Swap Locations

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Some sites use swap locations as entries in EPR.

When patients need to switch locations due to medical reasons, patient swap locations can be performed in the ADT EPR. For example, patient A and patient B need to switch locations. Patient A is in a private room and patient B is in a semi-private room. Both patients could be transferred into the swap location or non-census location, freeing up both of the unit beds. Then both Patient A and Patient B can be transferred into the correct unit and room/bed.

Example:   

A patient was in a swing bed from 0243 until 0405 that is the actual arrival time to the unit. The patient remained in ER until 0405 but MR staff had to electronically enter/place the patient somewhere.

The problem

Swing or swap locations are not real locations. While listed as in a swap location, the pt might still be in the old location or already be in a new location that gets entered after. Collectors seem to review the chart, make sense of what actually happened, and enter accordingly. If we engage in this manual sense-making, we can not use not use the Cognos EPR Report tools cleanly so would need to define how we deal with these patients.

Proposed consistent approach

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  • Allan, Julie and Tina had discussed this at a different meeting and decided we should just collect the swing beds as if they were already on the unit. The assumption was that they would only be in a swing bed for a few hours at most.
    • Stephanie pointed out that some of the cardiac pts are listed as in a swing bed for the whole duration of their OR stay (whereas others are listed as in OR). So it appears that the amount of time pts spend in swing beds can be considerable.
      • We decided to hold off on this discussion and bring it forward at the next task meeting which is Dec 16. Ttenbergen 11:28, 2020 December 8 (CST)
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Current state

<quote>...because cognos Is often using the swing bed as a legitimate date and time, we are getting incorrect information. I find that more often than not (not necessarily every single time), the swing bed entry is usually when the patient is still physically located in er, and has not yet, actually physically been moved up to the ward. The er needs to use that location to admit another patient. Therefore, they will put a “swing bed” entry in. because the swing bed entry is listed right after the er entry, cognos picks that up, and uses that as the admit to unit start date and time. This date and time, is, in actual fact wrong. The actual ward unit start time, is the next entry in the location history that does not have the swing bed tag as the location. (Debbie)</quote> Clarifications:

  • The entry is not picked up by Cognos "because the swing bed entry is listed right after the er entry", it is picked up because it is a unit entry during the timeframe of a service admission.
  • The swing bed is associated with whichever location it is a swing bed for. So, if the ER uses a ward swing bed, then maybe the real problem is that they should be using an ER swing bed? If they did, the pt would be correctly still listed as an ER
    • Not necessarily, swing bed usage is not specific to ER only, and occasionally ambiguous specific locations (ie. a location unit that the patient does not physically go to) for swing bed entries are all picked up by cognos resulting in false positives (exclusion patients) to show up on cognos.
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  • Debbie: When you say "the next entry in the location history", you mean the history on the EPR, right? Ttenbergen 09:26, 2020 December 3 (CST)
    • Yes, the location history in the epr. Each scenario with a swing bed entry can be different, and needs to be reviewed to ascertain the true and correct information. DPageNewton 09:45, 2020 December 3 (CST)
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  • Would it make sense to talk to STB about how the swing beds are used by ER? I don't think talking to anyone about how the swing beds are used by er would be helpful. I've explained in great detail a number of times, to a number of people why this occurs. I can't think of anything different that could potentially be done to work around the issue as it occurs in the first place. DPageNewton 10:59, 2020 December 3 (CST)
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  • Is there ever "room for interpretation" where both collectors would still consider the pt on their unit, or where both would consider them already/still on the other unit? If not, how and why?
    • I don't think there is room for "interpretation" as the entry for the "swing bed" is simply ignored, as if it weren't there. We at St. B. have been dealing with this issue since the beginning of time. DPageNewton 10:59, 2020 December 3 (CST)
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  • I supposed this swing bed is already happening in the past, before we have this COGNOS admitter. How it is handle? 1) is it included – such that the accept date is taken from that line of swing bed or 2) excluded and the next line where the Accommodation has an entry is the one chosen? I think we need to decide first if to include or not before solving the exclusion process. who to ask? --JMojica 16:02, 2020 December 2 (CST) we do 2)
    • excluded and the next line where the Accommodation has an entry is the one chosen? DPageNewton 10:59, 2020 December 3 (CST)
  • Absolutely agreed, Julie. But there is also an element of us reporting info different than maybe what other, EPR based reports would show. #"Swing beds" at STB shows the list of swing bed locations that show up in the Cognos data. They all are associated by name and data to the ward locations. So anyone generating data from EPR/Cognos would associate these with the units, not the previous location. We would be the only place associating them with still being in the ER. I just reviewed the raw Cognos data, and we get the bed, but not the bed start and end dttm. If we could get that we would be able to figure out what percentage of total LOS is affected by this, but it probably has the biggest impact on ER wait times
    • in the example I gave above, yes the er wait time is what would be affected. DPageNewton 10:59, 2020 December 3 (CST)
      • It sounds like anyone just looking at Cognos data would underestimate that time because pts look like they are on unit already. Ttenbergen 09:56, 2020 December 3 (CST)
        • I've spoken with the ward clerks on E5 on more than one occasion, and have been told, that when there is a swing bed entry for example, between an er location, and a ward location, the patient is still physically in the er, and has not been transferred up to the ward. e.g. #2-if the swing bed location is between say, E5, and another usual ward or unit location, then the patient is still physically on E5. In this example the los for E5 would be affected. I think that this is a concept that is not so easy to explain in words, especially if you're not particularly familiar with the ins and outs of epr. DPageNewton 10:59, 2020 December 3 (CST)
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The use of swap or swing locations makes it hard to follow patients in Cognos Report Integrator, so we need to find out more about how these are used.

Swing beds in Cognos2 Unit Starter

CUS lists when someone arrives on a unit, not in a bed.

So GH-SWAP Locations are shown and SBGH Swing Beds are not.

possible solution: exclude by filter

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  • One option would be to omit lines with current unit is a swap location from the cognos data via filter automatically, but it's not clear if this will result in the previous and subsequent records having non-matching next locations and previous locations. Can we just delete these lines from Cognos? Ttenbergen 14:03, 2020 August 28 (CDT)
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One problem with filtering these out would be that, I think, the unit record for a swap location might be the same as the unit record for a successive stay in that unit; ie. the bed entry chagnes, but the unit remains the same. So, the unit start dttm and unit end dttm don't care if part of the unit stay was in a swap location. Is that not true? If it is true, then how would we filter these out? if I eliminate every line that has a swap/swing bed (which I can do) then we will not get any line for those pts who never get into a real bed on that unit (which may be good), but we would still get the same line with unit start and end times including the swap/swing time for patients who eventually get into a bed on that unit. Ttenbergen 12:07, 2020 December 2 (CST)

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For these reasons all swing bed entries should be filtered out if possible.

possible solution: exclude by manual exclude

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  • Another option, and this seems to be what is being done now, is for collectors to "exclude" unit lines from Cognos that list "wrong" start or end times because part of the time is in a swap location.
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This will not exclude the record from Cognos2 Ender since that is based on service rather than unit.

Location specific info

"Swing beds" at STB

See SBGH Swing Beds

"Swap locations" at GRA

See GH-SWAP Location

HSC

According to Chastity there is no such thing at HSC.

Except, on 2021-02-12 we saw a unit "HSC-HOLD", and it wasn't clear what that was about.

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