HSC Virtual Ward

The HSC Virtual Ward is an internal medicine service where hospital physicians follow patients who are sent home with special supports.

For now this is just a placeholder / link anchor for this, decisions around collection are not 100% clear.

Even if we don't collect the actual records, we need to decide how we will code patients who come from or go there:

• Pre-admit Inpatient Institution are these in-patients for the purpose of
• Previous Location
• Dispo field (already started talking about this)

Do we consider these inpatients?

Discussed at the Steering Committee meeting 2025-07-08; my notes say the consensus was that these are not in-patients. I searched today to find out how the rest of the system will collect these, and it appears the do consider these in-patients:

• p32 of Analysis/Abstracting 2022-2023/Manuals/4-2025 26 HSC Abstracting Manual.pdf#search=virtual%20ward 2025-26 HSC Abstracting Manual instructs to code transfer to virtual ward as “transferred to inpatient care”.
• Patient Registration/Quick Reference Guides (QRGs)/Virtual Ward/Admitting Virtual Ward.pdf#search=virtual%20ward HIS - Virtual Ward Inpatient Registration says right in the title that this is an inpatient registration.

How we consider these has a lot of implications:

• indicators
  • will a hospitalization that includes a virtual ward stay be considered a continuous admission?
    • affects Readmissions
  • will we group them with the site for aggregates like LOS Medicine per hospital admission, occupancy, Medicine Primary Diagnosis Rate
  • some scores should only be calculated on the initial service encounter during an admission; how we treat virtual ward will impact how we need to consider these
  • how would we treat the from the perspective of Transfer Ready DtTm / Transfer Delay (Medicine)
• would we consider the virtual ward as an Pre-admit Inpatient Institution
  • this field is part of risk estimation, since patients who are previously inpatients have a higher risk for bad outcomes
  • hospital administrators use this field to find out from which sites patients are coming to their sites
• reports
  • Mortality and readmission report - is a patient who dies on the virtual ward part of HSC's mortality?
  • Directors Quarterly and Annual Report (Medicine) -
  • any other reports who consider a patient to remain in hospital, be associated with a specific institution, group together records as a continuous admission, etc, would also be affected
• other
  • We will need to decide if things like how to group a transfer to virtual ward from the perspective of where a patient was sent geographically; for "home" we have a postal code, for specific site dispo we have a facet table that provides an RHA, etc. A lot of these are deeply buried assumptions in our reports - we have a good listing of what fields are used, but the structured data in our documentation was not set up to track at this level.
• if we don't code them as inpatients, will this affect how our numbers compare to other data sources used by our data users?

Do we want to re-consider the decision to not collect these?

• virtual ward uses electronic charts, patient numbers are small (for now?), but we are low on collector capacity already
• if we were to enter them, would we collect them under the Medicine program, ie the Definition of a Medicine Program Admission? Would we collect them as a continuous admission/record or separate?
  • even if we decide not to collect these, we may need to update Definition of a Medicine Program Admission to explicitly exclude them.

Recommendation

• we should immediately break "HSC Virtual Ward" out as a specific entry in our s_dispo table and permit collection as Previous Location and Dispo
  • this is relatively quick to do, but we will likely encounter curve balls, such as collectors asking for instructions for unexpected scenarios, or Data Integrity Checks triggering because this doesn't fit into historical assumptions; we would need to know how to get answers quickly when that happens, and we would need direction on how to validate any changed assumptions

• as soon as possible, but definitely before the next quarterly report, we need to decide whether to treat these as inpatients
• if yes need to collect patients coming from virtual ward in Pre-admit Inpatient Institution
• Julie will need direction which of the indicators and reports should include these and how

Log

• 2025-11-07 - additional email to KM, need to get this answer out
• 2025-10-30 - additional questions re. implications of inpatient status; emailed Kym to find out if we should include Nick on that question, she gave an initial answer, I responded back, it trailed out
• 2025-10-23 - initial question in Dispo field re how to code discharge to this location
• 2025-09-23 - initial records showed up in Cognos data import. We don't collect these, but added the following as required for so we added
  • "HSC-Virtual Ward MED1" to the S Cognos Units table
  • "HSC Internal Med / Virtual Ward" to the S Cognos Services table
• 2025-07-08 CCMDB Monthly meeting - discussed that these are not in-patients