Transfer Ready DtTm tmp entry

Projects
Active?:	active
Program:	CC and Med
Requestor:	internal
Collection start:	2020-10-15
Collection end:

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.

Transfer Ready

This entry is about the time of an intent to move a patient to level of care that is lower 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.

Obviously we don't always know the team's intentions, but if they do write them down, then use that info.

Some considerations:

• The phrase "medically stable" could mean that the person is improved enough to go elsewhere, but it does not' necessarily mean that. For example it could technically indicate that the condition is not changing lately, which may or may not mean that they're ready to go elsewhere.
  • Thus, by itself that phrase cannot be used alone to suggest the patient is transfer ready

Example:

e.g. Deconditioned patient may be medically stable but intention can be to leave them where they are for now to re-condition e.g. Patient is medically stable but still needs a sitter --> another situation in which just being "medically stable" isn't sufficient to tell us if they're transfer ready

• In an ICU setting, you can take the following to indirectly indicate transfer ready to a lower level of care when nothing has been written:
  • care is stepped down to ward frequency (q4hrs or less) of vitals, off all forms of life support except possibly intermittent dialysis
  • HSC_IICU consult is written
• In a ward setting, you can take the following to indirectly indicate transfer ready to a lower level of care when nothing has been written:
  • care is stepped down to change iv meds to po, remove monitoring
• In either ICU or ward setting being made ACP-C can be taken as indirect evidence of being transfer ready.

What if the pt ends up transferred to a higher level of care

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.

Purpose

The purpose is to determine the avoidable days or bed wasted by patients who are deemed ready to leave the unit or ward and then either move to a lower level of care or leave the hospital. This is used as part of the concept Avoidable Days in ICU.

Data Collection Instructions

• Use tmp fields:
  • Project: Transfer Ready DtTm
  • Item: Transfer Ready DtTm
  • Transfer Ready Date: Date as defined in Transfer Ready DtTm, under column E.
  • Transfer Ready Time: Time as defined in Transfer Ready DtTm, under column M.
  • checkbox: to be checked only if a transfer ready date never became available
  • comment (under 'q'): only if TR date not available (ie if checkbox checked), enter either "not ready" or "not available" into the comment field.

initial pre-entered record

A first entry is added automatically to each new patient entered on the laptop.

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 Locs

If, after this initial entry, the patient moves to a physical location (ie new entry in Boarding Loc that has a different level in the Level of care hierarchy, then:

• leave the original line as is
• enter a new Transfer Ready DtTm tmp entry, either without a date (for now), or if a new transfer ready date from the new level of care is known by the time you enter this, enter the new date and time

We do not need a new record for every move, just for moves to a higher or lower level in the Level of care hierarchy. We need this for moves to a higher level as well because once a patient actually moves to a higher level of care, the original determination that they were transfer ready almost certainly is no longer valid.

How about the original ER entry - that is a high level of care location, but would we expect someone to become transfer ready there and then still move to the ward? Probably not. I'd say no entry for that part, but should see what Julie has to say. Ttenbergen 15:16, 2020 October 16 (CDT)

• SMW

• Cargo

• Categories

pt 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.

Enter either "not ready" or "not available" into the comment field so we know how to interpret the entry.

Don't check this until the patients actually moves to a unit with a different level of care (either stays in your collection or not) and you are sure a date never became available.

Patient arrives transfer ready

If a patient at any Boarding Loc and is already #Transfer Ready enter the same date into Transfer Ready DtTm field as the time of the respective Boarding Loc entry.

Status changing back and forth

If a patient changes from being transfer ready back to not being transfer ready, collect the first time they are transfer ready on their current level of care. If they become no longer transfer ready, leave it alone, and if they become transfer ready again at the same level of care, retain only the original Transfer Ready DtTm for that level.

If the patient moves to a different (higher or lower) level of care, then enter an additional Transfer Ready DtTm tmp entry.

How will these be matched with Boarding Loc entries, is additional data needed?

Should we be entering a date/TM for every entry? the reason I ask is because if we check off B and put not transfer ready in column Q, we often have multiple entries, How will Julie know which boarding LOC is associated with each transfer ready entry without a date? Lisa Kaita 10:14, 2020 October 20 (CDT) You could only enter a date if they were transfer ready, so Julie would still not be able to link unready ones. And maybe that's OK, since unready ones wouldn't contribute to wasted beds. But we need to ask Julie. Ttenbergen 15:58, 2021 January 21 (CST)

• SMW

• Cargo

• Categories

Transition to this way of entering transfer ready status

Use the old Transfer Ready DtTm field for transfer ready dttms before 2020-10-15, and use this new entry for dttms after.

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

Data Use

Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.

Used to generate Transfer_Delay, see Transfer_Delay#data use.

SAS Program

Background

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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