Avoidable Days (Critical Care)

Avoidable Days in ICU is the proportion of ICU total patient days being spent occupying an ICU bed when the patient no longer requires the intensity of care provided in an ICU setting. Another term used to call it is % Wasted beds.

Indicators
Indicator:	Avoidable Days in ICU
Created/Raw:	Created
Program:	Critical Care
Start Date:	Jan 1 2013
End Date:
Reports:	Critical Care Program Quality Indicator Report

• Cargo

• SMW:

• Categories

• Default form:

Also see Beds occupied by transferrable patients (Critical Care) for a similar concept.

QI domain

• Efficient

Reported as

Percent of total patient days

Significance

Avoidable days reflect the amount of time that patients occupy an ICU bed when the patient no longer requires the intensity of care provided in an ICU setting. It can identify and quantify issues around flow out of the ICU.

Sampling Plan / Procedure

Inclusion Criteria

100% of all patients physically present in an ICU bed awaiting transfer out of the ICU and having a date value on the Transfer Ready DtTm field

• For the Critical Care Report, the Directors and QIT agreed to separate the transfer to IICU and H6 from the rest of the locations (to home, to ward, to outside hospital ward, rehab, PCH) and those who died but have transfer ready date_time - start date Jan to March 2018 Qtr report.

Exclusion Criteria

Avoidable days exclude those with transfer ready date_time and went to HSC IICU and HSC H6 in Dispo

Frequency

• Once the transfer ready date has been written and the allowable 2.0 hours has elapsed, compute Transfer Delay (Critical Care) or the total time it takes for ICU patient to leave the unit.
  • If no time is indicated with the transfer ready date_tm field a proxy time of 10:00 am for day shift and midnight for night shift will be used for calculation purposes.
• To be completed at time of discharge from ICU, compute the total days spent in ICU (refer as LOS)
• To be calculated and reported on a monthly, quarterly or yearly basis based on either ICU Admission Dates or ICU Discharge Dates.
• For the Director reports, the discharge dates are used as the time of reference.

Definition and Derivation

Avoidable days is defined as the total time from date/time of transfer ready to date/time transfer out of ICU (in hours) less 2.0 hours (and divided by 24 to give yield total avoidable days)

• Refer to the definition of Transfer Ready DtTm and Transfer Delay (Critical Care)

Numerator

Num = Total Transfer Delay (Critical Care) in a given period

Denominator

Denom =Total LOS Per Service (ICU) Days on the same period as the numerator

Formula

Avoidable Days (%) = Num / Denom * 100

Example

• Time Reference: Discharge Dates from Jan 1, 2017 to March 31, 2017
• Total Avoidable Days of all patients with transfer ready date-time= 254.5
• Total LOS of all ICU discharges = 1175.3
• Avoidable Days (%) = 254.5 / 1175.3 * 100= 21.7%

Data Sources

• Transfer Delay (Critical Care)
• LOS Per Service

SAS Program

X:\Julie\SAS_CFE\CFE_macros\logphiunit.sas

Data Integrity Checks

• Query check long transfer delay

Data use

see infobox

Report Users

• Critical Care Directors and Site Managers
• Critical Care Quality Improvement Team (QIT)

Change Log

July 1, 2018 - Definition changed "Avoidable days is defined as the total time from date/time of transfer ready to date/time transfer out of ICU (in hours) less 2.0 hours (and divided by 24 to give yield total avoidable days)" from 4 hrs as per instruction by p:Jodi Walker Tweed.