Swap Locations: Difference between revisions

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Some sites use swap locations as entries in [[EPR]].  
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.
When patients need to switch locations, patient swap locations can be performed in the ADT EPR.  
 
{{Ex|
{{Ex |
* Ex 1: 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.
A patient was in a swing bed from 0243 until 0405 that is the actual arrival time to the unit.  
* Ex 2: 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 patient remained in ER until 0405 but MR staff had to electronically enter/place the patient somewhere.  
}}
}}


== The problem ==
== 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.
* We need to ensure this is dealt with consistently in the context of [[Using Cognos2 to keep track of patients]] and [[Cognos2 Unit Starter]]. [[CUS]] lists when someone arrives on a '''''unit''''', not in a bed. So, for [[GH-SWAP Location]]s it is immediately visible that pt is there, but for [[SBGH Swing Beds]] it is not.
 
* Since EPR/Cognos lists these patients as being physically on the unit already (just in a swing bed) and we list them (correctly) as still being in the ER, this could result in discrepancy between our reports and other hospital reports. This can't be fixed, but is good to know if we are ever asked about reasons for discrepancies.  
* Swing/swap bed location entries are an example of entries that can occur at STB site when a patient is temporarily located into a bed in epr for logistical purposes. Whenever a collector encounters this erroneous entry, the best consistent approach is to do an EPR/documentation review to reconcile potential discrepancies. The applicable cognos line(s) can then be manually excluded. Perhaps the discussion below could be either deleted or made legacy?
 
=== Proposed consistent approach ===
{{DiscussTask |
* 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'''. [[User:Ttenbergen|Ttenbergen]] 11:28, 2020 December 8 (CST)}}
 
=== Current state ===
STBICU
Swing/swap locations are not used by ICU as they represent the time the ward clerk is made aware the patient will be coming to the unit and in no way represent the actual arrival time; basically we ignore the swing times
ICU takes our arrival time directly from the ICU flow sheets
 
<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.
 
{{Discuss |
* Debbie: When you say ''"the next entry in the location history"'', you mean the history on the EPR, right? [[User:Ttenbergen|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. [[User:DPageNewton|DPageNewton]] 09:45, 2020 December 3 (CST)
}}
 
{{Discuss |
* 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. [[User:DPageNewton|DPageNewton]] 10:59, 2020 December 3 (CST)
 
}}
 
{{Discuss |
* 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. [[User:DPageNewton|DPageNewton]] 10:59, 2020 December 3 (CST)
}}
{{Discuss |
* 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?  --[[User:JMojica|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? [[User:DPageNewton|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. [[User:DPageNewton|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. [[User:Ttenbergen|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. [[User:DPageNewton|DPageNewton]] 10:59, 2020 December 3 (CST)
}}
 
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 Location]]s are shown and [[SBGH Swing Beds]] are not.
 
=== possible solution: exclude by filter ===
{{Discuss |
* 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)
}}
 
{{Discuss |
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. [[User:Ttenbergen|Ttenbergen]] 12:07, 2020 December 2 (CST)
}}
 
For these reasons all swing bed entries should be filtered out if possible.
 
=== possible solution: exclude by manual exclude ===
{{Discuss |
* 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. 
** if the collector believes there is a discrepancy in Cognos with the bed locations/swing bed entries, it is verified by reviewing EPR and documentation if pt has actually arrived to the unit. Because there are so many different units being used now, reviewing EPR is done more frequently. If this review  reveals the discrepancy then "excluding" the line(s) will usually work}}


This will not exclude the record from [[Cognos2 Ender]] since that is based on service rather than unit.
== The solution ==
We considered whether there are ways to deal with these in the data/filters/programs, but since the scenarios when and how these would be used aren't entirely predictable it was decided to keep these a manual process. See [[SBGH Swing Beds]] and [[GH-SWAP Location]] for details.  


== Location specific info ==
== Location specific info ==

Latest revision as of 12:17, 2022 January 27

Some sites use swap locations as entries in EPR.

When patients need to switch locations, patient swap locations can be performed in the ADT EPR.

Example:   
  • Ex 1: 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.
  • Ex 2: 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

  • We need to ensure this is dealt with consistently in the context of Using Cognos2 to keep track of patients and Cognos2 Unit Starter. CUS lists when someone arrives on a unit, not in a bed. So, for GH-SWAP Locations it is immediately visible that pt is there, but for SBGH Swing Beds it is not.
  • Since EPR/Cognos lists these patients as being physically on the unit already (just in a swing bed) and we list them (correctly) as still being in the ER, this could result in discrepancy between our reports and other hospital reports. This can't be fixed, but is good to know if we are ever asked about reasons for discrepancies.

The solution

We considered whether there are ways to deal with these in the data/filters/programs, but since the scenarios when and how these would be used aren't entirely predictable it was decided to keep these a manual process. See SBGH Swing Beds and GH-SWAP Location for details.

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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