Boarding Loc: Difference between revisions

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|ProjectActive=active
|ProjectActive=active
|ProjectProgram=CC and Med
|ProjectProgram=CC and Med
|ProjectRequestor=Critical Care program (Allan Garland)
|ProjectRequestor=internal
|ProjectCollectionStartDate=2019-Sep-20
|ProjectCollectionStartDate=2019-Sep-20
|Project=Borrow arrive
|Project=Boarding Loc
}}
}}
{{Discuss |How will we phase out [[Project Borrow arrive]] and the [[Off ward field]]? There will be patients who straddle the boundary. Also, Tina will need to know when the last applicable patients  with [[Project Borrow arrive]] have been discharged so the entries can be inactivated in tmp. Booked review meeting with Julie and Trish for Nov 6. }}


This project tracks where and when a patient '''arrives''' into a "borrowed bed".  
This isn't so much a project as way to track how patients physically move around the hospital. See [[Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry]] for information about it and why we needed to change it to this model.  


A "borrowed bed" is when a patient is not physically located in the place designated by the [[Service/Location]].
This project tracks where and when a patient '''arrives''' into a new physical location under the Medicine or ICU service.  


*Critical Care will track '''all instances''' of bed borrows and moves between beds
== Data Collection Instructions ==
**This new project replaces [[Project Borrow arrive]] for ICU's  (same concept, only name change)
=== How to enter this ===
*''New'' for Medicine:  track '''all instances''' of bed borrows and moves between beds at minimum for a pilot between 2019-09-01 - 2019-Nov-01 .
You can use the [["make loc" button]] to generate and pre-populate these entries.  
 
This project does '''not''' replace [[ICUotherService]]; we will still need this item in the event that both the bed and the service are both borrowed. Administration at STB want this data.  


{{Discussion}} STB MICU patients under CICU service transferred to STB medicine units-for the medicine profile does the Previous Location = Pre Admit Inpatient Institution ie. STB_MICU? Does previous service = Critical care in these instances when both a bed and service are borrowed in CICU?
*Use tmp fields:
** Project: '''{{PAGENAME}}'''
** start_dt and start_tm:
*** enter as per Cognos initially
*** before setting [[RecordStatus]] to complete, change the '''first''' Boarding Loc DtTm to be consistent with the First [[Service tmp entry]]; see [[DtTm for First Boarding Loc and First Service]]
** checkbox: not used for this project <!-- was used for cross checks in data before 2020-10-15 -->
** Item:
*** for the initial unit or ER and each physical move to another unit, enter the location by using the "make loc" button in [[Patient Viewer Tab Cognos ADT2]]
**** if the ward is not available in the dropdown, please notify Tina, Lisa, and Julie; Tina/Lisa will add the location to the dropdown and update the wiki as needed; Julie will note the change for her reports. eg. during the various COVID waves, many surgical wards were used for medicine overflow or COVID patients
**** leave what is in Cognos, the main office doesn't use this part for anything for home locations, but it can be used to crosscheck accuracy.  
* '''no location entered''' is the default
** that entry will not be allowed in a complete record; it is automatically deleted when by Cognos Make Loc button, but needs to be removed before setting a record to complete if it is still present.
<!--
*emailed to see if this automatic entry is still useful now that things are entered with make loc button [[User:Ttenbergen|Ttenbergen]] 13:05, 2023 January 25 (CST)
** We discussed this and decided to leave for now, as we don't manually delete it is populated by COGNOS when we choose the Make location button [[User:Lkaita|Lisa Kaita]] 13:59, 2023 February 1 (CST) -->


==== Exception: no two with same DtTm ====
* '''No two different boarding locations should have same start_dt and start_tm.'''
** if two boarding locations have the same Start_DtTm, this is an error, change one to be off by one minute, put a note in "notes" section to check boarding location to confirm the correct date and time for the boarding locations of concern.
** example: Not infrequently, the COGNOS data for HSC_SICU patients coming from the ER,  will show the first service, first boarding location(ER) and the second boarding location(SICU) as all having the same start_DtTm.  Our solution for this is to change the, second boarding location (SICU) to be off by one minute.  We then put a note in the notes section to confirm the boarding location(s) date and time and the first service_DtTm.


=Exception=
* when a patient is transferred to one of our units, ideally the first service and first [[boarding Loc]] should be the same date and time.  However, often they are not.  In these cases, always use the first service entry line as the date and time for first service and first [[boarding Loc]]  (make a note in the notes field to change to the first [[Boarding Loc]] date and time at a later date when reviewing the chart)
*example- patient transfers from ICU to medical unit.  first medicine service=May10@1400, First boarding loc=May10@1630.  While the correct first service and first [[Boarding Loc]] should be May 10@1630, enter the first service date and time from COGNOS (May 10@1400) for both the first service and first [[boarding Loc]].  There are two reasons for this: if you change the first service date and time without excluding that service it will fill up your CSS and you will not get the associated service end date and time. If you exclude that service entry all together than you will also not get the associated service end date and time. 
{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}


== Data Collection Instructions ==
==== GRA MICU ====
In [[L TmpV2 table |TMP]], a "no borrow" entry will automatically be added to every new Critical Care or Medicine patient's record.
* Grace ICU boarding in ER choose Boarding Location GH-Emergency
 
* Grace Main ICU choose Boarding Location and GH-Intensive Care
If the patient never ends up in a "borrowed bed" during their stay then, leave the default in Item as ''no borrow'' and also put a check mark in the checkbox. (this is to verify that there was no bed borrow, otherwise no one is sure is missed or not).
* Grace Recovery Room (ICU) choose Boarding Location and [[GH-Recovery Room]] and enter comment Covid+ICU
If the patient does end up in a "borrowed bed", change the item to the location of the borrow and enter the rest as per below: [[#How to enter this]].
* For External(SDC/NFA) ICU beds choose Boarding Loc and GH-External ICU and enter exact location in comments


Add a new tmp entry for every additional move/borrow within your centre that a patient makes during their stay at your [[Service/Location]]; including moves from borrowed location to your actual unit.
=== Special Case - cross-program boarding ===
If a patient is accepted by your service, taken care of  but '''remains at a location of a different service where we collect for some time''' before moving to your service, you need to enter a [[Boarding Loc]] entry for that period. That originating and different service location becomes the first Boarding loc.  


=== How to enter this ===
'''For medicine pts boarding in ICU''' you can use the explicit ICU entry that applies because all CC locations are explicitly included in Boarding Loc.
*Use tmp fields:
** Project: '''{{PAGENAME}}'''
** Item: '''no borrow''' is the default (check off the box under column B for all patients that are '''not''' borrowing a bed).
** Item: '''borrowed bed location''' (select the ward/unit where the bed was borrowed):
**** For beds borrowed in an ICU, specify the actual location of the borrowed bed.
**** For beds borrowed in a Medicine location,
***** for borrowed bed enter your hospital's "boarding" entry, eg "HSC - boarding"
***** enter your hospital's "Home medicine ward" when pt comes (back) to home ward, eg "GRA - Home medicine ward"
*** GRA - boarding (includes step-downs)
*** GRA - Home medicine ward
*** GRA - recovery
*** GRA_ER (a strange thing they only do at Grace for now) - added May 2.19
*** [[GRA MICU]]
*** HSC - boarding (includes step-downs)
*** HSC - Home medicine ward
*** HSC  -recovery
*** [[HSC_CCU]]
*** [[HSC_IICU]]
*** [[HSC_MICU]]
*** [[HSC_SICU]]
*** STB - recovery
*** STB - boarding (includes step-downs)
*** STB - Home medicine ward
*** [[STB_ACCU]]
*** [[STB_CICU]]
*** [[STB_MICU]]
** Enter start_dt: '''arrival date at borrowed bed''', under column E.
** Enter start_tm: '''arrival time at borrowed bed''', under column M.
** checkbox: '''to be checked only in case of "no borrow"


==Return from boarding Loc to own unit during same stay ==
'''For CC patients boarding on a Med ward where we collect''', enter "GRA_Med"/"HSC_Med"/"STB_Med" as applicable. We added these boarding loc options specifically for this scenario, and they are available only on CC laptops.  
* If the patient moves back to their "home unit", or "intended unit", make another '''borrowed bed location''' entry and select your home unit, e.g. ''HSC - Home medicine ward''. Enter the date/time for this move, as above.
*Dispo Tab
**[[Service/Location field]] enter: '''home''' ward/unit


=== Special Case - original arrival is in "borrowed bed" ===
{{Ex | This could happen if the team runs a code on a patient and accepts care for that patient, but for a period of time hasn't yet moved the patient. For Critical Care, you would enter a generic "<Site>_Med" "<Site>_Med" (ie [[GRA_Med]], [[HSC_Med]], [[STB_Med]]) for this patient so we don't have CC collectors keeping track of where regular, boarding or covid locations are.}}
If pt is admitted to your physician service but the original location is from an off-ward bed, code that location [[Arrive DtTm]] = borrow date and time.


The APACHE elements time frame will start in the off-ward bed location and TISS starts from the off-ward bed as well.
===Special Case- temporary boarding locations ===
Occasionally a patient may be transferred to a location that is normally a [[Boarding Loc]] that we would enter or discharge to, however that location may be used as a temporary boarding location for a procedure.  If after reading through the chart this is in fact the case, that [[Boarding Loc]] should not be entered in the TMP, as it should be regarded as though the patient were going for any procedure and then back to their home ward location.
*Sometimes [[Visits to temporary locations]] may look like boarding locations. See that page for info on making the distinction.
eg. Medicine patient is transferred to ICMS for a scope and is not admitted under critical care, that [[Boarding Loc]] for ICMS should not be entered in the TMP


=== Special Case - PACU ===
=== Special Case - Erroneous Unit information in [[Cognos EPR Report]] ===
If a bed is borrowed in PACU / post-anesthesia care / recovery unit, code this as a '''borrow'''. (i.e. <hosp> - recovery, e.g. "HSC - recovery").
Use what you know to be correct from chart and your knowledge of your hospital.


If the decision to accept to the service happens in PACU, the [[Arrive DtTm]] = the borrow date and time.  The APACHE elements are collected at PACU stay and TISS starts at PACU.
=== parked in ER ===
For further information please see
* [[Parked in ER]]


=== Special Case - From ER ===
Not included in this project. 
*The time spent/waiting in ER is done using [[Arrive DtTm]] vs [[Accept DtTm]].
**March 30.19: own ward, to own ER (under ICU physician care) then to own ICU when bed available.  Started occurring at Grace- March 30.19


=== Special Case - Parked ===
=== sources for Boarding Loc DtTm ===
Not included.
Sometimes the times are not when people really show up at a boarding loctation.  
*For patients who are [[Parked in ER]], no need an entry for these, since the ER delay will take care of them.


=== Special Case - ??? ===
==== Cognos Unit Listing ====
{{Discuss|
Usually the Cognos Unit start time can be used as [[Boarding Loc]].
* [[ECIP]] - these ''are'' now happening, so how would we enter them?
* [[EMIP]] - this structure ''could'' accommodate EMIPs, but the problem is
** how do we identify then (right now people take turns at some sites...
** which collector would collect them what service/location do we collect them as? Right now we have a special service location for these...
** how about that "service x" at HSC?


}}
==== First set of vital signs ====
The first set of vital signs is used as [[Boarding Loc]] dttm for arrival on the unit in ICU collection, if it is different from the Cognos Unit Start DtTm.


== Start/End Dates ==
== Start/End Dates ==
*Start: 2019-Sep-01: new admissions on and after this date.  
*CC Start: 2018-July-19 as [[Project Borrow arrive]] and has been renamed and continued as Boarding Loc starting 2019-Sep-01
*Med Start: 2019-Sep-01: new admissions on and after this date.  
* 2020-12-16: [[Change of GRA location names from "our" names to EPR/Cognos names]]
* 2022-01-01: [[Change of remaining location names from "our" names to EPR/Cognos names]]
*End: there is no planned end date
*End: there is no planned end date
== data checks ==
{{Discuss | Which if any of [[Project_Borrow_arrive#Data_Integrity_Checks_.28SMW.29]] will need to be moved over to this instead? }}


{{Data Integrity Check List}}
{{Data Integrity Check List}}
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::: where Next Arrival Date_time = Dispo Date_time if there is no more next arrival date_time.  
::: where Next Arrival Date_time = Dispo Date_time if there is no more next arrival date_time.  


The SAS program is saved in X:\Julie\SAS_CFE\CFE_macros\Bed_Borrow.sas
The SAS program is saved in S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas.
*the specific macros are %BoardingLoc, %ACCUBorrow, %ICUOtherService


== Background ==
== Background ==
{{Discuss |
* Will replace [[Off ward field]] to provide more meaningful data. 
** When? }}
See [[Bed borrow]] as aggregator page for other boarding and borrow related concepts.
See [[Bed borrow]] as aggregator page for other boarding and borrow related concepts.


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[[Category:Project]]
[[Category:Project]]
[[Category:Overflow]]
[[Category:Overflow]]
[[Category:EMIP]]
[[Category:PatientFollow Project]]
[[Category:Admit/Discharge]]

Latest revision as of 15:44, 2024 March 6

Projects
Active?: active
Program: CC and Med
Requestor: internal
Collection start: 2019-Sep-20
Collection end:

This isn't so much a project as way to track how patients physically move around the hospital. See Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry for information about it and why we needed to change it to this model.

This project tracks where and when a patient arrives into a new physical location under the Medicine or ICU service.

Data Collection Instructions

How to enter this

You can use the "make loc" button to generate and pre-populate these entries.

  • Use tmp fields:
    • Project: Boarding Loc
    • start_dt and start_tm:
    • checkbox: not used for this project
    • Item:
      • for the initial unit or ER and each physical move to another unit, enter the location by using the "make loc" button in Patient Viewer Tab Cognos ADT2
        • if the ward is not available in the dropdown, please notify Tina, Lisa, and Julie; Tina/Lisa will add the location to the dropdown and update the wiki as needed; Julie will note the change for her reports. eg. during the various COVID waves, many surgical wards were used for medicine overflow or COVID patients
        • leave what is in Cognos, the main office doesn't use this part for anything for home locations, but it can be used to crosscheck accuracy.
  • no location entered is the default
    • that entry will not be allowed in a complete record; it is automatically deleted when by Cognos Make Loc button, but needs to be removed before setting a record to complete if it is still present.

Exception: no two with same DtTm

  • No two different boarding locations should have same start_dt and start_tm.
    • if two boarding locations have the same Start_DtTm, this is an error, change one to be off by one minute, put a note in "notes" section to check boarding location to confirm the correct date and time for the boarding locations of concern.
    • example: Not infrequently, the COGNOS data for HSC_SICU patients coming from the ER, will show the first service, first boarding location(ER) and the second boarding location(SICU) as all having the same start_DtTm. Our solution for this is to change the, second boarding location (SICU) to be off by one minute. We then put a note in the notes section to confirm the boarding location(s) date and time and the first service_DtTm.

Exception

  • when a patient is transferred to one of our units, ideally the first service and first boarding Loc should be the same date and time. However, often they are not. In these cases, always use the first service entry line as the date and time for first service and first boarding Loc (make a note in the notes field to change to the first Boarding Loc date and time at a later date when reviewing the chart)
  • example- patient transfers from ICU to medical unit. first medicine service=May10@1400, First boarding loc=May10@1630. While the correct first service and first Boarding Loc should be May 10@1630, enter the first service date and time from COGNOS (May 10@1400) for both the first service and first boarding Loc. There are two reasons for this: if you change the first service date and time without excluding that service it will fill up your CSS and you will not get the associated service end date and time. If you exclude that service entry all together than you will also not get the associated service end date and time.

Combining Transfer Ready DtTm tmp entry and Boarding Loc records

GRA MICU

  • Grace ICU boarding in ER choose Boarding Location GH-Emergency
  • Grace Main ICU choose Boarding Location and GH-Intensive Care
  • Grace Recovery Room (ICU) choose Boarding Location and GH-Recovery Room and enter comment Covid+ICU
  • For External(SDC/NFA) ICU beds choose Boarding Loc and GH-External ICU and enter exact location in comments

Special Case - cross-program boarding

If a patient is accepted by your service, taken care of but remains at a location of a different service where we collect for some time before moving to your service, you need to enter a Boarding Loc entry for that period. That originating and different service location becomes the first Boarding loc.

For medicine pts boarding in ICU you can use the explicit ICU entry that applies because all CC locations are explicitly included in Boarding Loc.

For CC patients boarding on a Med ward where we collect, enter "GRA_Med"/"HSC_Med"/"STB_Med" as applicable. We added these boarding loc options specifically for this scenario, and they are available only on CC laptops.

Example:    
This could happen if the team runs a code on a patient and accepts care for that patient, but for a period of time hasn't yet moved the patient. For Critical Care, you would enter a generic "<Site>_Med"  "<Site>_Med" (ie GRA_Med, HSC_Med, STB_Med) for this patient so we don't have CC collectors keeping track of where regular, boarding or covid locations are.

Special Case- temporary boarding locations

Occasionally a patient may be transferred to a location that is normally a Boarding Loc that we would enter or discharge to, however that location may be used as a temporary boarding location for a procedure. If after reading through the chart this is in fact the case, that Boarding Loc should not be entered in the TMP, as it should be regarded as though the patient were going for any procedure and then back to their home ward location.

eg. Medicine patient is transferred to ICMS for a scope and is not admitted under critical care, that Boarding Loc for ICMS should not be entered in the TMP

Special Case - Erroneous Unit information in Cognos EPR Report

Use what you know to be correct from chart and your knowledge of your hospital.

parked in ER

For further information please see


sources for Boarding Loc DtTm

Sometimes the times are not when people really show up at a boarding loctation.

Cognos Unit Listing

Usually the Cognos Unit start time can be used as Boarding Loc.

First set of vital signs

The first set of vital signs is used as Boarding Loc dttm for arrival on the unit in ICU collection, if it is different from the Cognos Unit Start DtTm.

Start/End Dates

Data Integrity Checks (automatic list)

 AppStatus
Query check tmp ER Boarding Loc should exist if from ERCCMDB.accdbdeclined
Check if awaiting code is primary dx then Transfer Ready DtTm must be equal to Arrive DtTmCCMDB.accdbdeclined
Query s tmp check Boarding Loc and TransferReadyDtTm pairsCCMDB.accdbimplemented
Query check tmp 2 BL TR S same tmCCMDB.accdbimplemented
Query Check BL TR combiner nullCCMDB.accdbimplemented
Query check Transfer DtTm after paired BL and before later BLCCMDB.accdbimplemented
Query s tmp Boarding Loc ER delay reasonableCCMDB.accdbimplemented
Query check no consecutive same BL or ServiceCCMDB.accdbimplemented
Query check CCI TISS matching BoardingLoc timeCCMDB.accdbimplemented
Query check tmp Boarding Loc Service first sameCCMDB.accdbimplemented
Query s tmp check combined Boarding Loc and TransferReadyDtTmCCMDB.accdbimplemented
Query check transfer DtTm during admissionCCMDB.accdbimplemented
Query check tmp Service and Boarding Loc during admission timeframeCCMDB.accdbimplemented
Query check tmp service or location duplicateCCMDB.accdbimplemented
Query s tmp Boarding Loc date itemCCMDB.accdbimplemented
Query check minimal data set incompleteCCMDB.accdbimplemented
Query check tmp Transfer Ready not before Boarding LocCCMDB.accdbretired
Query s tmp check combined BL and TRDtTm nonsequentialCCMDB.accdbretired
Query check transfer ready tmp for each Boarding LocCCMDB.accdbretired
Query s tmp Boarding Loc no borrow but entryCCMDB.accdbretired

Data Use

Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.

SAS Program

The SAS program calculates the time spent in a borrowed bed at each ICU stay and summarize the total bed-days in a given interval that are taken up by boarders from elsewhere and how much a certain unit is boarding elsewhere.

Time spent in borrowed bed = Next Arrival Date_time - First Arrival Date_time
where Next Arrival Date_time = Dispo Date_time if there is no more next arrival date_time.

The SAS program is saved in S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas.

  • the specific macros are %BoardingLoc, %ACCUBorrow, %ICUOtherService

Background

See Bed borrow as aggregator page for other boarding and borrow related concepts.

The concept is similar to EMIPs but we will keep the EMIP separate from this project. The current EMIP will stay the same.--JMojica 10:37, 2019 September 20 (CDT)

Related articles

Related articles:
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