Definition of a Medicine Laptop Admission: Difference between revisions

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''For Critical Care, see [[Definition of an ICU_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.


The definition of a "Medicine patient" for the Regional Medicine Database is:
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.
*admitted under a Medicine service attending physician.  If patient doesn't meet this definition then we don't collect data and enter into the Medicine database.


Collection for medicine patients starts at [[Accept DtTm]] ie [[Accept_DtTm_field#Direct_Admissions.2FTransfers|possibly while in ER]].
== Included patients ==
* Collection starts at [[Service tmp entry]] DtTm, ie possibly while still in ER.


=== Identification of off-ward patients ===
* The following situations '''ARE''' included for the Regional Medicine Database.
{{discussTask| Current way of checking through [[Transfer Register]] will miss [[off ward]] patients who arrived at off-ward locations from elsewhere than emerg. Laura and Tina discussed, did not find solution yet, should be rare, though. 13:41, 2017 March 1 (CST)}}


see also [[EPR Reports]], [[Discharge Register]], [[Transfer Register]], [[Identifying ICU admissions]], [[Definition of a Medicine Service admission]], [[Definition of an ICU admission]]
=== 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"


{{discuss|
=== Inclusion based on location ===
We collect data on some patients who never arrive on one of our units, e.g. [[EMIP]]s. Are there any other scenarios? There was a page for the HSC off warders [[HSC Boarding Locations#Medicine]] which might help in thinking about these.}}
*Admitted to a core Medicine ward '''location''' but rather than being cared for by the regular ward team, the primary care service is
** Nephrology
** 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]])


=== Inclusion of some pt not attended by Internal Medicine Attendings ===
== Excluded patients ==
Generally we only include pts under Internal Medicine Attendings, but the following are exceptions where we collect even though pt is under other physician:  
* The following situations '''ARE NOT''' included for the Regional Medicine Database:  
* all neuro patients (per Dan Roberts, see also [[HSC Medicine Collection Guide]])
** Oncology patients admitted only for chemotherapy. These are short stay patients with only nursing IPN entries.
* many to D5 under service of nephrology, neurology, oncology (ward being a non-teaching medicine but those services continue to care for their patient unless accepted by Dr Dowhanic or Arneja(who won't handle the HD population))
** 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
*At SBGH Nephrology does admit to [[STB B5]] and will on occasion take over a patient when they are transferred off service to 6AS.
** 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


=== Exclude the following ===
=== Excluded service admissions can lead to missed records ===
We don't collect the following as medicine patients
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.
* patients at any site '''admitted under the oncology service''', e.g.
** [[STB E6]] - Occasionally Oncology patients are admitted for the prime reason of receiving Chemo, but we do not put these patients in the data base
{{Discuss | pls update how things are now that [[STB_E6_P]] has moved to [[STB_A7_B]]; is that still true? }}
* [[STB E5]] -  interventional radiology will admit a patient for an overnight procedure, we are not following these


=== there is no minimum stay requirement ===
== End of a database profile ==
There is no minimum stay requirement, if you can identify the admission, '''definitely include even short stay patients'''.
=== Bed holds ===
(there was confusion about excluding short stays in the past)
To see when a profile should continue vs new profile, see [[Bed holds]].  
 
== Special cases ==
See [[:Category:Overflow]] for various special cases, and whether they would be included or not.
 
== Related Articles ==
* [[Definition of an ICU admission]].


== Related Articles ==
== Related Articles ==

Latest revision as of 14:54, 2023 November 3

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.

Included patients

  • 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
    • Nephrology
    • 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)

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

Bed holds

To see when a profile should continue vs new profile, see Bed holds.

Related Articles

Related articles: