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.

Transfer ready date and time is the time a patient is deemed to be ready to leave the ward/unit; there are very specific collection instructions for this, and they are different for ICU and Medicine. See [[]] for how we use this data. 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.

ICU

The transfer ready date and time is when the pt is deemed stable enough to be transferred out of the ICU (usually to a ward setting). If the pt has a transfer ready status in ICU but deteriorates following this, the time and date would be changed accordingly. This differs from the ward transfer ready.

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 - ACP-C

ACP-C means transfer ready in ICU: As discussed with Dr Garland on May 12, 2014: When a pt is made ACP-C the pt could technically be transferred to hospice, home or a ward that is not an acute medicine ward. This means that the ACP-C pt does not need to be on an acute medicine ward or ICU. Subsequently, when a pt is made ACP-C this time could be used for transfer ready.

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
  • I know that the above refers to ICU but is this also applicable to Medicine patients? We have patients where they are made ACP-C, all meds and treatments are discontinued and they are basically waiting to die or be discharged home or somewhere to die there. Does this become a transfer ready date for Medicine?--CMarks 11:36, 2014 June 26 (CDT) Template:Discussion
    • flagged this in an email to Trish and Dr Garland Ttenbergen 16:50, 2014 June 26 (CDT)

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

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.

• • Patient arrives transfer-ready: If a pt already has a transfer ready date and time and is moved to another ward where a new profile is started, the transfer ready date and time will be the time of admission to that ward. For example, a pt has been in acute care and is medically stable on Oct 15 at 1000. This is your transfer ready data and time. The pt is then transferred to a chronic ward on Oct 30, and a new profile is started. The admit date for the new profile is Oct 30 and you should fill in the transfer ready date as Oct 30 (1000 hrs) because the pt is still medically stable and continues to wait for discharge. Julie needs them done this way as she links the profiles.--LKolesar 08:59, 10 November 2011 (CST)

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.)

Transfer ready DATE NOT available Medicine only

Go to: Collection of "No Transfer Date Medicine"

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)

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)

Data Use

Used to generate Transfer_Delay, which is used in Overstay and several reports, see also Transfer_Delay#data use.

Date and time formats

see Date and Time Format

Template:CCMDB Data Integrity Checks

CCMDB.mdb Transfer Date validation

If all of

• transfer ready date or even just time is blank
• survived,
• not Med Var 6 - AMA and not ICU Var 6 - 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.

Template:Discussion I don't think these run as written right now, and even if they do, they would be different than #NDC_Missing_TransferDate_w_pivot

NDC_Missing_TransferDate_w_pivot

This query in Centralized data front end.mdb flags patients discharged to "zz" or Like "?w" (ie home or ward) who have a discharge date "Between #2013/Oct/01# And #2013/Dec/31#" (?!) and a transfer date of #3000/Jan/01# (I think this would only catch those imported from Ed, not the newly sent ones).

for incomplete only

Template:Discussion Should this be changed to be like #CCMDB.mdb Transfer Date validation, once that is what we want it to be? Ttenbergen 14:43, 2014 June 23 (CDT)