ICU Interfacility Transfer

Percent of live ICU discharges that are transferred to an ICU located at a different hospital.

Indicators
Indicator:	ICU Interfacility Transfer
Created/Raw:	Created
Program:	Critical Care
Start Date:	Oct 2016
End Date:
Reports:	Critical Care Program Quality Indicator Report

• Cargo

• SMW:

• Categories

• Default form:

Usually used in aggregate form as "per location" and/or "per timeframe", e.g. by day/month/quarter/year x Ward/Unit x Hospital.

See more details on the definition of interfacility transfer in ICU Interfacility Report .

QI domain

• Efficient

Significance

Reasons for transfer may be either to manage ICU beds or access to a required medical service. Bed management transfers can increase the efficiency of ICU bed numbers within a region. Patient transfers may increase the time to appropriate management and may place patients at risk.

Sampling Plan / Procedure

Inclusion Criteria

100% patients who survived and left ICU

Exclusion Criteria

1. Patients transferred to a home hospital (i.e. not for medical or bed access reasons);
2. patients not formally evaluated by the ICU team;
3. patients admitted to a critical care unit within the same geographic site.

Frequency

• Month, quarter or year based on ICU discharge dates for Live ICU discharges
• Month, quarter or year based on ICU admission dates for the counts of transfers due to medical or bed access reasons

Definition and Derivation For Rate

Percent of live ICU discharges that are transferred to an ICU located at a different hospital.

Numerator

Num = Number of live ICU discharges that are transferred to an ICU located at a different hospital or the Transfer OUT (see below definition)

Denominator

Denom = Number of Live ICU discharges

Formula

Percent of live ICU discharges that are transferred to an ICU located at a different hospital = Num / Denom

Transfer for Medical Reason or Bed management

A report to specify the transfer "for medical reasons" vs. "for bed management" is added starting 2024. In order to determine the reason for transfer, the diagnoses on the transferring ICU will be evaluated depending on the facility the patient came from or the sending ICU and the admitting or receiving ICU. Also there are two perspective to consider in reporting transfer namely Transfer OUT and Transfer IN.

Medical Reason

• From STB facility to HSC ICUs - medical reasons include Neurological dxs, all types of trauma dxs and Monitoring Intracranial Pressure (MICP) procedure

• From HSC facility to STB ICMS/ACCU/ICCS - medical reasons include Cath Lab procedures, Cardiovascular Post-op dxs, Aortic aneurysm, thoracic with rupture, IABP and Peritoneal Dialysis

We need links for these if we want to maintain the ability to quickly check on the wiki if a change to a collection component would affect reports. It also makes for more integrated documentation. Yes I agree. Emailed Tina 7March2024 to seek help how to insert table. --JMojica 16:51, 2024 March 7 (CST)

• SMW

• Cargo

• Categories

• From Grace facility to HSC/STB ICUs - medical reasons include Cath Lab procedures, Cardiovascular Post-op dxs, Acute renal, vascular aneurysm, Neurological, all trauma, MICP, IABP, Peritoneal Dialysis, Hemodialysis, CRRT procedures
• From HSC/STB facility to Grace ICU - no medical reason

This should replace the above listing once Julie has reviewed

emailed Julie to confirm

• SMW

• Cargo

• Categories

ICD10 codes to derive medical reason for transport status

sort	ICD10 code	CCI code	From site STB to HSC ICU	From site HSC to STB ICU	From site GRA to HSC/STB ICU
1		Angioplasty, coronary (without stenting) (1.IJ.50.GQ-BD)		YES	YES
1		Angiogram, coronary (diagnostic cardiac catheterization) (3.IP.10.V^)		YES	YES
1		Angioplasty, coronary (with stenting) (1.IJ.50.GQ-OA)		YES	YES
1		ECMO, VA (1.LZ.37.GP-QM.va)		YES	YES
1		ECMO, VV (1.LZ.37.GP-QM.vv)		YES	YES
2		(T) Pericardium (1.HA) - Excision, Resection (87)		YES	YES
2		(T) Pericardium (1.HA) - Debridement (87d)		YES	YES
2		(T) Cardiac Conduction System (1.HH) - Destruction (59)		YES	YES
2		(T) Cardiac Conduction System (1.HH) - Repair (80)		YES	YES
2		(T) Cardiac Atrium (1.HM) - Removal of Foreign Body (56)		YES	YES
2		(T) Cardiac Atrium (1.HM) - Repair (80)		YES	YES
2		(T) Cardiac Atrium (1.HM) - Excision, Resection (87)		YES	YES
2		(T) Cardiac Atrium (1.HM) - Excision, Resection, total (89)		YES	YES
2		(T) Cardiac Atrium (1.HM) - Excision with Reconstruction, Replacement (90)		YES	YES
2		(T) Interatrial Septum (1.HN) - Occlusion (51)		YES	YES
2		(T) Interatrial Septum (1.HN) - Release, Decompression (72)		YES	YES
2		(T) Interatrial Septum (1.HN) - Repair (80)		YES	YES
2		(T) Cardiac ventricle (1.HP) - Implantation of Internal Device (53)		YES	YES
2		(T) Cardiac ventricle (1.HP) - Removal of Foreign Body (56)		YES	YES
2		(T) Cardiac ventricle (1.HP) - Repair (80)		YES	YES
2		(T) Interventricular Septum (1.HR) - Repair (80)		YES	YES
2		(T) Tricuspid Valve, Related Structures (1.HS) - Ultrasound (30)		YES	YES
2		(T) Tricuspid Valve, Related Structures (1.HS) - Implantation of Internal Device (53)		YES	YES
2		(T) Tricuspid Valve, Related Structures (1.HS) - Repair (80)		YES	YES
2		(T) Tricuspid Valve, Related Structures (1.HS) - Excision with Reconstruction, Replacement (90)		YES	YES
2		(T) Pulmonic Valve, Related Structures (1.HT) - Excision with Reconstruction, Replacement (90)		YES	YES
2		(T) Mitral Valve, Related Structures (1.HU) - Ultrasound (30)		YES	YES
2		(T) Mitral Valve, Related Structures (1.HU) - Implantation of Internal Device (53)		YES	YES
2		(T) Mitral Valve, Related Structures (1.HU) - Repair (80)		YES	YES
2		(T) Mitral Valve, Related Structures (1.HU) - Construction, Reconstruction (84)		YES	YES
2		(T) Mitral Valve, Related Structures (1.HU) - Excision with Reconstruction, Replacement (90)		YES	YES
2		(T) Aortic Valve, Related Structures (1.HV) - Occlusion (51)		YES	YES
2		(T) Aortic Valve, Related Structures (1.HV) - Implantation of Internal Device (53)		YES	YES
2		(T) Aortic Valve, Related Structures (1.HV) - Repair (80)		YES	YES
2		(T) Aortic Valve, Related Structures (1.HV) - Construction, Reconstruction (84)		YES	YES
2		(T) Aortic Valve, Related Structures (1.HV) - Excision with Reconstruction, Replacement (90)		YES	YES
2		(T) Heart, NOS (1.HZ) - Control of Bleeding (13)		YES	YES
2		(T) Heart, NOS (1.HZ) - Installation of External Appliance (37)		YES	YES
2		(T) Heart, NOS (1.HZ) - Drainage, Evacuation (52)		YES	YES
2		Pacemaker insertion, permanent (1.HZ.53.GR-NK)		YES	YES
2		(T) Heart, NOS (1.HZ) - Bypass (76)		YES	YES
2		(T) Heart, NOS (1.HZ) - Repair (80)		YES	YES
2		(T) Heart, NOS (1.HZ) - Excision, Resection, total (89)		YES	YES
2		(T) Heart, NOS (1.HZ) - Excision with Reconstruction, Replacement (90)		YES	YES
2		(T) Thoracic Aorta (1.IC) - Control of Bleeding (13)		YES	YES
2		(T) Thoracic Aorta (1.IC) - Implantation of Internal Device (53)		YES	YES
2		IABP (1.IC.53.GQ-QL)		YES	YES
2		(T) Thoracic Aorta (1.IC) - Bypass (76)		YES	YES
2		(T) Thoracic Aorta (1.IC) - Repair (80)		YES	YES
2		(T) Thoracic Aorta (1.IC) - Excision with Reconstruction, Replacement (90)		YES	YES
2		(T) Aorta, NOS (1.ID) - Computerized Tomography (CT) (20)		YES	YES
2		(T) Aorta, NOS (1.ID) - Repair (80)		YES	YES
2		(T) Aorta, NOS (1.ID) - Excision with Reconstruction, Replacement (90)		YES	YES
2		(T) Coronary Arteries (1.IJ) - MRI (40)		YES	YES
2		(T) Coronary Arteries (1.IJ) - Drainage, Evacuation (52)		YES	YES
2		(T) Coronary Arteries (1.IJ) - Removal of Foreign Body (56)		YES	YES
2		(T) Coronary Arteries (1.IJ) - Extraction (57)		YES	YES
2		(T) Coronary Arteries (1.IJ) - Bypass (76)		YES	YES
2		(T) Coronary Arteries (1.IJ) - Debridement (87d)		YES	YES
2		(T) Coronary Vessels, NOS (1.IL) - Repair (80)		YES	YES
2		(T) Pulmonary Artery (1.IM) - Repair (80)		YES	YES
2		(T) Pulmonary Artery (1.IM) - Excision with Reconstruction, Replacement (90)		YES	YES
2		(T) Vena Cava (1.IS) - Control of Bleeding (13)		YES	YES
2		(T) Vena Cava (1.IS) - Repair (80)		YES	YES
2		(T) Carotid Artery (1.JE) - Bypass (76)			YES
2		(T) Carotid Artery (1.JE) - Excision with Reconstruction, Replacement (90)			YES
2		(T) Abdominal Aorta (1.KA) - Excision with Reconstruction, Replacement (90)			YES
2		(T) Abdominal Aorta (1.KA) - Repair (80)			YES
3	Kidney, acute tubular necrosis (ATN) ( N17.0 )				YES
3	Kidney, acute renal failure NOS ( N17.9 )				YES
3	Kidney, acute renal failure, postprocedural ( N99.0 )				YES
4	Aortic aneurysm, abdominal with rupture ( I71.1)				YES
4	Aortic aneurysm, thoracic without mention of rupture ( I71.2)				YES
4	Aortic aneurysm, thoracic with rupture ( I71.3)			YES	YES
4	Aortic aneurysm, abdominal without mention of rupture ( I71.4)				YES
4	Aortic aneurysm, NOS with rupture ( I71.8)				YES
4	Aortic aneurysm, NOS without mention of rupture ( I71.9)				YES
4	Arterial aneurysm or dissection, NOS ( I72)				YES
5	Epilepsy, or seizure in patient with known epilepsy, any type incl myoclonic ( G40)		YES		YES
5	Status epilepticus (any seizure type) ( G41)		YES		YES
5	Seizure, NOS ( R56.88)		YES		YES
5	Eclampsia (seizures must occur) ( O15)		YES		YES
5	Intracranial abscess ( G06.0)		YES		YES
5	Intracranial or intraspinous veins or venous sinuses, septic thromboembolism ( G08)		YES		YES
5	Hemorrhage, subarachnoid or ruptured cerebral aneurysm ( I60)		YES		YES
5	Hemorrhage, intracerebral/intracranial, nontraumatic (ICH, hemorrhagic stroke) ( I61)		YES		YES
5	Subdural or epidural hematoma/hemorrhage, nontraumatic ( I62)		YES		YES
5	Cerebral infarction/stroke due to embolism ( I63.4)		YES		YES
5	Cerebral infarction/stroke, NOS ( I63.9)		YES		YES
5	Stroke, NOS ( I64)		YES		YES
5	Stenosis, narrowing or occlusion of precerebral arteries ( I65)		YES		YES
5	Cerebral aneurysm, nonruptured ( I67.1)		YES		YES
5	Cerebral vasospasm ( I67.84)		YES		YES
5	Cerebrovascular disease, NOS ( I67.9)		YES		YES
5	Normal pressure hydrocephalus ( G91.2)		YES		YES
5	Hydrocephalus, NOS ( G91.9)		YES		YES
5	Brain compression, including herniation ( G93.5)		YES		YES
5	Cerebral edema ( G93.6)		YES		YES
5	Arteriovenous malformation (AVM) of cerebral vessels ( Q28.2)		YES		YES
5	Brain death ( G93.81)				YES
6	(S00 to S99)		YES		YES
6	Multiple trauma ( T07)		YES		YES
6	Vertebra or spinal cord, level not specified/NOS, fracture, injury/trauma ( T08)		YES		YES
6	Upper limb (arm) bones, level not specified/NOS, fracture, injury/trauma ( T10)		YES		YES
6	Upper limb (arm), level not specified/NOS, open wound, injury trauma ( T11.1)		YES		YES
6	Upper limb (arm), level not specified/NOS, joints or ligaments, dislocation/sprain/strain, injury/trauma ( T11.2)		YES		YES
6	Upper limb (arm), level not specified/NOS, nerves, wound/injury/trauma ( T11.3)		YES		YES
6	Upper limb (arm), level not specified/NOS, blood vessels, wound/injury/trauma ( T11.4)		YES		YES
6	Upper limb (arm), level not specified/NOS, muscles/tendons, wound/injury/trauma ( T11.5)		YES		YES
6	Upper limb (arm), level not specified/NOS, amputation, injury/trauma ( T11.6)		YES		YES
6	Upper limb (arm), level not specified/NOS, wound/injury/trauma, NOS ( T11.9)		YES		YES
6	Lower limb (leg) bones, level not specified/NOS, fracture, injury/trauma ( T12)		YES		YES
6	Lower limb (leg), level not specified/NOS, superficial injury/trauma (minor, contusion) ( T13.0)		YES		YES
6	Lower limb (leg), level not specified/NOS, open wound, injury trauma ( T13.1)		YES		YES
6	Lower limb (leg), level not specified/NOS, joints or ligaments, dislocation/sprain/strain, injury/trauma ( T13.2)		YES		YES
6	Lower limb (leg), level not specified/NOS, nerves, wound/injury/trauma ( T13.3)		YES		YES
6	Lower limb (leg), level not specified/NOS, blood vessels, wound/injury/trauma ( T13.4)		YES		YES
6	Lower limb (leg), level not specified/NOS, muscles/tendons, wound/injury/trauma ( T13.5)		YES		YES
6	Lower limb (leg), level not specified/NOS, amputation, injury/trauma ( T13.6)		YES		YES
6	Lower limb (leg), level not specified/NOS, wound/injury/trauma, NOS ( T13.9)		YES		YES
6	Wound/injury/trauma, body region NOS ( T14.9)		YES		YES
7		ICP monitor (Placement of implanted, invasive intracranial pressure monitoring device) (2.AN.28.JA-PL)	YES		YES
8		IABP (1.IC.53.GQ-QL)		YES	YES
9		PD (Peritoneal dialysis) (1.PZ.21.HP-D4)		YES	YES
10		HD (Hemodialysis) (1.PZ.21.HQ-BR)			YES
11		CRRT (incl volume removal via PRISMA device) (1.PZ.21.HQ-BS)			YES

Change log for medical reason encoding

• 2023-12-05
  • remove for transfer from HSC to STB
    • (T) Carotid Artery - Bypass
    • (T) Carotid Artery - Excision with Reconstruction, Replacement
    • (T) Abdominal Aorta - Excision with Reconstruction, Replacement
    • (T) Abdominal Aorta - Repair
  • add to transfer from HSC to STB
    • Aortic aneurysm, thoracic with rupture
  • remove for STB to HSC transfer but include from GRA to HSC/STB transfer
    • Brain death
  • remove from the list
    • Encephalopathy, hypertensive
    • Posterior reversible encephalopathy syndrome (PRES)
    • Encephalopathy, toxic
    • Encephalopathy, NOS
    • Encephalopathy, septic or metabolic
    • Brain disorder, NOS
    • Transient ischemic attack (TIA), all types

Bed Management Reason

• If none in the above Medical reason, then it is bed management reason.

Transfer OUT

• Transfer OUT includes the transfers from a discharging or sending ICU to another site’s ICU for medical necessity or bed management reasons.
  • The number of transfers is attributed to the discharging or sending or originating ICUs.
  • To another site's ICU can be any ICU at different facility.
• For example, patients admitted at Grace ICU who are transferred to HSC MICU or STB ICMS are Transfer OUT.
  • Patients who are admitted at Grace ICU, had a procedure in other facility and then admitted to an ICU service in that or another facility are Transfer OUT.
  • Patients who are admitted at Grace ICU, had a procedure in other facility and then came back to Grace ICU are not Transfer OUT.

Transfer IN

• Transfer IN includes the transfers to a receiving or admitting ICU from another site for medical necessity or bed management reason.
  • The number of transfers is attributed to the receiving or admitting ICUs.
  • From another site can be another site’s ICU, ER, ICU, Ward, OR, RR, etc. Can be broken down from another site's ICU or Non-ICU service.
  • Example 1 - patients admitted to HSC MICU can be inpatients from STB ICMS or STB Ward or Grace ICU or Grace Ward or non-inpatients from STB ER or Grace ER. All these transfers are counted and attributed to HSC MICU. If need to separate from another site ICU, include only those from STB ICMS and Grace ICU. If from another site non-ICU service, include those from STB ER, STB Ward, Grace ER, Grace Ward. The reasons for transfer can either be medical or bed management reason.
  • Example 2- patients admitted to Grace ICU can inpatients from STB/HSC ICU/Ward or non-inpatient from STB/HSC ER/OR/etc. All transfers can be attributed to Grace ICU and broken from ICU or Non-ICU service. However, the reason for transfer will only be due to bed management.

Data Sources

• Dispo
• Dispo DtTm
• Previous Location
• Pre-admit Inpatient Institution

SAS Program

• S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\InterfacilityReasonMed.sas - list the diagnosis (old coding and ICD10 codes) that defines a medical reason for transfer
• S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\InterfacilityInOut.sas