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 (examples: HSC_HOBS, STB_IMCU as of 2020-10)
- 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
- ward outside WRHA
- PCH or home
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.
Special case - ER, OR and PACU
These are considered the highest level of care collected by that program. So,
- for a medicine patient on a med laptop, an ER/OR/PACU location is considered the same level of care as a HOBS unit
- for a critical care patient on a cc laptop, an ER/OR/PACU location is considered the same level of care as an MICU/SICU
Hierarchy and Transfer Ready Dt/Tm Entries
A Transfer Ready Dt/Tm is entered when a patient has been declared medically stable and/or ready to be transferred to a lower level of care (for example, a patient has been made ACP-C, deemed stable and ready for discharge home/to PCH, ready to be transferred from ICU to medicine, etc). For patients who present to ER and then are admitted to the medicine ward, they do NOT need a Transfer Ready date and time entry leaving ER because they are not going to a lower level of care (even though listed above indicates ER is a higher level of care). The care they will be receiving on medicine is considered to be equivalent to the level of care they received in ER. The line still needs to be entered/associated with the ER Boarding Loc, but follow the direction used when the patient is moved with a Transfer Ready date and time that is not available, or if they were not transfer ready.
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.
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Should Special case - ER, OR and PACU entry (see above) and what is written directly above need to be somehow be better reconciled? Otherwise apt to differing interpretation(s) for example, if ER is to be considered a "higher" level of care than a medicine unit a collector could enter a comment of "not available" as the patient did transfer to a "lower" level of care so theoretically was "transfer ready" based on special case above (as appears to be an exception) but a date/time was not available, or alternatively enter a comment of "not transfer ready" as the transfer to a medicine unit is not a lower level of care unless indicated otherwise while the patient is in ER (ie. change to ACP C). If left as is, would this be confusing to a new collector? |
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