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. HOBS or regular med ward for Medicine service patients, and regular ICU (ie not IICU)

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

JALT We had discussed making this "the level of care of where the pt goes" but the problem in this definition is pts who are discharged or AMA from or die in ER. So I have instead made it about the patient's service. Would that work as a definition? This would also remove the concept of "where the patient actually went" from the definition and might finally eliminate some of the confusion that comes from that. Ttenbergen 12:37, 2022 August 3 (CDT) I agree. --JMojica 13:09, 2022 August 3 (CDT)

• SMW

• Cargo

• Categories

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.