Boarding Loc

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Revision as of 14:23, 2019 September 23 by TOstryzniuk (talk | contribs) (Everyone - Please start this project in TMP Sept 20- Nov 1.19)
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Projects
Active?: planned
Program: CC and Med
Requestor: Critical Care program (Allan Garland)
Collection start: 2019-Sep-20
Collection end: 2019-Nov-01
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. 
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This project tracks where and when a patient arrives into a "borrowed bed".

A "borrowed bed" is when a patient is not physically located in the place designated by the Service/Location.

  • Critical Care will track all instances of bed borrows and moves between beds
  • New for Medicine: track all instances of bed borrows and moves between beds at minimum for a pilot between 2019-09-01 - 30.

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.

Data Collection Instructions

In TMP, a "no borrow" entry will automatically be added to every new Critical Care or Medicine patient's record.

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). 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.

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.

How to enter this

  • Use tmp fields:
    • Project: Boarding Loc
    • Item: no borrow is the default (check off the box under column B for all patients that do 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,
          • enter your hospital's "boarding" entry, eg "HSC - boarding"
          • enter "Home medicine ward" when pt comes (back) to home ward
      • CON - recovery (make inactive)
      • GRA - recovery
      • GRA - ER (a strange thing they only do at Grace for now) - added May 2.19
      • GRA MICU
      • HSC -recovery
      • HSC_CCU
      • HSC_IICU
      • HSC_MICU
      • HSC_SICU
      • OAK - recovery
      • STB - recovery
      • STB_ACCU
      • STB_CICU
      • STB_MICU
      • HSC - boarding
      • STB - boarding
      • GRA - boarding
    • 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"
  • If the patient moves back to their "home unit", or "intended unit", make another borrowed bed location entry and select your home unit. Enter the date/time for this move, as above.
      • We would then need our home units listed.--CMarks 13:05, 2019 September 20 (CDT)
Additional entries for additional moves?  Tina needs to add the home units for medicine for cases with only partial stay on boarding bed and moves back to home unit. 
  • If from home unit, another move to a boarding bed happens, then need to make another borrowed bed location entry and select your hospital's "boarding" entry for medicine or specific location for ICU . --JMojica 10:55, 2019 September 20 (CDT)
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Special Case - original arrival is in "borrowed bed"

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 - PACU

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").

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.

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

Not included.

  • For patients who are Parked in ER, no need an entry for these, since the ER delay will take care of them.

Special Case - ???

Any Medicine special cases we can think of?

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Start/End Dates

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

data checks

Which if any of Project_Borrow_arrive#Data_Integrity_Checks_.28SMW.29 will need to be moved over to this instead? 
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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 X:\Julie\SAS_CFE\CFE_macros\Bed_Borrow.sas

Background

Will replace Off ward field to provide more meaningful data.

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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