Avoidable Days (Critical Care): Difference between revisions

From CCMDB Wiki
Jump to navigation Jump to search
mNo edit summary
mNo edit summary
(9 intermediate revisions by 2 users not shown)
Line 9: Line 9:


==QI domain==
==QI domain==
* Efficient  
* [[QualityDomain::Efficient]]


==Reported as==
==Reported as==
Line 20: Line 20:
===Inclusion Criteria===
===Inclusion Criteria===
100% of all  patients physically present in an ICU bed awaiting transfer out of the ICU and having a date value on the [[Transfer Ready DtTm field]]
100% of all  patients physically present in an ICU bed awaiting transfer out of the ICU and having a date value on the [[Transfer Ready DtTm field]]
*For the Critical Care Report, the Directors and QIT agreed to separate the transfer to IICU from the rest of the locations (to home,  to ward, to outside hospital ward, rehab, PCH and those who died but have transfer ready date_time) - start date Jan to March 2018 Qtr report.


===Exclusion Criteria===
===Exclusion Criteria===


===Frequency===
===Frequency===
* Once the transfer order has been written and the allowable 4.0 hours has elapsed, compute [[Transfer Delay]] or the total time it takes for ICU patient to leave the unit.   
* Once the transfer ready date has been written and the allowable 4.0 hours has elapsed, compute [[Transfer Delay]] or the total time it takes for ICU patient to leave the unit.   
**If no time is indicated with the transfer order date a proxy time of 10:00 am for day shift and midnight for night shift will be used for calculation purposes.   
**If no time is indicated with the transfer ready date_tm field a proxy time of 10:00 am for day shift and midnight for night shift will be used for calculation purposes.   
**If more than one transfer order has been written, use the transfer order date & time closest to actual ICU transfer
* To be completed at time of discharge from ICU, compute the total days spent in ICU (refer as [[LOS]])
* To be completed at time of discharge from ICU, compute the total days spent in ICU (refer as [[LOS]])
* To be calculated and reported on a monthly, quarterly or yearly basis based on either ICU Admission Dates or ICU Discharge Dates.
* To be calculated and reported on a monthly, quarterly or yearly basis based on either ICU Admission Dates or ICU Discharge Dates.
Line 32: Line 32:


==Definition and Derivation==
==Definition and Derivation==
Avoidable days is defined as the total time from date/time of transfer order to date/time transfer out of ICU (in hours) less 4.0 hours (and divided by 24 to give yield total avoidable days)
Avoidable days is defined as the total time from date/time of transfer ready to date/time transfer out of ICU (in hours) less 2.0 hours (and divided by 24 to give yield total avoidable days)
*Note that there are occasions that written orders of transfer are not available but patient was ready or find stable enough to transfer as written anywhere in the chart.  The date and time of the latter will be used instead. 
{{Discussion}}
What are we measuring, the time from the written order or the time from when they are stable enough to transfer. The later will require judgement from data collectors. Not all ICU's are great at writing the orders for transfer when the patients are obviously ready. This delay occurs for many reasons.


{{discussion}}
*Refer to the definition of [[Transfer Ready DtTm]]  
*We need some direction on IICU consults.Is this a transfer ready time to a lower level of care? Is that the transfer ready time? It doesn't look good on our reports we the patients don't get transfered and it gets questioned by the office.
** The list of levels of care in [[Transfer Ready DtTm field]] seems to address this, no? If it doesn't, could you clarify the question please? Ttenbergen 14:50, 2018 May 31 (CDT)


===Numerator===
===Numerator===
Line 52: Line 47:
===Example===
===Example===
*Time Reference: Discharge Dates from Jan 1, 2017 to March 31, 2017
*Time Reference: Discharge Dates from Jan 1, 2017 to March 31, 2017
*Total Avoidable Days of all patients with transfer orders = 254.5
*Total Avoidable Days of all patients with transfer ready date-time= 254.5
*Total LOS of all ICU discharges = 1175.3
*Total LOS of all ICU discharges = 1175.3
*Avoidable Days (%)  = 254.5 / 1175.3 * 100= 21.7%
*Avoidable Days (%)  = 254.5 / 1175.3 * 100= 21.7%
Line 62: Line 57:
==SAS Program==
==SAS Program==
X:\Julie\SAS_CFE\CFE_macros\datetimes.sas
X:\Julie\SAS_CFE\CFE_macros\datetimes.sas
== Data Integrity Checks ==
* [[Query check long transfer delay]]


==Report Users==
==Report Users==
*Critical Care Directors and Site  Managers
*Critical Care Directors and Site  Managers
*Critical Care Quality Improvement Team (QIT)
*Critical Care Quality Improvement Team (QIT)
== Change Log ==
July 1, 2018 - Definition changed  "Avoidable days is defined as the total time from date/time of transfer ready to date/time transfer out of ICU (in hours) less 2.0 hours (and divided by 24 to give yield total avoidable days)" from 4 hrs as per instruction by [[p:Jodi Walker Tweed]].
== Related articles ==
{{Related Articles}}
[[Category: Transfer Ready]]
[[Category: Transfer Ready]]
[[Category: Admit/Discharge]]
[[Category: Admit/Discharge]]
[[Category: Length of stay]]
[[Category: Length of stay]]
[[Category: Data Use]]
[[Category: Reporting]]
[[Category: Statistical Analysis]]
[[Category: Take to Task team meeting]]

Revision as of 08:50, 2019 May 23

Avoidable Days in ICU is proportion of ICU total patient days being spent occupying an ICU bed when the patient no longer requires the intensity of care provided in an ICU setting.

Indicators
Indicator: Avoidable Days in ICU
Created/Raw: Created
Program: Critical Care
Start Date: Jan 1 2013
End Date:
Reports: Critical Care Program Quality Indicator Report


  • Cargo


  • SMW:
  • Categories
  • Default form:

QI domain

  • Efficient

Reported as

Percent of total patient days

Significance

Avoidable days reflects the amount of time that patients occupy an ICU bed when the patient no longer requires the intensity of care provided in an ICU setting. It can identify and quantify issues around flow out of the ICU.

Sampling Plan / Procedure

Inclusion Criteria

100% of all patients physically present in an ICU bed awaiting transfer out of the ICU and having a date value on the Transfer Ready DtTm field

  • For the Critical Care Report, the Directors and QIT agreed to separate the transfer to IICU from the rest of the locations (to home, to ward, to outside hospital ward, rehab, PCH and those who died but have transfer ready date_time) - start date Jan to March 2018 Qtr report.

Exclusion Criteria

Frequency

  • Once the transfer ready date has been written and the allowable 4.0 hours has elapsed, compute Transfer Delay or the total time it takes for ICU patient to leave the unit.
    • If no time is indicated with the transfer ready date_tm field a proxy time of 10:00 am for day shift and midnight for night shift will be used for calculation purposes.
  • To be completed at time of discharge from ICU, compute the total days spent in ICU (refer as LOS)
  • To be calculated and reported on a monthly, quarterly or yearly basis based on either ICU Admission Dates or ICU Discharge Dates.
  • For the Director reports, the discharge dates are used as the time of reference.

Definition and Derivation

Avoidable days is defined as the total time from date/time of transfer ready to date/time transfer out of ICU (in hours) less 2.0 hours (and divided by 24 to give yield total avoidable days)

Numerator

Num = Total Transfer Delay in a given period

Denominator

Denom =Total Patient Days on the same period as the numerator

Formula

Avoidable Days (%) = Num / Denom * 100

Example

  • Time Reference: Discharge Dates from Jan 1, 2017 to March 31, 2017
  • Total Avoidable Days of all patients with transfer ready date-time= 254.5
  • Total LOS of all ICU discharges = 1175.3
  • Avoidable Days (%) = 254.5 / 1175.3 * 100= 21.7%

Data Sources

SAS Program

X:\Julie\SAS_CFE\CFE_macros\datetimes.sas

Data Integrity Checks

Report Users

  • Critical Care Directors and Site Managers
  • Critical Care Quality Improvement Team (QIT)

Change Log

July 1, 2018 - Definition changed "Avoidable days is defined as the total time from date/time of transfer ready to date/time transfer out of ICU (in hours) less 2.0 hours (and divided by 24 to give yield total avoidable days)" from 4 hrs as per instruction by p:Jodi Walker Tweed.

Related articles

Related articles: