Transfer Ready DtTm tmp entry
| Projects | |
| Active?: | active |
| Program: | CC and Med |
| Requestor: | internal |
| Collection start: | 2020-10-15 |
| Collection end: | |
Transfer Ready
The status of "transfer ready" is about the time of an intent to move a patient to level of care that is lower in the Level of care hierarchy if there was an available bed there. Whether or not the patient actually moves does not matter, just that at some point there was an intent to move the pt.
Obviously we don't always know the team's intentions, but if they do write them down, then use that info.
Some considerations:
- The phrase "medically stable" could mean that the person is improved enough to go elsewhere, but it does not' necessarily mean that. For example it could technically indicate that the condition is not changing lately, which may or may not mean that they're ready to go elsewhere.
- Thus, by itself that phrase cannot be used alone to suggest the patient is transfer ready
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- In an ICU setting, you can take the following to indirectly indicate transfer ready to a lower level of care when nothing has been written:
- care is stepped down to ward frequency (q4hrs or less) of vitals, off all forms of life support except possibly intermittent dialysis
- HSC_IICU consult is written
- In a ward setting, you can take the following to indirectly indicate transfer ready to a lower level of care when nothing has been written:
- care is stepped down to change iv meds to po, remove monitoring
- In either ICU or ward setting being made ACP-C can be taken as indirect evidence of being transfer ready.
Question moved here from Level of care hierarchy:
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Transfers from ER to a medicine unit usually depend upon bed availability on a medicine unit and not whether the patient is "transfer ready" The tmp entry will almost always (there are exceptions) be "not available" with check box per wiki instructions. Should the comment be "not ready" for patients transferring from the ER location? |
What if the pt ends up transferred to a higher level of care
The original transfer Transfer Ready DtTm tmp entry does not change.
| Expand for details why |
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It might seem that a patient who was transfer ready but then moves to a higher level of care should be excluded, since they did not actually get transferred to a lower level of care. However, when the patient was deemed transfer ready, additional time in the ward was "wasted time" - if we could have sent them elsewhere we would have. If the patient later crashes, that doesn't make it not-wasted time - they could have crashed anywhere. So the interpretation that a pt moving to a higher level of care after transfer ready is not wasted time is not right. We discussed this repeatedly at task and steering meetings. The only way this makes sense is if it is done by intent. |
Data Collection Instructions
For each Boarding Loc entry (incl the original ER one, if present), enter the following:
- Project: Transfer Ready DtTm
- Item: Transfer Ready DtTm
- Transfer Ready Date: Date as defined in section #Transfer Ready above
- Transfer Ready Time: Time as defined in section #Transfer Ready above
- checkbox: to be checked only if a transfer ready date never became available
- comment (under 'q'):
- only if TR date not available (ie if checkbox checked), enter
- "not ready" if left location still not transfer ready
- "not available" unclear from chart if pt was transfer ready
- only if TR date not available (ie if checkbox checked), enter
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Below it had said "Enter "not available" if any of the following: ... arrived transfer ready" - is that really as intended? Wouldn't we enter the TRDT as the Boarding Loc time instead in that case? |
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initial pre-entered record
A first entry is added automatically to each new patient entered on the laptop.
The first time the patient becomes #Transfer Ready, enter the date and time into this pre-entered record.
additional records if there are additional Boarding Locs
For every additional Boarding Loc (whether it is at different Level of care hierarchy or not):
- leave the original line as is
- enter a new Transfer Ready DtTm tmp entry
- if the pt changes from not being #Transfer Ready to being #Transfer Ready during the stay at that Boarding Loc enter that dttm
- if the pt doesn't change to #Transfer Ready state, enter the checkbox and "not available"
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If the pt doesn't change to a transfer ready state during a location stay, should the comment be "not ready"? |
Patient arrives transfer ready
If a patient at any Boarding Loc and is already #Transfer Ready enter the same date into Transfer Ready DtTm field as the time of the respective Boarding Loc entry.
Patient doesn't become #Transfer Ready before leaving unit
If pt never becomes #Transfer Ready, check the checkbox to say so. This is so we can be sure the entry wasn't just forgotten.
Enter either "not ready" or "not available" into the comment field so we know how to interpret the entry.
Don't check this until the patients actually leaves that Boarding Loc (either to a next one or to Dispo) and you are sure a date never became available.
Status changing back and forth while on same Boarding Loc
If a patient changes from being transfer ready back to not being transfer ready, collect the first time they are #Transfer Ready at a given Boarding Loc. If they become no longer transfer ready, leave it alone, and if they become transfer ready again at the same level of care, retain only the original Transfer Ready DtTm for that level.
Start DtTm
We used the old Transfer Ready DtTm field for transfer ready dttms before 2020-10-15, and use this new entry for dttms after.
Data Use / Purpose
Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.
Used to generate Transfer_Delay and Avoidable Days in ICU.
How will these be matched with Boarding Loc entries, is additional data needed?
We will determine each Boarding Loc's Level of care hierarchy using the s_level_of_care table. Depending on data needs we will then be able to provide Transfer Delay either by unit or by level of care. To provide it by level of care we would choose the first dttm after (or at) arrival to the first Boarding Loc at a given level of care.
Background
This isn't so much a project as a change to Transfer Ready DtTm collection to allow us to collect more than one Transfer Ready DtTm per patient-program-stay. See Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry for why we needed to change to this.
Data Integrity Checks (automatic list)
Legacy
Similar to the old Transfer Ready DtTm field and Transfer Ready date and time, but we eliminated special cases and differences between medicine and critical care.