Transfer Ready DtTm tmp entry: Difference between revisions

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== 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.

* 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 a bed available. 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'''.

* 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 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 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.

~~{{DA| We need a consistent approach to how we handle~~ the following ~~scenarios: We can assume that in all scenarios there is no other clear documentation.~~

====Exceptions====

*1. Discharge order, or a ~~progress note~~ written ~~with date but no time. (either same day of discharge or day prior)~~

'''In an ICU''', take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:

*~~2. Discharge order written with date and time, but the order~~ is to ~~discharge the following day or on a specific date~~ (~~reasons for the delay are some times clearly documented,ie.if they are waiting for homecare services~~ or ~~transportation etc~~)~~, or discharge post last dose IV ABX, discharge after~~ dialysis.

* care is stepped down to '''ward frequency''' (q4hrs or less) of vitals AND off '''all''' forms of life support except possibly intermittent dialysis

*This is likely not an issue at SBGH because their notes would be automatically date and time stamped. At HSC when there is an order without a time for the day of discharge, we generally use 1000 as the time, as rounds happen between 9-1100, or should we just use the dispo date and time? For those orders that are written the day prior and the reason is waiting for services or transportation we would use the date the order is written ~~with the time 1000, for those that are waiting for medical treatments we use the dispo date and time. We also investigate, so that if the prior order~~ is ~~date and time stamped well after 1000, then we obviously cannot use the 1000 so we would use the dispo date and time. }}~~

* [[HSC_IICU]] consult is written

'''~~EXCEPTIONS:~~'''

* patient is made '''[[ACP C|ACP-C]]'''

~~'''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|ACP-C]]'''

'''On a medicine 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

* order is written to change all iv meds to po AND remove monitoring

*patient is made '''[[ACP C|ACP-C]]'''

* patient is made '''[[ACP C|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 or ready for transfer to a lower level of care, but the patient was discharged or transferred, in this case assign the transfer ready timing as the actual [[Dispo DtTm]] or the date and time of the next [[Boarding Loc]]

** for '''lateral moves''' ie. acute medicine ward to another medicine ward, or ICU to ICU there would be no [[Transfer Ready DtTm]] so the checkbox would be checked

'''For purposes of transfer ready the following services are considered to be a lower level of care:'''

* WRHA non-Medicine (e.g. surgery, family med, OB, etc) AND lower acuity ward in acute care hospital, whatever flavour of the month word they use for this, incl. rehab, geri-rehab, palliative care unit, etc

@@ Line 9: / Line 9: @@
 == 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.
+* 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 a bed available. 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'''.
+* 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 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 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.
-{{DA|  We need a consistent approach to how we handle the following scenarios:  We can assume that in all scenarios there is no other clear documentation.
+====Exceptions====
-*1. Discharge order, or a progress note written with date but no time.  (either same day of discharge or day prior)
+'''In an ICU''', take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:
-*2. Discharge order written with date and time, but the order is to discharge the following day or on a specific date (reasons for the delay are some times clearly documented,ie.if they are waiting for homecare services or transportation etc), or discharge post last dose IV ABX, discharge after dialysis.
+* care is stepped down to '''ward frequency''' (q4hrs or less) of vitals AND off '''all''' forms of life support except possibly intermittent dialysis
-*This is likely not an issue at SBGH because their notes would be automatically date and time stamped.  At HSC when there is an order without a time for the day of discharge, we generally use 1000 as the time, as rounds happen between 9-1100, or should we just use the dispo date and time?  For those orders that are written the day prior and the reason is waiting for services or transportation we would use the date the order is written with the time 1000, for those that are waiting for medical treatments we use the dispo date and time. We also investigate, so that if the prior order is date and time stamped well after 1000, then we obviously cannot use the 1000 so we would use the dispo date and time. }}
+* [[HSC_IICU]] consult is written
-'''EXCEPTIONS:'''
+* patient is made '''[[ACP C|ACP-C]]'''
-'''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|ACP-C]]'''
 '''On a medicine 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
+* order is written to change all iv meds to po AND remove monitoring
-*patient is made '''[[ACP C|ACP-C]]'''
+* patient is made '''[[ACP C|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 or ready for transfer to a lower level of care, but the patient was discharged or transferred, in this case assign the transfer ready timing as the actual [[Dispo DtTm]] or the date and time of the next [[Boarding Loc]]
-** for '''lateral moves''' ie. acute medicine ward to another medicine ward, or ICU to ICU there would be no [[Transfer Ready DtTm]] so the checkbox would be checked
 '''For purposes of transfer ready the following services are considered to be a lower level of care:'''
 * WRHA non-Medicine (e.g. surgery, family med, OB, etc) AND lower acuity ward in acute care hospital, whatever flavour of the month word they use for this, incl. rehab, geri-rehab, palliative care unit, etc