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== Collection instructions == === What is Transfer Ready === * The status of "transfer ready" is about the date/time of an '''intent''' to transfer a patient to '''lower''' level of care in the [[Level of care hierarchy]] if there was a bed available. Whether or not the patient actually moves does not matter, just that at some point there was an intent to move the pt. It also does not matter whether after such a determination the care team changed their minds about such a desired transfer. * Obviously we don't always know the team's ''intentions'', but if they do write them down, then '''use that info'''. ** In making this delineation, except as for the exceptions listed immediately below, only consider a clearly written intent that the team now desires the patient to be transferred to such a lower level of care. *** In particular, when a ward patient is transferred (e.g. home) without any notes stating the team’s intention to do so in advance or even an order to discharge, collectors ''should '''not''' attempt to make educated guesses'' from the notes of when the patient was ''probably'' clinically ready to leave and the checkbox is checked. See [[Level of care hierarchy]] for further information. ==== Specifically for ICU ==== '''In an ICU''', take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly: * Care is stepped down to '''ward frequency''' (q4hrs or less) of vitals AND off '''all''' forms of life support except possibly intermittent dialysis * [[HSC_IICU]] consult is written * patient is made '''[[ACP-C|ACP-C]]''' * for organ donors, see [[Guideline for coding organ donation after death]] * if the patient is a '''potential organ donor and then deemed not to be''', the Transfer Ready tmp DtTm will be when that determination is made * for those patients who are declared brain dead, and do '''not become actual or potential organ donors''', use the time of [[Brain death]] as the Transfer Ready DtTm tmp entry, and the time of cardiac death as the [[Dispo DtTm]] ====Specifically for Medicine ==== '''On a medicine ward''', take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly: *For SBGH If there is no discharge order, then the DC summary date/time that the attending signs off can be used, however if the date and time is after the DC time then it may be documented in a nursing or allied health IPN. Also, for SBGH often bed utilization will document when they are waiting on a transfer to an LAU or other facility, or rehab services will document when they are on the central wait list, or long term care (LTC) will document when they are approved for a PCH bed. *For HSC if there is no discharge order, then check the IPN notes (nursing, allied health etc), often bed utilization will document when they are waiting on a transfer to an LAU or other facility, or rehab services will document when they are on the central wait list, or long term care (LTC) will document when they are approved for a PCH bed. * Order is written to change all iv meds to po AND monitor discontinued/vital sign frequency is reduced * Patient is made '''[[ACP-C|ACP-C]]''' * When [[Dispo]] is PCH, use the date and time of the pre-panel checklist initiation as the [[Transfer Ready DtTm]], this will usually be documented in the notes by one of the allied health workers or LTC * If a discharge order is written during the preceding day(s) prior to discharge: ** and a specific date and time for discharge is documented in that order, the transfer ready date and time would be the date and time specified in the order. ** and If the order is to discharge after a specific test or procedure/treatment ie. dialysis or last dose of antibiotics, then the transfer ready date and time would be the time they finish the treatment or procedure. ** and there is no specific date and time documented for discharge or another order for discharge is written, then check the checkbox or use that new discharge order date and time * The discharge medication reconciliation form should NOT be used as transfer ready date and time. * '''PT/OT Assessment''': Before going home, some ward patients get a home safety evaluation from PT and OT, and if deemed safe for home get a homecare evaluation before going home. The transfer ready date/time in such a situation should be only after the PT/OT evaluation has deemed them safe to go home, i.e. before homecare has seen them. The rationale is that homecare evaluation can occur after discharge, but a hospitalized patient who “fails” their home safety evaluation will end up going to LTC, not home. * exception to this would be for those patients that are waiting for transfer to a rehab ward (Geri, stroke, amp, neuro etc) The date and time they are placed on the wait list for rehab can be used as their transfer ready date and time == Data entry instructions == * A "Transfer Ready" line is automatically created for each [[Boarding Loc]] entry. ** Project: '''Transfer Ready DtTm''' ** Item: the only available item is "Transfer Ready DtTm", just like the project entry. ** Date and Time vs checkbox: *** Collector needs to enter one of the following: **** '''First''' Date and Time during the stay '''at this [[Boarding Loc]]''' that patient '''became''' transfer ready as per [[#What is Transfer Ready]] above ::OR :::* checkbox checked if a clear transfer ready date and time are never documented, both must be present to be considered a valid Transfer Ready DtTm {{Combined instructions for Transfer Ready DtTm and Boarding Loc}} === Collection for each Boarding Loc === We currently only use the first entry per [[Level of care]] to calculate [[Transfer Delay]], but we collect both because: * It gives us the flexibility to report per location if requested * To make it easier for data collectors. This way, collectors don't have to try and go back and figure out if there was or was not a transfer ready in a prior location. They only need be concerned about the notes and orders from THIS boarding loc. == Start DtTm/Legacy == We used the old [[Transfer Ready DtTm field]] '''for transfer ready dttms''' before 2020-10-15, and use this new entry for dttms after. The data during the transition period for [[PatientFollow Project]] is inconsistent, so we use all the new and the old in [[Created TransferReady query]]. == Data Use / Purpose == Critical care and Medicine programs want to know this to better understand patient flow and bed utilization. Used via [[Created_TransferReady query]] and [[Created_transferDelay table]] to generate [[Transfer Delay]] and [[Avoidable Days (Critical Care)]]. {{DJ | * Grace Hospital not filled this out according to instructions documented here, but some old version instead. That makes data between GRA and other sites problematic to compare. Lisa and Gail have more info. We should document which version they have been using so it can be accounted for when using this data. }} == Background == This isn't so much a project as a change to [[Transfer Ready DtTm]] collection to allow us to collect more than one [[Transfer Ready DtTm]] per patient-program-stay. See [[Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry]] for why we needed to change to this. {{Data Integrity Check List}} == Log == 2021-07-08 - [[Change from Awaiting/delayed dx codes to Transfer Ready DtTm]] for data back to 2021-07-01 == Legacy == Similar to the old [[Transfer Ready DtTm field]] and [[Transfer Ready date and time]], but we eliminated special cases and differences between medicine and critical care. ==Related articles == {{Related Articles}} [[Category:Transfer Ready| *]] [[Category:L TmpV2 Data]] [[Category:Project]] [[Category:PatientFollow Project]] [[Category:Data Collection Guide]] [[Category:Admit/Discharge]] [[Category:End-of-life related data]]
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