Transfer for bed management: Difference between revisions

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'''Excludes:'''

'''Excludes: transfers for repatriation'''

* '''~~not for repatriation~~''' - We ~~will not use~~ this ~~code for repatriations of patients back to their local hospitals as that~~ is standard practice

* We DEFINE bed repatriation as a transfer of back to their local hospitals '''outside of WRHA'''

* We exclude this here because repatriation is standard practice

== Additional Info ==

* This is to ~~distinguish~~ service transfers for bed management reasons (e.g. to clear a bed from ~~the~~ sending unit so it can admit a patient~~), as opposed~~ to ~~transfers~~ for ~~medical reasons (~~e.g. patient transferred ~~from~~ Grace ICU to ~~MICU because she needs dialysis)~~

* This is to identify service transfers for bed management -- as opposed to transfer for medical reasons (e.g. patient transferred from Grace ICU to HSC MICU for dialysis)

* With just one exception, this code should ~~only~~ be used if the patient is transferred from one service on which we collect, to another service on which we collect, both at the same level (e.g. ICU-ICU, or ward-ward)

**most commonly this is to clear a bed from a full sending unit so it can admit a patient

**The exception is ~~that~~ transfers ~~from~~ ward ~~to Low~~ Acuity Units (LAU) and similar location types~~, should have this code included from the sending unit~~ (Note: this is ~~being done~~ in relation to a bed management project being done by Dan and Tina).

**service transfer should also be considered to be for bed management in the more complicated situation e.g. patient started out in Grace ICU --> developed renal dysfunction --> transferred for medical necessity to ICMS for dialysis --> kidneys improved and no longer needed dialysis --> transferred back to Grace ICU -- THIS transfer back should be coded as for bed management -- i.e. patient is transferred BACK to the original service after prior transfer for medical necessity.

**So, it should NOT be used when a patient goes: ICU service to ward service; Ward service to ICU service; ED on ED service to anywhere

* '''With just one exception''', this code should ONLY be used if the patient is transferred from one service on which we collect, to another service on which we collect, both at the same level (e.g. ICU-ICU, or ward-ward)

**The exception is transfers FROM ward or ICU TO low Acuity Units (LAU) and similar location types. (Note: this is in relation to a bed management project being done by Dan and Tina). But only use this if the patient actually goes to LAU, i.e. not if patient is on the list for LAU transfer, but ends up being discharged from hospital before transfer occurs.

**So, it should NOT be used when a patient goes: ICU service to ward service; Ward service to ICU service; ICU service to IICU service; ED on ED service to anywhere

* It should be coded as:

** An [[Acquired Diagnosis]] from a collection unit that is transferring a patient out

** An [[Admit Diagnosis]] for the collection unit that is taking the patient in transfer

*** [[Dx Date]] - if available, use the date the decision to transfer for medical reasons was documented, otherwise use the [[Dispo DtTm]]

** An [[Admit Diagnosis]] from a collection unit that is accepting the patient in transfer

*** The [[Admit Diagnosis]] should not be linked with primary [[Admit Diagnosis]] but prioritized lowest.

** For any transfer, it is possible that only the sending or only the receiving unit is one where we collect, so a counterpart may or may not exist

* This code will often mean that a patient would have a [[Transfer Ready DtTm tmp entry]] before this code's [[Dx Date]] for [[Medicine records]], but not necessarily for [[Critical Care records]] since the GRA ICU has the same [[Level of care]] as the HSC and STB ICUs, only with fewer attached services.

* ~~This code will often mean~~ that a patient ~~would~~ have a [[Transfer ~~Ready DtTm tmp entry~~]] ~~before this code's~~ [[~~Dx Date~~]] for [[~~Medicine records~~]], but ~~not necessarily~~ for [[~~Critical Care records~~]] ~~since~~ the ~~GRA~~ ICU has the ~~same~~ [[~~Level of care~~]] as the ~~HSC and STB ICUs, only with fewer attached services~~.

=== Relationship between [[Intended1stSrvc]] and [[Transfer for bed management]] ===

*Keeping track of this requires remembering that ICU database records are according to ICU service, not location. Thus, when the service changes the patient gets a new ICU record, while a change of physical location with no change in ICU service is ''not'' a new record (it's just a change in [[Boarding Loc]]).

*[[Intended1stSrvc]] ''only'' applies when a patient is initially admitted to an ICU service from a non-ICU location (e.g. ED, ward) -- it DOES NOT apply to direct transfer from one ICU service to a different ICU service (i.e. ICU-to-ICU transfer). If a patient undergoes direct ICU-to-ICU transfer for bed management reasons, the sending ICU record should have [[Transfer for bed management]] as an [[Acquired Diagnosis]], while the receiving ICU record should have [[Transfer for bed management]] as an [[Admit Diagnosis]]

*[[Transfer for bed management]] only applies to direct ICU-to-ICU service transfers.

**and this is regardless of the physical location of the patient upon that transfer, e.g. a patient who is "ECIP", still physically in ED but has been officially admitted to an ICU service, can have [[Transfer for bed management]], but cannot have [[Intended1stSrvc]] because such a patient has already been admitted to an ICU service and any opportunity to code [[Intended1stSrvc]] would apply to that initial ICU record when they were admitted to that first ICU service.

*Although it IS possible for a single ICU record to include BOTH of these, they would be for ''different ends'' of the ICU record, i.e. the beginning vs. the end

**e.g. Patient with pneumonia in HSC ED is admitted to SICU on SICU service due to lack of MICU beds. So that SICU service record has [[Intended1stSrvc]]=MICU, [[Service/Location]]=SICU, and [[Boarding Loc]]=SICU . Two days later, SICU has a bed crunch and the patient is transferred to Grace ICU, so in the SICU database record [[Transfer for bed management]] is coded as an [[Acquired Diagnosis]], while the Grace ICU record will have [[Transfer for bed management]] coded as an [[Admit Diagnosis]].

== Alternate ICD10s to consider coding instead or in addition ==

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== Candidate [[Combined ICD10 codes]] ==

{{~~discuss~~ |

{{DiscussTask | JALT

* In [[Medicine records]] this will sometimes be related to [[Awaiting/delayed transfer to long-term care/PCH inside or outside of Winnipeg]] in the context of [[Paneling]] and [[Alternate Level of Care (ALC)]]. Do we want to combine these as relevant? Do we anticipate wanting to report this data, and what do we need to consider to collect it to be able to do that? [[User:Ttenbergen|Ttenbergen]] 17:37, 27 November 2025 (CST)

}}

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* which of the [[reports]]/[[indicators]] is affected by this? You were working with Bojan to get a metric.... [[User:Ttenbergen|Ttenbergen]] 17:37, 27 November 2025 (CST)

** likely [[ICU Interfacility Report]] / [[ICU Interfacility Transfer]]

**Correct. The Interfacility report presents Medical and Bed mgt reasons separately for 1) Transfers OUT from an ICU to another ICU 2) Transfers IN to an ICU from another ICU and 3) Transfers IN to an ICU from Non-ICU servicen(ER, OR, Ward, etc.) --[[User:JMojica|JMojica]] 09:39, 19 January 2026 (CST)

}}

@@ Line 6: / Line 6: @@
 {{ICD10 category|Healthcare contact}}
-'''Excludes:'''
+'''Excludes: transfers for repatriation'''
-* '''not for repatriation''' - We will not use this code for repatriations of patients back to their local hospitals as that is standard practice
+* We DEFINE bed repatriation as a transfer of back to their local hospitals '''outside of WRHA'''
+* We exclude this here because repatriation is standard practice
 == Additional Info ==
-* This is to distinguish service transfers for bed management reasons (e.g. to clear a bed from the sending unit so it can admit a patient), as opposed to transfers for medical reasons (e.g. patient transferred from Grace ICU to MICU because she needs dialysis)
+* This is to identify service transfers for bed management -- as opposed to transfer for medical reasons (e.g. patient transferred from Grace ICU to HSC MICU for dialysis)
-* With just one exception, this code should only be used if the patient is transferred from one service on which we collect, to another service on which we collect, both at the same level (e.g. ICU-ICU, or ward-ward)
+**most commonly this is to clear a bed from a full sending unit so it can admit a patient
-**The exception is that transfers from ward to Low Acuity Units (LAU) and similar location types, should have this code included from the sending unit (Note: this is being done in relation to a bed management project being done by Dan and Tina).
+**service transfer should also be considered to be for bed management in the more complicated situation e.g. patient started out in Grace ICU --> developed renal dysfunction --> transferred for medical necessity to ICMS for dialysis --> kidneys improved and no longer needed dialysis --> transferred back to Grace ICU -- THIS transfer back should be coded as for bed management -- i.e. patient is transferred BACK to the original service after prior transfer for medical necessity.
-**So, it should NOT be used when a patient goes:  ICU service to ward service; Ward service to ICU service; ED on ED service to anywhere
+* '''With just one exception''', this code should ONLY be used if the patient is transferred from one service on which we collect, to another service on which we collect, both at the same level (e.g. ICU-ICU, or ward-ward)
+**The exception is transfers FROM ward or ICU TO low Acuity Units (LAU) and similar location types.  (Note: this is in relation to a bed management project being done by Dan and Tina).  But only use this if the patient actually goes to LAU, i.e. not if patient is on the list for LAU transfer, but ends up being discharged from hospital before transfer occurs.
+**So, it should NOT be used when a patient goes:  ICU service to ward service; Ward service to ICU service; ICU service to IICU service; ED on ED service to anywhere
 * It should be coded as:
 ** An [[Acquired Diagnosis]] from a collection unit that is transferring a patient out
+** An [[Admit Diagnosis]] for the collection unit that is taking the patient in transfer
 *** [[Dx Date]] - if available, use the date the decision to transfer for medical reasons was documented, otherwise use the [[Dispo DtTm]]
-** An [[Admit Diagnosis]] from a collection unit that is accepting the patient in transfer
 *** The [[Admit Diagnosis]] should not be linked with primary [[Admit Diagnosis]] but prioritized lowest.
 ** For any transfer, it is possible that only the sending or only the receiving unit is one where we collect, so a counterpart may or may not exist
+* This code will often mean that a patient would have a [[Transfer Ready DtTm tmp entry]] before this code's [[Dx Date]] for [[Medicine records]], but not necessarily for [[Critical Care records]] since the GRA ICU has the same [[Level of care]] as the HSC and STB ICUs, only with fewer attached services.
-* This code will often mean that a patient would have a [[Transfer Ready DtTm tmp entry]] before this code's [[Dx Date]] for [[Medicine records]], but not necessarily for [[Critical Care records]] since the GRA ICU has the same [[Level of care]] as the HSC and STB ICUs, only with fewer attached services.
+=== Relationship between [[Intended1stSrvc]] and [[Transfer for bed management]] ===
+*Keeping track of this requires remembering that ICU database records are according to ICU service, not location.  Thus, when the service changes the patient gets a new ICU record, while a change of physical location with no change in ICU service is ''not'' a new record (it's just a change in [[Boarding Loc]]).
+*[[Intended1stSrvc]] ''only'' applies when a patient is initially admitted to an ICU service from a non-ICU location (e.g. ED, ward) -- it DOES NOT apply to direct transfer from one ICU service to a different ICU service (i.e. ICU-to-ICU transfer).  If a patient undergoes direct ICU-to-ICU transfer for bed management reasons, the sending ICU record should have [[Transfer for bed management]] as an [[Acquired Diagnosis]], while the receiving ICU record should have [[Transfer for bed management]] as an [[Admit Diagnosis]]
+*[[Transfer for bed management]] only applies to direct ICU-to-ICU service transfers.
+**and this is regardless of the physical location of the patient upon that transfer, e.g. a patient who is "ECIP", still physically in ED but has been officially admitted to an ICU service, can have [[Transfer for bed management]], but cannot have [[Intended1stSrvc]] because such a patient has already been admitted to an ICU service and any opportunity to code [[Intended1stSrvc]] would apply to that initial ICU record when they were admitted to that first ICU service.
+*Although it IS possible for a single ICU record to include BOTH of these, they would be for ''different ends'' of the ICU record, i.e. the beginning vs. the end
+**e.g. Patient with pneumonia in HSC ED is admitted to SICU on SICU service due to lack of MICU beds.  So that SICU service record has [[Intended1stSrvc]]=MICU, [[Service/Location]]=SICU, and [[Boarding Loc]]=SICU .  Two days later, SICU has a bed crunch and the patient is transferred to Grace ICU, so in the SICU database record [[Transfer for bed management]] is coded as an [[Acquired Diagnosis]], while the Grace ICU record will have [[Transfer for bed management]] coded as an [[Admit Diagnosis]].
 == Alternate ICD10s to consider coding instead or in addition ==
@@ Line 28: / Line 37: @@
 == Candidate [[Combined ICD10 codes]] ==
-{{discuss |
+{{DiscussTask | JALT
 * In [[Medicine records]] this will sometimes be related to [[Awaiting/delayed transfer to long-term care/PCH inside or outside of Winnipeg]] in the context of [[Paneling]] and [[Alternate Level of Care (ALC)]]. Do we want to combine these as relevant? Do we anticipate wanting to report this data, and what do we need to consider to collect it to be able to do that? [[User:Ttenbergen|Ttenbergen]] 17:37, 27 November 2025 (CST)
 }}
@@ Line 38: / Line 48: @@
 * which of the [[reports]]/[[indicators]] is affected by this? You were working with Bojan to get a metric.... [[User:Ttenbergen|Ttenbergen]] 17:37, 27 November 2025 (CST)
 ** likely [[ICU Interfacility Report]] / [[ICU Interfacility Transfer]]
+**Correct.  The Interfacility report presents Medical and Bed mgt reasons  separately  for 1) Transfers OUT from an ICU to another ICU 2) Transfers IN to an ICU from another ICU and 3) Transfers IN to an ICU from Non-ICU servicen(ER, OR, Ward, etc.) --[[User:JMojica|JMojica]] 09:39, 19 January 2026 (CST)
 }}