Definitions
A number of definitions for data fields are proposed here with the aim of surfacing differences and finding parsimonious definitions.
A subset of these fields are used in the Data sets and a larger subset are used in the Uniform health data set, which is an attempt to lay out a vision of what type of information would ideally be captured for each patient encounter. Because the issues are discrete and warrant and isolated discussion, Coding systems and definitions for Waiting times are shown separately.
Inpatient
The definition of an Inpatient is a patient who is formally accepted by the hospital to be admitted and allocated a hospital bed designated in the bed complement. The duration of stay is generally for a period of time that crosses over from one calendar day to another. However, in the following cases a shorter duration may be classified as an admission, if the patient is determined to require an inpatient bed:
- Admission with patient discharge against medical advice on day of admission
- Admission with transfer out to another acute care institution on day of admission
- Abdmission for Obstetrical Delivery
- Admission with Approved Early Unplanned Discharge on Day of Admission
Outpatient
The definition of an Outpatient is a person who attends the accident or emergency unit, a day care program, hospital clinic or primary health care clinic to receive health care services. Outpatients do not utilize a hospital bed in the hospital bed complement and do not require an overnight stay at the hospital. Outpatients may have a visit of short duration or less than 24 hours without crossing over from one calendar day to another. Emergency Room patients who do not require an inpatient admission, but stay over the midnight hour and up to a maximum period of 24 hours, should be registered as Outpatients. Patients who arrive in the Emergency Room and expire prior to admission to hospital are registered as an Outpatient in the Emergency Room. Persons who are dead on arrival (DOA) to the Emergency Room of the hospital facility are registered as an Outpatient in the Emergency Room and flagged as DOA. Patients who are registered in the HIS on arrival and leave the outpatient area without having an assessment initiated are considered to have cancelled their visit and the visit should be cancelled in the HIS. A record of the cancelled visits must be maintained. Outpatients who on initial assessment require urgent inpatient care are transferred to the inpatient type as defined above.
Hospital bed
A licensed bed approved by the competent authority which is assigned to a patient who is arrives to a health care facililty for an emergent, urgent or elective/planned encounter. Beds may be designated for use as per the Definitions of Inpatient and Outpatient Care. Beds assigned temporarily for "holding" purposes in a no bed situation may be designated and included in hospital occupancy rate calculation (e.g. emergency room, recovery room). Only beds included in the licensed hospital bed complement will be used for purposes of hospital occupancy rate calculation. Beds may have an associated accommodation value such as private (i.e. single bed/room) or shared (i.e. multiple beds/room). Beds included in the hospital bed complement:
- Beds in general wards or units set up andstaffed for inpatient services
- Beds in special care units set up andstaffed for inpatient services(e.g. intensive care, coronary care, neonatal intensive care, pediatric intensive care, medical and surgical step-down, burn units)
- Beds excluded from the hospital bed complement:
- Beds/cots for healthy newborns
- Beds in Day Care units (e.g. surgical, medical, pediatric day care, interventional radiology)
- Beds in Dialysis units
- Beds in Labor Suites (e.g. birth day beds, birthing chairs)
- Beds in Operating Theatre
- Temporary beds such as stretchers
- Chairs, Cots or Beds used to accommodatesitters, parents, guardians accompanying patients or sick children andhealthy baby accompanying a hospitalized breast feeding mothe
- Beds closed during renovation of patient care areas when approved by the competent authority
Unavailable/Blocked Beds
Beds may be temporarily unavailable or blocked due to a variety of reasons. Beds that are unavailable due to renovations approved by the competent authority may be temporarily excluded from the bed complement. Beds that are unavailable due to clinical need (e.g. isolation patient in double bedded room), social reasons or lack of qualified resources will continue to be included in the bed complement, census and occupancy calculations. Reasons for unavailable/blocked beds may be collected.
Available Inpatient Bed Days
The bed complement multiplied by a defined time period (e.g. month).
Patient care levels
Patient Care Levels are intended to stratify inpatients and outpatients into homogenous patient groups that share common characteristics in respect of the resources required to manage the patient care. While the proposed patient care levels do not currently exist in each facility’s HIS, it is evident that the patient population in General Authority facilities may be commonly grouped into a variety of care levels. The proposed care levels identified for Long Term Care (LTC) require further discussion with the General Authority work group reviewing Long Term Care issues.
Alternate Level of Care in Acute Care Institution
This level of care is assigned to inpatients who no longer require the services of an “acute care” hospital but who remain in an acute care bed of a hospital due to unavailability of alternate facility or support services in the community or home. Patients who remain in an acute care bed for social reasons are classified as alternate level of care (ALC). Well Baby admitted to be with Mother, Social Babies and Children may be classified in this category when admitted for non-clinical reasons.
Rehabilitation (and Activation) Care
This is the type of care required by persons on any age, as a special use of acute care requiring a planned and corrdinated, intensive program of rehabilitation, without which they are unlikely to return to home or return to school or work. This care may be provided within a hospital facility or may be a free standing Rehabilitation faciltiy. The definition applies mainly to those persons with severy physical impariment, often associated with mental, emotional, social and vocational problems. Specialized staff is required to conduct the program.
Discharge Planning Beds in Acute Care Institutions
These beds are designated for interim placement of patients who no longer require acute care, but who need to remain in the hospital pending completion of appropriate discharge arrangements to a long term care facility. Patients continue to receive a variety of therapies in order to maintain the maximum level of activity prior to placement in the appropriate facility. Discharge planning beds are generally grouped on a specific unit and specialized staff is required to maintin the unit
Long Term Care - Personal Care
This is the type of care required by persons who are independently mobile, with or without mechanical aids, and whose primary need is for minimal non-professional supervision and/or assistance with the activities of daily living for the purpose of achieving or maintaining maximum personal independence in everyday activities. These services are available through Long Term Care to persons 19 years of age or older, but can occasionally, on an individual basis, be extended to a person under 19 years of age.
Long Term Care - Intermediate Care
The three Intermediate Care levels build on the Personal Care Level and recognize a need for care planning and supervision under the direction of a health care professional by introducing a combination of professional and non-professional (lay) supervision. This professional supervision is required on a daily rather than a 24-hour basis. Individuals at the Intermediate Care Levels are independently mobile, with or without mechanical aids.
- Intermediate Care I: This level of care recognizes the individual who requires moderate assistance with the activities of daily living and minimal professional care and/or supervision.
- Intermediate Care II: This level of care recognizes the individual who has more complex care needs, and who requires additional professional care and/or supervision.
- Intermediate Care III: This level of care primarily recognizes the individual who exhibits severe behaviour disturbances on a continuing basis and who presents a significant management problem. This level also recognizes the individual who has very heavy care requirements that require significant staff time to manage. In both instances, the individual at this level of care requires considerable supervision and/or assistance under the direction of a health care professional.
Long Term Care - Extended Care
This is the type of care required by persons of any age who are not in need of acute or rehabilitation treatment, but who have severe functional disability and are usually not independently mobile and/or have a chronic medical problem requiring daily supervision or treatment by a registered nurse. They require continuing medical supervision, and 24-hour services of other qualified professional health personnel. As with levels 7 and 8, they also require room and board, assistance with activities of daily living, and a therapeutic program of social and recreational activities, including physical exercise and mental stimulation, in order to maintain or improve functional ability.
Surgical Day Care
This is a care level as determined by a physician to be provided to patients who require surgical services and who do not require an inpatient admission and are admitted and discharged on the same calendar day.Patients meeting at least four of the criteria below qualify under Surgical Day Care Procedures:
- Procedure is scheduled and patient is registered directly to the unit or enters through the Emergency Room;
- Uses a special operating room suite, operating room or designated suite;
- May or may not require general anaesthetic, but usually requires the presence of anaesthesiologist and/or anaesthetic standby;
- Procedure is labour intensive (i.e., scrubbed assistant required) a period of post procedure observation is needed and/or Procedure is resource intensive (i.e., high capital costs, complex equipment required such as endoscopic equipment);
- Patient is usually discharged more than one hour post procedure, but less than overnight.
Other risk factors, such as existing comorbidities, mental disability, facility limitations and/or physical set-up, etc. may be valid reasons for performing a minor procedure and treatment as a Surgical Day Care Procedure. A Physician’s decision is required in accordance with facility policies. See Appendices A to D for guidelines (Surgical Day Care Procedures) and (Minor Procedures and Treatments).
Medical Day Care
- This is a care level determined by a physician to be provided to patients who require medical intervention under supervision and monitoring of a clinical professional. This is a medical service which is provided to patients who do not require inpatient admission and are admitted and discharged on the same calendar day.
- The patient is usually discharged more than one hour post procedure, but less than overnight. Medical Day Care procedures are generally less invasive than Surgical Day Care procedures. Services include blood and medication transfusions, procedures requiring minor sedation requiring period of recovery and certain radiological procedures. Care provided may be a single episode or an episode of care involving multiple treatments/interventions usually of a short term (e.g. 6 sessions of chemotherapy).
Emergency Care
Emergency care is provided to patients in the Emergency Room equipped to deal with a range of complaints from life and limb threatening conditions to minor illness or complaints. On arrival patients are assigned a triage category. After assessment patients may be admitted as inpatients or transferred to another acute care hospital or treated as an outpatient then discharged. Patients requiring inpatient admission to a hospital bed that is part of the hospital bed complement are transferred from the Oupatient Type - Emergency Care Level to the Inpatient Type - Acute Care Level. Patients staying in the Emergency Room for a longer duration for observation purposes prior to discharge are not counted as inpatients. Patients who arrive in the Emergency Room and expire prior to admission to hospital are registered as an Outpatient in the Emergency Room.
Persons who are dead on arrival (DOA) to the Emergency Room of the hospital facility are registered as an Outpatient - Emergency Care and flagged as DOA.
Recurring Care
Recurring patient care is provided to patients who require regularly scheduled series of clinical appointment or interventions (e.g. hemodialysis). Services should be clearly distinguishable by type of intervention/treatment. Recurring care may also be classified as Medical Day Care depending on the nature of the visit (e.g. chemotherapy).
Minor Surgery Care
This care level is assigned to designated clinics for minor procedures that could safely be performed in an appropriately equipped doctor’s office without need of general anaesthetic or proximity of an Anaesthetist service. Procedures are not labour intensive or not resource intensive. Patient is usually discharged less than an hour post-procedure. Minor procedures could also be performed and classified as part of routine clinic care. See Appendix B for description of minor procedures commonly classified as “minor” procedures. See Appendices B to D for guidelines (Minor Procedures and Treatments).
Clinic Care
Patients or clients receive this type of care on an outpatient basis, by a General Physician, Consultant Physician or non-physician health professional (e.g. Midwife, Nurse, Dietician, Physiotherapist, Occupational Therapist, Speech Therapist, Audiologist etc) for purposes of assessment, examination and minor treatment. Generally appointments are planned however, service may be provided on drop-in basis. Services may be distinctly different based on provider and should be distinguishable by nature of service and service provider.
Primary Health Care
Primary care practices are generally located in the community, thereby facilitating access to health care while maintaining a wide variety of specialty and institutional consultative and referral relationships for specific care needs. The structure of the primary care practice may include a team of physicians and non-physician health professionals providing health promotion, disease prevention, health maintenance, counselling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (e.g. office, inpatient, critical care, long-term care, home care, day care etc)
Diagnostic Services
This care level is assigned to Outpatient Diagnostic Centres that provide laboratory, radiology and cardiac, respiratory and neurological diagnostic services to outpatients referred directly from external facilities. Laboratory Diagnostic Centres may also process specimens referred from external agencies without the presence of a patient on site. Patients receiving diagnostic services that are ordered in the normal course of inpatient or outpatient encounters within the same hospital or facility are not registered separately in this category. Services should be distinguished by nature or visit and service provided. (i.e. patient attending for blood test versus specimen received in absence of patient).
Other definitions
Patient Day: The sum of all inpatient service days from midnight to midnight for each of the days in the defined period (e.g. month). An encounter that begins and ends on the same calendar day may be counted as one patient day as per the Definition of Inpatients.
Visit/Encounter Registration: The process of reviewing and recording a patient's arrival time to a facility including the review of patient specific data (e.g. demographic and visit details).
Room/Bed Transfers within Facility:
Interhospital Transfer:
Episode of Care: A period of time during which one or more visits occur for the management of the same condition(s). The beginning of the episode is the first assessment and/or treatment of a condition and the end of the episode is the last visit that completes a cycle of care management for the same condition(s).An episode of care is determined by the clinical provider.
New Patient: A new patient may be "new" to the health care facility or to a specific service or resource/service provider. A new patient may attend as an inpatient or outpatient with or without a referral from another health service provider.
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New to Health Care Facility: A patient who has never been seen previously in the facility.
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New to Clinic: A patient who has never been seen previously in the specific clinic.
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New Episode: A patient's first assessment and/or treatment of a condition that requires one or more visits to complete the cycle of care.
Follow-up Episode: A patient who has attended a specific clinic/service within the same episode of care.
Walk-In/Drop-In Patient: A patient who is seen on arrival without a scheduled appointment.
Canceled Visit/Encounter: The cancelation of an encounter after visit registration is completed. An encounter may not be canceled once the service has been initiated by a service provider. An encounter may be canceled if incorrect registration was performed and it was prior to the service being initiated by a service provider.
Scheduled Appointment: A pre-arranged visit of a patient to a health care service on a specified date and time for a fixed duration.
Attended Appointment: A patient arrives to a designated area and is registered and seen by the provider for a scheduled visit.
No Show Appointment: A patient did not attend his/her appointment and did not cancel the same. The encounter is not registered.
Cancelled Scheduled Appointment: An appointment that is determined by either the patient or the facility not to be required and is either abandoned or withdrawn.
Rescheduled Appointment: An appointment that is determined by either the patient or the facility to be changed to a new date and/or time to the same or a new resource.
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