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 internal medicine patients starts at [[Accept DtTm]] ie [[Accept_DtTm_field#Direct_Admissions.2FTransfers|possibly while in ER]], regardless of where they are, including if they are still in the ER (i.e. [[EMIP]]).
== Included patients ==
* Collection starts at [[Service tmp entry]] DtTm, ie possibly while still in ER.


{{DT | Med and ICU will be same definition and can then be collapsed. This is also discussed in [[Change to start collection at accept rather than arrive time]].
* The following situations '''ARE''' included for the Regional Medicine Database.
Ttenbergen 11:48, 2020 October 27 (CDT) }}


{{DT | Clear out or reconcile [[EPR Reports]], [[Discharge Register]], [[Transfer Register]], [[Definition of a Medicine Service admission]], [[Definition of an ICU admission]]}}
=== Inclusion based on service ===
__TOC__ 
*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"


=== Special cases - Inclusion of extra patients ===
=== Inclusion based on location ===
{{DA |
*Admitted to a core Medicine ward '''location''' but rather than being cared for by the regular ward team, the primary care service is
* Allan to ask Nick Hajidiacos what he wants and why.
** Nephrology
}}
** Neurology (includes "HSC Internal Med / Neurology" patients admitted to [[HSC HOBS]])
{{DiscussTask |
** Oncology -- ''EXCEPT'' if admitted ONLY for chemotherapy (if complications occur and Medicine service takes over, admit the pt starting at medicine service acceptance)
* Allan to ask Nick Hajidiacos what he wants and why.
*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]])
This is about the inclusion of some pt not attended by Internal Medicine Attendings. Generally we only include pts under Internal Medicine Service, but the following are exceptions where we collect even though pt is under other physician:
* all '''"HSC Internal Med / Neurology" patients that are admitted to [[HSC HOBS]]''', once they are discharged/transferred out of HOBS, we no longer follow the patient. (per Dan Roberts, see also [[HSC Medicine Collection Guide]])
* all '''nephrology patients'''
{{Discuss |
* many to D5 (Low [[Level of care hierarchy]]) 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))
** ''not sure what that line means now with the new model; would collectors need to include any non-med-service patients for this? If not, what are we actually saying with it?
}}


*At STB patients admitted under '''SBGH Internal Med/Nephrology''' are collected and included in the database.
== 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


=== Special cases - Exclusion STB Oncology patients ===
=== Excluded service admissions can lead to missed records ===
We don't collect Oncology patients at STB that are admitted only for chemotherapy. These are short stay patients with only nursing IPN entries. If these patients develop complications they are transferred to Internal medicine service for the duration of hospital stay. [[Task_Team_Meeting_-_Rolling_Agenda_and_Minutes_2020#ICU_Database_Task_Group_Meeting_.E2.80.93_November_18.2C_2020 Confirmed at Task Meeting]].
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.


These are excluded by excluding the following services from our [[Cognos Report Integrator]]:
== End of a database profile ==
* "SBGH Internal Med / Oncology"
=== Bed holds ===
* "HSC Oncology / Radiation"
To see when a profile should continue vs new profile, see [[Bed holds]].
* "HSC Oncology / Medicine"
 
=== Special cases - Exclusion STB Interventional Radiology patients ===
* [[STB_Med]] - interventional radiology will admit a patient for an overnight procedure, we are not following these
* This is correct, we do NOT follow interventional radiology patients who stay overnight for procedures. Your first clue that it's not an internal medicine is the attending physician. The attending physician will be an interventional radiologist, not an internal medicine doc. [[User:DPageNewton|DPageNewton]] 08:11, 2020 November 19 (CST)
 
{{Discuss |
* In Cognos I don't see a service that makes me think interventional radiology, but it might just be a service not included in the dump. Collectors: Do these patients show up in Cognos, and if so, how do you decide that this is what they are and they should be excluded? Ttenbergen 16:39, 2020 November 2 (CST)
* At this point I have not come across an interventional radiology patient in cognos admitter. See above for how we determine if it's an interventional radiology patient. If there is a way to definitely exclude them from the admitter that would be helpful. There are enough other exclusion patients in there already.  [[User:DPageNewton|DPageNewton]] 08:11, 2020 November 19 (CST)
* Tina, Debbie may have further info to clarify the above regarding overnight admissions following procedures
}}
 
=== Special cases - Exclusion HSC H6 patients ===
* patients admitted to HSC_H6 under "HSC Internal Med / Respiratory" or "HSC Internal Med / Neurology"
** H6 is also a medicine contingency ward, so we do follow some patients on H6 [[User:Lkaita|Lisa Kaita]] 10:59, 2020 November 4 (CST)


== 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: