Transfer Ready DtTm tmp entry

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:
      • 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

Combining Transfer Ready DtTm tmp entry and Boarding Loc records

• There needs to be one Transfer Ready DtTm tmp entry for each Boarding Loc and vice versa. To mark which entries belong together, use the same integer number in the "combiner" field in Patient Viewer Tab Cognos ADT2 for both records and in sequential order according to Boarding start_dt and start_tm. The presence of matching records is validated by query s_tmp_check_combined_Boarding_Loc_and_TransferReadyDtTm, and their sequential status by query s_tmp_check_combined_BL_and_TRDtTm_nonsequential.
• the integer number should be entered at the time that the paired Boarding Loc and Transfer Ready DtTm tmp entry are entered, as Julie uses this data early to report on

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)

	App	Status
Query check ICD10 needs awaiting if TR Dt and Dispo Dt on diff days	CCMDB.accdb	declined
Query check TISS each day	CCMDB.accdb	declined
Query check ICD10 awaiting has Transfer Ready DtTm	CCMDB.accdb	implemented
Query check transfer DtTm during admission	CCMDB.accdb	implemented
Query check has transfer ready date or checkbox	CCMDB.accdb	implemented
Query s tmp check combined Boarding Loc and TransferReadyDtTm	CCMDB.accdb	implemented
Query s tmp check Boarding Loc and TransferReadyDtTm pairs	CCMDB.accdb	implemented
Query check Transfer DtTm after paired BL and before later BL	CCMDB.accdb	implemented
Query Check BL TR combiner null	CCMDB.accdb	implemented
Query check tmp 2 BL TR S same tm	CCMDB.accdb	implemented
Query check long transfer delay	CCMDB.accdb	needs review
Function Validate Transfer Ready DtTm	CCMDB.accdb	retired
Function Transfer Ready DtTm vs status	CCMDB.accdb	retired
Query check transfer ready tmp for each Boarding Loc	CCMDB.accdb	retired
Query check tmp Transfer Ready not before Boarding Loc	CCMDB.accdb	retired
Query s tmp check combined BL and TRDtTm nonsequential	CCMDB.accdb	retired

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.

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