Transfer Ready DtTm tmp entry

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 date/time of an intent to transfer a patient to LOWER level of care 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. 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.
• EXCEPTIONS:
  • 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
  • In a ward, take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:
    • order is written to change all iv meds to po AND remove monitoring
    • patient is made ACP-C

Data Collection Instructions

• As of February 2021, there will be a transfer-ready entry for each and every boarding location. This entry takes 1 of only 2 possible forms:
  • If while in a given location the care team writes that they intend (as above) to transfer the patient to a lower level of care, then the entry is the date/time that they first indicate this intention.
  • If while in a given location the care team never writes such an intention, then instead of entering the date/time, collectors should indicate this by clicking the check box in this field.
• Thus, it is NOT true that every actual transfer to another physical location has a transfer ready date/time entered.
• And of course there should only be an actual date/time entered if the notes indicate the intent (as above) to send the patient to a LOWER level of care.
• What if a patient is clearly written as transfer-ready to a lower level, and then while in the same location he/she is written as transfer-ready to an EVEN LOWER level (e.g. home)? --- in this case there is no need to enter the 2nd of these transfer-ready events, i.e. the 1st of them suffice.
• 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/time to a LOWER level of never was indicated while in this location

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
  • 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"

If the pt doesn't change to a transfer ready state during a location stay, should the comment be "not ready"? The comment "not available" is indicated in above statement-is this inconsistent? Or is this comment intended for scenarios of never transfer ready patients moving from ER (higher acuity) to lower acuity medicine units whereby a transfer date/time is "not available"?

• SMW

• Cargo

• Categories

Matching up Boarding Locs and TrDtTms

Pam had a promising suggestion: "Or are data collectors to enter a matching count similar to combo codes?" - we could use the integer field of pairs of Transfer Ready and Boarding Locs to be able to match them. Should we do that? If you have concerns please post them here, else this will change likely when I am back from vacation early March. Ttenbergen 15:49, 2021 February 10 (CST)

• SMW

• Cargo

• Categories

Potential change

We discussed at Task that it might be easier to have different dropdowns as "item" entry instead of manually populating the comment. I think that's a good idea but wanted to give people a chance to shout "NOOOOO". So if you have concerns please post them here, else this will change likely when I am back from vacation early March. Ttenbergen 15:49, 2021 February 10 (CST) If we do this I need to also remove the automatically added item from the "Make loc" button so no one forgets to enter this. Ttenbergen 09:31, 2021 March 10 (CST)

• SMW

• Cargo

• Categories

• to make a smoother transition, is there any way for a Transfer Ready Dt/Tm line to automatically be put in when we enter a new Boarding Loc? Surbanski 12:57, 2021 February 12 (CST)
  • Implemented as of CCMDB.accdb Change Log 2021#2021-03-04: if the Boarding loc is started by clicking on a line in the Cognos Unit listing the TrDtTm line will also be added. Ttenbergen 10:48, 2021 March 4 (CST)

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.

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.
• 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.

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.

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.

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

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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