Transfer Ready DtTm tmp entry: Difference between revisions

|ProjectRequestor=internal  

=== 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 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. 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 below, only consider a clearly written intent that the team now desires the patient to be transferred to such a lower level of care.   

**Do not overinterpret what the team writes, e.g. do not code this if they just write "medically stable" but do not also indicate the actual desire/intent to transfer the patient.

**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

***patient is made '''[[ACP C|ACP-C]]'''

**In a ward, take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:

***order is written to change all iv meds to po AND remove monitoring

=== Matching up Boarding Locs and TrDtTms ===

{{DiscussTask |

* Pam had a promising suggestion: "Or are data collectors to enter a matching count similar to combo codes?" - we could use the integer field of pairs of Transfer Ready and Boarding Locs to be able to match them. Should we do that? If you have concerns please post them here, else this will change likely when I am back from vacation early March. [[User:Ttenbergen|Ttenbergen]] 15:49, 2021 February 10 (CST)

=== Potential change ===

* We discussed at [[Task Team Meeting - Rolling Agenda and Minutes|Task]] that it might be easier to have different dropdowns as "item" entry instead of manually populating the comment. I think that's a good idea but wanted to give people a chance to shout "NOOOOO". So if you have concerns please post them here, else this will change likely when I am back from vacation early March. [[User:Ttenbergen|Ttenbergen]] 15:49, 2021 February 10 (CST)

**'''If we do this I need to also remove the automatically added item from the [["Make loc" button]] so no one forgets to enter this. [[User:Ttenbergen|Ttenbergen]] 09:31, 2021 March 10 (CST)

* to make a smoother transition, is there any way for a Transfer Ready Dt/Tm line to automatically be put in when we enter a new Boarding Loc? [[User:Surbanski|Surbanski]] 12:57, 2021 February 12 (CST)

** Implemented as of [[CCMDB.accdb Change Log 2021#2021-03-04]]:  if the Boarding loc is started by clicking on a line in the Cognos Unit listing the TrDtTm line will also be added. [[User:Ttenbergen|Ttenbergen]] 10:48, 2021 March 4 (CST)

'''The original transfer {{PAGENAME}} does not change. '''

| always= Expand for details why

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 ==

*As of February 2021, there will be a transfer-ready entry for each and every boarding location. This entry takes 1 of 2 possible forms:

**If while in a given location the care team writes that they intend (as above) to transfer the patient to a lower level of care, then the entry is the date/time that they first indicate this intention.

**If while in a given location the care team never writes such an intention, then instead of entering the date/time, collectors should indicate this by clicking the check box in this field.

*Thus, it is NOT true that every actual transfer to another physical location has a transfer ready date/time entered.

*And of course there should only be an actual date/time entered if the notes indicate the intent (as above) to send the patient to a LOWER level of care.

*What if a patient is clearly written as transfer-ready to a lower level, and then while in the same location he/she is written as transfer-ready to an EVEN LOWER level (e.g. home)? --- in this case there is no need to enter the 2nd of these transfer-ready events, i.e. the 1st of them suffice.

*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'''

***'''only if TR date not available (ie if checkbox checked), enter

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

=== additional records if there are additional [[Boarding Loc]]s ===

For '''every''' additional [[Boarding Loc]] (whether it is at different [[Level of care hierarchy]] or not):

** 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"

{{Discuss| If the pt doesn't change to a transfer ready state during a location stay, should the comment be "not ready"? The comment "not available" is indicated in above statement-is this inconsistent? Or is this comment intended for scenarios of never transfer ready patients moving from ER (higher acuity) to lower acuity medicine units whereby a transfer date/time is "not available"? }}

==== Patient doesn't become [[#Transfer Ready]] before leaving unit ====

*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.

*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.

We used the old [[Transfer Ready DtTm]] field '''for transfer ready dttms''' before 2020-10-15, and use this new entry for dttms after.

Used to generate [[Transfer_Delay]] and [[Avoidable Days in ICU]].

=== 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.