Overstay Predictor Project

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Data collectors requirements

The data collectors on the unit will be asked to attend a general presentation to understand the transition coordinator role and plan. They will also be met with separately to discuss the following:

  • how to use the additional data collection tool on their laptops
  • where to find the Discharge planning screening tool
  • implementing the sticker code on the charts
  • documenting the patients name on the transition coordinators assignment sheet
  • time frames for chart reviews


Purpose

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.

Primary Investigator

Primary Investigator: Dr. Dan Roberts

Contact Person: Linda Hathout 391-5434 or LHathout@exchange.hsc.mb.ca

Pilot Information

Start Date

Grace Hospital 5 North start date: July 23rd 2012 Grace Hospital 5 South start date: Tentative start date September 3rd tentative

  • there is no 5 South; what about 3 South & # North?

End Date

There is no end date for the project at present; the committee will review results after 3 months and make adjustments at that time

Instructions

For every medicine patient admitted to the Grace 5N, as soon as possible, but definitely within 48 business hrs of admission:

  1. Find the new white Nursing Discharge Screening Tool form on the chart. It will be with the admission documentation.
    • the form is to be dated and time stamped
    • For the first 6 check boxes on the form, create a record for each in tmp entries and check the check box if the answer is Yes. (one to one from the form, no interpretation necessary)indicated if no answer is provided.
    • re question 4 (managing independently), if any of the boxes within question 4 are checked "no" or "x", the answer to question 4 should be checked "no"; all boxes within the question must be unmarked or given a check mark in order for question 4 to be checked "yes".
  2. the form is to be completed within 24 hours of admission; if it is not possible at time of admission, the admitting nurse will pass the responsibility for completion to the next duty nurse
    • The nurse can update the form within the first 24 hours after admission if, for example they receive information from the patients family that contradicts the patients answers. It is possible that depending on when you review that document these changes are not captured. This a known risk that has to be accepted.
    • If the form is not completed within the first 24 hours the data collector is to check with the bedside nurse and remind them to complete it?
  3. The information used in the predictor calculation is based on the minimal data set plus a handful of diagnostic codes that need to be checked for within the first 24 hours. The following as part of minimal data set:
    1. DOB
    2. Admit Date
    3. ADL
    4. CVA know or speculated as the admitting
    5. Dementia as an admitting reason or comorbid
    6. whether there was a permanent & severe neurological or spinal insult as an admitting diagnosis
  4. Once this information has been entered click the new “Overstay” button on the patient viewer form next to the notes field and it will turn a colour (colours based on an underlying algorithm too complicated to get into here, but based on tmp entries, age, comorbids, admit dxs and ADLs):
    • GREEN - low/no risk for discharge issues
    • YELLOW - some risk for discharge issues
    • RED - significant risk for discharge issues assign a transition coordinator.
    • GRAY - if some needed data is missing
  5. Based on the color displayed put that colored sticker on the patients chart. Stickers will be located adjacent to the transition coordinator binder at the unit clerk desk.
  6. If the patient has been designated as "red" for purposes of overstay prediction, the data collector will assign a Transition Coordinator by placing the patients name beside the transition coordinator on call for the time period of the patients admission. The transition coordinators will be assigned to cover between Friday to Monday, the next shift will go to Wednesday, the last will be Wednesday to Friday. If the designation is made after 1500 on the day of entry, the assignment will be deferred to the next day's coordinator. The rotation of Coordinators is made up of Home Care, Social Work, Physio, And OTs. After assignment, that service is responsible for following that patient throughout their hospital stay.

Overstay Predictor Diagnosis Code Used

June 12.12- the list of Overstay Predictor Diagnosis Code Used to be used for the overstay predictor algorithm was approved by Dr. Dan Roberts. Submitted to Julie Mojica & Linda Hathout.--Trish Ostryzniuk 17:03, 2012 June 12 (CDT)

  • Julie has connect with Rodrigo and update him. Rodrigo is the person working on algorhythm.--Trish Ostryzniuk 16:25, 2012 June 12 (CDT)
    • NOTE: Prior to above, on April 27.12-only CVA 505 is included in the algorithm to generate the colour only data pertaining to CVA 505 was given to Rodrigo (the programmer) for overstay analysis as per Tina.

Outstanding Issues & Questions

If you can't find data Question

Clarify with the bedside nurse. --Linda Hathout 21:45, 2012 July 5 (CDT)

working diagnoses Question

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?

  • yes indicate the CVA if it is suspected even if not confirmed.--Linda Hathout 21:48, 2012 July 5 (CDT)

Programming Stuff

testing for consistent data

Template:Discussion 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?

  • Program should not have let this through, I'll need to look into that. Ttenbergen 12:02, 2012 May 2 (CDT)

button colour persistence

  1. Every time I exit the Database and then reenter, I have to repress the overstay button as it has gone gray; reported on May 8.12.-- Stephanie Cortilet.
  2. Is the DX code for violent behaviour secondary to dementia included in the list?
  3. 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 (discharge).
  4. Does the algorithm include age, and/or whether the patient originally came from a nursing home? Patients from an existing nursing home bed will not overstay as frequently as those from home.
  5. 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

Other Questions

location of form and sticker

  1. Where on the chart will this new form be and will it be a colored form?--Trish Ostryzniuk 10:43, 2012 April 24 (CDT)
    • The form will be in the same section as the nursing database. Not sure about the colour. The sticker is 3/4 inch in diameter and needs to be placed on the spine of the chart. There is currently a small red dots used to indicate long term chart. This practice is being phased out.--Linda Hathout 22:04, 2012 July 5 (CDT)
  2. 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?

no need to document sticker colour changes

  1. Will it be necessary to document a difference in sticker colours if we need to change the colour once the algorithm has run?
    • No need. The original colour is based on the items you enter into tmp, so we can go back from that if needed. Ttenbergen 12:47, 2012 April 27 (CDT)

test scenarios for colours

  1. 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
    • 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. Ttenbergen 12:47, 2012 April 27 (CDT)

admission times and conditions at admission

  1. 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?
    • 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.--Ttenbergen 12:47, 2012 April 27 (CDT)
      • Pls let me know if you need more info.--Ttenbergen 12:47, 2012 April 27 (CDT)
  2. 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?
    • Use the answer the nurse provides even if you disagree. We will be testing the answers provided by the nurses to determine if they are a better predictor of transition support needs or can be used in conjunction with existing admission data to improve the effectiveness of the prediction tool.--Linda Hathout 22:11, 2012 July 5 (CDT)
  3. 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?
    • Only data upon admission to the unit should be used.--Linda Hathout 22:11, 2012 July 5 (CDT)
  4. If the patient is transferred from one medical unit to another within the facility, is their overstay predictor redone or do they carry the one from the original admitting ward with them?

Template:Discussion

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