Christopher Clay wrote: >I propose the following definition: "An episode is a period of management of >a patient from the time of presentation to a medical unit (which can be >anything from the teams or "firms" in a teaching hospital to an individual >practitioner) until the unit or a proxy "discharges" the patient." The >proxy could be a unit (on the last unit) to which the patient is transferred >during the course of the episode. (An example could be general surgery => >cardiology => cardiac surgery => rehabilitation: all one episode.) >I would be against using definitions based on legal responsibilities as that >is truly nebulous, especially in common law jurisdictions and is ultimately >at the whim of some judge. > > Actually, I agree with that, but we still need to be precise enough for the definition to work. As you say...
>... This is where the word "discharge" needs >definition. It is an active, transitive verb and that is why the intention >of the unit/doctor concerned should be the paramount consideration. It >their intention to relinquish direct responsibility that is crucial. > i.e. responsibility for providing any further care (until some later moment perhaps when you again accept responsibility for care) > It is >comparable to death in our jurisdiction. You are dead when a doctor says >you are! (i.e. declares "life extinct", or in the case of "brain dead", two >doctors after due deliberation but that is a special case.) >Our hospital systems speak of a "separation" which befits a hospital as >discharge is a form of separation. It might be more difficult in GP. I >think an episode has to be considered separate from say just "discharge from >hospital" which is better termed a "separation" or similar. An episode can >involve a period of inpatient and outpatient treatment. > > So a "separation" doesn't involve follow-up outpatient treatment/monitoring? >The question of transfer between units is difficult. If a person is admitted >under the abdominal surgeons with a stomach ulcer and is subsequently >transferred to the cardiologists when it is established 24 hours later that >it is a myocardial infarct, is that one or two episodes? Most people would >consider it to be one episode in natural terms but there could be a rule >requiring that this is two separate "incidents" for the purposes of >remuneration for example. It would be up to the two units as to whether >this would be called one or two episodes and could be handled semantically >by allowing that an episode can involve semantically "seamless" transfer >from one unit to another until a unit declares "DISCHARGE" and then the >episode is done. > > If we followed the Mayo model (and your definition, depending on which granularity of "medical unit" is identified), it would be one episode, but detailed EHR recording will of course provide correct coding/classification of the incidents, allowing remneratoin to occur as usual. How common is the Mayo model, where the initial clinician is the "team leader" (as Peter Elkin explained), and shepherds the episode through from go to woe? - thomas - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
