Transfer Delay (Critical Care): Difference between revisions

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{{Reporting Indicators
{{Reporting Indicators
|description='''Transfer Delay''' is the difference between [[Dispo_DtTm]] and [[#Transfer Ready DtTm in use at different times]] in decimal days.
|description='''Transfer Delay''' is the difference between [[Dispo_DtTm]] and [[#Transfer Ready DtTm in use at different times]] in decimal days.
|created_raw=created
|created_raw=Created
|Program=Critical Care
|Program=Critical Care
|indicator_start_date=1999-01-15
|indicator_start_date=1999-01-15
|indicator_name=Transfer_Delay_CC
|indicator_name=Transfer_Delay_CC
|program=Critical Care and Medicine
|program=Critical Care and Medicine
}} It is stored in the [[Transfer_Delay_CC]] field in [[Created_Variables_CC_2021 table]]. There is a similar concept in medicine, [[Transfer Delay (Medicine)|Transfer Delay]].  
}}
There is a similar concept in medicine, [[Transfer Delay (Medicine)]].
 
It is stored in the [[Transfer_Delay_CC]] field in [[Created_Variables_CC_2021 table]].


== Use ==
== Use ==
* The purpose is to determine the amount of time the patient is occupying a bed in an ICU setting when the patient no longer needs that [[Level of care hierarchy| level of care]] (also referred to as wasted bed) from the [[#Transfer Ready DtTm in use at different times]] until the [[Dispo DtTm]].
* The purpose is to determine the amount of time the patient is occupying a bed in an ICU setting when the patient no longer needs that [[Level of care hierarchy| level of care]] (also referred to as wasted bed) from the [[#Transfer Ready DtTm in use at different times]] until the [[Dispo DtTm]].
== Calculation of Transfer Delay ==
*Transfer Delay is the difference between [[Dispo DtTm]] and first [[Transfer Ready DtTm]].
{{Collapsable| always=see previous definitions| full=
*As agreed in JALT meeting March 22, 2023, transfer delays will be reported based on actual delay times with no more allowances of less than n hours.
*previously, transfer delay calculation followed the national Vital Signs Monitoring program guideline which subtracted 2 hrs from all actual delay time.
*In the meeting held Jan 11, 2023, it was decided as per approval from the Critical Care Director to define transfer delays as follows: (a) ignore such transfer delays <2 hrs, but (b) for all delays >=2 hrs to use the actual delay time.
}}


== Transfer Ready DtTm in use at different times ==
== Transfer Ready DtTm in use at different times ==
===  [[Admit DtTm]] or [[Dispo DtTm]] < 2020-10-01 00:00 ===
===  [[Admit DtTm]] or [[Dispo DtTm]] < 2020-10-01 00:00 ===
* Use the DtTm in [[Transfer Ready DtTm field]]
* Use the DtTm in [[Transfer Ready DtTm field]]
==== Calculation for reporting when transfer time missing ====
Before Oct 1,2020 -The following definitions are used by Julie in reporting from SAS, and by [[centralized_data_front_end.accdb]] to calculate the created_variables query.
* if discharge time  < 1000 HR then dummy=0001 HR (12:01 am),
* else if discharge time  >=  1000 HR dummy=1000HR  (10:00 am)
This was based on [[Critical Care Vital Sign Monitor]].
This is as per approval by [[Dr. Dan Roberts]].
Starting Oct 1,2020, transfer time is always present.
{{DT|
I have not yet added this part to the query. Does this just mean that before Oct 1 2020 it was reported this way, or is it still reported this way for values from before? If the latter, would it make sense to generate these values and update the old transfer ready dttms to this? If I include it in the question this will forever run slowly. Having said that... the same is true for the other values: I use an iif function to determine if we are before or after, and functions like that are slow. Should we automatically generate transfer ready tmp entries for the old data once and then not have to worry about this again? Especially for the second part, we have nothing to lose, the data would remain the same, just stored in new place. For the first part we would change data, but if you have always reported it that way that is just as well.
**I have checked my program and the substitution applies only when the entry in the transfer ready dttm field is just date which presumably  when the entry of dt and tm are in  separate two fields.  now when the entry became in the format dttm , the substitution no longer happened. so this was a long time ago then, even before Oct 2020.    what was the entry when there is no time?  00:00??
**  if you want to do the old data once, I am OK with that.  }}


=== [[Admit DtTm]] or [[Dispo DtTm]] >= 2020-10-01 00:00 ===
=== [[Admit DtTm]] or [[Dispo DtTm]] >= 2020-10-01 00:00 ===
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== Reporting of Transfer Delays ==
== Reporting of Transfer Delays ==
*Reported as count, Mean (average), Sum (Total), and Cumulative counts and percentage
* Include all cases with transfer ready dttm  (who went to same/lower/higher level of care or died).  
*A - Determine the patients who left alive to a lower level of care in the [[Dispo field]] and
* Refer to the following indicators:
** A1 - Have  transfer delays
#[[Avoidable Days (Critical Care)|Avoidable Days]]
** A2 - Have no transfer ready dttm - assign them as zero transfer delay
#[[Beds occupied by transferrable patients (Critical Care)|Beds occupied by transferrable patients]]
** Total True delays = Transfer delays from A1 +  zeroes from A2 ;  Total N = A1 + A2; Average True Delays=Total True Delays / Total N
** Total transfer delays > 2 hours  - sum up those patients from A1 but excluding those with transfer delays <= 2 hours  and compute the Average.
** Distribution of true transfer delays - counts, cumulative counts and percentage
***zero
***<= 4 hours
***>4h - 12h
***>12h - 1d
***>1d - 2d
***>2d - 3d
***>3d - 7d
***>10d - 14d
***>10d
 
*B - Determine and report the number of patients with transfer delays who had left alive and went to same level of care in the [[Dispo field]] .
*C - Determine and report the number of patients with transfer delays who died in the [[Dispo field]] before going anywhere.


== IICU and H6 Reporting ==
== IICU and H6 Reporting ==
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# to HSC IICU/H6, and  
# to HSC IICU/H6, and  
# to other wards/Home (including nursing home/long term care facility)  
# to other wards/Home (including nursing home/long term care facility)  
The [[Dispo]] location will be used to define the destination. As per Dr. Garland & Dr. Paunovic.
{{DJ |
* ''The [[Dispo]] location will be used to define the destination. As per Dr. Garland & Dr. Paunovic.
** I think we discussed at Task that we will do this differently now... right?
}}
 
{{DJ |
* The above is really about stratification, and not the indicator itself. Do you really only use it to stratify delays, or do you also report other indicators such as Length of Stay with it. Even if it is single-use, I think we should probably treat any generated value we use to stratify pretty much as we do Indicators, possibly using the same templates on the wiki. The stratification affects averages and totals, so it needs to be transparent. This is likely a can of worms because there must be much stratification in the reports. [[User:Ttenbergen|Ttenbergen]] 14:50, 7 December 2025 (CST)
 
}}


==SAS Program==
==SAS Program==
*S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\logphi_TR.sas
*S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\logphi_TR_Jan2023.sas
**  macro %CC_tready
**  macro %CC_tready
*S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas  (macro %boardtransf)
*S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas  (macro %boardtransf)


== Data use ==
== Data use ==
* [[Transfer Delay (Critical Care)|Transfer Delay]]
* [[Avoidable Days (Critical Care)]]
* [[Avoidable Days (Critical Care)]]
* [[Beds occupied by transferrable patients (Critical Care)|Beds occupied by transferrable patients]]
* [[Beds occupied by transferrable patients (Critical Care)|Beds occupied by transferrable patients]]