Previous Service field

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Data Element (edit)
Field Name: Previous_Service
CCMDB Label: Previous Service
CCMDB tab: Dispo
Table: L_Log table
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: 38

The most recent "originating service" which sends the patients to their current service location.

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Legacy implementation right in the table

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Collection Instruction

  • 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
  • Patients admitted after having a problem during an outpatient procedure are more complicated:
    • Such procedures include outpatient: GI endoscopy, bronchoscopy, cardiac cath, invasive radiology, procedures done at surgicentres, etc.
    • If the patient goes DIRECTLY from the outpatient procedure area to a Medicine ward or an ICU, then code the type of physician who was doing the procedure:
      • if, for example, it was a GI endoscopy, then the previous service was "GI", but as GI is not specifically listed in the dropdown list of services, then list it as "other"
    • If before being admitted to hospital the patient was sent from the procedure area to the ED:
      • if the patient was actually an ED patient (under the care of the ED docs) then code "Emergency Medicine"
      • if, for example, it was a GI endoscopy and the patient was not actually under ED care, but instead was directly admitted to the ED on the Medicine ward service, then the previous service was "Medicine"
  • 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 (as of January 2022 we checked and these account for <1% of all previous services)

From HD / From hemodialysis

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.

from OR

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

see Previous_Location_field#from_a_unit_that_is_partly_collected_by_us.2C_and_partly_not.

admission from a nursing station

  • For a direct admission to a collection unit from nursing stations, put "other (known, but not on list)".
  • If from a nursing station, patient dropped by ER , put "Emergency Medicine".
Discuss@task.png
  • To clarify the first point above is this applicable to admissions from nursing stations direct to collection units?
    • What makes you wonder, why would it not be applicable? Ttenbergen 11:42, 2022 March 24 (CDT)
    • I added text to the first point, is this clearer now?
  • To clarify the second point above is "Emergency Medicine" entered for direct admits to a collection service from nursing stations via ER? Thanks!
    • What makes you wonder, why would it not be applicable? Ttenbergen 11:42, 2022 March 24 (CDT)
      • The questions were asked with new collectors in mind for clarification tweaking purposes in regards to phrasing such as "dropped by ER" if the patient is a direct admit to service via ER from a nursing station should the previous service entry also be "other (known, but not on list)"?.
        • What does "dropped by ER" mean in this context? Is it "dropped by" as in visited, or as in someone dropped the ball? Ttenbergen 10:47, 2022 April 7 (CDT)
  • valid question thanks Pam, makes me wonder why we differentiate between the two situations, in my opinion they should be consistent and we should put Emergency Medicine for both situations. The previous location will identify that they were from a nursing station, which in my mind functions like an urgent care/ER triage. We (HSC) rarely get direct admits to the ward from a nursing station, but we get lot of direct admits via the ER from a nursing station. Pull in Julie to see if/how she reports on this. Lisa Kaita 12:41, 2022 April 13 (CDT)
    • emailed Julie Ttenbergen 10:25, 2022 April 21 (CDT)
      • this is a case of direct admits from nursing station parked at ER, correct? we have the list of specific MB nursing stations and generic outside MB nursing stations. why put unknown? In terms of previous service, this is seldom requested so I have not quality checked this field. Just did a quick browse on the database and filter previous location having '(parked)' - found 1269 entries and the previous service is not consistent. There are 940 already in-patients and 82 entered Emergency Medicine as previous service ( 67 out of 82 from HSC) while the 858 entered the actual service or unknown. With regards to the new process starting Oct2020, we won't know if direct admits even if already an inpatient. Example from Oct 2020, I found 134 already an inpatient from other facilities with previous location own ER and previous service Emergency Med while 49 enter the actual service. If known as direct admit parked at ER waiting for available bed then enter the prior inpatient service. Otherwise enter Emergency Medicine. --JMojica 11:29, 2022 April 21 (CDT)
        • I thought Previous Service was part of a standing report, and that that is the main or only reason we even capture it. If it's not used, should we still collect it? I will flag this for task. Ttenbergen 15:22, 2022 April 28 (CDT)
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Direct admit

For a direct admit via the ER, the Previous Service will be the primary service looking after the patient, prior to admission at your facility.

Example:   

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Urgent Care

For patients directly admitted from urgent care, code previous service as "Emergency Medicine".

Clinical Assessment Units

Specific instructions apply for coding previous service for the specific CAUs. See

Data Use

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.

Integrity checks

Data Integrity Checks (automatic list)

 AppStatus
Query check previous location vs service inconsistentCCMDB.accdbimplemented
Function Validate previous serviceCCMDB.accdbimplemented

Implementation

The field is populated with options from the s_previous_service table.

Legacy

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.