Transfer Ready date and time

Rewriting in progress.........

We track Transfer Ready date and time for patients in ICU and Medical wards as part of our Minimal Data Set, i.e. this his high-priority data that needs to be collected ASAP.

Transfer Date and Time

The transfer ready date is the first date during this ward stay that a patient was deemed medically ready to be discharged. If the patient status changes again after, the date remains in effect.

Sources (ICU)

In order of preference or which ever is msource is most reliable at your site.

• Physician Diagnosis Form (green sheet)
• Physicians’ Orders from patient chart
• ICU patient Log Book as recorded by unit clerk (from orders)
• Charge Nurse

All attempts should be made to record the time at which the patient was deemed to be ready for transfer.

When Transfer Ready should be recorded

• when a patient is sent to a ward (for ICU)
• when a patient is sent to IICU at HSC
• when a patient is transferred from a teaching ward to a NON-teaching ward.
• when a patient is ready to go home (unless pt goes AMA - home against medical advice)
• when a patient is ready to go to a long term chronic care facility

When Transfer Ready should not be recorded

• when a patient is being transferred to ICU
• when treatment is discontinued and/or death occurs; see further information about this at DC Treatment
• when a patient goes to the Operating Room
• when a patient goes for tests or procedure and returns to unit of origin ( i.e. angiography, CT scan, fluoroscopy, bronchoscopy, muga etc.)

Further, if a patient is on the transfer ready list and his condition deteriorates resulting in the need to remain in the unit, then this patients transfer ready is cancelled and the transfer ready date and time should be deleted. It the patient is put back on the transfer/discharge ready list, enter the new transfer ready date.

Instructions for medicine transfer ready dates and times

COPY OF: File:Transfer Ready ChartStamp Memo MEDICINE January 2012.pdf.

• It is important to understand that the transfer ready date and time indicates that the pt no longer needs a medicine bed in the hospital. Because of this definition, not all profiles will have a transfer ready date.
• If a pt moves from one ward to another and still requires hospital medical care, then that profile will not have a transfer ready date. Previously we saw this date as the date ready to leave that particular ward but this has changed based on Dr. Robert's definition.
• Dr Roberts will educate the medical staff about writing in the chart when the pt is medically stable enough for discharge. This is the date and time we will use.
• Another important change for medicine is that this date and time of transfer ready should not be changed even if the pt deteriorates and requires medical care again. Dr. Roberts wants the first day and time when the pt was deemed to be medically stable.
• If a pt already has a transfer ready date and time and is moved to another ward where a new profile is started, the transfer ready date and time will be the time of admission to that ward.

For example, a pt has been in acute care and is medically stable on Oct 15 at 1000. This is your transfer ready data and time. The pt is then transferred to a chronic ward on Oct 30, and a new profile is started. The admit date for the new profile is Oct 30 and you should fill in the transfer ready date as Oct 30 because the pt is still medically stable and continues to wait for discharge. Julie needs them done this way as she links the profiles.--LKolesar 08:59, 10 November 2011 (CST)

• We will re-start collecting transfer ready dates and times starting in November, 2011 even though Dr Roberts' indicators in the chart have not started yet. The data collectors will put in a transfer ready date and time if they have this available information from the current sources. --LKolesar 11:44, 9 November 2011 (CST)

stamps

• Spring 2012 - A "stamper" is suppose to be used by physicians on Medicine wards to document transfer ready.Trish Ostryzniuk 12:29, 2012 October 25 (EDT)
• January 2013 this data was moved to STB Electronic Patient Record. Chart stamping stopped because physicians were to record this in EPR.

See also

• Transfer Ready Survey Medicine March 8, 2013

Discussion

• Hi just want to clarify transfer ready times ie. pt was admitted Aug 1/11. Aug 15/11 service states medically stable transfered to S3 for panelling process Aug30/11. Pt discharged to nursing home Nov 10/11 When the pt is transferred to S3 I should be using Aug 15/11 as my admit time not the actual time pt arrived to the ward? Then how do we show the actual time pt arrives to the ward? Thanks
  • • Sorry if the above instructions are not clear enough, I will try to fix them. When a pt is transferred to a ward you still use the usual discharge and admit time. If this same pt already has a transfer ready date and time (when medically ready for discharge) which is Aug 15 in this example, this is already written as the transfer ready date and time in the first profile. If a new profile is started for the pt when transferred, the transfer ready time will be the same as the admit date because they are still waiting for discharge and have been transfer ready for a while already. Julie wants them done this way as she tracks the number of days waiting for discharge once transfer ready and will link this with the first profile. --LKolesar 08:59, 10 November 2011 (CST)
    • Sorry Laura, but I'm even more unclear about what we should be doing for patients transferred to another ward, who already have a transfer ready date and time from the first ward! You say above, "If a new profile is started for the pt when transferred, the transfer ready time will be the same as the admit date because they are still waiting for discharge and have been transfer ready for a while already." Does this mean that the admit date and time for the second move, or transfer is our usual date and time, and that the transfer ready date and time is the same as the admit date and time for the second profile? My understanding was that we use our usual dates and times for the admission to the second ward, but that the transfer ready date and time for the second profile would be the same as it was in the first profile. Am I mistaken about that?DPageNewton 13:01, 11 November 2011 (CST)
    • I know that it would make sense to use the same transfer ready date and time for the second profile but Julie does not want it done this way. She wants us to use the admit date and time of the second profile in this scenario as the transfer ready date and time because she links the two profiles. You can talk to her if you like. I already had this discussion with her. It has to do with the way she extracts data from the profiles.--LKolesar 07:04, 14 November 2011 (CST)
    • Based on the above information, I would suggest that when receiving a pt from another ward that the data collectors check the laptop of the sending ward to ensure they have knowledge of a transfer ready time from the sending ward. --LKolesar 14:36, 14 November 2011 (CST)
      • Is this something that would be useful to add to Transfer Tracker.mdb? Ttenbergen 18:04, 16 November 2011 (CST)
      • Yes, it would be a good item to include in the transfer tracker if this is possible. --LKolesar 16:02, 18 November 2011 (CST)
    • I just want to clarify transfer ready. The pt no longer has medical issues but may still be improving muscle strength and in self care (the pt still needs OT & PT). This pt is considered transfer ready because PT & OT are not considered medical issues. Correct? Judy 08/06/12.
  • The pt is not under-going medical treatment and can be discharged home. Quite often pts are discharged home and come in for occupational and physiotherapy but are not requiring medical intervention.--CMarks 12:01, 2012 June 11 (CDT)

Needs sorting

this came from the legacy section but needs to be figured now that we are collecting again.

• In medicine units, the transfer date and time are when a patient no longer requires an active inpatient bed for medical reasons.

When it was collected on med, the following applied:

NOTE: If a patient is considered transfer ready while on a teaching unit and then sent to a non teaching unit: The admit date and time & the discharge ready date and time on the non teaching unit is the same. Since the CCMDB.mdb will not allow admit and transfer date as the same time, please make the time 1 min. later to get past this issue.

• At HSC on the medicine wards, I believe we are not entering a discharge ready time when a patient has been deemed palliative. Am I to assume this is required??? If so let us know, and we will begin to enter the date and time the decision was made for patient to enter palliative care--JHutton 08:59, 17 September 2008 (CDT)
  • The above question is an old one but just to clarify, when a pt becomes palliative, they no longer require an active medical ward bed, so they are transfer ready by the new definition. The date and time for transfer ready is entered when they are deemed palliative. --LKolesar 15:18, 24 January 2012 (CST)
    • does this refer to Palliative Care dx? Ttenbergen 15:29, 24 January 2012 (CST)
      • In the case of a patient who has been made transfer ready, but few weeks later develops complications and subsequently dies, do we still leave in the transfer ready date?--FLindell 13:08, 2012 March 15 (CDT)
        • I was involved in the discussion that led to the new guidelines. Dr Roberts did indicate that he would like the transfer ready to be recorded and unchanged even if the pts condition changes. The original transfer ready date and time are still relevant to the study he is planning for this data. --LKolesar 15:04, 2012 March 19 (CDT)

Transfer Date and Time FOR ICU

Used only in the ICU this is the date and time of written or verbal orders from the attending physician for discharge/transfer from ICU.

Waiting time?

Waiting time starts when ICU attending deems patient ready to go.

• For IICU - waiting time for IICU only starts when IICU attending physician has deemed the patient a candidate. IICU consults (patients) cannot wait to be seen until IICU has a bed available.Trish Ostryzniuk 14:53, 2012 September 13 (CDT)as per Dr. Bojan Paunavic.

Transfer time FOR ICU

If you enter a transfer date you will also need to enter a transfer time. If no transfer time is available then enter

• 10:00 if discharge time is after 10:00
• 0:01 if before 10:00

In the past (before 2011-05-04) the statistician just entered these proxy values to be consistent with the Critical Care Vital Sign Monitor definitions. If the patient records allow you a better guess than this, use it. As of CCMDB.mdb_Change_Log_2011#ver_2011-05-04 a blank transfer time will no longer be accepted if a transfer date is present.

• see Transfer time rule for info on expected differences between admit and previous discharge times when transferring

Date and time formats

see Date and Time Format