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


== Data Collection Instructions ==
== Data Collection Instructions ==
=== How to enter this ===
=== How to enter this ===
You can use the [["Make loc" button]] to generate and pre-populate these entries.  
You can use the [["make loc" button]] to generate and pre-populate these entries.  


*Use tmp fields:
*Use tmp fields:
** Project: '''{{PAGENAME}}'''
** Project: '''{{PAGENAME}}'''
** Enter start_dt: '''arrival date at physical location''', under column E.
** start_dt and start_tm:  
** Enter start_tm: '''arrival time at physical location''', under column M.
*** enter as per Cognos initially
{{Discuss | who = Julie |
*** 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]]  
*** The '''first''' entry for [[Boarding Loc]] and for [[Service tmp entry]] need to have the same date and time because we only care about the portion of time in that earliest location that was under our service. So, e.g. if in ER the pt is accepted initially by surgery we don't care about the unit start date and time until our service takes over.
**** Flagging this: if we don't enter the actual unit start dttm (ie might be before service start) then these won't line up with Cognos data, so will not proberly show up as having been entered. I think the actual unit start should be used and any stripping out of times is a matter of reporting. The corresponding entry in [[Service tmp entry]] will need to be updated accordingly.  Ttenbergen 13:21, 2020 November 9 (CST)
***** why do we need to collect information which are not directly related to CC or Int Med patients?  regardless where we save the data, we should be consistent. that is how we crosscheck errors (whether it is time,location, diagnosis, procedures).  Is this a common situation or rare? if rare, then let it be an exception with Cognos data  (e.g. not line up).  if common, let us discuss in Task.  --[[User:JMojica|JMojica]] 15:08, 2020 November 9 (CST)
}}
** 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:  
*** '''no location entered''' is the default (that entry will not be allowed in a complete record)
*** 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]]
**** change the original entry to the first location the patient was during the admission in this record, e.g. ER, specific medicine ward etc
**** 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
**** for any physical move to another unit, enter an additional [[Boarding Loc]] entry:  
**** 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.
*** for "home" locations or other locations where there is a specific entry listed in the dropdown (eg ER)
* '''no location entered''' is the default  
**** item: the actual ward, e.g. STB_B5 or HSC_MICU
** 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.
**** comment: leave blank
<!--
*** for "boarding" and '''COVID Suspect''' locations
*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)
**** item: "<your site> - boarding" (eg. "HSC - boarding", resp. "HSC - ICU boarding")  
** 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) -->
**** comment: actual unit
 
*** for '''COVID Positive''' locations
==== Exception: no two with same DtTm ====
**** item: "<your site> - COVID unit" (eg. "GRA - COVID unit")
* '''No two different boarding locations should have same start_dt and start_tm.'''  
**** comment: actual unit
** 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}}
 
==== 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 ===
=== 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 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 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 pts boarding in ICU''' you can use the explicit ICU entry that applies because all CC locations are explicitly included in Boarding Loc.
For Medicine laptops this isn't an issue because all CC locations are explicitly included in Boarding Loc.


=== Special Case - Parked ===
'''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.  
*For patients who are [[Parked in ER]], just follow usual instructions, a special entry is no longer needed, since the ER delay will take care of them.


=== Special Case - EMIP/ECIP ===
{{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.}}
See [[2020-10 EMIP changes]]


=== Special Case - COVID ===
===Special Case- temporary boarding locations ===
* For details of which patients to inlcude, see [[2020-10 COVID unit collection]].  
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.
* For units with special designation see [[COVID Designated Ward]]
*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 - COVID ''status of unit'' changes while patient location and service remains same ===
* If the unit a patient is on changes to be a [[COVID Designated Ward]], or changes to no longer be a COVID unit, and the patient stays put and remains on your service.
** If the unit a patient is on changes to be a COVID unit, enter a [[Boarding Loc]] entry of <your site> - COVID unit (e.g. "STB - COVID unit") for any admission to and time spent in a COVID unit
*** enter the actual location into the comment field, e.g. E6
** If the unit a patient is on changes to no longer be a COVID unit, and the patient stays put, enter a [[Boarding Loc]] entry of the [[Service/Location]], e.g. STB_E6_B
***Grace Main ICU Choose Boarding Location and GRA_MICU. Grace Recovery Room (ICU) Choose boarding location and GRA-recovery and enter comment Covid+ICU. For External(SDC/NFA) beds choose boarding loc and GRA-ICU boarding and enter exact location in comments.[[User:Gthomson2|Gthomson2]] 08:47, 2020 November 18 (CST)
=== Special Case - Erroneous Unit information in [[Cognos EPR Report]] ===
=== Special Case - Erroneous Unit information in [[Cognos EPR Report]] ===
Sometimes there are location entries in Cognos that are errors. EG. a patient may be listed as having gone to a weird unit for 5 minutes and then moved to a more reasonable one. They were probably never on that weird unit. For those cases, just exclude the location from your list so it doesn't clutter things, and don't enter this as a location.
Use what you know to be correct from chart and your knowledge of your hospital.


{{Discuss | who = Julie |
=== parked in ER ===
* To confirm: Julie, this means that if a pt was listed in Congos as some bogus unit for the first 6 hours of their stay, we would list their stay on our unit as starting 6 hours later. this would probably trigger some of Pagasa's cross checks, and give you 6 hours of missing occupancy. I still think it's the right way to deal with this error since messing with the times would break how entries are linked to Cognos, but I want to make sure we are all aware that this is a thing and how we approach it. Ttenbergen 13:29, 2020 November 9 (CST)
For further information please see
** when does this phenomenon occur - at the beginning or in between transfers?  if at the beginning, then just exclude. If in between transfers during an episode, is there a query done for that? Pagasa' query will crosschecks between records and not within episode. But if that happens, since only the arrived date is entered, I will always assume continuous stay defining the end date as the start date of the next boarding location.
* [[Parked in ER]]
}}


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


== Loose ends ==
=== sources for Boarding Loc DtTm ===
{{DT |
Sometimes the times are not when people really show up at a boarding loctation.
* [[Query ''check ER Delay not too big'']] needs to be changed to include the new [[Boarding Loc]] schema . }}
 
==== Cognos Unit Listing ====
Usually the Cognos Unit start time can be used as [[Boarding Loc]].


{{Discuss |
==== First set of vital signs ====
Which if any of [[Project_Borrow_arrive#Data_Integrity_Checks_.28SMW.29]] will need to be moved over to this instead? }}
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.


{{DT |
== Start/End Dates ==
* inactivate legacy entry '''Home Medicine ward''' once last pt using it is discharged
*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


{{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 ==
Line 112: Line 112:
[[Category:EMIP]]
[[Category:EMIP]]
[[Category:PatientFollow Project]]
[[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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