EMIP: Difference between revisions

From CCMDB Wiki
Jump to navigation Jump to search
m (→‎EMIP as previous location for ICU: take to task meeting)
 
(158 intermediate revisions by 13 users not shown)
Line 1: Line 1:
EMIP stands for '''E'''mergency '''M'''edicine "'''IN'''" patient and is used as a [[Location field|location]] / in the Medicine database. It is used to as location for patients who are admitted to the medicine service and spend their entire hospital admission in the ER (emergency department) while under the care of Medicine Service attending physician.  
EMIP stands for '''E'''mergency '''M'''edicine "'''I'''n" '''P'''atient. It is used for patients who are admitted to our internal medicine service and spend their entire '''admission under one of the medicine services we follow''' in the ER (emergency department).  
This sort of thing happens at the '''Victoria General Hospital''' and the '''Grace General Hospital'''


== Collection Instructions ==
==Definition of EMIP==  
* [[Service/Location field]] - your EMIP (e.g. GRA_EMIP)
An EMIP is a Patient who has a record in [[EPR]]/[[Cognos Report Integrator]] for a [[Service tmp entry | Service]] we collect while in ER, and who does not then end up on one of the wards/units that correspond with that service, regardless where they go instead.
* [[Previous Service field]] - likely emergency medicine, unless some other service accepted them prior to medicine, and was never able to get them out of the ER either, and medicine accepted the patient from them 
 
* [[Accept DtTm field]] - the time Medicine accepted them, i.e. the time they became an EMIP
{{Ex |
* [[Arrive DtTm field]] - same as [[Accept DtTm field]]
# Pt has an order or some entry that medicine has accepted the patient while still in ER.
* [[Previous Location field]] - use normal instructions
# The patient leaves the ER to either
#* home or
#* any other '''out of hospital location''' or
#* the patient is transferred '''within the hospital to any service''' because Medicine decides that they will not take the pt but the patient needs different care or
#* dies in ER ("ED Death after Arrival" in [[Cognos]])
#* leaves [[AMA]] ("ED Reg/Triaged/Assess LAMA" in [[Cognos]])
}}
 
=== Patients in ER admitted under other services are not EMIPs ===
Our definition of EMIP includes only patients that were followed by one of '''''our''''' services. So, patients who were followed by Family Medicine or Trauma while still in the ER are '''not EMIPs'''.
 
== Identifying EMIPs ==
=== Identifying EMIPs in [[Cognos2 Service Starter]] ===
[[EMIP]]s show up in [[Cognos2 Service Starter]]. They can't be identified there as EMIPs, but that's OK, since they really are just like any other patient now and should just be entered.


== EMIP as previous location for ICU ==
There has been some discussion whether or not a patient accepted by our service but still in ER when Cognos first lists them should actually be entered then, or only after they either leave from ER or become an inpatient. People have been leaving these un-entered both out of old habit (when EMIPs were entered following different rules you first had to know if a pt would need to be entered as EMIP or as regular) and to be able to enter the unit at the same time, rather than having to remember to go back to the record later to enter the unit. There really is no longer a reason to delay these, especially starting with [[Using Cognos2 to keep track of patients]], instead they become something for which we would need to add tools to CSS to identify them. Please enter them as they show up on [[Cognos2 Service Starter]]o.
{{discussion}}{{discuss@task}}
What if EMIP patient doesn't come to medicine ward (making them no longer EMIP) but deteriorates and is admitted to ICU? Do you collect these as EMIPs? Do you omit them from collection? Discussed with Trish but we did not know what collectors do with these.
The answer to this will also define whether or not "***_EMIP" needs to be available as in [[Previous Location field]]. Ttenbergen 17:34, 2016 May 9 (CDT)
*EMIPs are by definition Emergency Medicine Inpatients and never leave the Emergency Department until discharge. Their entire LOS is in the ER. They are not entered into the database until they have been discharged.  If they are moved to any other unit, they are no longer EMIPs but are entered into the database for Medicine or ICU as appropriate. EMIP cannot be a previous location. 
**The [[Previous Location field]] is the most recent physical location of a patient before they arrived at the collection location. EMIP is not a physical location. This patient would be admitted from a previous location of ER. 
**[[Service Sending to ICU | Sending Service]] is the service that the patient was under the care of "prior to" being sent to collection location.  Main office will review if patient is an EMIP then goes to ICU, does ICU reports want to note sending service to be ''Medicine Service'' in these circumstances?  Will let you know.
*when a medicine patient deteriorates in the ER  and is then admitted to ICU, we do not enter them as an EMIP patient for two reasons,; they are no longer.by definition an EMIP patient, and the patient will be captured by ICU data collection  [[User:Lkaita|Lisa Kaita]] 22:14, 2016 May 9 (CDT)
* I concur with Lisa --[[User:LKolesar|LKolesar]] 06:42, 2016 May 10 (CDT)


== Do these happen for ICU? ==
== Entering data for EMIPs ==
*When the ICU doctors see a pt in ER and accept them while they are still there, the accept date and time will reflect this.  They will then be transported to the ICU at some point and therefore we do not use the EMIP designation as it becomes an ICU admission. --[[User:LKolesar|LKolesar]] 10:36, 2016 May 11 (CDT)
=== Entering patients in dispo tab fields ===
** What if pt dies after acceptance and before move? That would make them EMIP. Would hopefully be rare, but it would mean we don't need special case between ICU and medicine for this. Ttenbergen 14:11, 2016 May 11 (CDT)
* [[Service/Location field]] - your Generic [[HSC_Med]], [[GRA_Med]], [[STB_Med]]
* [[Previous Location field]] - use normal instructions


{{discussion}} Do these ever happen for ICU? If they don't, then we should change the instructions to no longer say Medicine only because it's irrelevant. If they '''do''' happen, then we should likely include them in collection, no? Is there any reason to have different instructions? Ttenbergen 08:36, 2016 May 11 (CDT)
'''Follow the instructions in [[Boarding Loc]], [[Service tmp entry]], [[Transfer Ready DtTm tmp entry]]; if you do, none of the old special instructions for EMIPs should be required. That's part of the point of going to the new scheme. '''


== Locations ==
=== Collecting an EMIP who has been transferred to your location ===
=== [[VIC EMIP]] ===
Collection includes patients who are discharged to another service's location in the hospital. (eg Med to CC or CC to Med)
See [[VIC_Medicine_Collection_Guide#Identifying_OVER_and_EMIP_patients]].
*if an EMIP patient is transferred to an ICU, that ICU would use e.g. [[GRA_Med]] as [[Previous Location]] for the new scheme.  Before start date of new scheme,[[Previous Location]] is '''site_EMIP'''
** For [[Pre-admit Inpatient Institution field | Pre-admit Inpatient Institution]] = GRA_Med for the new scheme.  Before start date of new scheme,[[Previous Location]] is '''site_EMIP'''
** For [[Previous Service]] = Medicine
*If a pt who starts out on the EMIP track turns into a medicine [[Boarding Loc]] patient, collect them as you would any other [[Boarding Loc]] patient.  


=== [[GRA EMIP]] ===
'''EMIP scenario''' 
* start date: November, 2010
* In ER under '''Medicine service''' and left your hospital to Home or died in ER
* see [[GRA_Medicine_Collection_Guide#EMIPs_at_the_Grace]] for how these are identified at the Grace.
* In ER under '''Medicine service''' and transferred to other locations under '''different''' service in your hospital
{{discussion}} should all EMIPs be coded as overflow since they spend their entire LOS in the ER not the ward?
* In ER under '''Medicine service''' and discharged to other locations in another hospital
'''NOT an EMIP'''
* In ER under '''Medicine service''' and then moved to a '''Medicine service''' ward  (i.e. a regular Medicine admission)
* In ER under '''Medicine service''' and then moved to other ward but under '''Medicine service''' (i.e. a case of [[Off_ward_field|off ward patients]]).


=== [[STB_EMIP]]===
{{Ex|
See [[STB_Medicine_Collection_Guide#Process_for_identifying_Overflow_and_EMIP_patients]]
*(1) Internal Med answered consult but deferred and admitted under Critical Care service. Consults do not count as admissions, the patient has to be accepted to Internal med service, and in this scenario would be considered an admission to Critical care only.
*(2) Rural Patient accepted by Internal Med service but deteriorated enroute to Winnipeg. Transport team transferred to ER resus room and Critical care consulted, admitted, and assumed care of the patient. This should only be collected as a Critical care service profile, as the patient was assumed by CC service upon arrival at the hospital. (Just as we would not collect for any other patient who died before they ever made it to the hospital).
}}


== Serial numbers used ==
== Related articles ==  
Patients in EMIP have their own [[serial number]]s starting at number 1.
{{Related Articles}}


== Related Articles ==
{{Collapsable
* [[Site and Location table]]
| always= Legacy Information
* [[OVER]]
| full=
* [[VIC_EMIP]], [[GRA_EMIP]], [[STB_EMIP]] and [[HSC_EMIP]] used to be [[Service/Location field]] entries in the Medicine database until [[2020-10 EMIP changes]] / [[Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry]]  
* there used to not be a critical care counterpart, see [[ECIP]] for more info
* since the concept only applied to Med pts and we didn't collect those at CON and OAK, patients in Concordia ER or Oaks ER could not become EMIPs
}}


[[Category: Site and Location]]
[[Category: Information Specific to Victoria Hospital]]
[[Category: Overflow]]
[[Category: Overflow]]
[[Category: Multiple Encounter linking]]
[[Category: EMIP| *]]
[[Category: Dispo]]

Latest revision as of 14:40, 2023 November 3

EMIP stands for Emergency Medicine "In" Patient. It is used for patients who are admitted to our internal medicine service and spend their entire admission under one of the medicine services we follow in the ER (emergency department).

Definition of EMIP

An EMIP is a Patient who has a record in EPR/Cognos Report Integrator for a Service we collect while in ER, and who does not then end up on one of the wards/units that correspond with that service, regardless where they go instead.

Example:   
  1. Pt has an order or some entry that medicine has accepted the patient while still in ER.
  2. The patient leaves the ER to either
    • home or
    • any other out of hospital location or
    • the patient is transferred within the hospital to any service because Medicine decides that they will not take the pt but the patient needs different care or
    • dies in ER ("ED Death after Arrival" in Cognos)
    • leaves AMA ("ED Reg/Triaged/Assess LAMA" in Cognos)

Patients in ER admitted under other services are not EMIPs

Our definition of EMIP includes only patients that were followed by one of our services. So, patients who were followed by Family Medicine or Trauma while still in the ER are not EMIPs.

Identifying EMIPs

Identifying EMIPs in Cognos2 Service Starter

EMIPs show up in Cognos2 Service Starter. They can't be identified there as EMIPs, but that's OK, since they really are just like any other patient now and should just be entered.

There has been some discussion whether or not a patient accepted by our service but still in ER when Cognos first lists them should actually be entered then, or only after they either leave from ER or become an inpatient. People have been leaving these un-entered both out of old habit (when EMIPs were entered following different rules you first had to know if a pt would need to be entered as EMIP or as regular) and to be able to enter the unit at the same time, rather than having to remember to go back to the record later to enter the unit. There really is no longer a reason to delay these, especially starting with Using Cognos2 to keep track of patients, instead they become something for which we would need to add tools to CSS to identify them. Please enter them as they show up on Cognos2 Service Startero.

Entering data for EMIPs

Entering patients in dispo tab fields

Follow the instructions in Boarding Loc, Service tmp entry, Transfer Ready DtTm tmp entry; if you do, none of the old special instructions for EMIPs should be required. That's part of the point of going to the new scheme.

Collecting an EMIP who has been transferred to your location

Collection includes patients who are discharged to another service's location in the hospital. (eg Med to CC or CC to Med)

EMIP scenario

  • In ER under Medicine service and left your hospital to Home or died in ER
  • In ER under Medicine service and transferred to other locations under different service in your hospital
  • In ER under Medicine service and discharged to other locations in another hospital

NOT an EMIP

  • In ER under Medicine service and then moved to a Medicine service ward (i.e. a regular Medicine admission)
  • In ER under Medicine service and then moved to other ward but under Medicine service (i.e. a case of off ward patients).
Example:   
  • (1) Internal Med answered consult but deferred and admitted under Critical Care service. Consults do not count as admissions, the patient has to be accepted to Internal med service, and in this scenario would be considered an admission to Critical care only.
  • (2) Rural Patient accepted by Internal Med service but deteriorated enroute to Winnipeg. Transport team transferred to ER resus room and Critical care consulted, admitted, and assumed care of the patient. This should only be collected as a Critical care service profile, as the patient was assumed by CC service upon arrival at the hospital. (Just as we would not collect for any other patient who died before they ever made it to the hospital).

Related articles

Related articles:
Legacy Information   
Retrieved from "https://ccmdb.kuality.ca/index.php?title=EMIP&oldid=160374"