Patient Transfers and Moves across UHN

 

Covered in this topic:

When to use a Visit Conversion

When to use a Discharge and Admit

When to use a Transfer

When to use a LOA

Other Resources: Editing and Other Functionality

 

It is very important to select the correct options in EPR for patient transfers and moves across UHN. All incorrect entries affect our funding and reporting to the Ministry of Health & Long Term Care.

 

The table below summarizes the most common patient transfers & moves across UHN.

 

Table Legend:

Blue font - Acute Care workflow
Red font - Emergency workflow (ED and PESU)
Green font - Rehab workflow

 

 

When to use a Visit Conversion

Use visit conversion to change the current visit to a new visit type.

 
The Patient's Starting Location
 		 The Patient's Destination EPR Function(s) to Use
From a Same Day Visit (SP Visit)
 
The patient has completed a medical/surgical day procedure and now needs to be admitted to an IP unit		 To an Inpatient Visit
 
The patient moves to an inpatient unit
 
e.g. The patient moves to General Medicine
e.g. TG-5MA to TG-ES13
 		 SP to IP conversion
 
Convert the Same Day Visit (SP) visit to an Inpatient (IP) visit
From the Emergency Department (ED)
 
The decision is made to admit patient to the hospital (from ED)
 
The patient leaves ED
 		 To an Acute Care Inpatient Unit
 
The patient moves to an inpatient unit at TG, PM or TW
 
e.g. TG Emergency to TG-13ES General Medicine		 EP to IP conversion
 
Convert the Emergency (EP) visit to an Inpatient (IP) visit
From ED PESU
 
The decision is made to admit patient to the hospital (from the Emergency Department Psychiatric Emergency Services Unit - PESU)
 
The patient leaves PESU
 		 To Acute IP Mental Health
 
The patient moves to an acute care inpatient Menta Health unit
 
e.g. TW-PESU-EP to TG-ES 8 Psychiatry		 EP to IP conversion
 
Convert the Emergency (EP) visit to an Inpatient (IP) visit

 

 

When to use Discharge and Admit (Visit Creation)

Use discharge and admit for inpatients moves between different levels of care.

 
The Patient's Starting Location
 		 The Patient's Destination EPR Function(s) to Use

From an acute IP unit

 

The patient leaves an acute care inpatient unit (TG, TW, PM)

To a rehab IP unit

 

The patient moves to a rehab inpatient unit

 

e.g. The patient moves from TG-7A to UC-8 South IP

Discharge, New admission (create a new visit)

 

Sending Unit: The acute care inpatient unit discharges the patient in EPR

 

Receiving Unit: The rehab inpatient unit creates a new visit admission in EPR

 

From a rehab IP unit

 

The patient leaves an inpatient rehab unit (TR).

To a rehab IP unit (different site*)

 

The patient moves to another inpatient rehab unit at a different site

 

e.g. the patient moves from BC-South 4 to UC-7S  

Discharge, New admission (create a new visit)

 

Sending Unit: The rehab inpatient unit discharges the patient in EPR

 

Receiving Unit: The rehab inpatient unit at the new site creates a new visit in EPR*

 

*Geriatric Rehab/dialysis patients may follow a different flow, follow-up with unit management for appropriate EPR function.
 

From a rehab IP unit

 

The patient leaves an inpatient rehab unit (TR)

To Acute IP unit

 

The patient moves to an acute care unit (different site) at TG, PM or TW
 
Eeg. UC-8 South to TG-7AB

Discharge, New admission (create a new visit)

 

Sending Unit: The rehab inpatient unit discharges the patient in EPR

 

Receiving Unit: The acute care  inpatient unit (at the new site) creates a new visit in EPR
 

From the Emergency Department (ED)

 

The patient leaves the Emergency Department

To the ED PESU

 

The patient moves to ED PESU (Emergency Department Psychiatric Emergency Services Unit)
 
e.g. TG Emergency to TW-PESU-EP

Discharge, New admission (Create a new visit)

 

Sending Unit: The ED discharges the patient in EPR

 

Receiving Unit: The ED PESU creates a new visit in EPR
 

From the ED PESU

 

The patient leaves ED PESU

 

The patient was originally in the Emergency Department (ED) and has been in ED PESU under 24 hours.
 

To the Emergency Department (ED)

The patient returns to the Emergency Department within 24 hours

 

e.g. TW-PESU-EP to Emergency

Discharge, Discharge Reversal

 

Sending Unit: The ED PESU discharges the patient in EPR

 

Receiving Unit: The ED performs a Discharge Reversal in EPR
 

From the ED PESU

 

The patient leaves ED PESU

 

The patient was originally in the ED and has been in ED PESU over 24 hours OR the patient has not had a recent ED visit

To the Emergency Department (ED)

 

The patient moves to the Emergency Department

 

e.g. TW-PESU-EP to Emergency

 

*this is applicable to a patient returning to the ED from PESU after a 24 hour period OR a new visit from ED PESU to ED

Discharge, New admission (Create a new visit)

 

Sending Unit:  The ED PESU discharges the patient in EPR

 

Receiving Unit:  The ED creates a new visit in EPR
 

 

 

When to Use a Transfer

Use the transfer functionality for inpatients moves between the same levels of care.

Visits may not be transferred from Acute sites to Rehab sites.

 
The Patient's Starting Location
 		 The Patient's Destination EPR Function(s) to Use

From an acute IP unit

 

The patient leaves an acute care inpatient unit (TG, TW, PM)

To an acute IP unit (same site)

 
The patient moves to acute care inpatient unit at the same site
e.g. TG-13ES to  TG-4A
 
*includes the transfer to an Acute Care Mental Health Inpatient Unit
 		 Use the EPR Transfer Functionality

From an acute IP unit

 

The patient leaves an acute care inpatient unit (TG, TW, PM)
 

To an acute IP unit (different site)

The patient moves to a different site at TG, PM or TW
 
e.g. TG-13ES to TW-5B		 Use the EPR Transfer Functionality 

From a rehab IP unit

 

The patient leaves a rehab unit (TR).

To a rehab IP unit (same site)

 
The patient moves to another rehab unit at the same site
 
e.g. The patient moves from LC-1A to LC-2B
 

Use the EPR Transfer Functionality

 

*If the level of care is changing (e.g. Rehab to CCC) a discharge and admit is required. See section above)

 

 

When to Use a LOA **FOR TR ONLY**

  1. To mark TR patients away when sent to Acute Care inpatient units or Emergency

  2. To mark TR patients away for overnight leaves or day passes

  
The Patient's Starting Location
 		 The Patient's Destination EPR Function(s) to Use

From a rehab IP unit

 

The patient leaves an inpatient rehab unit (TR).

To ED, and then back to original rehab IP

 

The patient temporarily moves to the Emergency Department, and then moves back to the original rehab inpatient unit

 

e.g. UC-5 South to Emerge and back to UC-5 South

  1. Rehab visit: completes check-out LOA (patient leaves TR)

  2. New ED admission (and discharge upon patient discharge)

  3. Rehab visit: completed check-in LOA (patient returns to TR)

Note: two separate visits are used

 

(1)Sending Unit: The rehab inpatient unit performs the LOA check out procedure in EPR 

(2)Receiving Unit: The Emergency Department creates a new EP visit in EPR. Discharges the EP visit in EPR upon patient discharge

(3)Return to Rehab: The rehab unit performs the LOA check-in procedure in EPR on original visit

 

TR to ED workflow Tip sheet

TR Reminders for LOA Checkout
 

From a rehab IP unit

 
The patient leaves an inpatient rehab unit (TR)

To ED, and then to new Acute IP unit

 

The patient temporarily moves to the Emergency Department, and then moves to an acute care unit, at a different UHN site

 

e.g. UC-8 South to Emerge and then to TG-13ES

  1. Rehab visit: completes check-out LOA

  2. New ED admission (new EP visit)

  3. Rehab discharges the TR IP visit (patient in ED)

  4. ED visit conversion to an acute IP visit

(1)Sending Unit: The rehab inpatient unit performs the LOA check out procedure in EPR 

(2)Receiving Unit: The ED creates a new EP visit in EPR

(3) Rehab visit discharge: Rehab discharges the TR IP visit.

(4)Visit Conversion: The emergency visit is converted to an IP visit

 

Note: If the patient needs to return back to the original TR site:

  • The Acute Care staff (on the IP unit) discharges the acute IP visit

  • TR staff creates a NEW TR IP visit to admit the patient back to the unit.

TR to ED workflow Tip sheet

TR Reminders for LOA Checkout

 

 

Other Resources: Editing and Other Functionality

Here are some other eManual topics to assist you when visit changes are required:

Incorrect entry in EPR affects funding and reporting.

 

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