Transfer Delay (Medicine)
Transfer Delay is the difference between Dispo_DtTm and #Time patient is ready for transfer in decimal days. Other terms use to call it are Beds Occupied by transferable patients, Wasted Beds, Avoidable Days.
| Indicators | |
| Indicator: | Transfer Delay (Medicine) |
| Created/Raw: | created |
| Program: | Medicine |
| Start Date: | 2003-10-01 |
| End Date: | |
| Reports: | Directors Quarterly and Annual Report (Medicine) |
See also Transfer Delay.
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Use
- The purpose is to determine the amount of time the patient is occupying a bed in a High Observation ward or a regular ward setting when the patient is no longer needing that level of care from the Transfer Ready DtTm until the Dispo DtTm or end date and time of this level of care.
Definition
- Actual Transfer delay is the difference between End Dttm of a given level of care and #Time patient is ready for transfer in decimal days.
- Two End Dttm
- If the patient stayed in one or more wards having the same level of care, the end dttm is the Dispo DtTm.
- if the patient stayed in both High Observation ward and regular ward which have different level of care, the end dttm is the last dttm of this same level of care which is the start dttm of the different level of care.
- Example a scenario HOBS1 -> regular ward -> HOBS2 -> Home - the delays for first HOBS Transfer Ready DtTm is until the Start dttm of the arrival to the regular ward; the regular ward Transfer Ready DtTm is until the Start dttm of the arrival to the HOBS2 and the HOBS2 Transfer Ready DtTm is until Dispo DtTm.
Implementation
Time patient is ready for transfer
The definition of this has changed between before and after PatientFollow Project.
Starting Oct 1, 2020, it will need to be calculated differently.
It is not reported by ward, it is reported only per episode / profile.
Julie sums up the multiple transfer delays that might be present.
Start time is first transfer ready per level of care; end is either last of this level of care, or dispo.
- Before Oct 1, 2020, it is calculated by Created_Variables_Common_maker query and stored in Created_Variables_Common table in CFE.
- Starting Oct 1, 2020, it will be added but haven't started.
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_dev_CFE
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Which Transfer Ready DtTm To Use?
Before Oct 1, 2020
- for each patient in ICU and Medicine ward, the transfer date and time is taken from the Transfer Ready DtTm field.
Starting Oct 1, 2020
- for each record and each boarding location in Medicine, the transfer date and time is taken from the Transfer Ready DtTm tmp entry.
- for each record, it is possible to have one or more entries of Transfer Ready DtTm corresponding to one or more boarding locations.
- for each record, it is possible to have more than one Level of care hierarchy namely
- WRHA HOB Medicine ward
- HSC-GH7S - from May 1, 2005 to April 14, 2020, Aug 8,2020 to present
- HSC-GB2 - from April 14, 2020 to Aug 8, 2020
- SBGH-L2ME - from Oct 1, 2018 to April 1,2019
- WRHA regular Medicine ward (CTU or NTU)
- WRHA HOB Medicine ward
- for each record if the patient moves to various locations, the first Transfer Ready DtTm from a Boarding Loc with the same level of care will be used
- for example, a Med patient stays in high obs bed and then move to regular ward bed and then another regular ward bed. There are two levels of care - one for high obs and another which is lower, for the regular ward. At least two Transfer Ready DtTm intent are expected here - first intent for high obs ready to go to a regular ward and the second intent is from a regular ward to be discharged to another lower level of care or home or PCH. Assuming that there are transfer orders both at regular ward 1 and regular ward 2 and both are with same level of care, the first Transfer Ready DtTm time will be used in calculating the wasted bed for that lower level of care. There will be another wasted bed to be calculated for the high Obs level of care from the Transfer Ready DtTm to the time the patient left the high obs bed (ie the Dispo DtTm or the next Boarding Loc start DtTm. Transfer delays for high obs and regular ward will be separately reported.
- if the Med patient stays in more than one regular wards (or boarding location), all locations are considered with the same level of care, the wasted bed is calculated from the first Transfer Ready DtTm until Dispo DtTm.
Why collect per ward in medicine when we only report per admission?
To make it easier for data collectors. This way, collectors don't have to try and go back and figure out if there was or was not a transfer ready in a prior location. They only need be concerned about the notes and orders from THIS boarding loc.
Calculation when transfer time missing
- Before Oct 1,2020 - The following definitions are used by Julie in reporting from SAS, and by centralized_data_front_end.accdb to calculate the created_variables query.
- if discharge time < 1200 HR then dummy=0001 HR (12:01 am) ,
- else if discharge time >= 1200 HR dummy=1200HR (12:00 noon)
This is as per approval by Dr. Dan Roberts.
- Starting Oct 1,2020, transfer time is always present.
Reporting of Transfer Delays
- Reported as count, Mean (average), Sum (Total), and Cumulative counts and percentage separately for High Obs and regular ward
- A - Determine the patients who left alive to a lower level of care in the Dispo field and
- A1 - Have transfer delays
- A2 - Have no transfer ready dttm - assign them as zero transfer delay
- Total True delays = Transfer delays from A1 + zeroes from A2 ; Total N = A1 + A2; Average True Delays=Total True Delays / Total N
- Total transfer delays > 4 hours - sum up those patients from A1 by excluding those with transfer delays <= 4 hours and compute the Average.
- Distribution of true transfer delays - counts, cumulative counts and percentage
- zero
- <= 4 hours
- >4h - 12h
- >12h - 1d
- >1d - 2d
- >2d - 3d
- >3d - 7d
- >10d - 14d
- >10d
- B - Determine and report the number of patients with transfer delays who had left alive and went to a higher or same level of care in the Dispo field .
- C - Determine and report the number of patients with transfer delays who died in the Dispo field before going anywhere
SAS Program
- S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\logphi_TR.sas
- %Med_tready
- S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas (macro %boardtransf)
Data use
Beds occupied by transferrable patients
Data Integrity Checks (automatic list)
| App | Status | |
|---|---|---|
| Query check long transfer delay | CCMDB.accdb | needs review |