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Transfer Delay (Critical Care): Difference between revisions

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{{Data_element
{{Reporting Indicators
| field_name = Transfer Delay
|description='''Transfer Delay''' is the difference between [[Dispo_DtTm]] and [[#Transfer Ready DtTm in use at different times]] in decimal days.
| element_description =  '''Transfer Delay''' is the difference between [[Dispo_DtTm]] and [[Transfer_Ready_DtTm]] in decimal days.
|created_raw=Created
Another term used to call it is '''Wasted beds'''.
|Program=Critical Care
| in_table = Created_Variables_Common table
|indicator_start_date=1999-01-15
| data_type = number
|indicator_name=Transfer_Delay_CC
| datafield_length = single
|program=Critical Care and Medicine
| program_collecting = Med and CC
}}
| created_raw = Created
There is a similar concept in medicine, [[Transfer Delay (Medicine)]].
| data_element_sort_index = 7
| data_element_start_date = 1999-01-15}}


{{Reporting Indicators
It is stored in the [[Transfer_Delay_CC]] field in [[Created_Variables_CC_2021 table]].
| description = Transfer Delay
 
| indicator_name = Transfer Delay
== Use ==
| created_raw = Created 
* The purpose is to determine the amount of time the patient is occupying a bed in an ICU setting when the patient no longer needs that [[Level of care hierarchy| level of care]] (also referred to as wasted bed) from the [[#Transfer Ready DtTm in use at different times]] until the [[Dispo DtTm]].
| program = Critical Care and Medicine
== Calculation of Transfer Delay ==
| indicator_start_date = 1999-01-15
*Transfer Delay is the difference between [[Dispo DtTm]] and first [[Transfer Ready DtTm]].
| indicator_end_date =  
{{Collapsable| always=see previous definitions| full=
*As agreed in JALT meeting March 22, 2023, transfer delays will be reported based on actual delay times with no more allowances of less than n hours.
*previously, transfer delay calculation followed the national Vital Signs Monitoring program guideline which subtracted 2 hrs from all actual delay time.
*In the meeting held Jan 11, 2023, it was decided as per approval from the Critical Care Director to define transfer delays as follows: (a) ignore such transfer delays <2 hrs, but (b) for all delays >=2 hrs to use the actual delay time.
}}
}}
== Use ==
* The purpose is to determine the amount of time the patient is occupying a bed in an ICU or an IICU or a High Observation ward or a regular ward setting when the patient is no longer needing that [[Level of care hierarchy| level of care]] (also refer as wasted bed) from the [[Transfer Ready DtTm]] until the [[Dispo DtTm]].


== Definition Details ==
== Transfer Ready DtTm in use at different times ==
*'''Transfer Delay Over 2 hours for Critical Care''' (ie subtract 2 hrs from transfer delay)
===  [[Admit DtTm]] or [[Dispo DtTm]] < 2020-10-01 00:00 ===
* Use the DtTm in [[Transfer Ready DtTm field]]


=== Which Transfer Ready DtTm To Use? ===
=== [[Admit DtTm]] or [[Dispo DtTm]] >= 2020-10-01 00:00 ===
==== Before Oct 1, 2020 ====
* Use the ''first'' [[Transfer Ready DtTm tmp entry]], as derived by [[created_FirstTransferReady query]]
* For each patient in ICU and  Medicine ward,  the transfer date and time is taken from the [[Transfer Ready DtTm field]].
* It is calculated by [[Created_Variables_Common_maker query]] and stored in [[Created_Variables_Common table]] in [[CFE]].


==== Starting Oct 1, 2020 ====
==== Background ====
* For each record and each boarding location in ICU and Medicine, the transfer date and time is taken from the [[Transfer Ready DtTm tmp entry]].
* For each record, it is possible to have one or more entries of [[Transfer Ready DtTm tmp entry]] corresponding to one or more [[Boarding Loc |boarding locations]].
* For each record, it is possible to have one or more entries of [[Transfer Ready DtTm]] corresponding to one or more boarding locations.
* We only collect one [[level of care hierarchy | level of care]] per CC record, so we only ever care about the first [[Transfer Ready DtTm tmp entry]] that has a DtTm
* if the patient moves to various locations, the '''first''' [[Transfer Ready DtTm]] from a [[Boarding Loc]] will be used
* Any additional [[Transfer Ready DtTm tmp entry]] will be ignored for this calculation
**As described in [[Transfer Ready DtTm tmp entry]], collectors make a notation about transfer ready in each separate boarding loc, looking solely at whether or not the patient was recorded as transfer ready from that location (i.e. collectors should not "carry over" knowledge about transfer readiness at prior boarding locs).
**BUT, when calculating "wasted days", Julie will only use the '''FIRST''' transfer ready date/time:
***example 1:  Mr. Jones spent 7 days in Location1 and then directly transferred to Location2 where he stayed another 7 days.  On Location1 day 3 a progress note said he was ready to go to ward, but he didn't.  At no time during his Location2 stay did any notes indicate transfer readiness.  Julie will calculate this as 4 wasted Location1 days, and 7 wasted Location2 days.
***example 2:  Mr. Jones spent 7 days in Location1 and then directly transferred to Location2 where he stayed another 7 days.  On Location1 day 3 a progress note said he was ready to go to ward, but he didn't.  On Location2 day 1 a progress note indicates transfer readiness.  Julie will calculate this as 4 wasted Location1 days, and 7 wasted Location2 days.
***example 3:  Mr. Jones spent 7 days in Location1 and then directly transferred to Location2 where he stayed another 7 days.  On Location1 day 3 a progress note said he was ready to go to ward, but he didn't.  On Location2 day 5 a progress note indicates transfer readiness.  Julie will calculate this as 4 wasted MICU days, and 7 wasted SICU days.
***ALL 3 of these examples have the same # of wasted days.


*QUESTION: ''Why record a transfer ready date/time from each boarding loc if we are only actually going to use the first of them?'' 
==== Why collect per boarding loc when we only report per admission? ====
**ANSWER: ''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.''
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.


== Reporting of Transfer Delays ==
* Include all cases with transfer ready dttm  (who went to same/lower/higher level of care or died).
* Refer to the following indicators:
#[[Avoidable Days (Critical Care)|Avoidable Days]]
#[[Beds occupied by transferrable patients (Critical Care)|Beds occupied by transferrable patients]]


== IICU and H6 Reporting ==
== IICU and H6 Reporting ==
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# to HSC IICU/H6, and  
# to HSC IICU/H6, and  
# to other wards/Home (including nursing home/long term care facility)  
# to other wards/Home (including nursing home/long term care facility)  
The [[Dispo]] location will be used to define the destination. As per Dr. Garland & Dr.Paunovic.
The [[Dispo]] location will be used to define the destination. As per Dr. Garland & Dr. Paunovic.
 
== Calculation when transfer time missing ==
The following definitions are used by Julie in reporting from SAS, and by [[centralized_data_front_end.accdb]] to calculate the created_variables query.
 
* if discharge time  < 1000 HR then dummy=0001 HR (12:01 am),
* else if discharge time  >=  1000 HR dummy=1000HR  (10:00 am)
 
This was based on [[Critical Care Vital Sign Monitor]].
 
This is as per approval by [[Dr. Dan Roberts]].


==SAS Program==
*S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\logphi_TR_Jan2023.sas
**  macro %CC_tready
*S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas  (macro %boardtransf)


== Data use ==
== Data use ==
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== related fields ==
== related fields ==
* [[Arrive_DtTm]]  
* [[Admit DtTm]]  
* [[Dispo_DtTm]]  
* [[Dispo_DtTm]]  
* [[Transfer Ready DtTm tmp entry]]
* [[Transfer Ready DtTm tmp entry]]
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== Related Articles ==
== Related Articles ==
{{Related Articles}}
{{Related Articles}}
== Legacy ==
{{LegacyContent
|explanation=xxx
|content= 
=== Reporting change from 4 to 2 hrs ===
*Starting July 1, 2018 '''Transfer Delay Over 2 hours for Critical Care''' (i.e. subtract 2 hours instead of 4 hours from transfer delay as per instruction by Jodi Walker Tweed.)
}}




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