Transfer Delay (Critical Care)

Transfer Delay is the difference between Dispo_DtTm and #Time patient is ready for transfer in decimal days.

Indicators
Indicator:	Transfer Delay
Created/Raw:	created
Program:	Critical Care and Medicine
Start Date:	1999-01-15
End Date:
Reports:	Critical Care Program Quality Indicator Report, Directors Quarterly and Annual Report (Critical Care), HSC ICUs Data by Patient

• Cargo

• SMW:
  • "created" is not in the list (Created, Raw) of allowed values for the "IndicatorCreatedRaw" property.

• Categories

• Default form:

Use

• The purpose is to determine the amount of time the patient is occupying a bed in an ICU setting when the patient is no longer needing that level of care (also referred to as wasted bed) from the Transfer Ready DtTm until the Dispo DtTm.

Definition

Transfer Delay is the difference between Dispo_DtTm and #Which Transfer Ready DtTm To Use? in decimal days.

Which Transfer Ready DtTm To Use?

Before Oct 1, 2020

• For each patient in ICU and Medicine ward, the transfer date and time is taken from the Transfer Ready DtTm field.
• It is calculated by Created_Variables_Common_maker query and stored in Created_Variables_Common table in CFE.

Starting Oct 1, 2020

• For each record and each boarding location in ICU , the transfer date and time is taken from the Transfer Ready DtTm tmp entry.
• For each record, it is possible to have one or more entries of Transfer Ready DtTm tmp entry corresponding to one or more boarding locations.
• if the patient moves to various locations, the first Transfer Ready DtTm from a Boarding Loc will be used
  • As described in Transfer Ready DtTm tmp entry, collectors make a notation about transfer ready in each separate boarding loc, looking solely at whether or not the patient was recorded as transfer ready from that location (i.e. collectors should not "carry over" knowledge about transfer readiness at prior boarding locs).
  • BUT, when calculating "wasted days", Julie will only use the FIRST transfer ready date/time:
    • example 1: Mr. Jones spent 7 days in Location1 and then directly transferred to Location2 where he stayed another 7 days. On Location1 day 3 a progress note said he was ready to go to ward, but he didn't. At no time during his Location2 stay did any notes indicate transfer readiness. Julie will calculate this as 4 wasted Location1 days, and 7 wasted Location2 days.
    • example 2: Mr. Jones spent 7 days in Location1 and then directly transferred to Location2 where he stayed another 7 days. On Location1 day 3 a progress note said he was ready to go to ward, but he didn't. On Location2 day 1 a progress note indicates transfer readiness. Julie will calculate this as 4 wasted Location1 days, and 7 wasted Location2 days.
    • example 3: Mr. Jones spent 7 days in Location1 and then directly transferred to Location2 where he stayed another 7 days. On Location1 day 3 a progress note said he was ready to go to ward, but he didn't. On Location2 day 5 a progress note indicates transfer readiness. Julie will calculate this as 4 wasted Location1 days, and 7 wasted Location2 days.
    • ALL 3 of these examples have the same # of wasted days.

Why collect per ward in medicine when we only report per admission?

To make it easier for data collectors. This way, collectors don't have to try and go back and figure out if there was or was not a transfer ready in a prior location. They only need be concerned about the notes and orders from THIS boarding loc.

Reporting of Transfer Delays

• Reported as count, Mean (average), Sum (Total), and Cumulative counts and percentage
• A - Determine the patients who left alive to a lower level of care in the Dispo field and
  • A1 - Have transfer delays
  • A2 - Have no transfer ready dttm - assign them as zero transfer delay
  • Total True delays = Transfer delays from A1 + zeroes from A2 ; Total N = A1 + A2; Average True Delays=Total True Delays / Total N
  • Total transfer delays > 2 hours - sum up those patients from A1 by excluding those with transfer delays <= 2 hours and compute the Average.
  • Distribution of true transfer delays - counts, cumulative counts and percentage
    • zero
    • <= 4 hours
    • >4h - 12h
    • >12h - 1d
    • >1d - 2d
    • >2d - 3d
    • >3d - 7d
    • >10d - 14d
    • >10d

• B - Determine and report the number of patients with transfer delays who had left alive and went to same level of care in the Dispo field .
• C - Determine and report the number of patients with transfer delays who died in the Dispo field before going anywhere.

IICU and H6 Reporting

For the ICU annual and quarter reports, the transfer ready delay to the IICU and to HSC H6 (LTV) are reported separately from the transfer delay to the other Wards and home. Thus two derived delay variables, namely:

1. to HSC IICU/H6, and
2. to other wards/Home (including nursing home/long term care facility)

The Dispo location will be used to define the destination. As per Dr. Garland & Dr. Paunovic.

Calculation when transfer time missing

Before Oct 1,2020 -The following definitions are used by Julie in reporting from SAS, and by centralized_data_front_end.accdb to calculate the created_variables query.

• if discharge time < 1000 HR then dummy=0001 HR (12:01 am),
• else if discharge time >= 1000 HR dummy=1000HR (10:00 am)

This was based on Critical Care Vital Sign Monitor.

This is as per approval by Dr. Dan Roberts.

Starting Oct 1,2020, transfer time is always present.

SAS Program

• S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\logphi_TR.sas
  • macro %CC_tready
• S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas (macro %boardtransf)

Data use

• Transfer Delay
• Avoidable Days (Critical Care)
• Beds occupied by transferrable patients

Data Integrity Checks (automatic list)

	App	Status
Query check long transfer delay	CCMDB.accdb	needs review

related fields

• Admit DtTm
• Dispo_DtTm
• Transfer Ready DtTm tmp entry
• LOS
• Transfer Delay

Legacy

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Reporting change from 4 to 2 hrs

• Starting July 1, 2018 Transfer Delay Over 2 hours for Critical Care (i.e. subtract 2 hours instead of 4 hours from transfer delay as per instruction by Jodi Walker Tweed.)