Transfer Ready DtTm tmp entry: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 25: | Line 25: | ||
* The purpose is to determine the amount of time the patient is occupying a bed in an ICU or an IICU or a High Observation ward or a regular ward setting when the patient is no longer needing that level of care (also refer as wasted bed) from the transfer order date time until the discharge date time. | * The purpose is to determine the amount of time the patient is occupying a bed in an ICU or an IICU or a High Observation ward or a regular ward setting when the patient is no longer needing that level of care (also refer as wasted bed) from the transfer order date time until the discharge date time. | ||
* if the patient moves to various locations, the '''first''' transfer ready date time from the '''same''' level of care will be used. | * if the patient moves to various locations, the '''first''' transfer ready date time from the '''same''' level of care will be used. | ||
** For example, a Med patient stays in high obs bed and then move to regular ward bed and then another regular ward bed. There are two levels of care - one for high obs and another which is lower, for the regular ward. At least two transfer ready dttm intent are expected here - first intent for high obs ready to go to a regular ward and the second intent is from a regular ward to be discharged to another lower level of care or home or PCH. Assuming that there are transfer orders both at regular ward 1 and regular ward2 and both are with same level of care, the first transfer date time will be used in calculating the wasted bed for that lower level of care. There will be another wasted bed to be calculated for the high Obs level of care from the time of transfer order to the time the patient left the high obs bed. The sum of the two scenarios will be the total wasted bed for that patient. | ** For example, a Med patient stays in high obs bed and then move to regular ward bed and then another regular ward bed. There are two levels of care - one for high obs and another which is lower, for the regular ward. At least two transfer ready dttm intent are expected here - first intent for high obs ready to go to a regular ward and the second intent is from a regular ward to be discharged to another lower level of care or home or PCH. Assuming that there are transfer orders both at regular ward 1 and regular ward2 and both are with same level of care, the first transfer date time will be used in calculating the wasted bed for that lower level of care. There will be another wasted bed to be calculated for the high Obs level of care from the time of transfer order to the time the patient left the high obs bed. The sum of the two scenarios will be the total wasted bed for that patient. | ||
** if the Med patient stays in more than one regular wards (or boarding location) or a CC patient stays in more than one ICU location (or boarding ICU location), all locations are considered with the same level of care, the wasted bed is calculated from the first transfer ready dttm until dispo dttm. | |||
== Data entry instructions == | == Data entry instructions == | ||
Revision as of 15:00, 2021 May 5
| Projects | |
| Active?: | active |
| Program: | CC and Med |
| Requestor: | internal |
| Collection start: | 2020-10-15 |
| Collection end: | |
Collection instructions
What is 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.
- In particular, when a ward patient is transferred (e.g. home) without any notes stating the team’s intention to do so in advance or even an order to discharge, collectors should not attempt to make educated guesses from the notes of when the patient was probably clinically ready to leave.
- 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:
- 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
- BUT in the absence of some clear indication (a discharge order, or a progress note, or one of the 2 items immediately above), do NOT try to guess at the transfer ready timing. For example, if there is no such order, and no note saying that the patient was ready to leave, but the patient was discharged, in this case assign the transfer ready timing as the actual discharge timing.
Use of Transfer Ready Date and Time
- The purpose is to determine the amount of time the patient is occupying a bed in an ICU or an IICU or a High Observation ward or a regular ward setting when the patient is no longer needing that level of care (also refer as wasted bed) from the transfer order date time until the discharge date time.
- if the patient moves to various locations, the first transfer ready date time from the same level of care will be used.
- For example, a Med patient stays in high obs bed and then move to regular ward bed and then another regular ward bed. There are two levels of care - one for high obs and another which is lower, for the regular ward. At least two transfer ready dttm intent are expected here - first intent for high obs ready to go to a regular ward and the second intent is from a regular ward to be discharged to another lower level of care or home or PCH. Assuming that there are transfer orders both at regular ward 1 and regular ward2 and both are with same level of care, the first transfer date time will be used in calculating the wasted bed for that lower level of care. There will be another wasted bed to be calculated for the high Obs level of care from the time of transfer order to the time the patient left the high obs bed. The sum of the two scenarios will be the total wasted bed for that patient.
- if the Med patient stays in more than one regular wards (or boarding location) or a CC patient stays in more than one ICU location (or boarding ICU location), all locations are considered with the same level of care, the wasted bed is calculated from the first transfer ready dttm until dispo dttm.
Data entry instructions
- A "Transfer Ready" line is automatically entered for each Boarding Loc entry.
- Project: Transfer Ready DtTm
- Item: Transfer Ready DtTm
- Collector needs to enter one of the following:
- First Date and Time during the stay at this Boarding Loc that patient was transfer ready as per #What is Transfer Ready above
- OR
- checkbox checked that a transfer ready status was never documented for this patient while at this Boarding Loc
Combining Transfer Ready DtTm tmp entry and Boarding Loc records
- There needs to be one Transfer Ready DtTm tmp entry for each Boarding Loc and vice versa. To mark which entries belong together, use the same integer number in the "combiner" field in Patient Viewer Tab Cognos ADT2 for both records and in sequential order according to Boarding start_dt and start_tm. The presence of matching records is validated by query s_tmp_check_combined_Boarding_Loc_and_TransferReadyDtTm, and their sequential status by query s_tmp_check_combined_BL_and_TRDtTm_nonsequential.
- the integer number should be entered at the time that the paired Boarding Loc and Transfer Ready DtTm tmp entry are entered, as Julie uses this data early to report on
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.
Transfer ready to serveral different lower levels of care
- If there 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 of care, only enter the first date and time.
What if the pt ends up transferred to a higher level of care
The original 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. |
Start DtTm/Legacy
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.
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)
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.