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EMIP stands for '''E'''mergency '''M'''edicine "'''IN'''" patient and is used as a [[Service/Location field]] in the Medicine database. It is used for patients who are admitted to the medicine service and spend their entire '''admission under the medicine service''' in the ER (emergency department). We are tracking this as [[VIC_EMIP]], [[GRA_EMIP]], [[STB_EMIP]] and [[HSC_EMIP]].
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).  


== Patient admitted to Family Medicine and then ICU... ==
==Definition of EMIP==  
{{Discussion}}
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.
*Hi guys, can you help Michelle at VIC with this question?  What do you do if you have an EMIP under another service in ER, never goes to that service, but then goes to ICU?[[User:TOstryzniuk|Trish Ostryzniuk]] 18:51, 2017 February 16 (CST)
**I have just come across a patient who was admitted under family medicine, but while in the ER deteriorated, and ended up being admitted to the MICU. I am not sure what to enter for [[Previous Location field]]/[[Pre-admit Inpatient Institution field]]. If I enter EMIP, then it requires the previous service to be medicine, instead of family medicine. Should I ignore the initial acceptance to family medicine, and just code this patient as an ER admission? If this is the case, then my temp studies for accept dt/source will be a little bit complicated. Please advise! Thanks,[[Michelle Lagadi]]
*** If they were admitted to Family Medicine, but never to a service where we collect, they were not an EMIP, because never a medical patient. The '''[[Previous Location field]]''' would be the physical location, ie Emergency Room. The '''[[Previous Service field]]''' would be family medicine. '''[[Pre-admit Inpatient Institution field]]''' would be following usual instructions - were they an inpatient? Ttenbergen 23:29, 2017 February 20 (CST)


== Collection Instructions ==
{{Ex |
=== identifying patients ===
# Pt has an order or some entry that medicine has accepted the patient while still in ER.
see [[EMIP Report]]; see individual articles (eg [[HSC_EMIP]]) for who collects this at which site, and see [[:Category:Site Specific Collection Guide|site specific collection guides]] for details on the collection process, papers, binders.
# 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]])
}}


=== Entering patients ===
=== Patients in ER admitted under other services are not EMIPs ===
* [[Service/Location field]] - your EMIP (e.g. GRA_EMIP)
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'''.
* [[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  -in order for a pt to be an EMIP they must have been accepted by Medicine for admission otherwise they would just be an Emergency patient
 
* [[Accept DtTm field]] - the time Medicine accepted them, i.e. the time they became an EMIP
== Identifying EMIPs ==
* [[Arrive DtTm field]] - same as [[Accept DtTm field]]
=== 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.
 
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.
 
== Entering data for EMIPs ==
=== Entering patients in dispo tab fields ===
* [[Service/Location field]] - your Generic [[HSC_Med]], [[GRA_Med]], [[STB_Med]]
* [[Previous Location field]] - use normal instructions
* [[Previous Location field]] - use normal instructions
* See [[Overstay_Predictor_Project_Collection_Instructions#Possible_Scenario_-_EMIP_patient_that_never_made_it_to_the_ward]] for how to code overstay for these patients.


=== Patients discharged to other locations in hospital ===
'''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. '''
Collection includes patients who are discharged to a non-medicine location in the hospital. So, if an EMIP patient is transferred to an ICU, that ICU would use e.g. GRA_EMIP as [[Previous Location]].
 
If a pt who starts out on the EMIP track turns into a medicine [[off ward field |off ward]] patient, collect them as you would any other off-ward patient.  
=== 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)
*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.  


'''EMIP scenario'''   
'''EMIP scenario'''   
*Entire LOS in ER under '''Medicine service''' and left your hospital to Home or died in ER
* In ER under '''Medicine service''' and left your hospital to Home or died in ER
*Entire LOS in ER under '''Medicine service''' and discharge to other locations under '''different''' service in your hospital  
* In ER under '''Medicine service''' and transferred to other locations under '''different''' service in your hospital  
*Entire LOS in ER under '''Medicine service''' and discharge to other locations under '''different''' service in another hospital  
* In ER under '''Medicine service''' and discharged to other locations in another hospital
'''NOT an EMIP'''
'''NOT an EMIP'''
*if LOS has partial stay in ER under '''Medicine service''' and then move to a '''Medicine service''' ward  (i.e. a regular Medicine admission)
* In ER under '''Medicine service''' and then moved to a '''Medicine service''' ward  (i.e. a regular Medicine admission)
*if LOS has partial stay in ER under '''Medicine service''' and then move to other ward but under '''Medicine service''' (i.e. a case of OVER)(overflow) {{discussion}} Would like to make sure this has a link to the relevant concept... is this [[Off_ward_field]]? Ttenbergen 16:24, 2017 January 26 (CST)
* 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]]).
 
=== [[HSC Community and Clinical Decision Unit (CCDU)]] ===
{{discussion}}
Are there ever EMIPs in [[HSC Community and Clinical Decision Unit (CCDU)]]? Would we catch them? Ttenbergen 11:27, 2016 December 29 (CST)


== No ICU counterpart ==
{{Ex|
see [[ECIP]] for more info
*(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 150.
{{Related Articles}}


== Related Articles ==
{{Collapsable
* [[Site and Location table]]
| always= Legacy Information
* [[OVER]]
| full=
* [[Bed borrow]]
* [[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: Overflow]]
[[Category: Overflow]]
[[Category: EMIP|*]]
[[Category: EMIP| *]]

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   
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