Transfer Ready DtTm tmp entry: Difference between revisions

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|ProjectActive=active
|ProjectActive=active
|ProjectProgram=CC and Med
|ProjectProgram=CC and Med
|ProjectRequestor=internal  
|ProjectRequestor=internal
|ProjectCollectionStartDate=2020-10-15
|ProjectCollectionStartDate=2020-10-15
|Project=Transfer Ready DtTm tmp entry
|Project=Transfer Ready DtTm tmp entry
}}
}}


=== Transfer Ready ===
== Collection instructions ==
The status of "transfer ready" is about the time of an '''intent''' to move a patient to level of care that is lower in the [[Level of care hierarchy]] if there was an available bed there. Whether or not the patient actually moves does not matter, just that at some point there was an intent to move the pt.
=== 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.


Obviously we don't always know the team's ''intentions'', but if they do write them down, then '''use that info'''.
See [[Level of care hierarchy]] for further information.


Some considerations:
==== Specifically for ICU ====
*The phrase '''"medically stable"'' could mean that the person is improved enough to go elsewhere, but it '''does not''' necessarily mean that.  For example it could technically indicate that the condition is not changing lately, which may or may ''not'' mean that they're ready to go elsewhere.
'''In an ICU''', take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:
**Thus, by itself that phrase cannot be used alone to suggest the patient is transfer ready
* Care is stepped down to '''ward frequency''' (q4hrs or less) of vitals AND off '''all''' forms of life support except possibly intermittent dialysis
{{Ex |
* [[HSC_IICU]] consult is written  
*e.g. Deconditioned patient may be medically stable but intention can be to leave them where they are for now to re-condition
* patient is made '''[[ACP C|ACP-C]]'''
*e.g. Patient is medically stable but still needs a sitter --> another situation in which just being "medically stable" isn't sufficient to tell us if they're transfer ready
* 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
*In an '''ICU setting''', you can take the following to indirectly indicate transfer ready to a lower level of care when nothing has been written:
* 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]]
**care is stepped down to '''ward frequency''' (q4hrs or less) of vitals, off '''all''' forms of life support except possibly intermittent dialysis
**[[HSC_IICU]] consult is written  
*In a '''ward setting''', you can take the following to indirectly indicate transfer ready to a lower level of care when nothing has been written:
**care is stepped down to change iv meds to po, remove monitoring
*In either '''ICU or ward setting''' being made '''[[ACP C|ACP-C]]''' can be taken as indirect evidence of being transfer ready.
 
Question moved here from [[Level of care hierarchy]]:
{{Discuss| Transfers from ER to a medicine unit usually depend upon bed availability on a medicine unit and not whether the patient is "transfer ready" The tmp entry will almost always (there are exceptions) be "not available" with check box per wiki instructions. Should the comment be "not ready" for patients transferring from the ER location? }}
 
==== What if the pt ends up transferred to a higher level of care ====
'''The original transfer {{PAGENAME}} does not change. '''
{{Collapsable
| always= Expand for details why
| full= 
It might '''seem''' that a patient who was transfer ready but then moves to a higher level of care should be excluded, since they did not actually get transferred to a lower level of care. However, when the patient was deemed transfer ready, additional time in the ward was "wasted time" - if we could have sent them elsewhere we would have. If the patient later crashes, that doesn't make it not-wasted time - they could have crashed anywhere. So the interpretation that a pt moving to a higher level of care after transfer ready is not wasted time is not right. We discussed this repeatedly at task and steering meetings. The only way this makes sense is if it is done by intent.
}}
 
== Data Collection Instructions ==
For '''each [[Boarding Loc]]'''  entry (incl the original ER one, if present), enter the following:
* Project: '''Transfer Ready DtTm'''
* Item: '''Transfer Ready DtTm'''  
* Transfer Ready Date: Date as defined in section [[#Transfer Ready]] above
* Transfer Ready Time: Time as defined in section [[#Transfer Ready]] above
* checkbox: '''to be checked only if a transfer ready date never became available'''
* comment (under 'q'):
** '''only if TR date not available (ie if checkbox checked), enter
*** "not ready" if left location still not transfer ready
*** "not available" unclear from chart if pt was transfer ready
 
{{DiscussTask |
Below it had said "Enter "not available" if any of the following: ...  arrived transfer ready" - is that really as intended? Wouldn't we enter the TRDT as the Boarding Loc time instead in that case?
}}
 
{{DiscussTask |
* Should "not available" be used when the pt was ready but the time is not clear, or only when no transfer ready status was indicated? What is the use case for that entry? [[User:Ttenbergen|Ttenbergen]] 09:31, 2021 February 10 (CST)
}}
 
=== initial pre-entered record ===
A first entry is added automatically to each new patient entered on the laptop.


The first time the patient becomes [[#Transfer Ready]], enter the date and time into this pre-entered record.  
====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]]'''
* 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


=== additional records if there are additional [[Boarding Loc]]s ===
* The discharge medication reconciliation form should NOT be used as transfer ready date and time.
For '''every''' additional [[Boarding Loc]] (whether it is at different [[Level of care hierarchy]] or not):
* leave the original line as is
* enter a new {{PAGENAME}}
** if the pt '''changes''' from ''not'' being [[#Transfer Ready]] to being [[#Transfer Ready]] during the stay at that [[Boarding Loc]] enter that dttm
** if the pt ''doesn't change '''to''' [[#Transfer Ready]] state'', enter the checkbox and "not available"


=== Patient arrives transfer ready ===
* '''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.
If a patient at any [[Boarding Loc]] and is already [[#Transfer Ready]] enter the same date into [[Transfer Ready DtTm field]] as the time of the respective [[Boarding Loc]] entry.
* 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


==== Patient doesn't become [[#Transfer Ready]] before leaving unit ====
== Data entry instructions ==
If pt never becomes [[#Transfer Ready]], check the checkbox to say so. This is so we can be sure the entry wasn't just forgotten.
* 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


Enter either "not ready" or "not available" into the comment field so we know how to interpret the entry.
{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}


'''Don't check this until the patients actually leaves that [[Boarding Loc]] (either to a next one or to [[Dispo]]) and you are sure a date never became available.
=== 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.


=== Status changing back and forth while on same [[Boarding Loc]] ===
== Start DtTm/Legacy ==
If a patient changes from being transfer ready back to not being transfer ready, collect the '''first''' time they are [[#Transfer Ready]] at a given [[Boarding Loc]]. If they become no longer transfer ready, leave it alone, and if they become transfer ready again at the same level of care, retain only the original Transfer Ready DtTm for that level.  
We used the old [[Transfer Ready DtTm field]] '''for transfer ready dttms''' before 2020-10-15, and use this new entry for dttms after.


== Start DtTm ==
The data during the transition period for [[PatientFollow Project]] is inconsistent, so we use all the new and the old in [[Created TransferReady query]].
We used the old [[Transfer Ready DtTm]] field '''for transfer ready dttms''' before 2020-10-15, and use this new entry for dttms after.


== Data Use / Purpose ==
== Data Use / Purpose ==
Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.
Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.


Used to generate [[Transfer_Delay]] and [[Avoidable Days in ICU]].
Used via [[Created_TransferReady query]] and [[Created_transferDelay table]] to generate [[Transfer Delay]] and [[Avoidable Days (Critical Care)]].
 
=== How will these be matched with [[Boarding Loc]] entries, is additional data needed? ===
We will determine each [[Boarding Loc]]'s [[Level of care hierarchy]] using the [[s_level_of_care table]]. Depending on data needs we will then be able to provide [[Transfer Delay]] either by unit or by [[Level of care hierarchy | level of care]]. To provide it by level of care we would choose the first dttm after (or at) arrival to the first [[Boarding Loc]] at a given level of care.


== Background ==
== Background ==
Line 97: Line 72:


{{Data Integrity Check List}}
{{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 ==
== Legacy ==
Line 110: Line 88:
[[Category:Data Collection Guide]]
[[Category:Data Collection Guide]]
[[Category:Admit/Discharge]]
[[Category:Admit/Discharge]]
[[Category:End-of-life related data]]

Latest revision as of 19:28, 2024 November 16

Projects
Active?: active
Program: CC and Med
Requestor: internal
Collection start: 2020-10-15
Collection end:

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
  • 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
  • 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:
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

Combining Transfer Ready DtTm tmp entry and Boarding Loc records

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).

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 Checks (automatic list)

 AppStatus
Query check ICD10 needs awaiting if TR Dt and Dispo Dt on diff daysCCMDB.accdbdeclined
Query check TISS each dayCCMDB.accdbdeclined
Query check ICD10 awaiting has Transfer Ready DtTmCCMDB.accdbimplemented
Query check transfer DtTm during admissionCCMDB.accdbimplemented
Query check has transfer ready date or checkboxCCMDB.accdbimplemented
Query s tmp check combined Boarding Loc and TransferReadyDtTmCCMDB.accdbimplemented
Query s tmp check Boarding Loc and TransferReadyDtTm pairsCCMDB.accdbimplemented
Query check Transfer DtTm after paired BL and before later BLCCMDB.accdbimplemented
Query Check BL TR combiner nullCCMDB.accdbimplemented
Query check tmp 2 BL TR S same tmCCMDB.accdbimplemented
Query check long transfer delayCCMDB.accdbneeds review
Function Validate Transfer Ready DtTmCCMDB.accdbretired
Function Transfer Ready DtTm vs statusCCMDB.accdbretired
Query check transfer ready tmp for each Boarding LocCCMDB.accdbretired
Query check tmp Transfer Ready not before Boarding LocCCMDB.accdbretired
Query s tmp check combined BL and TRDtTm nonsequentialCCMDB.accdbretired

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:
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