Transfer Delay (Critical Care)

Transfer Delay is the difference between Dispo_DtTm and #Transfer Ready DtTm in use at different times in decimal days.

Indicators
Indicator:	Transfer_Delay_CC
Created/Raw:	created
Program:	Critical Care and Medicine
Start Date:	1999-01-15
End Date:
Reports:	Critical Care Program Quality Indicator Report, Directors Quarterly and Annual Report (Critical Care), HSC ICUs Data by Patient

• Cargo

• SMW:
  • "created" is not in the list (Created, Raw) of allowed values for the "IndicatorCreatedRaw" property.

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• Default form:

There is a similar concept in medicine, Transfer Delay (Medicine).

It is stored in the Transfer_Delay_CC field in Created_Variables_CC_2021 table.

Use

• The purpose is to determine the amount of time the patient is occupying a bed in an ICU setting when the patient no longer needs that level of care (also referred to as wasted bed) from the #Transfer Ready DtTm in use at different times until the Dispo DtTm.

Calculation of Transfer Delay

• Initially, transfer delays calculation follows the national Vital Signs Monitoring program guideline whihc is substracting 2 hrs from all actual delay intervals.
• In the meeting held Jan 11, 2023, it was decided as per approval from the Critical Care Director to define transfer delays as follows: (a) ignore such transfer delays <2 hrs, but (b) for all delays >=2 hrs to use the actual delay time.

Transfer Ready DtTm in use at different times

Admit DtTm or Dispo DtTm < 2020-10-01 00:00

• Use the DtTm in Transfer Ready DtTm field

Discussed with Julie that we will actually update these in the data rather than do these updates at reporting time. The query below should do it. Pagasa, could you apply it when you get a chance and update here when done? Thanks! Ttenbergen 09:46, 2022 June 29 (CDT) when I started to make the query to update this I came across TRs that were not on the same date as the dispo_dttm. I can understand why we would change times if the TR is on the Dispo Dt, but it doesn't seem to make sense to change them if they are earlier. So, I just want to make sure that you really would have reported e.g. the following with a changed time. D_ID Transfer_Ready_DtTm Dispo_DtTm HrsMins new_tr_dttm GRA_N3-3089 2007-07-31 2007-08-23 15:30:00 00:00:00 2007-07-31 10:00:00 I only make a substitution if same date with Dispo date. Added that part now. however when I have looked at my current code, I no longer have this substitution. Is it because you have combined the dttm together when we moved to access from Ed's and thus the time became 00:00. how did you handle it when transitioning to ACCESS, those without time - did you make the transfer ready dttm blanks or made time to 00:00 ? --JMojica 11:37, 2022 September 21 (CDT) This is one field in Access now, so leaving them blank isn't an option. So you treated blank and midnight differently? Would anyone reasonably become transfer ready at midnight? No rounds happening then. I guess it's possible. So, really you haven't done this for some time, possibly since we moved form Ed's version? I am also prepared to take this whole thing out of the documentation and not do it at all... Ttenbergen 16:20, 2022 September 22 (CDT) I agree, let us drop this whole thing out about transfer time missing and do not do any substitution at all when time is missing. --JMojica 11:08, 2022 October 12 (CDT) Will you stop doing them in SAS as well, then? Otherwise we are back to inconsistent definitions. Ttenbergen 11:55, 2022 October 12 (CDT) ****** OK. --JMojica 08:53, 2022 October 19 (CDT)

added: no added date action: no action date

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• Categories

There were problems with the query I provided to Pagasa, this one doesn't seem to play nice if pasted as SQL. Waiting for reply from Julie on above before providing update since it might change. Ttenbergen 11:04, 2022 September 21 (CDT)

• SMW

• Cargo

• Categories

Query to run if we really want to do this for all records w zero times even if different dates.

UPDATE L_Log INNER JOIN created_Program ON L_Log.D_ID = created_Program.D_ID SET L_Log.Transfer_Ready_DtTm = [transfer_ready_dttm]+IIf(TimeValue([dispo_dttm])<#12/30/1899 10:0:0#,#12/30/1899 0:1:0#,#12/30/1899 10:0:0#)
WHERE (((L_Log.Transfer_Ready_DtTm)>#1/1/1900#) AND ((created_Program.program)="cc") AND ((L_Log.Dispo_DtTm) Is Not Null) AND ((TimeValue(Nz([transfer_ready_dttm],#1/1/1900#))=#12/30/1899#)=True) AND ((DateValue(Nz([dispo_dttm],#1/2/1900#))=DateValue(Nz([transfer_ready_dttm],#1/1/1900#)))=True));

Admit DtTm or Dispo DtTm >= 2020-10-01 00:00

• Use the first Transfer Ready DtTm tmp entry, as derived by created_FirstTransferReady query

Background

• For each record, it is possible to have one or more entries of Transfer Ready DtTm tmp entry corresponding to one or more boarding locations.
• We only collect one level of care per CC record, so we only ever care about the first Transfer Ready DtTm tmp entry that has a DtTm
• Any additional Transfer Ready DtTm tmp entry will be ignored for this calculation

Why collect per boarding loc 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.

Reporting of Transfer Delays

• Include all cases with transfer ready dttm (who went to same/lower/higher level of care or died).
• Refer to the following indicators:

1. Avoidable Days
2. Beds occupied by transferrable patients

IICU and H6 Reporting

For the ICU annual and quarter reports, the transfer ready delay to the IICU and to HSC H6 (LTV) are reported separately from the transfer delay to the other Wards and home. Thus two derived delay variables, namely:

1. to HSC IICU/H6, and
2. to other wards/Home (including nursing home/long term care facility)

The Dispo location will be used to define the destination. As per Dr. Garland & Dr. Paunovic.

SAS Program

• S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\logphi_TR.sas
  • macro %CC_tready
• S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas (macro %boardtransf)

Data use

• Transfer Delay
• Avoidable Days (Critical Care)
• Beds occupied by transferrable patients

Data Integrity Checks (automatic list)

	App	Status
Query check long transfer delay	CCMDB.accdb	needs review

related fields

• Admit DtTm
• Dispo_DtTm
• Transfer Ready DtTm tmp entry
• LOS
• Transfer Delay

Legacy

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Reporting change from 4 to 2 hrs

• Starting July 1, 2018 Transfer Delay Over 2 hours for Critical Care (i.e. subtract 2 hours instead of 4 hours from transfer delay as per instruction by Jodi Walker Tweed.)