Transfer Ready DtTm field

see Transfer time rule for the unrelated rules around patients transferring between wards we collect data on

Data Element (edit)
Field Name:	Transfer_Ready_DtTm
CCMDB Label:	Transfer Ready DtTm
CCMDB tab:	Dispo
Table:	L_Log
Data type:	date
Length:	not stated
Program:	Med and CC
Created/Raw:	Raw
Start Date:	2016-07-01
End Date:	2300-01-01
Sort Index:	47
Data Dependencies(Reports/Indicators/Data Elements):	No results

Date and time the intent to discharge a patient to a lower level in the #hierarchy of levels of care was documented.

• SMW

Legacy implementation right in the table

• Cargo

• Categories

• Forms

See #hierarchy of levels of care for meaning of "lower level of care".

Purpose

The purpose is to determine the avoidable days or bed wasted by patients who are deemed ready to leave the unit or ward and then either move to a lower level of care or leave the hospital. Bed wasted or avoidable days are being derived from Transfer Ready DtTm and Discharge Date_time (or Dispo Dt_Tm).

Collection Instruction

For each patient,

• if a date/time of intent to transfer to lower level in the #hierarchy of levels of care is documented, enter it into the Transfer Ready Date and Time Field
  • if a patient arrives transfer-ready enter the same date into Transfer Ready DtTm field as in Arrive_DtTm field.
• if not available because the patient was clearly not transfer ready, leave the date/time empty and enter "not transfer ready" into the "TR info status field"
• if not available but the patient probably was transfer ready and it just wasn't documented, enter "not available" into the "TR info status field"

This entry is about the time of an intent, nothing to do with what actually happened to the patient after.

• • If the patient is "medically stable" (written anywhere in the chart) and/or care is stepped down ie. VS decreased, off monitor, IV meds changed to PO meds, etc. then the patient is "transfer ready". For instance a patient may be very deconditioned but still be medically stable. This can be decided by our nursing judgement as we follow the patient through their hospital stay on our wards. This was discussed at a previous task meeting and Dr Garland agreed that it can be decided by data collectors. --CMarks 14:39, 2017 January 13 (CST)
  • Another comment regarding ICU transfer ready: Often a patient has care D/C'ed (ventilator or vasoactive drugs stopped). Sometimes the pt does not pass away right away but they are made ACP-C. In these cases, we should still say they are transfer ready because they no longer require ICU care. Just wanted to clarify that even if D/C tx is indicated, there are cases where the pt may be transfer ready for a while before death actually occurs.(Technically if they needed the bed, they could transfer the patient). If they pass away immediately upon D/C tx then there is no need to put a transfer ready date and time,(Use "not transfer ready"). --LKolesar 08:45, 2017 January 16 (CST)

Hierarchy of levels of care

We require an entry in this field when the transfer is from higher to lower level of care:

• WRHA ICU
• WRHA IICU
• WRHA HOB ward
• WRHA teaching ward
• WRHA nonteaching ward / EMIP
• ward outside WRHA
• PCH or home

ACP C

• A patient is transfer ready on Medicine or ICU once they become ACP-C (decided at Task Group Meeting on Jan 18, 2016).

status changing back and forth

If a patient changes from being transfer ready back to not being transfer ready, collect the first transfer ready dttm.

There used to be different instructions for Medicine and Critical Care but they are being unified with the move to the new fields as discussed with Dr. Garland, Dr. Roberts and Randy Martin.

Data Use

Used to generate Transfer_Delay, which is used in Overstay and several reports, see also Transfer_Delay#data use.

Template:CCMDB Data Integrity Checks

• Function Dispo Chronological()
• function Panelling_admit_transfer_same(Pat_ID): a record is an error if both
  • Primary Admit Diagnosis = Panelling or Discharge Planning (90601 or 90602)
  • (Transfer Ready DtTm) <> (Arrive DtTm)
• query check_dispo_lower_acuity_than_location and function Transfer_Ready_DtTm_vs_Location_vs_Dispo check for patients going to lower level of care but without Transfer Ready Date; Check will launch an error but allow no date, ie it's just a reminder, see #hierarchy of levels of care.

Legacy

Similar to the old Transfer Ready date and time, but we eliminated special cases and differences between medicine and critical care. Going forward the entry will be collected even if pt dies or goes to ER etc. It's the intent that counts, not what ended up happening. Resp. field names L_Log.R_TRDate and L_Log.R_TRTime