Transfer Ready DtTm tmp entry: Difference between revisions

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== Collection instructions ==
== Collection instructions ==
=== What is Transfer Ready ===
=== 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 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.
* 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'''.
* 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 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.
*** 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.
*EXCEPTIONS:
**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|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
***patient is made '''[[ACP C|ACP-C]]'''
***BUT in the absence of some clear indication (a discharge order, or a progress note, or one of the 2 items immediately above), do NOT try to guess at the transfer ready timing. For example, if there is no such order, and no note saying that the patient was ready to leave or ready for transfer to a lower level of care, but the patient was discharged or transferred, in this case assign the transfer ready timing as the actual [[Dispo DtTm]] or the date and time of the next [[Boarding Loc]]


See [[Level of care hierarchy]] for further information.


*Special Note regarding Transfer Ready from a ward: 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.
==== Specifically for ICU ====
**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.
'''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|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|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 ==
== Data entry instructions ==
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** Date and Time vs checkbox:  
** Date and Time vs checkbox:  
***  Collector needs to enter one of the following:
***  Collector needs to enter one of the following:
**** '''First''' Date and Time during the stay '''at this [[Boarding Loc]]''' that patient was transfer ready as per [[#What is Transfer Ready]] above; '''do not "carry forward" a transfer ready from any prior [[Boarding Loc]]'''
**** '''First''' Date and Time during the stay '''at this [[Boarding Loc]]''' that patient '''became''' transfer ready as per [[#What is Transfer Ready]] above
***** i.e. this is the '''transition''' to transfer ready, so if they arrived already transfer ready at a [[Boarding Loc]] you should ''not'' enter the start of that [[Boarding Loc]] and instead enter the date of a subsequent new first transfer ready status at this second [[Boarding Loc]]
::OR
::OR
:::* checkbox checked if the patient is not transfer ready (ie. moves to a higher level of care)
:::* 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
:: OR
:::if there is no clear [[Transfer Ready DtTm]] enter the [[Dispo DtTm]] if discharged from hospital or use the date and time of the subsequent [[Boarding Loc]] if transferred to a lower level of care.
 
{{Ex| Mr Jones went from MICU to SICU.  In MICU he was transfer ready but at no time after transfer did the team caring for him in the SICU write that he was transfer ready.  Thus he will have a transfer ready date/time from the MICU boarding loc, but not from the SICU boarding loc.}}


{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}
{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}


=== Patient doesn't become [[#Transfer Ready]] before leaving unit ===
=== Collection for each Boarding Loc ===
* 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.  
We currently only use the first entry per [[Level of care]] to calculate [[Transfer Delay]], but we collect both because:
* 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.
* 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.


=== Transfer ready to serveral different lower levels of care ===
The data during the transition period for [[PatientFollow Project]] is inconsistent, so we use all the new and the old in [[Created TransferReady query]].
* If there 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 of care, only enter the first date and time.
 
=== What if the pt ends up transferred to a higher level of care ===
'''The original {{PAGENAME}} does not change. We want the first one one only.'''
{{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.
After discussion with medicine, Allan reported back that they want the '''first medically stable'' only ([[Task Team Meeting - Rolling Agenda and Minutes 2021#ICU Database Task Group Meeting – June 15, 2021]]).
}}
 
== 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.


== 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 (Critical Care)]].
Used via [[Created_TransferReady query]] and [[Created_transferDelay table]] to generate [[Transfer Delay]] and [[Avoidable Days (Critical Care)]].


== Background ==
== Background ==

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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