ICU Interfacility Transfer: Difference between revisions

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{{Reporting Indicators
{{Reporting Indicators
| description = Percent of live ICU discharges that are transferred to an ICU located at a different hospital.
| description = Percent of live ICU discharges that are transferred to an ICU located at a different hospital.  
| indicator_name = {{PAGENAME}}
| indicator_name = {{PAGENAME}}
| created_raw = Created
| created_raw = Created
| program = Critical Care
| program = Critical Care
| indicator_start_date =  
| indicator_start_date = Oct 2016
| indicator_end_date =  
| indicator_end_date =  
}}
}}
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 definition of interfacility transfer in [[ICU Interfacility Report]] .


===QI domain===
===QI domain===
*[[QualityDomain::Safe]]
*[[QualityDomain::Timely]]
*[[QualityDomain::Effective]]
*[[QualityDomain::Efficient]]
*[[QualityDomain::Efficient]]
*[[QualityDomain::Patient and Family Centered]]
 
*[[QualityDomain::Staff workload]]
*[[QualityDomain::Understanding of patient population]]
==Significance==
==Significance==
Reasons for transfer may be either to manage ICU beds or access to a required medical service.  Bed management transfers can increase the efficiency of ICU bed numbers within a region.  Patient transfers may increase the time to appropriate management and may place patients at risk.   
Reasons for transfer may be either to manage ICU beds or access to a required medical service.  Bed management transfers can increase the efficiency of ICU bed numbers within a region.  Patient transfers may increase the time to appropriate management and may place patients at risk.   


==Sampling Plan / Procedure==
==Sampling Plan / Procedure==
{{discuss | who=Julie | question= What are the details? }}
===Inclusion Criteria===
===Includion Criteria===
100% patients who survived and left ICU
{{discuss | who=Julie | question= What are the details? }}
===Exclusion Criteria===
===Exclusion Criteria===
{{discuss | who=Julie | question= What are the details? }}
# Patients transferred to a home hospital (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===
===Frequency===
{{discuss | who=Julie | question= What are the details? }}
*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.
Percent of live ICU discharges that are transferred to an ICU located at a different hospital.


===Numerator===
===Numerator===
{{discuss | who=Julie | question= What are the details? }}
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===
===Denominator===
{{discuss | who=Julie | question= What are the details? }}
Denom = Number of Live ICU discharges
 
===Formula===
Percent of live ICU discharges that are transferred to an ICU located at a different hospital = Num / Denom
 
== Transfer for Medical Reason or Bed management ==
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 Reasons ===
* 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 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
|-
! sort !! 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
** 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.
**The number of transfers is attributed to the discharging or sending or originating ICUs. 
** To '''another site's ICU''' can be any ICU at different facility.
* For example, patients admitted at Grace ICU who are transferred to HSC MICU or STB ICMS are Transfer OUT.
**Patients who are admitted at Grace ICU, had a procedure in other facility and then admitted to an ICU service in that or another facility are Transfer OUT.
**Patients who are admitted at Grace ICU, had a procedure in other facility and then came back to Grace ICU are '''not''' Transfer OUT.
 
=== Transfer IN ===
*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''' service.
** 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==
==Data Sources==
* [[Dispo]]
* [[Dispo]]
* [[Dispo DtTm]]
* [[Previous Location]]
* [[Pre-admit Inpatient Institution]]
* [[Service Location]]
* [[Service tmp entry]]


==SAS Program==
==SAS Program==
{{discuss | who=Julie | question= What are the details? }}
*S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\InterfacilityReasonMed.sas  - list the diagnosis (old coding and ICD10 codes) that defines a  medical reason for transfer
 
*S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\InterfacilityInOut.sas
==Report Users==
{{discuss | who=Julie | question= What are the details? }}


== Related articles ==  
== Related articles ==  
{{Related Articles}}
{{Related Articles}}

Latest revision as of 12:44, 2024 March 12

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

Indicators
Indicator: ICU Interfacility Transfer
Created/Raw: Created
Program: Critical Care
Start Date: Oct 2016
End Date:
Reports: Critical Care Program Quality Indicator Report


  • Cargo


  • SMW:
  • Categories
  • Default form:

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 definition of interfacility transfer in ICU Interfacility Report .

QI domain

  • Efficient

Significance

Reasons for transfer may be either to manage ICU beds or access to a required medical service. Bed management transfers can increase the efficiency of ICU bed numbers within a region. Patient transfers may increase the time to appropriate management and may place patients at risk.

Sampling Plan / Procedure

Inclusion Criteria

100% patients who survived and left ICU

Exclusion Criteria

  1. Patients transferred to a home hospital (i.e. not for medical or bed access reasons);
  2. patients not formally evaluated by the ICU team;
  3. patients admitted to a critical care unit within the same geographic site.

Frequency

  • 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 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 or the Transfer OUT (see below definition)

Denominator

Denom = Number of Live ICU discharges

Formula

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

Transfer for Medical Reason or Bed management

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 Reasons

  • 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 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
ICD10 codes to derive medical reason for transport status
sort ICD10 code CCI code From site STB to HSC ICU From site HSC to STB ICU From site GRA to HSC/STB ICU
1 Angioplasty, coronary (without stenting) (1.IJ.50.GQ-BD) YES YES
1 Angiogram, coronary (diagnostic cardiac catheterization) (3.IP.10.V^) YES YES
1 Angioplasty, coronary (with stenting) (1.IJ.50.GQ-OA) YES YES
1 ECMO, VA (1.LZ.37.GP-QM.va) YES YES
1 ECMO, VV (1.LZ.37.GP-QM.vv) YES YES
2 (T) Pericardium (1.HA) - Excision, Resection (87) YES YES
2 (T) Pericardium (1.HA) - Debridement (87d) YES YES
2 (T) Cardiac Conduction System (1.HH) - Destruction (59) YES YES
2 (T) Cardiac Conduction System (1.HH) - Repair (80) YES YES
2 (T) Cardiac Atrium (1.HM) - Removal of Foreign Body (56) YES YES
2 (T) Cardiac Atrium (1.HM) - Repair (80) YES YES
2 (T) Cardiac Atrium (1.HM) - Excision, Resection (87) YES YES
2 (T) Cardiac Atrium (1.HM) - Excision, Resection, total (89) YES YES
2 (T) Cardiac Atrium (1.HM) - Excision with Reconstruction, Replacement (90) YES YES
2 (T) Interatrial Septum (1.HN) - Occlusion (51) YES YES
2 (T) Interatrial Septum (1.HN) - Release, Decompression (72) YES YES
2 (T) Interatrial Septum (1.HN) - Repair (80) YES YES
2 (T) Cardiac ventricle (1.HP) - Implantation of Internal Device (53) YES YES
2 (T) Cardiac ventricle (1.HP) - Removal of Foreign Body (56) YES YES
2 (T) Cardiac ventricle (1.HP) - Repair (80) YES YES
2 (T) Interventricular Septum (1.HR) - Repair (80) YES YES
2 (T) Tricuspid Valve, Related Structures (1.HS) - Ultrasound (30) YES YES
2 (T) Tricuspid Valve, Related Structures (1.HS) - Implantation of Internal Device (53) YES YES
2 (T) Tricuspid Valve, Related Structures (1.HS) - Repair (80) YES YES
2 (T) Tricuspid Valve, Related Structures (1.HS) - Excision with Reconstruction, Replacement (90) YES YES
2 (T) Pulmonic Valve, Related Structures (1.HT) - Excision with Reconstruction, Replacement (90) YES YES
2 (T) Mitral Valve, Related Structures (1.HU) - Ultrasound (30) YES YES
2 (T) Mitral Valve, Related Structures (1.HU) - Implantation of Internal Device (53) YES YES
2 (T) Mitral Valve, Related Structures (1.HU) - Repair (80) YES YES
2 (T) Mitral Valve, Related Structures (1.HU) - Construction, Reconstruction (84) YES YES
2 (T) Mitral Valve, Related Structures (1.HU) - Excision with Reconstruction, Replacement (90) YES YES
2 (T) Aortic Valve, Related Structures (1.HV) - Occlusion (51) YES YES
2 (T) Aortic Valve, Related Structures (1.HV) - Implantation of Internal Device (53) YES YES
2 (T) Aortic Valve, Related Structures (1.HV) - Repair (80) YES YES
2 (T) Aortic Valve, Related Structures (1.HV) - Construction, Reconstruction (84) YES YES
2 (T) Aortic Valve, Related Structures (1.HV) - Excision with Reconstruction, Replacement (90) YES YES
2 (T) Heart, NOS (1.HZ) - Control of Bleeding (13) YES YES
2 (T) Heart, NOS (1.HZ) - Installation of External Appliance (37) YES YES
2 (T) Heart, NOS (1.HZ) - Drainage, Evacuation (52) YES YES
2 Pacemaker insertion, permanent (1.HZ.53.GR-NK) YES YES
2 (T) Heart, NOS (1.HZ) - Bypass (76) YES YES
2 (T) Heart, NOS (1.HZ) - Repair (80) YES YES
2 (T) Heart, NOS (1.HZ) - Excision, Resection, total (89) YES YES
2 (T) Heart, NOS (1.HZ) - Excision with Reconstruction, Replacement (90) YES YES
2 (T) Thoracic Aorta (1.IC) - Control of Bleeding (13) YES YES
2 (T) Thoracic Aorta (1.IC) - Implantation of Internal Device (53) YES YES
2 IABP (1.IC.53.GQ-QL) YES YES
2 (T) Thoracic Aorta (1.IC) - Bypass (76) YES YES
2 (T) Thoracic Aorta (1.IC) - Repair (80) YES YES
2 (T) Thoracic Aorta (1.IC) - Excision with Reconstruction, Replacement (90) YES YES
2 (T) Aorta, NOS (1.ID) - Computerized Tomography (CT) (20) YES YES
2 (T) Aorta, NOS (1.ID) - Repair (80) YES YES
2 (T) Aorta, NOS (1.ID) - Excision with Reconstruction, Replacement (90) YES YES
2 (T) Coronary Arteries (1.IJ) - MRI (40) YES YES
2 (T) Coronary Arteries (1.IJ) - Drainage, Evacuation (52) YES YES
2 (T) Coronary Arteries (1.IJ) - Removal of Foreign Body (56) YES YES
2 (T) Coronary Arteries (1.IJ) - Extraction (57) YES YES
2 (T) Coronary Arteries (1.IJ) - Bypass (76) YES YES
2 (T) Coronary Arteries (1.IJ) - Debridement (87d) YES YES
2 (T) Coronary Vessels, NOS (1.IL) - Repair (80) YES YES
2 (T) Pulmonary Artery (1.IM) - Repair (80) YES YES
2 (T) Pulmonary Artery (1.IM) - Excision with Reconstruction, Replacement (90) YES YES
2 (T) Vena Cava (1.IS) - Control of Bleeding (13) YES YES
2 (T) Vena Cava (1.IS) - Repair (80) YES YES
2 (T) Carotid Artery (1.JE) - Bypass (76) YES
2 (T) Carotid Artery (1.JE) - Excision with Reconstruction, Replacement (90) YES
2 (T) Abdominal Aorta (1.KA) - Excision with Reconstruction, Replacement (90) YES
2 (T) Abdominal Aorta (1.KA) - Repair (80) YES
3 Kidney, acute tubular necrosis (ATN) ( N17.0 ) YES
3 Kidney, acute renal failure NOS ( N17.9 ) YES
3 Kidney, acute renal failure, postprocedural ( N99.0 ) YES
4 Aortic aneurysm, abdominal with rupture ( I71.1) YES
4 Aortic aneurysm, thoracic without mention of rupture ( I71.2) YES
4 Aortic aneurysm, thoracic with rupture ( I71.3) YES YES
4 Aortic aneurysm, abdominal without mention of rupture ( I71.4) YES
4 Aortic aneurysm, NOS with rupture ( I71.8) YES
4 Aortic aneurysm, NOS without mention of rupture ( I71.9) YES
4 Arterial aneurysm or dissection, NOS ( I72) YES
5 Epilepsy, or seizure in patient with known epilepsy, any type incl myoclonic ( G40) YES YES
5 Status epilepticus (any seizure type) ( G41) YES YES
5 Seizure, NOS ( R56.88) YES YES
5 Eclampsia (seizures must occur) ( O15) YES YES
5 Intracranial abscess ( G06.0) YES YES
5 Intracranial or intraspinous veins or venous sinuses, septic thromboembolism ( G08) YES YES
5 Hemorrhage, subarachnoid or ruptured cerebral aneurysm ( I60) YES YES
5 Hemorrhage, intracerebral/intracranial, nontraumatic (ICH, hemorrhagic stroke) ( I61) YES YES
5 Subdural or epidural hematoma/hemorrhage, nontraumatic ( I62) YES YES
5 Cerebral infarction/stroke due to embolism ( I63.4) YES YES
5 Cerebral infarction/stroke, NOS ( I63.9) YES YES
5 Stroke, NOS ( I64) YES YES
5 Stenosis, narrowing or occlusion of precerebral arteries ( I65) YES YES
5 Cerebral aneurysm, nonruptured ( I67.1) YES YES
5 Cerebral vasospasm ( I67.84) YES YES
5 Cerebrovascular disease, NOS ( I67.9) YES YES
5 Normal pressure hydrocephalus ( G91.2) YES YES
5 Hydrocephalus, NOS ( G91.9) YES YES
5 Brain compression, including herniation ( G93.5) YES YES
5 Cerebral edema ( G93.6) YES YES
5 Arteriovenous malformation (AVM) of cerebral vessels ( Q28.2) YES YES
5 Brain death ( G93.81) YES
6 (S00 to S99) YES YES
6 Multiple trauma ( T07) YES YES
6 Vertebra or spinal cord, level not specified/NOS, fracture, injury/trauma ( T08) YES YES
6 Upper limb (arm) bones, level not specified/NOS, fracture, injury/trauma ( T10) YES YES
6 Upper limb (arm), level not specified/NOS, open wound, injury trauma ( T11.1) YES YES
6 Upper limb (arm), level not specified/NOS, joints or ligaments, dislocation/sprain/strain, injury/trauma ( T11.2) YES YES
6 Upper limb (arm), level not specified/NOS, nerves, wound/injury/trauma ( T11.3) YES YES
6 Upper limb (arm), level not specified/NOS, blood vessels, wound/injury/trauma ( T11.4) YES YES
6 Upper limb (arm), level not specified/NOS, muscles/tendons, wound/injury/trauma ( T11.5) YES YES
6 Upper limb (arm), level not specified/NOS, amputation, injury/trauma ( T11.6) YES YES
6 Upper limb (arm), level not specified/NOS, wound/injury/trauma, NOS ( T11.9) YES YES
6 Lower limb (leg) bones, level not specified/NOS, fracture, injury/trauma ( T12) YES YES
6 Lower limb (leg), level not specified/NOS, superficial injury/trauma (minor, contusion) ( T13.0) YES YES
6 Lower limb (leg), level not specified/NOS, open wound, injury trauma ( T13.1) YES YES
6 Lower limb (leg), level not specified/NOS, joints or ligaments, dislocation/sprain/strain, injury/trauma ( T13.2) YES YES
6 Lower limb (leg), level not specified/NOS, nerves, wound/injury/trauma ( T13.3) YES YES
6 Lower limb (leg), level not specified/NOS, blood vessels, wound/injury/trauma ( T13.4) YES YES
6 Lower limb (leg), level not specified/NOS, muscles/tendons, wound/injury/trauma ( T13.5) YES YES
6 Lower limb (leg), level not specified/NOS, amputation, injury/trauma ( T13.6) YES YES
6 Lower limb (leg), level not specified/NOS, wound/injury/trauma, NOS ( T13.9) YES YES
6 Wound/injury/trauma, body region NOS ( T14.9) YES YES
7 ICP monitor (Placement of implanted, invasive intracranial pressure monitoring device) (2.AN.28.JA-PL) YES YES
8 IABP (1.IC.53.GQ-QL) YES YES
9 PD (Peritoneal dialysis) (1.PZ.21.HP-D4) YES YES
10 HD (Hemodialysis) (1.PZ.21.HQ-BR) YES
11 CRRT (incl volume removal via PRISMA device) (1.PZ.21.HQ-BS) YES

Change log for medical reason encoding

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.
    • The number of transfers is attributed to the discharging or sending or originating ICUs.
    • To another site's ICU can be any ICU at different facility.
  • For example, patients admitted at Grace ICU who are transferred to HSC MICU or STB ICMS are Transfer OUT.
    • Patients who are admitted at Grace ICU, had a procedure in other facility and then admitted to an ICU service in that or another facility are Transfer OUT.
    • Patients who are admitted at Grace ICU, had a procedure in other facility and then came back to Grace ICU are not Transfer OUT.

Transfer IN

  • 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 service.
    • 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

SAS Program

  • S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\InterfacilityReasonMed.sas - list the diagnosis (old coding and ICD10 codes) that defines a medical reason for transfer
  • S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\InterfacilityInOut.sas

Related articles

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