Off ward field

Data Element (edit)
Field Name:	off_ward
CCMDB Label:	Off Ward
CCMDB tab:	Dispo
Table:	L_Log
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 an bed that is not at their actual collection location between Arrive DtTm and Dispo DtTm.

• SMW

Legacy implementation right in the table

• Cargo

• Categories

• Forms

This includes patients who spent their entire admission off-ward, but not #EMIPs.

Collection Instructions

How to identify off-ward patients

<details needed>

Template:Discussion 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)

see also EPR Reports, Discharge Register, Transfer Register

We collect data on some patients who never arrive on one of our units, e.g. EMIPs, OVERs, ICU pts in PACU. (Template:Discussion any other scenarios?) Template:Discussion

from identifying in boarding locations...

• Up to now, I have never made a profile on a PACU patient that never arrived in the ICU. It is possible that ICU accepts a pt in PA and then the pt never actually gets to the ICU (gets better or dies), however up to now I have never made a profile for these (very very rare if ever). Is this something you want done? The problem is that I would not know the pt was under ICU while in PACU if they never come to the ICU. There is nothing in our system to alert me to this.
  • However, if a patient who was accepted to ICU while in PACU does come to the ICU, then a profile is done and the accept time will reflect the time the pt was accepted to ICU service. --LKolesar 09:30, 2016 May 17 (CDT)
• How does HSC SICU do it? Trish Ostryzniuk 16:58, 2016 May 17 (CDT)
• These patients are found in several ways. The SICU clerk may know about the patient and put them in the SICU log book, or they may be on the white board and be shown as in PACU or there may be a green sheet for them. We now check EPR with a print out on Mondays, that show all admits from the last 7 days and make sure all patients have been caught.

It is possible that one or two a year are missed but we can't know about what has no documentation.--Jpeterson 07:39, 2016 May 18 (CDT)

These patients can be identified in the EPR as follows:

Template:Discussion Laura and Lisa agreed to fill in the details here. Ttenbergen 14:40, 2016 May 16 (CDT)

STB

• Medicine service patients that spend all or part of their time on an off-service ward.

Process for identifying Overflow 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 ICMS).

Note from Vic

• Overs can only be found in the admission/disharge book in Medical records at the Vic. Copy the information (name and chart number and discharge date) The nurse collecting on CTU S4 collects this information. Check to see if patient is a VMU patient or CTU patient. If VMU give information to nurse who is collecting on 5N/5S ( VMU has separate laptop same with CTU ) Make sure you indicate that the patient is an Over in access ( enter OVZ) and follow your serial log numbers according to last log number. As in EMIPs/Overs when checking the book in Medical records initial the page of discharges last checked.

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.

generated list for overflows also includes EMIP patients

• • When reviewing the list of patients generated by the above method, you can also identify some EMIP patients. The patients that were accepted by medicine while in ER and subsequently were transferred to a different service while still in ER are actually EMIP patients. For example, the pt was under medicine while in ER but later (while still in ER) are taken over by surgery, palliative, critical care, etc. These are EMIP patients. --Malcudia 07:46, 2017 February 10 (CST)

Entering Overflow patients

• If these patients ultimately get transferred to one of the medicine wards (E5, E6 or B5), 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 overflows that must be entered on the E5 laptop.
• This patient list is 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 the E5 data collector will enter them on her laptop. --LKolesar 06:48, 2017 February 1 (CST)

Patients who are on off service wards part of their stay only

• When a pt comes to E5, E6 or B5 from an off-service ward (this includes 6AS), 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 E6 to 7AS (surgical ward) but still admitted under internal medicine. 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.

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 transfered 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.

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 occupancy and some patient risks.

See also

• Bed borrow

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.