Previous Service field
|Data Element (edit)|
|CCMDB Label:||Previous Service|
|Program:||Med and CC|
The most recent "originating service" which sends the patients to their current service location.
For each patient,
- enter the option that most closely matches
- for medicine ward-to-ward moves, code "medicine" as previous service
- for ICU-to-ICU moves, code "Critical Care" if no other specific service is documented
- for pt from ER, code "Emergency Medicine" unless a different service had accepted them and is handing them off to Medicine
- for pt direct from ambulatory not via ER, code "not applicable" if no other specific service is documented
- if the service is not listed, code "other (known but not on list)"
- in these cases we don't care about the details; if we see too many others we may add additional options in future
From HD / From hemodialysis
- Patient admitted from outpatient HD to ward/ICU - code HD as Previous Location, and Nephrology as Previous Service.
- Patient transferred from ER to HD, then to ward/ICU - code HD as Previous Location, and Nephrology as Previous Service.
- Patient admitted to medicine ward, goes to HD for dialysis, then is transferred to another ward/ICU - code HD as previous location, and Medicine service as Previous Service.
Comment from Task meeting, needs to either be integrated or can be removed if already consistent:
- Came to dialysis from being an outpatient: Previous Location=dialysis; Previous Service=Nephrology; Prior Inpatient Location=n.a.
- Came to dialysis from ED: Previous Location=dialysis; Previous Service=ED; Prior Inpatient Location=n.a.
- Came to dialysis from a prior, different, inpatient location: Previous Location=dialysis; Previous Service=service of that prior inpatient location; Prior Inpatient Location=that prior inpatient location
From Cardiac Cath Lab
- A patient goes to emergency, then is sent to the cardiac cath lab for an angiogram. Julie would like the sending service to be Emergency Medicine in these cases (not cardiology). Discussed at the task group meeting on July 20, 2017.
- Most patients come to CCU or ICU via the heart cath as a code stemi, in which case the previous service is cardiology because they bypass ER and go direct to the heart cath lab.
- The previous service is who was looking after the pt before the heart cath in some situations. For example, if ECMO is done in the heart cath lab : If the pt was on a ward or unit prior to the procedure, the service is whatever ward or unit it was that sent the pt there. If ER sends a pt for a VV ECMO, the ER is the sending service, unless ICU takes over the pt prior to the ECMO. (They would need to consult cardiac surgery for the ecmo procedure but it would be the ICU that takes over the care ultimately).
This was discussed at the task group meeting on June 21, 2017.
If a patient comes from an OR/RR, code the responsible surgical service as previous service.
Nursing Home Wards (HSC/GRA)
We treat patients that went through the HSC/GRA Nursing Home as having been discharged. So, admission from there should be as if admitted from home, so put "not applicable" into the Previous Service field. This does not affect the Visit Admit DtTm field definition - remember, that is defined by EPR entry.
Admit from home
For an admission directly from home bypassing the ER enter Previous Service = 'Not applicable'.
from EMIP via ER
The case of VIC ER to STB EMIP to VIC ER to VIC Ward is a bit tricky because STB EMIP signify being an inpatient under Medicine service before going to VIC ER. WIKI defines Previous Service as the "originating service" for those patient's who where already in a prior inpatient location. It would be easier to define the previous service if this is a case of direct transfer to VIC Medicine service and parked only in VIC ER. This is a good question - which to use, Emergency Medicine or Medicine? Since it is known that there is prior inpatient service, I am more on the second one 'Medicine'. This can be a similar case when the previous location is Operating or Recovery and the responsible surgical service is coded as previous service. If coming from home to another ER to own ER to own Ward, then previous service is clearly Emergency medicine.
admission from a unit partly collected by us
admission from a nursing station
- For direct admission from a nursing station, put "other (known, but not on list)".
- If from a nursing station, patient dropped by ER , put "Emergency Medicine".
If a pt is physically in ER and officially under the care of primary service eg Neurology, then code Previous Service as Neurology.
If pt was not yet accepted, code Previous Service as Emergency Medicine.
For patients directly admitted from urgent care, code previous service as "Emergency Medicine".
Specific instructions apply for coding previous service for the specific CAUs. See
Sending service to ICU will be reported to the Critical Care Director whose interest is to determine the sending services for patients who where already in a prior inpatient location before coming to ICU (refer to minutes of Task Meeting dated 13 April 2015 and 11June 2015). The data to be reported will be filtered to include only those in-patients prior to ICU.
Data Integrity Checks (SMW)
|Function Validate previous service||CCMDB.accdb||implemented|
|Query check previous location vs service inconsistent||CCMDB.accdb||implemented|
The field is populated with options from the s_previous_service table.
For medicine this concept is related to ER Wait.
For critical care this concept is related to Service Sending to ICU - refer to Task Meeting minutes dated June 11, 2015.
- see updated minutes dated August 24, 2017.