Difference between revisions of "Boarding Loc"

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** Enter start_tm: '''arrival time at physical location''', under column M.
** Enter start_tm: '''arrival time at physical location''', under column M.
*** '''[[#First Service tmp entry and the first Boarding Loc should be the same]]'''
*** '''[[#First Service tmp entry and the first Boarding Loc should be the same]]'''
** checkbox: not used for this project <!-- was used for cross checks in data before 2020-10-15 -->
** checkbox: not used for this project <!-- was used for cross checks in data before 2020-10-15 -->
** Item:  
** Item:  
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**** item: "<your site> - COVID unit" (eg. "GRA - COVID unit")  
**** item: "<your site> - COVID unit" (eg. "GRA - COVID unit")  
**** comment: actual unit
**** comment: actual unit
** '''No two different boarding locations should have same start_dt and start_tm.'''
{{First Service and Boarding Loc same}}
{{First Service and Boarding Loc same}}


{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}
{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}


{{Discuss|*Patients  with previous location own ER but DID NOT  show boarding loc ER in tmp for each laptop  ( except H5 and H7 )
**Are these correct? Any explanations? 
***Are these patients have zero wait time in ER because beds are available? 
***Or the patients while at ER  are NOT taken care by the admitting service physician but by different service physician?
*Patients  with Previous location labels NOT own ER but showed boarding loc ER in tmp for each laptop
**Case of EMIPs or ECIPs  or Parked at ER -  are the legit ones.  How about for the following scenarios of EMIPs, ECIPs and direct admits:
***If no waiting time at  ER, should first boarding loc ER be entered?
***If being taken care by a different service while at ER and not the admitting service, should first boarding loc ER be entered?
**Are the patients from own site  previous locations namely,  own OR, recovery, ambulatory, dialysis, STB MICU, STB ACCU, Cath Lab and boarding  at  ER to wait until bed is available,  possible scenarios? 
***Parked at ER usually happens for direct admits from other sites and not from own sites. I understand now with COVID, this happens in GRA CC for patients coming from wards. Does this happen at HSC and STB too?
*Are there other scenarios you have encountered not mention here? --[[User:JMojica|JMojica]] 11:38, 2021 July 26 (CDT)}}
==== GRA MICU ====
==== GRA MICU ====
* Grace ICU boarding in ER choose Boarding Location GH-Emergency
* Grace ICU boarding in ER choose Boarding Location GH-Emergency
* Grace Main ICU choose Boarding Location and GH-Intensive Care
* 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
* 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
* For External(SDC/NFA) ICU beds choose Boarding Loc and GH-External ICU and enter exact location in comments


=== Special Case - cross-program boarding ===
=== Special Case - cross-program boarding ===
If a patient is accepted by your service but '''remains at a location of a different service for some time''' before moving to your service, you need to enter a [[Boarding Loc]] entry for that period.
If a patient is accepted by your service, taken care of  but '''remains at a location of a different service 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 Critical Care collection, 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" (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. The generic "<Site>_Med" entry would only be available on CC laptops.  
For Critical Care collection, 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" (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. The generic "<Site>_Med" entry would only be available on CC laptops.  
Line 64: Line 53:


=== Special Case - Direct admit ===
=== Special Case - Direct admit ===
*For patients who are [[Direct admit]] and passed by own site ER, just follow usual instructions, a special entry is no longer needed, since the ER delay will take care of them.
*For patients who are [[Direct admit]] and passed by own site ER, just follow usual instructions, a special entry is no longer needed, since the ER delay will take care of them.  The first boarding loc is "your <site> - ER".
*For patients who are [[Direct admit]] and went directly to the ward/"<your site> - boarding" under Medicine or ICU service, the first boarding loc is the ward/"<your site> - boarding" under Medicine or ICU service.
*For patients who are [[Direct admit]] and went directly to the ward/"<your site> - boarding" under Medicine or ICU service, the first boarding loc is the ward/"<your site> - boarding" under Medicine or ICU service.


=== Special Case -  EMIP/ECIP ===
=== Special Case -  EMIP/ECIP ===
See [[2020-10 EMIP changes]]
See [[2020-10 EMIP changes]]
=== Special Case -  From ED but went directly to the ward ===
For patients accepted by your service who did not spend time in ER but went directly to the ward, there is no need to include  "<your site>_ER" as the boarding loc.  Enter your ward/"<your site> - boarding" as the first boarding location.


=== Special Case - Erroneous Unit information in [[Cognos EPR Report]] ===
=== Special Case - Erroneous Unit information in [[Cognos EPR Report]] ===

Latest revision as of 17:05, 2021 August 24

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
    • Enter start_dt: arrival date at physical location, under column E.
    • Enter start_tm: arrival time at physical location, under column M.
    • checkbox: not used for this project
    • Item:
      • no location entered is the default (that entry will not be allowed in a complete record)
        • change the original entry to the first location the patient was during the admission in this record, e.g. ER, specific medicine ward etc
        • for any physical move to another unit, enter an additional Boarding Loc entry:
      • for "home" locations or other locations where there is a specific entry listed in the dropdown (eg ER)
        • item: the actual ward, e.g. STB_B5 or HSC_MICU
        • comment: leave blank, or alternately you can leave what is automatically added; the main office doesn't use this part for anything for home locations, it is only used as per directions on this page and ignored otherwise.
      • for "boarding" and COVID Suspect locations
        • item: "<your site> - boarding" (eg. "HSC - boarding", resp. "HSC - ICU boarding")
        • comment: actual unit
      • for COVID Positive locations
        • item: "<your site> - COVID unit" (eg. "GRA - COVID unit")
        • comment: actual unit
    • No two different boarding locations should have same start_dt and start_tm.
First Service tmp entry and the first Boarding Loc should be the same

The first Service tmp entry and the first Boarding Loc should be the same. Follow the instruction for the first Boarding Loc DtTm and then set the first Service tmp entry to the same DtTm.

  • As of April 2021, the initial Boarding Loc date/time should be identical to the first Service tmp entry date/time
    • Previously this wasn't always the case, and it's an issue because if you just copy over the locations from COGNOS, the date that comes along with it will NOT generally be the correct timing for when our service (ICU or Medicine) took over care.
    • This really comes up in 2 main situations: (i) ICU or Medicine takes over care in ED, or (ii) ICU takes over care of a ward patient while she/he is still physically on the ward.

Combining Transfer Ready DtTm tmp entry and Boarding Loc records

There needs to be one Transfer Ready DtTm tmp entry for each Boarding Loc and vice versa. To mark which entries belong together, use the same integer number in the "combiner" field in Patient Viewer Tab Cognos ADT2 for both records and in sequential order according to Boarding start_dt and start_tm. The presence of matching records is validated by query s_tmp_check_combined_Boarding_Loc_and_TransferReadyDtTm, and their sequential status by query s_tmp_check_combined_BL_and_TRDtTm_nonsequential.

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 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 Critical Care collection, 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" (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. The generic "<Site>_Med" entry would only be available on CC laptops.

For Medicine laptops this isn't an issue because all CC locations are explicitly included in Boarding Loc.

Special Case - Direct admit

  • For patients who are Direct admit and passed by own site ER, just follow usual instructions, a special entry is no longer needed, since the ER delay will take care of them. The first boarding loc is "your <site> - ER".
  • For patients who are Direct admit and went directly to the ward/"<your site> - boarding" under Medicine or ICU service, the first boarding loc is the ward/"<your site> - boarding" under Medicine or ICU service.

Special Case - EMIP/ECIP

See 2020-10 EMIP changes

Special Case - From ED but went directly to the ward

For patients accepted by your service who did not spend time in ER but went directly to the ward, there is no need to include "<your site>_ER" as the boarding loc. Enter your ward/"<your site> - boarding" as the first boarding location.

Special Case - Erroneous Unit information in Cognos EPR Report

See Process for bad data in Cognos

Should be entered promptly

Occupancy per ward is being reported and/or requested. I have to change my program using the boarding loc info - have two fields arrival and departure per boarding location. It is very important that the location and dates arrived must be promptly entered so I can calculate occupancy accurately for the right physical location. --JMojica 09:38, 2020 October 14 (CDT)

Start/End Dates

  • Start: 2019-Sep-01: new admissions on and after this date.
  • End: there is no planned end date


Data Integrity Checks (automatic list)

 AppStatus
Check if awaiting code is primary dx then Transfer Ready DtTm must be equal to Arrive DtTmCCMDB.accdbdeclined
Query check tmp service or location duplicateCCMDB.accdbimplemented
Query s tmp check combined Boarding Loc and TransferReadyDtTmCCMDB.accdbimplemented
Query s tmp check combined BL and TRDtTm nonsequentialCCMDB.accdbimplemented
Query s tmp check Boarding Loc and TransferReadyDtTm pairsCCMDB.accdbimplemented
Query s tmp apostrophe in commentCCMDB.accdbimplemented
Query check tmp ER Boarding Loc should exist if from ERCCMDB.accdbimplemented
Query check tmp Boarding Loc Service first sameCCMDB.accdbimplemented
Query s tmp Boarding Loc date itemCCMDB.accdbimplemented
Query check minimal data set incompleteCCMDB.accdbimplemented
Query s tmp Boarding Loc no borrow but entryCCMDB.accdbimplemented
Query check transfer DtTm during admissionCCMDB.accdbimplemented
Query check tmp Transfer Ready not before Boarding LocCCMDB.accdbimplemented
Query check tmp Service and Boarding Loc during admission timeframeCCMDB.accdbneeds review
Query check CCI TISS time means must be twoCCMDB.accdbneeds review
Query check CCI TISS matching BoardingLoc timeCCMDB.accdbready to implement
Query check transfer ready tmp for each Boarding LocCCMDB.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 X:\Julie\SAS_CFE\CFE_macros\Bed_Borrow.sas

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)

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