the instructions above and just link from there? Maybe?
  • Cross-checks - this is done by which queries?
  • Data Use - The actual way that's done may well be different for different Indicators and Reports, so it would likely be best if the details were stored in the respective pages with a link back to this page whenever the concept crops up.
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