Transfer Ready DtTm tmp entry: Difference between revisions

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m discussed at task meeting that there need not be comments for Transfer Ready DtTm, and therefore no check required.
clean-up of some duplication and integration of some Q&A, please read and flag if anything is not clear or not as you understood it
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*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.
*EXCEPTIONS:
*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 an ICU, take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:
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***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, but the patient was discharged, in this case assign the transfer ready timing as the actual discharge timing.
***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.
----
*As of February 2021, there will be a transfer-ready entry for each and every boarding location.  This entry takes 1 of only 2 possible forms: 
**If while in a given location the care team writes that they intend (as above) to transfer the patient to a lower level of care, then the entry is the date/time that they first indicate this intention.
**If while in a given location the care team never writes such an intention, then instead of entering the date/time, collectors should indicate this by clicking the check box in this field.
*Thus, it is NOT true that every actual transfer to another physical location has a transfer ready '''date/time''' entered, but there will be either a date or a checkbox check.
*And of course there should only be an actual date/time entered if the notes indicate the ''intent'' (as above) to send the patient to a LOWER level of care (whether or not transfer happens doesn't matter).
*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.


== Data entry instructions ==
== Data entry instructions ==
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** Project: '''Transfer Ready DtTm'''
** Project: '''Transfer Ready DtTm'''
** Item: '''Transfer Ready DtTm'''  
** Item: '''Transfer Ready DtTm'''  
* Collector needs to enter the following:
* Collector needs to enter one of the following:
**Transfer Ready Date: Date as defined in section [[#Transfer Ready]] above
** '''First Date and Time''' during the stay at this [[Boarding Loc]] that patient was transfer ready as per [[#What is Transfer Ready]] above
**Transfer Ready Time: Time as defined in section [[#Transfer Ready]] above
::OR
**checkbox: to be checked only if a transfer ready date/time to a LOWER level of never was indicated ''while in this location''
:* checkbox checked that a transfer ready status was never documented for this patient while at this [[Boarding Loc]]


{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}
{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}
=== 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 ===
=== What if the pt ends up transferred to a higher level of care ===
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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.  
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.  
}}
}}
=== 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.


== Start DtTm/Legacy ==
== Start DtTm/Legacy ==
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Used to generate [[Transfer_Delay]] and [[Avoidable Days in ICU]].
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 hierarchy | 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 ==
== Background ==

Revision as of 13:10, 2021 April 29

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.
  • 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:
      • 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
    • 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.

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:
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

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)

 AppStatus
Query check ICD10 needs awaiting if TR Dt and Dispo Dt on diff daysCCMDB.accdbdeclined
Query check TISS each dayCCMDB.accdbdeclined
Query check ICD10 awaiting has Transfer Ready DtTmCCMDB.accdbimplemented
Query check transfer DtTm during admissionCCMDB.accdbimplemented
Query check has transfer ready date or checkboxCCMDB.accdbimplemented
Query s tmp check combined Boarding Loc and TransferReadyDtTmCCMDB.accdbimplemented
Query s tmp check Boarding Loc and TransferReadyDtTm pairsCCMDB.accdbimplemented
Query check Transfer DtTm after paired BL and before later BLCCMDB.accdbimplemented
Query Check BL TR combiner nullCCMDB.accdbimplemented
Query check tmp 2 BL TR S same tmCCMDB.accdbimplemented
Query check long transfer delayCCMDB.accdbneeds review
Function Validate Transfer Ready DtTmCCMDB.accdbretired
Function Transfer Ready DtTm vs statusCCMDB.accdbretired
Query check transfer ready tmp for each Boarding LocCCMDB.accdbretired
Query check tmp Transfer Ready not before Boarding LocCCMDB.accdbretired
Query s tmp check combined BL and TRDtTm nonsequentialCCMDB.accdbretired

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.

Related articles

Related articles:
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