Transfer Ready date and time

see Transfer time rule for the unrelated rules around patients transferring between wards we collect data on Rewriting in progress.........your patience and help appreciated.

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.

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

Transfer Date and Time

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

Sources

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

• Physician Diagnosis Form (green sheet) (available for ICU only)
• Transfer Ready stamp on physician orders or progress note (Medicine only)
• STB Electronic Patient Record
• Physicians’ Orders from patient chart
• ICU patient Log Book as recorded by unit clerk (from orders)
• Charge Nurse
• IPN - Often a physician will write "medically stable" in the IPN but not in the orders.--CMarks 07:51, 2014 March 3 (CST)

Transfer Ready date/time

ICU

Required for ICU when

• a patient is sent to a ward from an ICU
• a patient is sent to IICU at HSC
• a patient is ready to go home (ZZ)
• See ICU special cases below

Not required for ICU when

• goes home ICU Var 6 - AMA Against Medical Advice
• when patient dies in the ICU
• transfer to from one ICU to another ICU in same center in other ICU in city.
• sent to operating room (OR)
• Sent for procedure or test, (example: angiogram, CT scan, fluroscopy, bronchoscopy, MUGA scan etc.) and doesn't return to unit.

ICU Special Case - DC Treatment

• when DC Treatment AND pt is put on transfer list AND goes to a ward AND dies there, then transfer ready date should be recorded
• Do not record a transfer ready date/time if the unit physician discontinues life-support (withdraws therapy, DC Treatment) on a patient AND pt is put on transfer list BUT dies BEFORE going to a ward. Leave it blank. This field is not for recording the date and time when discontinuation of life support process started

ICU Special Case - Condition Deteriorates

• If a patient is on the transfer ready list in ICU 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. If the patient is put back on the transfer/discharge ready list, enter the new transfer ready date. Not applicable to Medicine ward patient.

Medicine

Required for Medicine when

• a patient is sent from a Teaching medicine ward to a Non-teaching medicine ward

Template:Discussion is this to be done when the patient stays on the same Medicine ward?

• • Do you mean if patient status changes from teaching to non teaching but stays on same medicine ward as nonteaching?Trish Ostryzniuk 17:57, 2014 February 28 (CST)
• a patient is sent Home (ZZ)
• a patient is sent to a long term care facility (NW, DW, RW...)

Not required for Medicine when

• patient is being transferred to an ICU
• a patient goes from one medical teaching unit to another in same facility or another facility in the city.
  • exception: if patient was transfer ready in one medical teaching unit, but in the interim, gets sent to another teaching unit while waiting for longer term care, then transfer ready date can be recorded in first teaching unit, and for the second teaching unit, the transfer ready date/time will be the SAME as admit date/time to the receiving ward. 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.
• goes home Med Var 6 - AMA Against Medical Advice
• when patient dies on a medicine ward
• transfer to an ICU
• sent to operating room (OR)
• Sent for procedure or test, (example: angiogram, CT scan, fluroscopy, bronchoscopy, MUGA scan etc.)

Medicine Special Case - Condition Deteriorates

If a patient develops a complication AFTER they were deemed to be medically stable and transfer ready, you do not cancell their transfer ready date/time. 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 OverstayProject. As per discussions with Roberts for updated guidelines. --LKolesar 15:04, 2012 March 19 (CDT)

Date and time formats

see Date and Time Format

Template:CCMDB Data Integrity Checks

Transfer Date validation

If all of

• transfer ready date /time is blank
• survived,
• var6 is not AMA
• the discharge-to location ends in W, U, Z, X

then

• give an error requiring a comment in notes
• don't allow final-check if notes are blank

This is checked at registry-check or final check.

Transfer Time validation

If there is a transfer date, a transfer time is required also. This is checked at registry-check or final check.

Legacy Information

stamper implementation

• 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.

Discussion Leading up to dropping "transfer ready" date collection for Medicine

This is legacy information only.

We did not collect transfer ready date and time for medicine patients from 2010-May-19 until November 2011 for the following reasons. We re-started collection because the data was seen as important enough to collect it even if it is not perfect.

As discussed in the Critical Care Review Group, the transfer ready date information is not very organized or consistent city wide so its value is questionable. Since the data is unreliable, we are are planning to propose to stop collecting this. Does anyone have any thoughts on this?

Dec 9.2008-Transfer Ready date/time

• Transfer ready date/time - will continue to be collected until further notice.

Betty Lou Rock will determine if this will be used or not. She plans to set up a working group to assess if a system could be developed within the Hospital system to make this data more reliable. Data collectors rely on Dr.’s orders, where this information frequently not recorded and they guess at time and sometimes date when a call to the bed desk for a patient who is transfer ready. ICU, because it is a smaller unit, collectors have a better chance of obtaining a fairly good estimate. Some ICU are very good at writing these orders, others are not. On Medicine there is a significant problem in obtaining accurate information because of lack of chart documentation. Currently there is no consistent process in place at each hospital that maintains a record of transfer ready dates/times where data collectors can draw or verify this information from. The next Steering Next Database Committee meeting is in February and Task team will follow up the status of transfer ready date. TOstryzniuk 17:44, 9 December 2008 (CST)

• At the HSC Transfer Ready is being called to admitting dept and recorded on forms. Perry Gray and Dr. Garland set these up. The forms are being faxed to us and entered by Data Processor into Transfer Ready Access database. The Steering Committee must review this information and decide it will still continue. The data coming in this route does not seem very reliable. Poor documentation and not legible.--TOstryzniuk 21:57, 6 November 2009 (CST)
  • For ICU the data collectors will continue to collect transfer/discharge ready.Betty Lou Rock invited Linda Hathout to a ICU QA meeting to explore other ways this information may be collected. Perry Gray has stopped the paper process from the Medical records department at the beginning of this month.--TOstryzniuk 20:11, 19 May 2010 (CDT)