Transfer Ready DtTm tmp entry: Difference between revisions

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Allan, Julie and Tina met to discuss this and settle the inconsistencies in these instructions. Please read and change how you enter these, and as always, ask questions on wiki as they come up.
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|Project=Transfer Ready DtTm tmp entry
|Project=Transfer Ready DtTm tmp entry
}}
}}
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 ===
=== 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.
The status of "transfer ready" 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'''.
Obviously we don't always know the team's ''intentions'', but if they do write them down, then '''use that info'''.
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==== What if the pt ends up transferred to a higher level of care ====
==== 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.  
'''The original transfer {{PAGENAME}} does not change. '''
 
{{Collapsable
==== Purpose ====
| always= Expand for details why
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]].
| 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.  
}}


== Data Collection Instructions ==
== Data Collection Instructions ==
*Use tmp fields:
For '''each [[Boarding Loc]]'''  entry (incl the original ER one, if present), enter the following:  
** Project: '''Transfer Ready DtTm'''
* Project: '''Transfer Ready DtTm'''
** Item: '''Transfer Ready DtTm'''  
* Item: '''Transfer Ready DtTm'''  
** Transfer Ready Date: Date as defined in [[Transfer Ready DtTm]], under column E.
* Transfer Ready Date: Date as defined in section [[#Transfer Ready]] above
** Transfer Ready Time: Time as defined in [[Transfer Ready DtTm]], under column M.
* Transfer Ready Time: Time as defined in section [[#Transfer Ready]] above
** checkbox: '''to be checked only if a transfer ready date never became available'''
* 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.
* 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 ===
=== initial pre-entered record ===
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=== additional records if there are additional [[Boarding Loc]]s ===
=== additional records if there are additional [[Boarding Loc]]s ===
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:  
For '''every''' additional [[Boarding Loc]] (whether it is at different [[Level of care hierarchy]] or not):  
* leave the original line as is
* leave the original line as is
* enter a new {{PAGENAME}}, 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
* enter a new {{PAGENAME}}
** if the pt '''changes''' from ''not'' being [[#Transfer Ready]] to being [[#Transfer Ready]] during the stay at that [[Boarding Loc]] enter that dttm
** if the pt ''doesn't change '''to''' [[#Transfer Ready]] state'', enter the checkbox and "not available"
{{Ex |
Enter "not available" if any of the following:
* arrived transfer ready
* left location still not transfer ready
}}


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.
=== Patient arrives transfer ready ===
{{Discuss| who = Julie |
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.
* 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)}}


==== pt doesn't become [[#Transfer Ready]] before leaving unit ====
==== Patient 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.  
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.
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.
'''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.


=== Patient arrives transfer ready ===
=== Status changing back and forth while on same [[Boarding Loc]] ===
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.
If a patient changes from being transfer ready back to not being transfer ready, collect the '''first''' time they are [[#Transfer Ready]] at a given [[Boarding Loc]]. 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.  
 
=== 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 hierarchy|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? ===
=== How will these be matched with [[Boarding Loc]] entries, is additional data needed? ===
{{Discuss | who = Julie |
We will determine each [[Boarding Loc]]'s [[Level of care hierarchy]] using the [[s_level_of_care table]]. Depending on data needs we will then be able to provide [[Transfer Delay]] either by unit or by [[Level of care hierarchy | level of care]]. To provide it by level of care we would choose the first dttm after (or at) arrival to the first [[Boarding Loc]] at a given level of care. 
* 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? [[User:Lkaita|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. [[User:Ttenbergen|Ttenbergen]] 15:58, 2021 January 21 (CST) }}


== Transition to this way of entering transfer ready status ==
== Start DtTm ==
Use the old [[Transfer Ready DtTm]] field '''for transfer ready dttms''' before 2020-10-15, and use this new entry for dttms after.
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 Integrity Check List}}
== Data Use / Purpose ==
 
== Data Use ==
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]], see [[Transfer_Delay#data use]].
Used to generate [[Transfer_Delay]] and [[Avoidable Days in ICU]].


== SAS Program ==
== SAS Program ==


== Background ==
== 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 Check List}}
== Legacy ==
== 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.
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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==Related articles ==
==Related articles ==
{{Related Articles}}
{{Related Articles}}


[[Category:Transfer Ready| *]]
[[Category:Transfer Ready| *]]

Revision as of 14:20, 2021 February 4

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

Transfer Ready

The status of "transfer ready" 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

The original transfer Transfer Ready DtTm tmp entry does not change.

Expand for details why   

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.

Data Collection Instructions

For each Boarding Loc entry (incl the original ER one, if present), enter the following:

  • Project: Transfer Ready DtTm
  • Item: Transfer Ready DtTm
  • Transfer Ready Date: Date as defined in section #Transfer Ready above
  • Transfer Ready Time: Time as defined in section #Transfer Ready above
  • 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

For every additional Boarding Loc (whether it is at different Level of care hierarchy or not):

  • leave the original line as is
  • enter a new Transfer Ready DtTm tmp entry
Example:   

Enter "not available" if any of the following:

  • arrived transfer ready
  • left location still not transfer ready

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.

Patient 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 leaves that Boarding Loc (either to a next one or to Dispo) and you are sure a date never became available.

Status changing back and forth while on same Boarding Loc

If a patient changes from being transfer ready back to not being transfer ready, collect the first time they are #Transfer Ready at a given Boarding Loc. 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.

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

We will determine each Boarding Loc's Level of care hierarchy using the s_level_of_care table. Depending on data needs we will then be able to provide Transfer Delay either by unit or by level of care. To provide it by level of care we would choose the first dttm after (or at) arrival to the first Boarding Loc at a given level of care.

Start DtTm

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

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 in ICU.

SAS Program

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

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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