Level of care hierarchy

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, palliative, 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

level of care of the ED

We consider the ER to be at the standard level of care for the Service taking care of the patient i.e. regular med ward for Medicine (not HOBS) and regular ICU (not IICU).

This definition is relevant for decisions about the Transfer Ready DtTm tmp entry and consequently about reporting Transfer Delay.

Rationale for Medicine - ER will be treated as regular ward because the intention to where to transfer the patient is usually unknown or not documented. Thus, any delay in transfer from ER is treated as a bed wasted to regular ward. If it happens that the patient with transfer ready at ER went to HOBS, the TR Dttm until the start dttm at HOBS is bed wasted regular ward. If at HOBS, patient becomes transfer ready, it is bed wasted to HOBS until the start of the different level of care. This case will have two wasted bed - one regular and one HOBS.

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.

The level of care of Boarding Locs that a patient is actually on is used to aggregate Transfer Delay (Medicine).

Data for levels of care

This was implemented one way before PatientFollow Project and is set up differently now:

• Before: the 'acuity_level' column in s_dispo table maps the Service/Location in L_Log table to level of care in single digits
• Now: the s_level_of_care table in CCMDB.accdb maps the 'item' in Boarding Loc to level of care in double digits

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.