Swap Locations: Difference between revisions
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* 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 | * 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) | ** 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) | ***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) | **** 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) | ||
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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. | 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 [[Cognos EPR Report]] === | === Swing beds in [[Cognos EPR Report]] === |
Revision as of 19:05, 2020 December 8
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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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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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 Cognos EPR Report
We have swing beds listed, but no bed start and end dttms. We would be able to derive the bed dates and times, but it would not be straightfwd because we would have to define it as "a change in nothing other than a bed" - the report includes many columns and not all are completely clear so we might not get what we expect.
Also, as mentioned in #Current State above, the entries are not used consistently, so we could still end up with messy data.
possible solution: exclude by filter
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) |
For these reasons all swing bed entries should be filtered out if possible.
possible solution: exclude by manual exclude
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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
A swing bed entry is used "as a placeholder to virtually locate a patient when their not physically on the unit such as in the Operating Room. " These show up in Cognos EPR Report as AsgnBed_Current
- SBGH-A6CM-A6CSWG-01
- SBGH-ICCS-CR5SWG-01
- BGH-ICCS-CR5SWG-02
- SBGH-ICCS-CR5SWG-03
- SBGH-ICCS-CR5SWG-04
- SBGH-ICCS-CR5SWG-05
- SBGH-ICCS-CR5SWG-06
- SBGH-ICMS-E2SWG-01
- SBGH-L2ME-L2SWG-01
According to the Cognos data of 2020-12-08:
- avg LOS in a swing bed: 2.91 hrs
- max LOS in a swing bed: 10hrs
- total LOS in non-swing beds: 69897
- total LOS in swing beds: 134
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"Swap locations" at GRA
A wap location is used when a pt is swapped form one bed to another.
These show up in Cognos EPR Report as AsgnBed_Current:
- GH-SWAP Location
No such thing at HSC
According to Chastity there is no such thing at HSC.
Related articles
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