Level of care hierarchy

From CCMDB Wiki

We use the concept of a level of care hierarchy in the context of Transfer Delays. See Transfer Delay to understand how it is used. Level of care applies to a patient's combination of Boarding Loc item and comment entry (which together define a physical location). Which location has which level of care is stored in the s_level_of_care table.

Levels of Care

  • The list of levels of care from highest to lowest are:
    • WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU (also for PACU or OR)
    • Other MB RHA ICU or Other Province ICU
    • WRHA IICU
    • WRHA HOB Medicine ward (HSC_HOBS as of 2022-05)
    • WRHA regular Medicine ward (CTU or NTU)
    • WRHA non-Medicine (e.g. surgery, family med, OB, etc) AND lower acuity ward in acute care hospital, whatever flavour of the month word they use for this, incl. rehab, geri-rehab, palliative care unit, etc
      • To be clear here, we DO consider these locations "lower" levels than are Medicine wards, and the reason is that a major purpose of the levels is to be able to count up "wasted" bed-days in ICUs or Medicine wards. But of course the care provided in these other locations are not truly lower levels.
    • Ward outside WRHA
    • PCH or home
  • Regarding the level of care of the ED
    • The ED is unique in this regard as it can take on various different levels of care
    • When the patient’s care is taken over in ED (either Medicine or ICU) and then the patient goes to Medicine or ICU --> consider the time in ED as being the SAME level of care as where the person goes to (i.e. Medicine or ICU).
    • In the unusual circumstance that Medicine ward team takes over care while the patient is still in the ED, but before going to a Medicine ward the decision is made to send the person to a level of care lower than Medicine wards (e.g. home, back to PCH, change in ACP to C, etc) then consider the time in ED as being that of a Medicine ward.
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JALT

  • I wonder if the above clause is where the confusion keeps coming from that it matters to Transfer Delay where a patient actually goes. Where is the above distinction supposed to be applied, and how? It it only to apply to when a collector would enter a transfer ready dttm, or also to what Julie might do in reporting after? The former would make some sense, since collectors would have access to additional info. Just changing it in reporting would not make sense, though. If it is the former, then the info is really related to whether it is counted as a transfer ready decision, not what level of care something is. So it should be clarified and moved to Transfer Ready DtTm tmp entry and clarified. Ttenbergen 09:17, 2022 May 19 (CDT)
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When to use the Levels of Care

When the intent is to move the patient from a higher level of care to a lower level of care, transfer ready date and time has to be entered corresponding to the physical location where the decision was made. The entries are done following the guidelines in the Boarding Loc and Transfer Ready DtTm tmp entry.

Actual listing of care levels for different Boarding Locs

The s_level_of_care table in CCMDB.accdb (and automatically linked into CFE contains a mapping of our Boarding Locs to their level of care.

Why are some non-med locations considered "lower"

We DO consider some non-medicine locations "lower" levels than are Medicine wards, and the reason is that a major purpose of the levels is to be able to count up "wasted" bed-days in ICUs or Medicine wards. But of course the care provided in some of these other locations are not truly lower levels.

Related articles

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