ICU Interfacility Transfer: Difference between revisions

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| indicator_start_date = Oct 2016

| indicator_end_date =

| DataDependencies=Dispo; Dispo DtTm; Previous Location; Pre-admit Inpatient Institution; Service Location; Service tmp entry

}}

Usually used in aggregate form as "per location" and/or "per timeframe", e.g. by day/month/quarter/year x Ward/Unit x Hospital.

See more details on the ~~different scenario~~ of transfer in [[ICU Interfacility Report]] .

See more details on the definition of interfacility transfer in [[ICU Interfacility Report]] .

===QI domain===

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100% patients who survived and left ICU

===Exclusion Criteria===

# Patients transferred to a home hospital (i.e. not for medical or bed access reasons);

# Patients transferred to a home hospital / repatriated/repatriations (i.e. not for medical or bed access reasons);

# patients not formally evaluated by the ICU team;

# patients admitted to a critical care unit within the same geographic site.

===Frequency===

Month, quarter or year based on ICU discharge dates.

*Month, quarter or year based on ICU discharge dates for Live ICU discharges

*Month, quarter or year based on ICU admission dates for the counts of transfers due to medical or bed access reasons

==Definition and Derivation==

==Definition and Derivation For Rate==

Percent of live ICU discharges that are transferred to an ICU located at a different hospital.

===Numerator===

Num = Number of live ICU discharges that are transferred to an ICU located at a different hospital

Num = Number of live ICU discharges that are transferred to an ICU located at a different hospital or the Transfer OUT (see below definition)

===Denominator===

Denom = Number of Live ICU discharges

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== Transfer for Medical Reason or Bed management ==

A ~~similar thing used~~ to ~~be reported for~~ transfer "for medical reasons" vs. "for bed management"~~. This~~ is ~~now~~ added ~~in the report~~ starting 2024. In order to determine the reason for transfer, the diagnoses on the transferring ICU will be evaluated ~~and would~~ depending on the ~~sending~~ facility ~~(where~~ patient came from) and the admitting ICU.

A report to specify the transfer "for medical reasons" vs. "for bed management" is added starting 2024. In order to determine the reason for transfer, the diagnoses on the transferring ICU will be evaluated depending on the facility the patient came from or the sending ICU and the admitting or receiving ICU. Also there are two perspective to consider in reporting transfer namely Transfer OUT and Transfer IN.

=== Medical ~~Reason~~===

* From STB facility to HSC ICUs - medical reasons include Neurological dxs, all types of trauma dxs and MICP procedures

=== Medical Reasons ===

* From HSC facility to STB ICMS/ACCU/ICCS - medical reasons include Cath Lab procedures, Cardiovascular Post-op dxs, Aortic aneurysm, thoracic with rupture, IABP and Peritoneal Dialysis

* From HSC facility to STB ICMS/ACCU/ICCS - medical reasons include Cath Lab procedures (#1), Cardiovascular Post-op dxs (#2), Aortic aneurysm,thoracic with rupture (#4), IABP (#8) and Peritoneal Dialysis (#9)

* From Grace facility to HSC/STB ICUs - medical reasons include Cath Lab procedures, Cardiovascular Post-op dxs, Acute renal, vascular aneurysm, Neurological, all trauma, MICP, IABP, Peritoneal Dialysis, Hemodialysis, CRRT procedures.

* From STB facility to HSC MICU/SICU/IICU - medical reasons include Neurological dxs (#5), all types of trauma dxs (#6) and Monitoring Intracranial Pressure (MICP) procedure (#7)

* From Grace facility to HSC/STB ICUs - medical reasons include Cath Lab procedures (#1), Cardiovascular Post-op dxs (#2), Acute renal (#3), vascular aneurysm (#4), Neurological (#5), all trauma (#6), MICP (#7), IABP (#8), Peritoneal Dialysis (#9), Hemodialysis (#10), CRRT procedures (#11)

* From HSC/STB facility to Grace ICU - no medical reason

{| class="wikitable sortable"

|+ ICD10 codes to derive medical reason for transport status

|-

! reason grouping !! ICD10 code !! CCI code !! From site STB to HSC ICU !! From site HSC to STB ICU !! From site GRA to HSC/STB ICU

|-

| 1 || ||{{ CCIWithCode | Angioplasty, coronary (without stenting) }} || || YES || YES

|-

| 1 || ||{{ CCIWithCode | Angiogram, coronary (diagnostic cardiac catheterization) }} || || YES || YES

|-

| 1 || ||{{ CCIWithCode | Angioplasty, coronary (with stenting) }} || || YES || YES

|-

| 1 || ||{{ CCIWithCode | ECMO, VA }} || || YES || YES

|-

| 1 || ||{{ CCIWithCode | ECMO, VV}} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Pericardium}} - {{ CCIWithCode |Excision, Resection }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Pericardium}} - {{ CCIWithCode |Debridement}} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Cardiac Conduction System}} - {{ CCIWithCode |Destruction}} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Cardiac Conduction System}} - {{ CCIWithCode |Repair}} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Cardiac Atrium}} - {{ CCIWithCode |Removal of Foreign Body}} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Cardiac Atrium}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Cardiac Atrium}} - {{ CCIWithCode |Excision, Resection }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Cardiac Atrium}} - {{ CCIWithCode |Excision, Resection, total }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Cardiac Atrium}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Interatrial Septum}} - {{ CCIWithCode |Occlusion }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Interatrial Septum}} - {{ CCIWithCode |Release, Decompression }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Interatrial Septum}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Cardiac ventricle}} - {{ CCIWithCode |Implantation of Internal Device }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Cardiac ventricle}} - {{ CCIWithCode |Removal of Foreign Body }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Cardiac ventricle}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Interventricular Septum}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Tricuspid Valve, Related Structures}} - {{ CCIWithCode |Ultrasound }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Tricuspid Valve, Related Structures}} - {{ CCIWithCode |Implantation of Internal Device }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Tricuspid Valve, Related Structures}} - {{ CCIWithCode |Repair}} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Tricuspid Valve, Related Structures}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Pulmonic Valve, Related Structures}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Mitral Valve, Related Structures}} - {{ CCIWithCode |Ultrasound }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Mitral Valve, Related Structures}} - {{ CCIWithCode |Implantation of Internal Device }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Mitral Valve, Related Structures}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Mitral Valve, Related Structures}} - {{ CCIWithCode |Construction, Reconstruction }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode |(T) Mitral Valve, Related Structures}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Aortic Valve, Related Structures}} - {{ CCIWithCode |Occlusion }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode |(T) Aortic Valve, Related Structures}} - {{ CCIWithCode |Implantation of Internal Device }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode |(T) Aortic Valve, Related Structures}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Aortic Valve, Related Structures}} - {{ CCIWithCode |Construction, Reconstruction }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Aortic Valve, Related Structures}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode |(T) Heart, NOS}} - {{ CCIWithCode |Control of Bleeding }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Heart, NOS}} - {{ CCIWithCode |Installation of External Appliance }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode |(T) Heart, NOS}} - {{ CCIWithCode |Drainage, Evacuation }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode |Pacemaker insertion, permanent }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Heart, NOS}} - {{ CCIWithCode |Bypass }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Heart, NOS}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Heart, NOS}} - {{ CCIWithCode |Excision, Resection, total }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Heart, NOS}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Thoracic Aorta}} - {{ CCIWithCode |Control of Bleeding }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Thoracic Aorta}} - {{ CCIWithCode |Implantation of Internal Device }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | IABP }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Thoracic Aorta}} - {{ CCIWithCode |Bypass }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Thoracic Aorta}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Thoracic Aorta}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Aorta, NOS}} - {{ CCIWithCode |Computerized Tomography (CT) }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Aorta, NOS}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Aorta, NOS}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Coronary Arteries}} - {{ CCIWithCode |MRI }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Coronary Arteries}} - {{ CCIWithCode |Drainage, Evacuation }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Coronary Arteries}} - {{ CCIWithCode |Removal of Foreign Body }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Coronary Arteries}} - {{ CCIWithCode |Extraction }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Coronary Arteries}} - {{ CCIWithCode |Bypass }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Coronary Arteries}} - {{ CCIWithCode |Debridement }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Coronary Vessels, NOS}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Pulmonary Artery}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Pulmonary Artery}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Vena Cava}} - {{ CCIWithCode |Control of Bleeding }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Vena Cava}} - {{ CCIWithCode |Repair }} || || YES || YES

|-

| 2 || ||{{ CCIWithCode | (T) Carotid Artery}} - {{ CCIWithCode |Bypass}} || || || YES

|-

| 2 || ||{{ CCIWithCode | (T) Carotid Artery}} - {{ CCIWithCode |Excision with Reconstruction, Replacement}} || || || YES

|-

| 2 || ||{{ CCIWithCode | (T) Abdominal Aorta}} - {{ CCIWithCode |Excision with Reconstruction, Replacement}} || || || YES

|-

| 2 || ||{{ CCIWithCode | (T) Abdominal Aorta}} - {{ CCIWithCode |Repair}} || || || YES

|-

| 3 ||{{ ICD10ByCode | N17.0 }} || || || || YES

|-

| 3 ||{{ ICD10ByCode | N17.9 }} || || || || YES

|-

| 3 ||{{ ICD10ByCode | N99.0 }} || || || || YES

|-

| 4 ||{{ ICD10ByCode | I71.1}} || || || || YES

|-

| 4 ||{{ ICD10ByCode | I71.2}} || || || || YES

|-

| 4 ||{{ ICD10ByCode | I71.3}} || || || YES || YES

|-

| 4 ||{{ ICD10ByCode | I71.4}} || || || || YES

|-

| 4 ||{{ ICD10ByCode | I71.8}} || || || || YES

|-

| 4 ||{{ ICD10ByCode | I71.9}} || || || || YES

|-

| 4 ||{{ ICD10ByCode | I72}} || || || || YES

|-

| 5 ||{{ ICD10ByCode | G40}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | G41}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | R56.88}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | O15}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | G06.0}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | G08}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | I60}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | I61}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | I62}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | I63.4}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | I63.9}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | I64}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | I65}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | I67.1}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | I67.84}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | I67.9}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | G91.2}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | G91.9}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | G93.5}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | G93.6}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | Q28.2}} || || YES || || YES

|-

| 5 ||{{ ICD10ByCode | G93.81}} || || || || YES

|-

| 6 || [[Category:Trauma|Trauma]] (S00 to S99) || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T07}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T08}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T10}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T11.1}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T11.2}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T11.3}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T11.4}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T11.5}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T11.6}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T11.9}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T12}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T13.0}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T13.1}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T13.2}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T13.3}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T13.4}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T13.5}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T13.6}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T13.9}} || || YES || || YES

|-

| 6 ||{{ ICD10ByCode | T14.9}} || || YES || || YES

|-

| 7 || ||{{ CCIWithCode |ICP monitor (Placement of implanted, invasive intracranial pressure monitoring device) }} || YES || || YES

|-

| 8 || ||{{ CCIWithCode |IABP}} || || YES || YES

|-

| 9 || ||{{ CCIWithCode |PD (Peritoneal dialysis)}} || || YES || YES

|-

| 10 || ||{{ CCIWithCode |HD (Hemodialysis) }} || || || YES

|-

| 11 || ||{{ CCIWithCode |CRRT (incl volume removal via PRISMA device)}} || || || YES

|}

==== Change log for medical reason encoding ====

* 2023-12-05

** All related emails between Drs. Bojan Paunovic and Carmen Hrymak and Julie are in S:\MED\MED_CCMED\CCMDB_Special_Projects\Interfacilty transfers

** remove for transfer from HSC to STB

*** [[(T) Carotid Artery]] - [[Bypass]]

*** [[(T) Carotid Artery]] - [[Excision with Reconstruction, Replacement]]

*** [[(T) Abdominal Aorta]] - [[Excision with Reconstruction, Replacement]]

*** [[(T) Abdominal Aorta]] - [[Repair]]

** add to transfer from HSC to STB

*** [[Aortic aneurysm, thoracic with rupture]]

** remove for STB to HSC transfer but include from GRA to HSC/STB transfer

*** [[Brain death]]

** remove from the list

*** [[Encephalopathy, hypertensive]]

*** [[Posterior reversible encephalopathy syndrome (PRES)]]

*** [[Encephalopathy, toxic]]

*** [[Encephalopathy, NOS]]

*** [[Encephalopathy, septic or metabolic]]

*** [[Brain disorder, NOS]]

*** [[Transient ischemic attack (TIA), all types]]

=== Bed Management Reason ===

* If none in the above Medical reason, then it is bed management reason.

=== Transfer OUT ===

*Transfer OUT includes the transfers from a discharging or sending ICU to another site’s ICU for medical necessity or bed management reasons.

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*Transfer IN includes the transfers to a receiving or admitting ICU from another site for medical necessity or bed management reason.

**The number of transfers is attributed to the receiving or admitting ICUs.

** From '''another site''' can be another site’s ICU, ER, ICU, Ward, OR, RR, etc. Can be broken down from another site's '''ICU''' or '''Non-ICU''' ~~location~~.

** From '''another site''' can be another site’s ICU, ER, ICU, Ward, OR, RR, etc. Can be broken down from another site's '''ICU''' or '''Non-ICU''' service.

** ~~For example,~~ patients admitted to HSC MICU can be inpatients from STB ICMS or STB Ward or Grace ICU or Grace Ward or non-inpatients from STB ER or Grace ER. All these transfers are counted and attributed to HSC MICU. If need to separate from another site ICU, include only those from STB ICMS and Grace ICU. If from another site non-ICU ~~location~~, include those from STB ER, STB Ward, Grace ER, Grace Ward.

** Example 1 - patients admitted to HSC MICU can be inpatients from STB ICMS or STB Ward or Grace ICU or Grace Ward or non-inpatients from STB ER or Grace ER. All these transfers are counted and attributed to HSC MICU. If need to separate from another site ICU, include only those from STB ICMS and Grace ICU. If from another site non-ICU service, include those from STB ER, STB Ward, Grace ER, Grace Ward. The reasons for transfer can either be medical or bed management reason.

** Example 2- patients admitted to Grace ICU can inpatients from STB/HSC ICU/Ward or non-inpatient from STB/HSC ER/OR/etc. All transfers can be attributed to Grace ICU and broken from ICU or Non-ICU service. However, the reason for transfer will only be due to bed management.

~~==Data Sources==~~

* ~~[[Dispo]]~~

* ~~[[Dispo DtTm]]~~

* [[Previous Location]]

* [[Pre-~~admit Inpatient Institution]]~~

==SAS Program==

@@ Line 6: / Line 6: @@
 | indicator_start_date = Oct 2016
 | indicator_end_date =
+| DataDependencies=Dispo; Dispo DtTm; Previous Location; Pre-admit Inpatient Institution; Service Location; Service tmp entry
 }}
 Usually used in aggregate form as "per location" and/or "per timeframe", e.g. by day/month/quarter/year x Ward/Unit x Hospital.
-See more details on the different scenario of transfer in [[ICU Interfacility Report]] .
+See more details on the definition of interfacility transfer in [[ICU Interfacility Report]] .
 ===QI domain===
@@ Line 22: / Line 23: @@
 % patients who survived and left ICU
 ===Exclusion Criteria===
-# Patients transferred to a home hospital (i.e. not for medical or bed access reasons);
+# Patients transferred to a home hospital / repatriated/repatriations (i.e. not for medical or bed access reasons);
 # patients not formally evaluated by the ICU team;
 # patients admitted to a critical care unit within the same geographic site.
 ===Frequency===
-Month, quarter or year  based on  ICU discharge dates.
+*Month, quarter or year  based on  ICU discharge dates for Live ICU discharges
+*Month, quarter or year  based on  ICU admission dates for the counts of transfers due to medical or bed access reasons
-==Definition and Derivation==
+==Definition and Derivation For Rate==
 Percent of live ICU discharges that are transferred to an ICU located at a different hospital.
 ===Numerator===
-Num = Number of live ICU discharges that are transferred to an ICU located at a different hospital
+Num = Number of live ICU discharges that are transferred to an ICU located at a different hospital or the Transfer OUT (see below definition)
 ===Denominator===
 Denom = Number of Live ICU discharges
@@ Line 41: / Line 43: @@
 == Transfer for Medical Reason or Bed management ==
-A similar thing used to be reported for transfer "for medical reasons" vs. "for bed management". This is now added in the report starting 2024.   In order to determine the reason for transfer, the diagnoses on the transferring ICU will be evaluated and would depending on the sending facility (where patient came from)  and the admitting ICU.
+A report to specify the  transfer "for medical reasons" vs. "for bed management" is added starting 2024.   In order to determine the reason for transfer, the diagnoses on the transferring ICU will be evaluated depending  on the facility the patient came from or the sending ICU and the admitting or receiving ICU.  Also there are two perspective to consider in reporting transfer  namely Transfer OUT and Transfer IN.
-=== Medical Reason===
-* From STB facility to HSC ICUs - medical reasons include Neurological dxs, all types of trauma dxs and MICP procedures
+=== Medical Reasons ===
-* From HSC facility to STB ICMS/ACCU/ICCS - medical reasons include Cath Lab procedures, Cardiovascular Post-op dxs, Aortic aneurysm, thoracic with rupture, IABP and Peritoneal Dialysis
+* From HSC facility to STB ICMS/ACCU/ICCS - medical reasons include Cath Lab procedures (#1), Cardiovascular Post-op dxs (#2), Aortic aneurysm,thoracic with rupture (#4), IABP (#8) and Peritoneal Dialysis (#9)
-* From Grace facility to HSC/STB ICUs - medical reasons include Cath Lab procedures, Cardiovascular Post-op dxs, Acute renal, vascular aneurysm, Neurological, all trauma, MICP, IABP, Peritoneal Dialysis, Hemodialysis, CRRT procedures.
+* From STB facility to HSC MICU/SICU/IICU - medical reasons include Neurological dxs (#5), all types of trauma dxs (#6) and Monitoring Intracranial Pressure (MICP) procedure (#7)
+* From Grace facility to HSC/STB ICUs - medical reasons include Cath Lab procedures (#1), Cardiovascular Post-op dxs (#2), Acute renal (#3), vascular aneurysm (#4), Neurological (#5), all trauma (#6), MICP (#7), IABP (#8), Peritoneal Dialysis (#9), Hemodialysis (#10), CRRT procedures (#11)
+* From HSC/STB facility to Grace ICU - no medical reason
+{| class="wikitable sortable"
+|+ ICD10 codes to derive medical reason for transport status
+|-
+! reason grouping !! ICD10 code !! CCI code !! From site STB to HSC ICU !! From site HSC to STB ICU !! From site GRA to HSC/STB ICU
+|-
+| 1 || ||{{ CCIWithCode | Angioplasty, coronary (without stenting) }} ||  || YES || YES
+|-
+| 1 || ||{{ CCIWithCode | Angiogram, coronary (diagnostic cardiac catheterization) }} ||  || YES || YES
+|-
+| 1 || ||{{ CCIWithCode | Angioplasty, coronary (with stenting) }} ||  || YES || YES
+|-
+| 1 || ||{{ CCIWithCode | ECMO, VA }} ||  || YES || YES
+|-
+| 1 || ||{{ CCIWithCode | ECMO, VV}} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Pericardium}} - {{ CCIWithCode |Excision, Resection }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Pericardium}} - {{ CCIWithCode |Debridement}} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Cardiac Conduction System}} - {{ CCIWithCode |Destruction}} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Cardiac Conduction System}} - {{ CCIWithCode |Repair}} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Cardiac Atrium}} - {{ CCIWithCode |Removal of Foreign Body}} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Cardiac Atrium}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Cardiac Atrium}} - {{ CCIWithCode |Excision, Resection }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Cardiac Atrium}} - {{ CCIWithCode |Excision, Resection, total }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Cardiac Atrium}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Interatrial Septum}} - {{ CCIWithCode |Occlusion }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Interatrial Septum}} - {{ CCIWithCode |Release, Decompression }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Interatrial Septum}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Cardiac ventricle}} - {{ CCIWithCode |Implantation of Internal Device }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Cardiac ventricle}} - {{ CCIWithCode |Removal of Foreign Body }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Cardiac ventricle}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Interventricular Septum}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Tricuspid Valve, Related Structures}} - {{ CCIWithCode |Ultrasound }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Tricuspid Valve, Related Structures}} - {{ CCIWithCode |Implantation of Internal Device }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Tricuspid Valve, Related Structures}} - {{ CCIWithCode |Repair}} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Tricuspid Valve, Related Structures}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Pulmonic Valve, Related Structures}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Mitral Valve, Related Structures}} - {{ CCIWithCode |Ultrasound }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Mitral Valve, Related Structures}} - {{ CCIWithCode |Implantation of Internal Device }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Mitral Valve, Related Structures}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Mitral Valve, Related Structures}} - {{ CCIWithCode |Construction, Reconstruction }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |(T) Mitral Valve, Related Structures}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Aortic Valve, Related Structures}} - {{ CCIWithCode |Occlusion }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |(T) Aortic Valve, Related Structures}} - {{ CCIWithCode |Implantation of Internal Device }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |(T) Aortic Valve, Related Structures}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Aortic Valve, Related Structures}} - {{ CCIWithCode |Construction, Reconstruction }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Aortic Valve, Related Structures}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |(T) Heart, NOS}} - {{ CCIWithCode |Control of Bleeding }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Heart, NOS}} - {{ CCIWithCode |Installation of External Appliance }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |(T) Heart, NOS}} - {{ CCIWithCode |Drainage, Evacuation }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |Pacemaker insertion, permanent }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Heart, NOS}} - {{ CCIWithCode |Bypass }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Heart, NOS}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Heart, NOS}} - {{ CCIWithCode |Excision, Resection, total }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Heart, NOS}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    (T) Thoracic Aorta}} - {{ CCIWithCode |Control of Bleeding }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    (T) Thoracic Aorta}} - {{ CCIWithCode |Implantation of Internal Device }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    IABP }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    (T) Thoracic Aorta}} - {{ CCIWithCode |Bypass }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |   (T) Thoracic Aorta}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    (T) Thoracic Aorta}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |   (T) Aorta, NOS}} - {{ CCIWithCode |Computerized Tomography (CT) }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    (T) Aorta, NOS}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    (T) Aorta, NOS}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    (T) Coronary Arteries}} - {{ CCIWithCode |MRI }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    (T) Coronary Arteries}} - {{ CCIWithCode |Drainage, Evacuation }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    (T) Coronary Arteries}} - {{ CCIWithCode |Removal of Foreign Body }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    (T) Coronary Arteries}} - {{ CCIWithCode |Extraction }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode |    (T) Coronary Arteries}} - {{ CCIWithCode |Bypass }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T)  Coronary Arteries}} - {{ CCIWithCode |Debridement }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Coronary Vessels, NOS}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Pulmonary Artery}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Pulmonary Artery}} - {{ CCIWithCode |Excision with Reconstruction, Replacement }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Vena Cava}} - {{ CCIWithCode |Control of Bleeding }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Vena Cava}} - {{ CCIWithCode |Repair }} ||  || YES || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Carotid Artery}} - {{ CCIWithCode |Bypass}} ||  ||  || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Carotid Artery}} - {{ CCIWithCode |Excision with Reconstruction, Replacement}} ||  ||  || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Abdominal Aorta}} - {{ CCIWithCode |Excision with Reconstruction, Replacement}} ||  ||  || YES
+|-
+| 2 || ||{{ CCIWithCode | (T) Abdominal Aorta}} - {{ CCIWithCode |Repair}} ||  ||  || YES
+|-
+| 3 ||{{ ICD10ByCode | N17.0   }} || ||  ||  || YES
+|-
+| 3 ||{{ ICD10ByCode | N17.9   }} || ||  ||  || YES
+|-
+| 3 ||{{ ICD10ByCode | N99.0   }} || ||  ||  || YES
+|-
+| 4 ||{{ ICD10ByCode | I71.1}} || ||  ||  || YES
+|-
+| 4 ||{{ ICD10ByCode | I71.2}} || ||  ||  || YES
+|-
+| 4 ||{{ ICD10ByCode | I71.3}} || ||  || YES || YES
+|-
+| 4 ||{{ ICD10ByCode | I71.4}} || ||  ||  || YES
+|-
+| 4 ||{{ ICD10ByCode | I71.8}} || ||  ||  || YES
+|-
+| 4 ||{{ ICD10ByCode | I71.9}} || ||  ||  || YES
+|-
+| 4 ||{{ ICD10ByCode | I72}} || ||  ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | G40}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | G41}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | R56.88}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | O15}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | G06.0}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | G08}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | I60}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | I61}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | I62}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | I63.4}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | I63.9}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | I64}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | I65}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | I67.1}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | I67.84}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | I67.9}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | G91.2}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | G91.9}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | G93.5}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | G93.6}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | Q28.2}} || || YES ||  || YES
+|-
+| 5 ||{{ ICD10ByCode | G93.81}} || ||  ||  || YES
+|-
+| 6 ||  [[Category:Trauma|Trauma]] (S00 to S99) || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T07}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T08}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T10}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T11.1}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T11.2}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T11.3}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T11.4}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T11.5}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T11.6}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T11.9}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T12}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T13.0}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T13.1}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T13.2}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T13.3}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T13.4}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T13.5}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T13.6}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T13.9}} || || YES ||  || YES
+|-
+| 6 ||{{ ICD10ByCode | T14.9}} || || YES ||  || YES
+|-
+| 7 || ||{{ CCIWithCode |ICP monitor (Placement of implanted, invasive intracranial pressure monitoring device) }} || YES ||  || YES
+|-
+| 8 || ||{{ CCIWithCode |IABP}} ||  || YES || YES
+|-
+| 9 || ||{{ CCIWithCode |PD (Peritoneal dialysis)}} ||  || YES || YES
+|-
+| 10 || ||{{ CCIWithCode |HD (Hemodialysis) }} ||  ||  || YES
+|-
+| 11 || ||{{ CCIWithCode |CRRT (incl volume removal via PRISMA device)}} ||  ||  || YES
+|}
+==== Change log for medical reason encoding ====
+* 2023-12-05
+** All related emails between Drs. Bojan Paunovic and Carmen Hrymak and Julie are in  S:\MED\MED_CCMED\CCMDB_Special_Projects\Interfacilty transfers
+** remove for transfer from HSC to STB
+*** [[(T) Carotid Artery]] - [[Bypass]]
+*** [[(T) Carotid Artery]] - [[Excision with Reconstruction, Replacement]]
+*** [[(T) Abdominal Aorta]] - [[Excision with Reconstruction, Replacement]]
+*** [[(T) Abdominal Aorta]] - [[Repair]]
+** add to transfer from HSC to STB
+***  [[Aortic aneurysm, thoracic with rupture]]
+** remove for  STB to  HSC transfer but include from GRA to HSC/STB transfer
+*** [[Brain death]]
+** remove from  the list
+*** [[Encephalopathy, hypertensive]]
+*** [[Posterior reversible encephalopathy syndrome (PRES)]]
+*** [[Encephalopathy, toxic]]
+*** [[Encephalopathy, NOS]]
+*** [[Encephalopathy, septic or metabolic]]
+*** [[Brain disorder, NOS]]
+*** [[Transient ischemic attack (TIA), all types]]
+=== Bed Management Reason ===
+* If none in the above Medical reason, then it is bed management reason.
 === Transfer OUT ===
 *Transfer OUT includes the transfers from a discharging or sending ICU to another site’s ICU  for medical necessity or bed management reasons.
@@ Line 57: / Line 344: @@
 *Transfer IN includes the transfers to a receiving or admitting ICU from another site for medical necessity or bed management reason.
 **The number of transfers is attributed to the receiving or admitting ICUs.
-** From '''another site''' can be another site’s ICU, ER, ICU, Ward, OR, RR, etc. Can be broken down  from another site's '''ICU''' or '''Non-ICU''' location.
+** From '''another site''' can be another site’s ICU, ER, ICU, Ward, OR, RR, etc. Can be broken down  from another site's '''ICU''' or '''Non-ICU''' service.
-** For example, patients admitted to HSC MICU can be inpatients from STB ICMS or STB Ward or Grace ICU or Grace Ward or non-inpatients from STB ER or Grace ER.  All these transfers are counted and attributed to HSC MICU.  If need to separate from another site ICU, include only those from STB ICMS and Grace ICU.  If from another site non-ICU location, include those from STB ER, STB Ward, Grace ER, Grace Ward.
+** Example 1 - patients admitted to HSC MICU can be inpatients from STB ICMS or STB Ward or Grace ICU or Grace Ward or non-inpatients from STB ER or Grace ER.  All these transfers are counted and attributed to HSC MICU.  If need to separate from another site ICU, include only those from STB ICMS and Grace ICU.  If from another site non-ICU service, include those from STB ER, STB Ward, Grace ER, Grace Ward. The reasons for transfer can either be medical or bed management reason.
+** Example 2- patients admitted to Grace ICU can inpatients from STB/HSC ICU/Ward or non-inpatient from STB/HSC ER/OR/etc. All transfers can be attributed to Grace ICU and broken from ICU or Non-ICU service. However, the reason for transfer will only be due to bed management.
-==Data Sources==
-* [[Dispo]]
-* [[Dispo DtTm]]
-* [[Previous Location]]
-* [[Pre-admit Inpatient Institution]]
 ==SAS Program==