Transfer Ready DtTm tmp entry: Difference between revisions
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=== Transfer Ready === | === Transfer Ready === | ||
For the purpose of this field, Transfer Ready means... | For the purpose of this field, Transfer Ready means... | ||
This entry is about the time of an '''intent''', nothing to do with what '''actually happened''' to the patient after. | This entry is about the time of an '''intent''', nothing to do with what '''actually happened''' to the patient after. | ||
[[Level of care hierarchy]] | |||
Any of these criteria, for a patient going to a '''lower''' level of care, as per hierarchy below: | |||
*The goal here is to identify the intention of the team to send the patient to a lower level if there was an available bed there. | |||
**Obviously we don't always know the team's intentions, but if they do write them down, then USE THAT INFO. | |||
*Regarding the statement that the patient is "medically stable" | |||
**This phrase 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 | |||
**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|ACP-C]] can be taken as indirect evidence of being transfer ready. | |||
{{TT |need to concentrate the details here }} | |||
== Data Collection Instructions == | == Data Collection Instructions == | ||
Revision as of 16:22, 2021 January 21
| Projects | |
| Active?: | active |
| Program: | CC and Med |
| Requestor: | internal |
| Collection start: | 2020-10-15 |
| Collection end: | |
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
For the purpose of this field, Transfer Ready means...
This entry is about the time of an intent, nothing to do with what actually happened to the patient after.
Any of these criteria, for a patient going to a lower level of care, as per hierarchy below:
- The goal here is to identify the intention of the team to send the patient to a lower level if there was an available bed there.
- Obviously we don't always know the team's intentions, but if they do write them down, then USE THAT INFO.
- Regarding the statement that the patient is "medically stable"
- This phrase 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
- 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.
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need to concentrate the details here |
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Data Collection Instructions
- Use tmp fields:
- Project: Transfer Ready DtTm
- Item: Transfer Ready DtTm
- Transfer Ready Date: Date as defined in Transfer Ready DtTm, under column E.
- Transfer Ready Time: Time as defined in Transfer Ready DtTm, under column M.
- 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
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:
- leave the original line as is
- enter a new Transfer Ready DtTm tmp entry, 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
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.
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pt 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 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.
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 in Arrive_DtTm field.
How will these be matched with Boarding Loc entries, is additional data needed?
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This entry is about intent
- This is my dilemma with our definition, it is the intent which I cannot qualify thru the data. if I see an entry in transfer ready date but the physical transfer location is the same or higher level of care, I have to consider that transfer ready date to be valid. I rely that the entry is correct. I rather have the definition to be consistent with the level of care (except for Deaths) so I can quality check the transfer date entry and remove the intent as part of the definition. The goal is to measure bed wastage and when the patient moves to the same or higher level of care, that is not bed wastage to me. --JMojica 10:18, 2020 October 16 (CDT)
- 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. The only way this makes sense is if it is done by intent. Ttenbergen 15:16, 2020 October 16 (CDT)}}
Purpose
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.
What is being sought here is the intent to send someone to a lower level of care only. Thus, it doesn’t matter what actually happened after this intent occurs (e.g. patient getting sicker and the transfer intent cancelled).
Transition to new way of entering this
Use the old Transfer Ready DtTm field for transfer ready dttms before 2020-10-15, and use this new entry for dttms after.
Data Integrity Checks (automatic list)
Data Use
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.
SAS Program
Background
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.