Pre-admit Inpatient Institution field

This field is currently being implemented, please check the instructions and put a discussion for anything that isn't clear. 

The Pre-admit Inpatient Institution field identifies the previous inpatient location of patients who were already inpatients elsewhere before coming to our unit. This does not include patients who just arrived at an ER elsewhere and were not admitted as inpatient there.

For example, a patient arriving from Selkirk Hospital via the local ER would have the ER coded in the Previous Location field and Selkirk coded in the Pre-admit Inpatient Institution field.

Collection Instruction

For each patient,

• enter the option that most closely matches
• if you know the situation but nothing on the list matches closely, enter other - known

but not listed

• if the situation is unknown, enter location missing/unknown
• If the previous location was temporary put NA/not applicable in this field or the program doesn't let you complete the registry to complete the file.

• If the patient did not come from an inpatient location, enter "not applicable", for example if they came from home or a clinic. The ER is not an inpatient location.

If you know how we code the location exactly, you can type it. Otherwise press the "magic wand" button to take you to the S dispo chooser‎ to help filter options if desired.

Where to find this information

If patient came from a different Winnipeg hospital this will be recorded in the “Visit History” on the EPR.

Example

• ICU Vic---family medicine ward at the Vic---ED HSC---ED STB---cath lab---ICU HSC.
  • The PrevInptLocation field is: VIC_Ward

Ambiguous locations

The following are considered inpatient locations in this context:

• EMIPs are considered
• day-surgery patients ending up on our unit directly

Questions

how about nursing stations?

• We used to collect nursing stations in hospital previous but would not include them under the new scheme because they are not inpatient locations.

We are planning a meeting with Randy Martin to discuss. For now you can't enter nursing stations here, so, don't. Ttenbergen 18:16, 2016 April 28 (CDT)

Movement in the same hospital

• After talking with coworkers, I realize we are treating this field differently - it would be helpful for clarification. Is this field associated with the PREVIOUS INSTITUTION or PREVIOUS LOCATION? For example, if a patient moves around in the SAME hosptial to numerous wards, but was never admitted in a different hosptial, do I enter NA or the previous WARD?Mschaffer 08:01, 2016 May 6 (CDT)
  • Example: Thompson Ward to Grace ICU to Grace Medicine ward. The Grace ICU will capture the movement from Thomspon. What is the pre admit inpatient institution for the Grace medicine admission - Thompson ward or grace ICU? - Mschaffer 08:01, 2016 May 6 (CDT)
    • GRA Med ward admission from GRA ICU: The PreAdmit Inpatient Institution would be same as Previous Location - GRA_ICU. Trish Ostryzniuk 12:57, 2016 May 6 (CDT)

ER -> cath lab -> ward scenario

• If the previous location is the heart cath lab (which is a temporary location), then I should add a pre-admit inpatient institution. However, if the patient comes to the cath lab from ER, I cannot put this location because it also is a temporary location. Currently we do not put in the heart cath lab as a place to admit from, instead we use where they were located just prior to the cath lab (ER in this example). I thought that Julie tracked Winnipeg hospital use of ER's for Randy so if we will no longer be able to put that the pt came from ER in this setting, then this will be entirely missed. Just checking! --LKolesar 14:21, 2016 April 14 (CDT)
  • A scenario of patient who went ICU elsewhere --> Ward elsewhere --> ER1 --> ER2 --> Cath Lab --> ICU/Ward will enter the pre-admit inpatient Institution as Ward elsewhere according to Allan Garland. JMojica 13:28, 2016 May 2 (CDT)

HSC ER to GGH ICU to GGH Ward

• pt sent to GGH ICU from HSC ER with order to transfer presumably because no critical care beds at HSC. Not treated as an admission by ER standards, but clearly had to be admitted or would not have been sent to ICU. Should this be treated as an inpatient admission for our purposes, so HSC ER would be entered as preadmit institution location?

ER -> OR -> Unit/ward =

• I have a patient I admitted from the recovery room to ICU (prior to recovery room they were an emergency room patient, went to the OR as an E1), previous location is recovery room, but there is no option for Grace OR or recovery in the pre-admit inpatient institution field, do I put this as n/a? because she was in the ER? I put previous service as general surgery Lisa Kaita 13:00, 2016 May 3 (CDT)
  • Code Pre-admit Inpatient Institution field as n/a, the ER is not an inpatient location. And you are right about the previous service. Ttenbergen 10:39, 2016 May 4 (CDT)

intra-hospital transfers

• When we have patients moving from ward to ward, we normally do not go back to their original admission date to gather data especially as some patients have been admitted for over a year. Will it be acceptable to continue this practice?--CMarks 12:39, 2016 April 11 (CDT)
  • For intra-hospital transfers of inpatient (excluding pts who were only in ER/OR at previous location), code the previous hospital location. Ttenbergen 10:34, 2016 May 3 (CDT)

Readmission from Grace/HSC Nursing Home

• currently discharges to and admissions from Grace Nursing Home are treated as new admissions (with the exception of the Discharge Screening Tool which is labelled 'transferred form'). Technically, though, this is an interhospital transfer, and the hospital treats it as a continuous admission. Will this require a previous Inpatient Institution entry? And will the visit admission date then be the original admission date, or the date transferred from one ward to the other? SCortilet
  • We treat these nursing home wards as inpatient locations for at least some scenarios. We will treat them as inpatient locations for this.
  • E.G.code Grace Nursing Home as Previous Location field and code Grace Ward (or e.g. VIC_S5 if known) as Pre-admit Inpatient Institution field.
  • Visit Admit DtTm field is the original hospital admit DtTm.

Data Use / Purpose

To document where those patients who were inpatients immediately before arriving on our ward/unit came from.

The detailed information will allow us also to distinguish between patients who were or were not inpatients before arrival. This is relevant to a patient's risk of bad outcomes.

The information will also give our administrators a better idea of which other hospitals are sending us patients, which they will use for planning.

Template:CCMDB Data Integrity Checks

• Records for all Admit froms in #Temporary locations need to have an entry (possibly "none")
• Records for all Admit froms not in #Temporary locations need to not have an entry

Not yet implemented Ttenbergen 14:11, 2015 May 27 (CDT)

• Template:Discussion do these make sense? (old q from Tina)
  • YES. if these are done, you may delete the ones I wrote above. JMojica 12:31, 2015 May 28 (CDT)

Reports

Template:Discussion Which reports will this be on? Ttenbergen 10:33, 2016 March 22 (CDT)

Implementation

The field is populated with options from the s_dispo table.

Legacy

This field is part of the 2016 Time and Place changes and did not previously exist.