Transfer Ready DtTm tmp entry

Projects
Active?:	active
Program:	CC and Med
Requestor:	internal
Collection start:	2020-10-15
Collection end:

Collection instructions

What is Transfer Ready

• The status of "transfer ready" is about the date/time of an intent to transfer a patient to lower level of care in the Level of care hierarchy if there was a bed available. Whether or not the patient actually moves does not matter, just that at some point there was an intent to move the pt. It also does not matter whether after such a determination the care team changed their minds about such a desired transfer.
• Obviously we don't always know the team's intentions, but if they do write them down, then use that info.
  • In making this delineation, except as for the exceptions listed immediately below, only consider a clearly written intent that the team now desires the patient to be transferred to such a lower level of care.
    • In particular, when a ward patient is transferred (e.g. home) without any notes stating the team’s intention to do so in advance or even an order to discharge, collectors should not attempt to make educated guesses from the notes of when the patient was probably clinically ready to leave and the checkbox is checked.

See Level of care hierarchy for further information.

Specifically for ICU

In an ICU, take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:

• care is stepped down to ward frequency (q4hrs or less) of vitals AND off all forms of life support except possibly intermittent dialysis
• HSC_IICU consult is written
• patient is made ACP-C

Specifically for Medicine

On a medicine ward, take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:

• order is written to change all iv meds to po AND remove monitoring
• patient is made ACP-C

• PT/OT Assessment: Before going home, some ward patients get a home safety evaluation from PT and OT, and if deemed safe for home get a homecare evaluation before going home. The transfer ready date/time in such a situation should be only after the PT/OT evaluation has deemed them safe to go home, i.e. before homecare has seen them. The rationale is that homecare evaluation can occur after discharge, but a hospitalized patient who “fails” their home safety evaluation will end up going to LTC, not home.

We need a consistent approach to how we handle the following scenario: We can assume that in all scenarios there is no other clear documentation. 1. Discharge order written with date and time, but the order is to discharge the following day or on a specific date (reasons for the delay are some times clearly documented, ie if they are waiting for homecare services or transportation etc, or discharge post last dose IV ABX, discharge after dialysis. 2. Recently at SB, they have been including the Med Reconciliation orders in EPR documents. Typically, once a pt is transferrable, a Med Rec is initiated. If there are no discharge orders, no discharge summary and no discharge time documented, including the examples above specific to Medicine, could we (SB) also use this as our TransferReady dtm?--Mailah Damian 13:51, 2022 May 18 (CDT)

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Data entry instructions

• A "Transfer Ready" line is automatically created for each Boarding Loc entry.
  • Project: Transfer Ready DtTm
  • Item: the only available item is "Transfer Ready DtTm", just like the project entry.
  • Date and Time vs checkbox:
    • Collector needs to enter one of the following:
      • First Date and Time during the stay at this Boarding Loc that patient became transfer ready as per #What is Transfer Ready above

OR

• checkbox checked if a clear transfer ready date and time are never documented

Combining Transfer Ready DtTm tmp entry and Boarding Loc records

• There needs to be one Transfer Ready DtTm tmp entry for each Boarding Loc and vice versa. To mark which entries belong together, use the same integer number in the "combiner" field in Patient Viewer Tab Cognos ADT2 for both records and in sequential order according to Boarding start_dt and start_tm. The presence of matching records is validated by query s_tmp_check_combined_Boarding_Loc_and_TransferReadyDtTm, and their sequential status by query s_tmp_check_combined_BL_and_TRDtTm_nonsequential.
• the integer number should be entered at the time that the paired Boarding Loc and Transfer Ready DtTm tmp entry are entered, as Julie uses this data early to report on

Start DtTm/Legacy

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 (Critical 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)

	App	Status
Query check ICD10 needs awaiting if TR Dt and Dispo Dt on diff days	CCMDB.accdb	declined
Query check TISS each day	CCMDB.accdb	declined
Query check ICD10 awaiting has Transfer Ready DtTm	CCMDB.accdb	implemented
Query check transfer DtTm during admission	CCMDB.accdb	implemented
Query check has transfer ready date or checkbox	CCMDB.accdb	implemented
Query s tmp check combined Boarding Loc and TransferReadyDtTm	CCMDB.accdb	implemented
Query s tmp check Boarding Loc and TransferReadyDtTm pairs	CCMDB.accdb	implemented
Query check Transfer DtTm after paired BL and before later BL	CCMDB.accdb	implemented
Query Check BL TR combiner null	CCMDB.accdb	implemented
Query check tmp 2 BL TR S same tm	CCMDB.accdb	implemented
Query check long transfer delay	CCMDB.accdb	needs review
Function Validate Transfer Ready DtTm	CCMDB.accdb	retired
Function Transfer Ready DtTm vs status	CCMDB.accdb	retired
Query check transfer ready tmp for each Boarding Loc	CCMDB.accdb	retired
Query check tmp Transfer Ready not before Boarding Loc	CCMDB.accdb	retired
Query s tmp check combined BL and TRDtTm nonsequential	CCMDB.accdb	retired

Log

2021-07-08 - Change from Awaiting/delayed dx codes to Transfer Ready DtTm for data back to 2021-07-01

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.

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