Understanding Dates in Demand Manager

Note: Your Staff Manager configuration may not include this optional application. To add this application to your configuration, contact your Clinical Consultant or Client Advocate.

The two most important dates in Demand Manager are the departure date and the discharge date.

• The departure date is the date a patient is expected to leave the current location (for patients with location-based patterns, this could be a transfer out of the current unit or an expected hospital discharge) or transfer out of the current level of care (for patients with a criteria-based pattern).
• The discharge date is the date a patient is expected to leave the facility.

You manage and update patient departure and discharge dates and times with the Administer Patient Pattern window. The page displays manually entered dates with an m next to the date/time column. Demand Manager can receive manual edits directly from users or indirectly through edits to other solutions interfaced to Demand Manager. You can use either method or both; Demand Manager processes and displays dates and times in the order the solution received them. This means that a projected discharge date and time change received from the source system interface can overwrite a user's projected discharge date and time entry in Demand Manager.

Departure Dates

Demand Manager automatically assigns a patient a departure date based on the patient's assigned pattern. This date does not change unless a user manually updates it or the patient transfers to a new location (for location-based patterns) or transfers to a new level of care (for criteria-based patterns with two or more defined levels of care). When a patient with a location-based pattern transfers to a new location, Demand Manager can be configured to either persist the manual edit or update the departure date with the Total Length of Stay (TLOS) defined for the new location or location/hospital service pattern. By default, the departure date is updated when the patient receives a new location-based pattern. Contact your Clinical Consultant or Client Advocate to configure the option to persist manual departure dates across transfers for patients with location-based patterns. When a patient transfers to a new level of care, Demand Manager updates the departure date based on the duration defined for the level of care in the patient’s current library pattern.

Demand Manager automatically gives a patient with a criteria-based pattern defined by two or more Levels of Care an eight hour LOS in the departure date and time box if the patient’s actual TLOS has not exceeded the expected hospital discharge date on the Administer Patient Pattern window and:

• The patient transfers to a level of care that is not in the current library pattern.
• The patient transfers to a level of care that is in the current library pattern, but the transfer is out of sequence compared to the pattern.
• The patient visits a pattern level of care twice but the level of care is not in the pattern twice.

Demand Manager does not assign any departure dates automatically if:

• The criteria-based Library pattern has a single Level of Care defined or the Level of Care is unassigned.
• The patient’s actual TLOS has exceeded the expected hospital discharge date on the Administer Patient Pattern window.

Discharge Dates

The discharge date is the patient's expected hospital discharge date. The TLOS of the patient’s library pattern determines the date shown in this box. You may or may not be able to edit the discharge date depending on the patient's assigned library pattern type. If the patient’s current library pattern is location-based, the discharge date cannot be edited. Instead, you should update the departure date to indicate the patient’s departure from the current location; this departure could be a transfer to another location or an expected hospital discharge.

The discharge date changes automatically if a new library pattern is assigned and the discharge date has never been updated either through Staff Manager or through another solution interfaced with Staff Manager. If this occurs, all subsequent updates for active patients must be received from a Departure Date update in another solution interfaced to Staff Manager or entered directly into the Edit Patient Patterns dialog in Demand Manager.

Dates and the Administer Patient Pattern Window

The Demand Manager configuration Persist Manual Discharge setting affects departure and discharge dates for patients as they transfer and receive new location-based patterns as shown in the following table.

A patient's departure and discharge dates may be updated when you select a new criteria-based library pattern directly in Demand Manager. When a user assigns the patient a new pattern, the following changes occur on the Administer Patient Pattern window before you click Save.

After your change is processed or if pattern assignment criteria are received from the registration application, the dates update as follows:

Once a library pattern is selected and assigned manually by a user in the Administer Patient Patten Window, all future criteria-based library pattern assignments, with the exception of patterns assigned using DRG criteria, are updated by users. DRG criteria received from the registration application or entered manually by user override all other patterns assigned.

Patient Pattern Bar End and Demand Manager Target Care Hour Calculations

The end of the progress pattern is displayed in the pattern bar as D to denote the expected hospital discharge. The pattern bar end date and time on the Patient Pattern Management page matches the projected departure (or discharge) date on the Administer Patient Pattern window until very close to the projected departure date and time.

Demand Manager assumes that patients remain in their current location until it receives a discharge or transfer event. If Demand Manager does not receive a discharge or transfer event, then Demand Manager automatically pushes patterns forward to calculate care hours. The application requires that patterns be pushed in order to calculate future target care hours.

The pattern bar end date and time on the Patient Pattern Management page pushes forward automatically every 15 minutes using the push forward duration in hours and threshold minutes defined for the application. For example, if the push forward duration is 72 hours and the threshold minutes are 720 minutes, every 15 minutes the system looks for patient patterns that end in the next 720 minutes (12 hours) and push the patterns forward 72 hours. The system then calculates care hours for these patients for the next 72 hours. This process repeats every 15 minutes until Demand Manager receives a transfer or discharge event or the patient's projected departure or discharge date and time is changed in the Administer Patient Pattern window, thus resetting the pattern end. There are two ways you can change a patient's departure or discharge date and time: by changing the date and time manually (either through Staff Manager or through the source system interfaced with Staff Manager) or by assigning the patient a new progress pattern.

The default setting for the automatic push forward duration is 24 hours and the default setting for threshold minutes is 60 minutes. This means that every 15 minutes, the system pushes patterns that end in the next 60 minutes forward 24 hours.

If your length of stay management processes ensure that projected departure dates and times are accurate and up to date at all times in Demand Manager, either through manual entry or through an interfaced solution, the duration and threshold minutes should be set to minimum values, such as duration of 1 hour and threshold minutes of 15 minutes. This means that every 15 minutes the system pushes patterns that end in 15 minutes forward one hour. This ensures the most accurate workload for the next hour.

If projected departure dates in Demand Manager are not being updated by users, the duration and threshold minutes should be set to duration 72 hours and threshold minutes 1440 minutes (24 hours). This means that every 15 minutes the system pushes patterns that end in the next 24 hours forward 72 hours.

The result of Demand Manager automatically pushing pattern end dates and time out is that the Patient Assignment page can display different care hours for patients with the same pattern and acuity levels because the patients have different pattern end dates and times.

Demand Manager does not change the date and time on the Administer Patient Pattern window when pushing patterns, as the application uses this date and time to generate patient length of stay alerts.

Contact your System Administrator or Cerner Clairvia Support to configure the settings for the pattern push duration and threshold minutes.

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