Off ward field

Data Element (edit)
Field Name:	off_ward
CCMDB Label:	Off Ward
CCMDB tab:	Dispo
Table:	L_Log table
Data type:	number
Length:	long integer
Program:	Med and CC
Created/Raw:	Raw
Start Date:	2016-07-01
End Date:	2300-01-01
Sort Index:	39

Checked/true if the patient who meets the Definition of a Medicine Service admission or Definition of an ICU admission spent any time in a bed that is not at their actual collection location between Arrive DtTm and Dispo DtTm. The patient must be covered by the attending of the service of the home unit that is credited with the "off ward" designation.

• SMW

Legacy implementation right in the table

• Cargo

• Categories

• Forms

This includes patients who spend part or all of their admission located on an off service ward, but not #EMIPs.

Collection Instructions

How to identify off-ward patients

Current way of checking through transfer list from ER will miss off ward patients who arrived at off-ward locations from elsewhere than emerg. Laura and Tina discussed, did not find solution yet, should be rare, though. 13:41, 2017 March 1 (CST)

• SMW

• Cargo

• Categories

see also EPR Reports, Discharge Register, Transfer Register, Identifying ICU admission, Definition of a Medicine Service admission, Definition of an ICU admission

We collect data on some patients who never arrive on one of our units, e.g. EMIPs any other scenarios? There was a page for the HSC off warders I think...)

• SMW

• Cargo

• Categories

Process for identifying Off ward Patients

1. Go to Citrix Apps on Desktop
2. Click on EPR Reports
3. Log in with username and password (same as your initial log into your computer)
4. Click on “Patient List Reports”
5. Click on “Transfer Register”
6. Fill in Facility (hospital you are checking)
7. Put in a time frame that you wish to search. Do not use the current date as you want it to reflect full days, not a partial day.
8. Fill in unit as "emergency" of the correct facility
9. Under “unit filters on”, select “from or to”. All other fields remain unchanged.
10. Click on "View Report" button.
11. Scroll though the list to look for only internal medicine patients that went to off-service wards. (Do not count patients that go to the ICU).

EMIPs

Occasionally, when reveiwing this generated list you will also notice some patients that are actually EMIP patients that ended up going to other wards after leaving ER. These would not be off ward patients but, instead would be entered as EMIP's. For example, the pt, while in ER was accepted by medicine, then, before leaving ER, they changed service to ICU or Surgery or Palliative, etc. These are actually captured as EMIP's. So if the pt went to ICU the Pre-admit Inpatient Institution and the Previous Location would be EMIP. --LKolesar 12:46, 2017 March 2 (CST)

Vic

Example of a VIC OFF WARD scenario: Patient on a collection unit transferred to Urgent Care for assessment then returned to collection Unit and the bed was held for patient

STB

• Off service ward:
  • A6.

HSC

• off service wards:
  • RR5 & RR6 - HSC_Med_nonteaching_contingency_beds#Medicine_Overflow_HSC_RR5_.26_RR6
  • B5 - HSC_Med_nonteaching_contingency_beds#Medicine_Overflow_HSC_B5
  • HSC CAU - may or may not be overflow see HSC_Med_nonteaching_contingency_beds#HSC_CAU

GRA

• Off service ward:
  • 2South (ortho surgery unit)

How to enter patient into CCMDB

Collection Instructions - current ward

If the patient meets the definition at the top, check the "off ward" checkbox located underneath the Service/Location field.

Enter the laptop's regular collection location into the Service/Location field, not the off-ward location.

Collection Instructions - next ward (if applicable)

The Pre-admit Inpatient Institution field and Previous Location field of the next encounter would use the Service/Location field of the previous collection location where available, not the off-ward location.

Collection Instructions - previous ward (if applicable)

The Dispo field of the previous encounter would use the Service/Location field of the next collection location where available, not the off-ward location.

Not intended for off-ward tests

see Bed holds

EMIP

EMIPs are in their collection location, e.g. GRA_EMIP, so they are not off ward. Don't check the field.

Parked in ER

Parked in ER is before Arrive DtTm, so they are not "off ward". Don't check the field.

1. find patients as per off ward field article
2. Write down a list of these patients with their chart numbers on a paper.
3. Place this list on the bulletin board in the medicine office so that both medicine data collectors are aware that there are medicine service patients on off-service wards in the hospital.

Entering off ward patients

• If these patients ultimately get transferred to one of the medicine wards, then the data collector that does that ward will enter those patients on their laptop, reflecting their entire stay from the admission from ER. In the dispo tab the Off ward field must be ticked off as they were off ward for part of their stay.
• If these patients get discharged from the off service ward to home or out of hospital location, then these are considered Off ward field that must be entered on one of the medicine laptops, because their entire stay was on an off service ward.(There may be individual hospital differences on which laptop is used for these entries).
• This patient list can be posted on the bulletin board of the medicine office. If they are admitted to one of the medicine wards, then that data collector will cross that person off the list. Once a week check if the pt is still in the hospital, if they have left and were never admitted to one of the medicine wards, then a designated data collector will enter them on her laptop. --LKolesar 12:54, 2017 March 2 (CST)

Patients who are on a off wards for part of their stay only

• When a pt comes to one of the medicine wards from an off-service ward, the data collector must go to the original presentation of the pt to see if this pt was accepted to medicine on the off-service ward prior to their arrival on their own ward. If you see that the pt was looked after by internal medicine prior to their arrival from the other ward, make sure you start your profile on the original date that medicine accepted them (usually in ER).
• On occasion, medicine patients are transferred to off service wards, but are still admitted under the internal medicine service. ie. patient transferred from a medical ward to a surgical ward but still are admitted under internal medicine service. The attending may be different than the admitting service but it is still an internal medicine attending. Please continue to follow these patients (new profile is not required) until they are discharged or transferred to an off service ward under family medicine or any other service other than internal med. Please note the location in the RECORD box to indicate where the pt is currently located. --LKolesar 13:05, 2017 March 2 (CST)

How to determine when a patient is no longer under an internal medicine service

In the EPR the patient list will show the "provider" which should identify which service the attending physicians is from. However, because this is not always consistently kept up to date when services change, the following checks can help to determine if a patient remains under internal medicine or switches to another service.

1. In EPR,Check the orders under transfers/care directives, to see if there has been an order to switch from internal medicine to another service. Use the time transferred to the other ward as the discharge time or use the time in the order when the other service took over care if the pt remains on the off-service ward. (orders are currently only available to view at STB).

2. In EPR, go to the patient info tab, select care providers from the left hand column, a list should come up with providers and their discipline with a date. If you see that the most recent attending is no longer an internal medicine physician then there has likely been a change of service. You may be able to confirm this by checking under the documents tab, sort by discipline, and then check the medicine notes that correspond to the date found in the care providers list. The progress notes from different services will be identified as such in the notes section. If you determine that they are in fact now under a new service (with no corresponding order), use the date and time of the attending switch in the care provider list as your discharge date and time.

Data Use

Relevant to Bed occupancy and some patient risks.

As of 17:13, 2017 November 9 (CST) we don't use it in reports but it is used to explain such things as over-census situations.

See also

• Bed borrow

Cross Checks

Legacy but still implemented: ACCU_borrow#If_ACCU_entry_then_off-ward_should_be_checked

Legacy

initial mis-connection

From 2016-07-01 to 2016-08-?? the control for this field had been incorrectly connected to the pharm_complete field. Since medicine doesn't use that field we could reclaim data for medicine from there. CC uses the field so could not reclaim data for them. Data for CC will be reported starting 2016-09-01.

pre-2016 fields for similar content

We used to collect related information in multiple places. Once we are comfortable with the new dispo fields we want to stop collection of the old fields. The fields are:

• ICU Var 3 - Overflow
• ICU Var 4 - Parked in ER
• ICU Var 5 - Overflow

Old data would be transferred to new fields where the translation is not ambiguous. We can keep a snapshot of Centralized with the data pre-translation in case we ever want to go back to it.