Definition of a Medicine Laptop Admission
This page defines what would be a profile in the Medicine portion of the database (see also Definition of a Critical Care Laptop Admission); it is relevant for Using Cognos2 to keep track of patients general data use.
Each Medicine profile constitutes all care in any Internal Medicine location (see Boarding Loc) or Service (see Service tmp entry) at a given hospital with certain exceptions (see #Excluded patients further below in this article). Thus once a patient is admitted to an Internal Medicine service at a given hospital (regardless of where they are physically), a profile begins -- and the same profile includes all continuous direct transfers among Internal Medicine services and locations while under Medicine at that same hospital. For a transfer between hospitals a new database profile is started.
- Collection starts at Service tmp entry DtTm, ie possibly while still in ER.
- The following situations ARE included for the Regional Medicine Database.
Inclusion based on service
- Admitted under a Medicine service attending physician anywhere in the hospital (including, for example, if they are remaining in ED because there is no medicine ward bed yet). (see #excluded patients)
- includes "HSC Oncology / Medicine"
Inclusion based on location
- Admitted to a core Medicine ward location but rather than being cared for by the regular ward team, the primary care service is
- Neurology (includes "HSC Internal Med / Neurology" patients admitted to HSC HOBS)
- Oncology -- EXCEPT if admitted ONLY for chemotherapy (if complications occur and Medicine service takes over, admit the pt starting at medicine service acceptance)
- When you enter such a patient into the Medicine Database, you should include the time in ED when they were on that service (Nephro, Neuro, Onc).
- For these inclusions based on location, once pt is transferred out of the Medicine ward location, we no longer follow the patient. (see #excluded patients)
- The following situations ARE NOT included for the Regional Medicine Database:
- Oncology patients admitted only for chemotherapy. These are short stay patients with only nursing IPN entries.
- Nephrology, Oncology or Neurology patients whose primary care service is (respectively) nephrology, oncology or neurology -- who are NOT on a core Medicine ward location, ie they are admitted to an overflow medicine location
- Patients admitted to HSC_H6 or HSC_H7S (High OBs) under "HSC Internal Med / Respiratory"
- Patients who use a ward bed for a procedure but are NOT admitted to the Medicine service, and indeed these patients are usually not formally inpatients at all. Examples include a patient who is using a ward bed for: insertion of a central line; diagnostic endoscopy; dialysis.
- "HSC Internal Med / Neurology" -- on HSC_H6, actually this fits into the above rules, as HSC_H6 is not a Medicine ward location.
- Interventional radiology pts admitted for an overnight procedure (not on Cognos EPR Report so easy to exclude)
- Exclude "HSC Oncology / Radiation"
- Exclude "IV infusion Administration"
- Exclude patients admitted to STB Internal Medicine/Respiratory service
Excluded service admissions can lead to missed records
There are scenarios in which a legitimate admission may be missed when Using Cognos2 to keep track of patients. If a patient's first location upon admission is one where we don't collect, the patient would be excluded from CSS. If the patient then moves to a location where we would collect them without changing services, this change will not show up in Cogonos since we already excluded the service admission. We have occasionally found these records when looking for other things, but some are likely getting through. We discussed this and could not think of a way to overcome this, so this is only to document that this can happen.
End of a database profile
To see when a profile should continue vs new profile, see Bed holds.