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| | {{Project |
| | |ProjectActive=legacy |
| | |ProjectProgram=Med |
| | |ProjectRequestor=Mary Ann Lynch and Dr Eberhard Renner |
| | |ProjectCollectionStartDate=2012-11-05 |
| | |ProjectCollectionStopDate=2019-10-01 |
| | |Project={{PAGENAME}} |
| | }} |
| | {{LegacyContent |
| | |explanation= no more [[overstay]] as of October 1, 2019 |
| | |content= |
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| == Purpose ==
| | '''''See [[Overstay Predictor Project Collection Instructions]] for collection instructions for this project.''''' |
| A small number of patients overstays for a significant amount of time after they are medically ready for discharge. Though the number of patients is small, a significant proportion of bed-days is wasted in the process. We are piloting a process at the Grace where an "overstay coordinator" will be assigned to patients at risk of overstaying. Whether a patient is at risk is determined by the ward nurse assessing risk factors on a form, and by an assessment algorithm that takes into account the values mentioned as mandatory above; the combination of these results in a chart being assigned a colour sticker, and the transition coordinators monitor these chart stickers.
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| ==Primary Investigator==
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| Primary Investigator: [[Dr. Dan Roberts]]
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| *Overstay Predictor Project for Medicine [http://ccmdb.kuality.ca/index.php/Minutes_Team_Meeting_December_5,_2011 - Dec 5.11 collection team meeting discussion item 6]
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| == Pilot Information ==
| | '''STOP DATE''': for any new admissions as of October 1, 2019. Outstanding admission prior to October 1.19 must have overstay completed.--[[User:TOstryzniuk|Trish Ostryzniuk]] 16:50, 2019 November 18 (CST) |
| Official pilot start data for the Grace has been delayed, meeting to discuss new plans is scheduled for May 3.
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| #is there any update from this meeting?
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| Please continue the informal testing that has been going on for the last few days.
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| Thanks! [[User:Ttenbergen|Ttenbergen]] 14:19, 2012 April 30 (CDT)
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| *thank you Stephanie and Sheila for super feedback.[[User:TOstryzniuk|Trish Ostryzniuk]] 15:32, 2012 April 30 (CDT)
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| == Instructions ==
| | A small number of patients overstays for a significant amount of time after they are medically ready for discharge. Though the number of patients is small, a significant proportion of bed-days is wasted in the process. The Overstay Predictor Project uses an [[Overstay Predictor Project Algorithm | algorithm]] to that uses data collected by the Critical Care and Medicine Database to predict an overstay risk. This risk is communicated to ward staff using a red sticker on charts and a direct communication to the unit manager. |
| For every '''medicine''' patient at the '''Grace''' hospital, '''as soon as possible''', but definitely '''within 48 business hrs of admission''':
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| * find the new "Overstay" form on the chart
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| *for the first 6 check boxes on the form, create a record for each in tmp entries and check the checkbox if the answer is Yes. (one to one from the form, no interpretation necessary)
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| *(I will add a picture of the form here once we have a final version)
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| #so if the answer to the question is "yes" we check the box, then if the answer is "no" we do not check the box,; the current prototype form I have also has "unknown" as a possible answer-how would we note this?
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| * Also, enter at least all the following as part of minimal dataset
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| ** DOB
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| ** Admit Date
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| ** ADLs
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| ** whether there was any '''CVA''' or '''Dementia''' as a comorbid
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| ** whether there was a '''stroke''' as an admit diagnosis (neurological or spinal insult)
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| * Click the new “Overstay” button on the patient viewer form next to the notes field and it will turn a colour (colors based on an underlying algorithm too complicated to get into here, but based on tmp entries, age, comorbids, admit dxs and ADLs):
| | ==Legacy== |
| ** GREEN - low/no risk for discharge issues
| | see [[Overstay Project Start Stop dates | Implementation Dates]] |
| ** YELLOW - some risk for discharge issues
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| ** RED - significant risk for discharge issues.
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| ** GRAY - if some needed data is missing
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| * If the chart already has a sticker the '''same''' colour then you are done
| | {{Data Integrity Check List|}} |
| * if the colour in the program is different from the one on the chart put a sticker of the program colour over the sticker on the chart. Stickers will be supplied.
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| === If you can't find data === | | == Related Articles == |
| * I have emailed Linda to please fill in who the collector should talk to if there are problems with the Overstay form or the other data required for the project in a timely manner.
| | {{Related Articles}} |
| #has this been determined?
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| [[User:Ttenbergen|Ttenbergen]] 14:45, 2012 April 23 (CDT)
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| ==Questions==
| | [[Category: OverstayProject]] |
| === location of form and sticker ===
| | }} |
| Where on the chart will this new form be and will it be a colored form?[[User:TOstryzniuk|Trish Ostryzniuk]] 10:43, 2012 April 24 (CDT)
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| * not known yet, will add details when we get them. [[User:Ttenbergen|Ttenbergen]] 12:56, 2012 April 27 (CDT)
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| *What is the purpose of putting the sticker on the chart; will this be looked for by other disciplines to identify the need for their intervention?
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| ** see [[#Purpose]] [[User:Ttenbergen|Ttenbergen]] 11:56, 2012 May 2 (CDT)
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| === no need to document sticker colour changes ===
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| #Will it be necessary to document a difference in sticker colours if we need to change the colour once the algorithm has run?
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| #* no need. The original colour is based on the items you enter into tmp, so we can go back from that if needed. [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
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| === test scenarios for colours ===
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| #How can I test the yellow colour?-I can only get the overstay button to be red or green using multiple different combinations of the check boxes
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| #* yellow would be based on a combination of comorbids and ADLs and age. Make a patient a little less sick and they will become yellow. Sorry, can't give you exact instructions, the algorithm is pretty messy. [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
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| === admission times and conditions at admission ===
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| The time we use as the time of admission will be different than the time of admission to the unit, and often significant time has passed between the 2 times so the information collected is different e.g. pt is confused at our admission time but by the time the patient goes to the unit, the patient is now A & O etc or vice versa. Will this affect the algorithm?
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| * Use the data as you would have entered before as that is what the algorithm was based on. I hope that helps, since I know some collectors used to collect this much later. Pls let me know if you need more info. [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
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| #what if our assessment differs from that of the admitting nurse e.g. they ask the pt/family on admission if they have fallen within the past 6 months and are told no or the information is not available, and we see from looking through the chart that falls have been documented within this timeframe?
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| #is the admission information the only source used or will the complications be taken into consideration e.g. if the pt develops a new cva as a complication do we redo the overstay predictor?
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| === List of DX codes included in Model ===
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| *Trish, Sheila, Stephanie, Laura, working on list of DX this week.--[[User:TOstryzniuk|Trish Ostryzniuk]] 11:31, 2012 May 28 (CDT)
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| **Dr. Dan Roberts:
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| -Strokes would include all intracranial hemorrhages
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| as well as ischaemic thromboembolic events for this
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| purpose. Other inclusions would be spinal cord events
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| resulting in new paraplegia or quadreplegia.
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| These are neurologic insults that almost invariably
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| lead to permanent severe physical plus or minus
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| cognitive disability.
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| -Dr. Roberts clarified that medically what causes a likely
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| permanent decrease in functional status is any diagnosis related
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| to a central nervous system injury. While there are other non-neurological
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| diagnosis that may result in a functional decline, they are rare.
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| ==== [https://secure.wikimedia.org/wikipedia/en/wiki/Lacunar_stroke Lacunar Strokes]====
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| Should lacunes or lacunar infarcts that are/have been asymptomatic but are reported on a CT be included as CVAs in the comorbids?
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| *No. If no physical/funtional impairment what so ever then no, don't code.--[[User:TOstryzniuk|Trish Ostryzniuk]] 15:52, 2012 April 27 (CDT)
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| ** They should be reported like they always have been. We are basing the algorithm on previous data. This does not preclude us from discussing that question independently on the appropriate wiki page. Trish, I have no idea what a lacunar infarct is, could you provide the link? [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
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| * If I read that question and the wikipedia article, then I wonder: are talking about Silent lacunar infarctions only here? Surely if there are symptom's it's coded, no? But as what code? Did we enter them into the comorbids before? Either way, this should probably be coded at the appropriate article, '''not''' here. [[User:Ttenbergen|Ttenbergen]] 17:54, 2012 April 27 (CDT)
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| ==== [[Intracerebral hemorrhage]]s in comorbids ====
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| We code Intracerebral hemorrhage (ICH) as 502** if it is a diagnosis, but we don't have a comorbid code for it.
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| #Should ICHs be considered CVA in comorbids?
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| #*Yes if it caused a stroke then code 505 in comorbid.
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| #*They should be reported like they always have been. We are basing the algorithm on previous data. This does not preclude us from discussing that question independently on the appropriate wiki page. Trish, I have no idea what a ICH is, could you provide the link? [[User:Ttenbergen|Ttenbergen]] 12:47, 2012 April 27 (CDT)
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| === Did we consider all alternative diagnosis for CVA ===
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| We code several diagnosis as alternatives to a [[CVA-Cerebral Vascular Accident]]:
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| * [[Intracerebral hemorrhage]] and subcodes
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| * [[Brain Stem Hemorrhage]]
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| * how about [[Cerebral Infarct Cause NYD]]
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| * '''are there more?''' {{discussion}}
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| Whether they should be included in our algorithm depends on how we code them. Neither article gives instructions to code in addition to or instead of CVA 505 (we have this instruction for some other dxs). What is the coding practice? {{discussion}}
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| '''current status'''
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| * as of 2012-04-27
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| ** only CVA 505 is included in the algorithm to generate the colour
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| ** only data pertaining to CVA 505 was given to Rodrigo (the programmer) for overstay analysis
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| ** '''This issue might be relevant for other topics like the MOST score and wherever else we report on CVA, such as MOST and APACHE'''
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| *I have sent an email to the overstay team for advice. [[User:Ttenbergen|Ttenbergen]] 18:28, 2012 April 27 (CDT)
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| We will need to re-evaluate the algorithm with this in mind. Linda will discuss with Rodrigo and Dr Roberts at the next overstay meeting May 3. [[User:Ttenbergen|Ttenbergen]] 14:02, 2012 April 30 (CDT)
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| === testing for consistent data ===
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| I intentionally left out one of the overstay questions in the temp file expecting to get a gray overstay predictor score indicating missing information but am getting yellow-is this correct?
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| * Program should not have let this through, I'll need to look into that. [[User:Ttenbergen|Ttenbergen]] 12:02, 2012 May 2 (CDT)
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| === working diagnoses ===
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| Occasionally the working diagnosis written by the MD is CVA but this has not been confirmed by CT; should this be coded in admission diagnosis anyway and then removed later if not confirmed?
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| * Will confirm process[[User:Ttenbergen|Ttenbergen]] 12:02, 2012 May 2 (CDT)
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| === button colour persistence ===
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| every time I exit the Database and then reenter, I have to repress the overstay button as it has gone gray; this is still an issue May 8
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| * Will confirm process[[User:Ttenbergen|Ttenbergen]] 12:02, 2012 May 2 (CDT)
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| #is the dx code for violent behaviour secondary to dementia included in the list?
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| #would it be helpful for us to note the reason the pt has stayed past the date it is noted they are medically stable somewhere; the chart usually notes whether the pt is being panelled, waiting for services or assessments etc. or whether the pt becomes "unstable" again while waiting for d/c
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| #does the algorithm include age, and/or whether the pt originally comes from a nursing home? pts from an existing nursing home bed will not overstay as frequently as those from home
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| #is it possible for the 6 overstay requirements in the temp file to be generated automatically like the postal code is rather than having to add the 12 items manually? we then would just have to check the box to answer each question
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| [[Category: All Projects]]
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