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 time of an intent to move a patient to level of care that is lower 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.

Obviously we don't always know the team's intentions, but if they do write them down, then use that info.

Some considerations:

• The phrase "medically stable" 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

Example:

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.

ER is considered "higher acuity/level" (Level of care hierarchy) than medicine units so for patients who are never transfer ready per healthcare team moving from ER to medicine units is the tmp entry comment "not available"? And for moves to higher level care units and lateral medicine moves for patients who are never transfer ready per healthcare team is the tmp entry comment "not transfer ready"? These questions are specific to what comment is to be entered in tmp for patients who are never transfer ready per healthcare team in these scenarios. Transfer ready dttm is not about where the pt DID move. It tells whether the team would want them at a lower level of care. So a med pt in ER could be ready to go home but needs a care home spot so can't leave hospital. That would mean they were transfer ready in ER even though they then went to a med ward. I will flag this for Task because it keeps coming up so either I misunderstand this or we need to find a way to make it clear to everyone else. Ttenbergen 10:16, 2021 February 10 (CST)

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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)

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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)

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• 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.

Data Collection Instructions

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 never became available
• comment (under 'q'):
  • only if TR date not available (ie if checkbox checked), enter
    • "not ready" if left location still not transfer ready
    • "not available" unclear from chart if pt was transfer ready

Below it had said "Enter "not available" if any of the following: ... arrived transfer ready" - is that really as intended? Wouldn't we enter the TRDT as the Boarding Loc time instead in that case?

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Should "not available" be used when the pt was ready but the time is not clear, or only when no transfer ready status was indicated? What is the use case for that entry? Ttenbergen 09:31, 2021 February 10 (CST)

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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"?

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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 the time of the respective Boarding Loc entry.

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.

Enter either "not ready" or "not available" into the comment field so we know how to interpret the entry.

The comment terms "Not ready" and "not available" need further clarification as to use of one or the other for patients who are never transfer ready, see question above

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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.

Status changing back and forth while on same Boarding Loc

If a patient changes from being transfer ready back to not being transfer ready, collect the first time they are #Transfer Ready at a given Boarding Loc. If they become no longer transfer ready, leave it alone, and if they become transfer ready again at the same level of care, retain only the original Transfer Ready DtTm for that level.

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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