Boarding Loc: Difference between revisions

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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
*** '''These will be the actual arrivals on the unit, which might of course be before the [[Accept DtTm]] / [[Service tmp entry]] dttm''' ( see [[#Why do we use the actual unit start dttm rather than the time they became our pt on a unit | why]])<!-- as discussed at Task 2020-12-02 -->
*** 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 -->
** 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
<!--
{{Discuss | who = Julie |
*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)  
* CCMDB automatically populates the comment column with the local actual unit names. To make this blank, collectors have to remove the entry. Is there a good reason why it can't just stay in there? (emailed Julie)[[User:Ttenbergen|Ttenbergen]] 16:43, 2021 January 18 (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) -->
**Not sure I understand.  do you mean when the item{{=}}'STB CICU' then comment{{=}}'STB CICU', when item{{=}}'STB ER' then comment{{=}}'STB ER', when item{{=}}'STB ICU Boarding' then comment{{=}}the localunit say 'STB_CICU' or 'STB ACCU' or 'STB_*'.  I think it is just OK if they stay in comment. no need to remove.
 
*** Yes, generally speaking the comments for boarding and covid would stay the same, just the comment for home locations would now be allowed to stay the same. Specifically, the values listed in "Boarding Loc" column of s_Cognos_unit would be used. [[User:Ttenbergen|Ttenbergen]] 10:14, 2021 January 19 (CST)
==== Exception: no two with same DtTm ====
}}
* '''No two different boarding locations should have same start_dt and start_tm.'''  
*** for "boarding" and '''COVID Suspect''' locations
** 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.
**** item: "<your site> - boarding" (eg. "HSC - boarding", resp. "HSC - ICU boarding")
** 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.
**** comment: actual unit
 
*** for '''COVID Positive''' locations
=Exception=
**** item: "<your site> - COVID unit" (eg. "GRA - COVID unit")
* 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)
**** comment: actual unit
*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 ====
==== GRA MICU ====
* Grace Main ICU Choose Boarding Location and GRA_MICU
* Grace ICU boarding in ER choose Boarding Location GH-Emergency
* Grace Recovery Room (ICU) Choose boarding location and GRA-recovery and enter comment Covid+ICU.
* Grace Main ICU choose Boarding Location and GH-Intensive Care
* For External(SDC/NFA) beds choose boarding loc and GRA-ICU boarding and enter exact location in comments.
* 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


==== Why do we use the actual unit start dttm rather than the time they became our pt on a unit ====
=== Special Case - cross-program boarding ===
We decided to use the actual unit start dttm because as the start of the boarding loc entry for two reasons:
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.
* it is the actual time a pt arrived on that unit, so it's a more intuitive data point for someone not familiar with our data
* it allows clean matching to Cognos entries so the various Cognos tools can identify if an entry has already been dealt with


=== Special Case - cross-program boarding ===
'''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.
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.


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


=== Special Case - Parked ===
{{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.}}
*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 ===
===Special Case- temporary boarding locations ===
See [[2020-10 EMIP changes]]
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 - COVID ===
=== Special Case - Erroneous Unit information in [[Cognos EPR Report]] ===
* For details of which patients to inlcude, see [[2020-10 COVID unit collection]].  
Use what you know to be correct from chart and your knowledge of your hospital.
* For units with special designation see [[COVID Designated Ward]]


=== Special Case - COVID ''status of unit'' changes while patient location and service remains same ===
=== parked in ER ===
* 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, put a new boarding loc entry to reflect the new unit status:
For further information please see
** 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
* [[Parked in ER]]
*** 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


=== 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.


{{Discuss | who = Julie |
=== sources for Boarding Loc DtTm ===
* 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)
Sometimes the times are not when people really show up at a boarding loctation.  
** when does this phenomenon occur - at the beginning or in between transfers?  (Julie)
*** It seems to be a matter of data entry errors, so I suppose it can occur at any time. [[User:Ttenbergen|Ttenbergen]] 11:00, 2020 November 18 (CST)
** if at the beginning, then just exclude. (Julie)
***If we ignore it if it happens at the beginning, it will mean Cognos lines that are not linked to anything. They will either clutter the screen as "not yet entered", or will need to be excluded manually by collectors. I think manually excluding them would get them off the list, but if a collector then tries to make sense of what they see the next day it will be confusing. [[User:Ttenbergen|Ttenbergen]] 11:00, 2020 November 18 (CST)
** 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. (julie)
*** Not sure what kind of query you have in mind. We only collect the unit starts, so there are no unit ends to cross check against. This means we should define how to enter these "bogus" units as either including them with the previous or including them with the next unit. I would prefer including them with previous because it doesn't break linking with Cognos for the next unit. [[User:Ttenbergen|Ttenbergen]] 11:00, 2020 November 18 (CST)


}}
==== Cognos Unit Listing ====
Usually the Cognos Unit start time can be used as [[Boarding Loc]].


== Should be entered promptly ==
==== First set of vital signs ====
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.  --[[User:JMojica|JMojica]] 09:38, 2020 October 14 (CDT)
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
== Loose ends ==
{{DT |
* [[Query ''check ER Delay not too big'']] needs to be changed to include the new [[Boarding Loc]] schema . }}
{{Discuss |
Which if any of [[Project_Borrow_arrive#Data_Integrity_Checks_.28SMW.29]] will need to be moved over to this instead? }}
{{DT |
* inactivate legacy entry '''Home Medicine ward''' once last pt using it is discharged
}}


{{Data Integrity Check List}}
{{Data Integrity Check List}}
Line 117: Line 96:
::: 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 132: 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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