How to find a patient in a ward?

Many systems have a need to answer the question: “How to find patients/encounters that are at ward X at moment T?”.

There are key points to consider when forming the search criteria:

• We are most likely interested only in IMP (inpatient encounter) encounters, so we should filter by class.
• We are interested only in in-progress encounters, so we need to filter by status.
• We are most likely interested in querying by organizational hierarchy, the organizational unit (ward) responsible for the patient (not physical location).

Organizational ward should be communicated using the serviceProvider property.

FHIR request parameters: GET /Encounter

• class = IMP
• status = in-progress
• period gt and le filters as per target moment
• serviceProvider = id of the ward organization resource

Historically some systems keep the ward encounter active when the patient is sent to ICU. Leaving the encounter in an in-progress state would cause a gotcha: encounter says that it’s active but patient is not really there. Using encounter´s location elements could be used to express that the patient has no active location in the ward, but this might be difficult to process for client systems and depend heavily on the organizational and location structures of a facility. Because of these problems, the encounter SHOULD not be kept in-progress when the patient is in an ICU period (if there is a need for “recycling” the ward period encounter, it should be set to finished and then back to in-progress upon return from the ICU).

Why not use Location.managingOrganization?

Encounters location field is a reference to Location that has a field managingOrganization. Use of this to find the organization responsible for the patient is problematic. Location.managingOrganization might change for different reasons (a room is assigned to another organization) and this would have an unexpected effect on the responsibility-concern. Location.managingOrganization is “too far” from the encounter to be useful in this context.

Querying by physical location

Querying by location is also an option. Here the focus is on the physical location and not the organizational responsibility towards the patient. This blog post will describe the process.

Generated Narrative: Encounter

identifier: id: id-for-ward-encounter (use: USUAL)

status: in-progress

class: inpatient encounter (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code IMP = 'inpatient encounter', stated as 'inpatient encounter')

subject: Patient/patient-of-municipality " HENKILÖ"

period: 2022-02-27 01:03:00+0200 --> (ongoing)

Locations

serviceProvider: Organization/1.2.246.10.8286189.10.100012 "Kirurgian vuodeosasto 4B, Länsi-Pohjan keskussairaala, LPSHP"