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| '' see [[Transfer time rule]] for the unrelated rules around patients transferring between wards we collect data on | | {{Data element |
| | |field_name=Transfer_Ready_DtTm |
| | |CCMDB_label=Transfer Ready DtTm |
| | |CCMDB_tab=Dispo |
| | |in_table=L_Log table |
| | |data_type=date |
| | |program_collecting=Med and CC |
| | |created_raw=Raw |
| | |data_element_start_date=1999-06-01 |
| | |data_element_end_date=2020-10-15 |
| | |data_element_sort_index=47 |
| | |element_description=Date and time the '''intent to discharge''' a patient to a lower level in the [[Level of care hierarchy]] was documented. |
| | }} |
| | See [[Transfer Ready DtTm tmp entry]] |
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| | The data in this field will be retained in [[Centralized_data.accdb]]'s [[L_Log table]] since it doesn't follow the same pattern as the new entry. The field no longer exists in [[CCMDB data.mdb]]. |
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| {{Data_element
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| | field_name = Transfer_Ready_DtTm
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| | CCMDB_label = Transfer Ready DtTm
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| | CCMDB_tab = Dispo
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| | element_description = Date and time the '''intent to discharge''' a patient to a lower level in the [[#hierarchy of levels of care]] was documented.
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| | in_table = L_Log table
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| | data_type = date
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| | program_collecting = Med and CC
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| | created_raw = Raw
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| | data_element_start_date = 2016-07-01
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| | data_element_sort_index = 47
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| }}
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| See [[#hierarchy of levels of care]] for meaning of "lower level of care".
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| == Purpose ==
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| The purpose is to determine the avoidable days or bed wasted by patients who are deemed ready to leave the unit or ward and then either move to a lower level of care or leave the hospital. This is used as part of the concept [[Avoidable Days in ICU]].
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| What is being sought here is the ''intent'' to send someone to a lower level of care only. Thus, it doesn’t matter what actually happened after this intent occurs (e.g. patient getting sicker and the transfer intent cancelled). <!-- Clarified at the 11Sept2017 Steering Committee meeting -->
| | See [[Transfer Ready DtTm tmp entry]] for what this field is about, or see the history of this page for how it has been used at different times before moving to the new field. |
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| == Collection Instruction == | | == Collection Instruction == |
| | === Entering a Transfer Ready DtTm === |
| | Follow the instructions in [[Transfer Ready DtTm tmp entry]]. |
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| | {{Collapsable |
| | | always= Before 2020-10-15 |
| | | full= |
| For each patient, | | For each patient, |
| * enter the first date/time of '''intent''' to transfer to lower level in the [[#hierarchy of levels of care]] is documented into the Transfer Ready Date and Time Field; see [[#status changing back and forth]] | | * enter the first date/time of '''intent''' to transfer to lower level in the [[Level of care hierarchy]] is documented into the Transfer Ready Date and Time Field; see [[#status changing back and forth]] |
| ** if a patient '''arrives transfer-ready''' to a [[#hierarchy of levels of care | lower level]] of care '''than ''your'' ward''' enter the same date into [[Transfer Ready DtTm field]] as in [[Arrive_DtTm field]]. | | ** if a patient '''arrives transfer-ready''' to a [[Level of care hierarchy | lower level]] of care '''than ''the current'' ward''' enter the same date into [[Transfer Ready DtTm field]] as in ''Arrive_DtTm field''. |
| * if not available because the patient was '''clearly not transfer ready''', leave the date/time '''empty''' and enter "'''not transfer ready'''" into the "'''[[TR info status field]]'''" | | * if not available because the patient was '''clearly not transfer ready''', leave the date/time '''empty''' and enter "'''not transfer ready'''" into the "'''[[TR info status field]]'''" |
| * if not available but the patient probably was transfer ready and it just wasn't documented, leave the date/time '''empty''' and enter '''"not available"''' into the "'''[[TR info status field]]'''" | | * if not available but the patient probably was transfer ready and it just wasn't documented, leave the date/time '''empty''' and enter '''"not available"''' into the "'''[[TR info status field]]'''" |
| This entry is about the time of an '''intent''', nothing to do with what '''actually happened''' to the patient after. | | This entry is about the time of an '''intent''', nothing to do with what '''actually happened''' to the patient after. |
| | | }} |
| === what is transfer ready? === | | === What is transfer ready? === |
| Any of these criteria, for a patient going to a '''lower''' level of care, as per hierarchy below:
| | moved to [[Transfer Ready DtTm tmp entry#Transfer Ready]] |
| * "medically stable" written anywhere in the chart
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| * care is stepped down e.g. vital signs decreased, off monitor, IV meds changed to PO meds
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| * once patient becomes [[ACP C|ACP-C]], Medicine or ICU, regardless of whether or not they are still intubated and ventilated <!--(decided at Task Group Meeting on Jan 18, 2016). -->
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| ** {{DA | ACP-C still qualify as transfer-ready would that still be true for a pt in e.g. D5, when there may be no plan to discharge or send to lower level of care? }}
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| * date and time that the IICU consult is written for patient going to [[HSC_IICU]]
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| * a deconditioned patient may still be medically stable if they can re-condition elsewhere; use your judgment.
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| * if criteria are otherwise met but need a sitter or some other level of care the the ward can't provide is required then the patient is still considered transfer ready
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| === Hierarchy of levels of care === | | === Hierarchy of levels of care === |
| We require an entry in this field when the transfer is from higher to lower level of care: | | We require an entry in this field when the intent is to transfer from higher to lower level of care. See [[Level of care hierarchy]] for a list. |
| * WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU
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| * Other MB RHA ICU or Other Province ICU <!--(confirmed by Dr. Allan Garland 2Oct2017)-->
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| * WRHA IICU
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| * WRHA HOB ward
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| * "ward" - the following are all considered the same level of care
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| ** WRHA teaching ward
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| ** WRHA non-teaching ward / EMIP
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| ** residents may set patients to be "non-teaching" because their quota is filled - see [[#pt becoming non-teaching is not a reason to consider transfer ready]] for details
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| ** WRHA sub-acute medicine ward (family medicine service)
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| ** WRHA transitional care ward (family medicine service)
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| * ward outside WRHA
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| * PCH or home
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| {{Discuss | who = all | question = would need to be reconciled as part of [[Eliminating distinction between different ward types]]}}
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| === status changing back and forth === | | === Collection Start Dates === |
| If a patient changes from being transfer ready back to not being transfer ready, collect the '''first''' transfer ready dttm.
| | * Critical Care: all units on board June 1, 1999 |
| | | * Medicine : all wards on board Jan 1, 2005 |
| === pt becoming non-teaching is not a reason to consider transfer ready ===
| | ** Temporary Stopped Date in all wards: May 1, 2010 to Nov 30, 2011 |
| * @ HSC we no longer consider patients who are made non-teaching as "transfer ready". This is because residents routinely change patients from "teaching" to "non-teaching" when their quota of patients is filled. The patient moves to non-teaching status under the staff man but are routinely changed back to teaching once discharges occur.--[[User:CMarks|CMarks]] 13:56, 2017 October 3 (CDT) | |
| ** StB B5 NTU routinely admits Nephrology NT Service patients as well as lateral transfers such as HSC, as identified above, but does not transfer them back to a CTU. Instead the teaching unit Doctors follow the patient on the NT ward they are admitted to.[[User:ENagy|ENagy]] 14:12, 2017 October 6 (CDT)E.Nagy | |
| *** {{discussion}} Is this only for HSC? Probably not, right? if not the HSC part above should come out and the direction for this be made generic. Does this really point to a general lack of distinction between teaching and non-teaching? If so, do we need to adjust other processes about this? Ttenbergen 08:54, 2018 June 7 (CDT) | |
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| {{Discuss | who = all | question = would need to be reconciled as part of [[Eliminating distinction between different ward types]]}}
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| == Data Use ==
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| Used to generate [[Transfer_Delay]], which is used in [[Overstay]] and several reports, see also [[Transfer_Delay#data use]].
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| == Cross Checks == | | == Cross Checks == |
| {{Data Integrity Check List}} | | {{Data Integrity Check List}} |
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| == Related Articles ==
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| {{Related Articles}}
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| == Legacy == | | == Legacy == |
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| Resp. field names L_Log.R_TRDate and L_Log.R_TRTime | | Resp. field names L_Log.R_TRDate and L_Log.R_TRTime |
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| | == Related Articles == |
| | {{Related Articles}} |
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| [[Category: 2016 Time and Place changes]] | | [[Category:2016 Time and Place changes]] |
| [[Category: Admit/Discharge]] | | [[Category:Admit/Discharge]] |
| [[Category: Transfer Ready]] | | [[Category:Transfer Ready]] |
| [[Category: Data Collection Guide]]
| | [[Category:Registry Data]] |
| [[Category: Registry Data]] | |
| [[Category: Transfer Ready| *]]
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| [[Category:Site/Location check]]
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