Transfer Delay

More Info

• Transfer Delay is reported as one of the following Indicators, see those pages for how specifically it is used there.
  • Transfer Delay (Critical Care)
  • Transfer Delay (Medicine)
• Transfer Delay is a concept involving:
  • The Level of care hierarchy
  • Transfer Ready DtTm = the date/time when a patient in a location with a given Level of Care is deemed ready by the care team to be transferred to a LOWER Level of Care
• Transfer Delay is specific to the current Level of Care
  • At a given Level of Care, it is the interval from the first designation as Transfer-Ready until the first of the following occur:
    • Death while at that same Level of Care
    • Transfer to a lower Level of Care
    • Transfer to a HIGHER Level of Care -- when this occurs, the "clock restarts" for possible Transfer Delay at that higher level
• So a single patient, during hospitalization who goes: {Ward --> ICU --> Ward --> ICU} could have Transfer Delays associated with EACH of the 4 locations.
• When a patient transfers between locations at the SAME Level of Care (e.g. Ward1 --> Ward2 or ICU1-->ICU2) if the patient had a transfer-ready date/time in the first of these locations (Ward1 or ICU1 in the examples) then the total Transfer Delay at that Level includes the time in the 1st location after the Transfer Ready DtTm + ALL the time in the 2nd location at the same Level of Care
  • i.e. as above, transferring to a lower or higher Level of Care resets the Transfer-Ready clock, but transfer to another location at the same Level of Care does not reset that clock.

Some Explanations/Rationale

• The main purpose of tracking Transfer Delays is for administrators to estimate bed needs:
  • e.g: Delays in transfers out of ICU generally are, in a sense "wasted ICU bed-days", and the cumulative number of ICU days patients spend waiting to leave ICU may indicate both inadequate ward beds AND a possible ability to reduce the number of ICU beds if it were possible to promptly send ICU patients out as soon as they are clinically ready
  • e.g: Delays in moving a patient -- who is physically in ED but has been admitted to the Medicine service -- to the ward may indicate problems a need for more ward beds, or more effective ED-to-ward transfer
• Regarding a patient deemed Transfer-Ready to a lower Level of Care but who before such transfer gets sicker and remains in their current location/level
  • These days are INCLUDED in the wasted bed-days at the current Level of Care -- while it might seem like those days after the decision to "cancel" the transfer to a lower Level should not be counted as "wasted" at the current Level, the reason we include them is that we never know what would have happened if the patient had indeed gone to the lower Level promptly, and it is possible that she/he would not have gotten sicker if the transfer had occurred promptly