ICU Interfacility Transfer

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Percent of live ICU discharges that are transferred to an ICU located at a different hospital.

Indicators
Indicator: ICU Interfacility Transfer
Created/Raw: Created
Program: Critical Care
Start Date: Oct 2016
End Date:
Reports: Critical Care Program Quality Indicator Report


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Usually used in aggregate form as "per location" and/or "per timeframe", e.g. by day/month/quarter/year x Ward/Unit x Hospital.

See more details on the definition of interfacility transfer in ICU Interfacility Report .

QI domain

  • Efficient

Significance

Reasons for transfer may be either to manage ICU beds or access to a required medical service. Bed management transfers can increase the efficiency of ICU bed numbers within a region. Patient transfers may increase the time to appropriate management and may place patients at risk.

Sampling Plan / Procedure

Inclusion Criteria

100% patients who survived and left ICU

Exclusion Criteria

  1. Patients transferred to a home hospital (i.e. not for medical or bed access reasons);
  2. patients not formally evaluated by the ICU team;
  3. patients admitted to a critical care unit within the same geographic site.

Frequency

  • Month, quarter or year based on ICU discharge dates for Live ICU discharges
  • Month, quarter or year based on ICU admission dates for the counts of transfers due to medical or bed access reasons

Definition and Derivation For Rate

Percent of live ICU discharges that are transferred to an ICU located at a different hospital.

Numerator

Num = Number of live ICU discharges that are transferred to an ICU located at a different hospital or the Transfer OUT (see below definition)

Denominator

Denom = Number of Live ICU discharges

Formula

Percent of live ICU discharges that are transferred to an ICU located at a different hospital = Num / Denom

Transfer for Medical Reason or Bed management

A report to specify the transfer "for medical reasons" vs. "for bed management" is added starting 2024. In order to determine the reason for transfer, the diagnoses on the transferring ICU will be evaluated depending on the facility the patient came from or the sending ICU and the admitting or receiving ICU. Also there are two perspective to consider in reporting transfer namely Transfer OUT and Transfer IN.

Medical Reason

  • From STB facility to HSC ICUs - medical reasons include Neurological dxs, all types of trauma dxs and MICP procedures

What is the acronym MICP?

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  • From HSC facility to STB ICMS/ACCU/ICCS - medical reasons include Cath Lab procedures, Cardiovascular Post-op dxs, Aortic aneurysm, thoracic with rupture, IABP and Peritoneal Dialysis
We need links for these if we want to maintain the ability to quickly check on the wiki if a change to a collection component would affect reports. It also makes for more integrated documentation. 
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  • From Grace facility to HSC/STB ICUs - medical reasons include Cath Lab procedures, Cardiovascular Post-op dxs, Acute renal, vascular aneurysm, Neurological, all trauma, MICP, IABP, Peritoneal Dialysis, Hemodialysis, CRRT procedures
  • From HSC/STB facility to Grace ICU - no medical reason

Bed Management Reason

  • If none in the above Medical reason, then it is bed management reason.

Transfer OUT

  • Transfer OUT includes the transfers from a discharging or sending ICU to another site’s ICU for medical necessity or bed management reasons.
    • The number of transfers is attributed to the discharging or sending or originating ICUs.
    • To another site's ICU can be any ICU at different facility.
  • For example, patients admitted at Grace ICU who are transferred to HSC MICU or STB ICMS are Transfer OUT.
    • Patients who are admitted at Grace ICU, had a procedure in other facility and then admitted to an ICU service in that or another facility are Transfer OUT.
    • Patients who are admitted at Grace ICU, had a procedure in other facility and then came back to Grace ICU are not Transfer OUT.

Transfer IN

  • Transfer IN includes the transfers to a receiving or admitting ICU from another site for medical necessity or bed management reason.
    • The number of transfers is attributed to the receiving or admitting ICUs.
    • From another site can be another site’s ICU, ER, ICU, Ward, OR, RR, etc. Can be broken down from another site's ICU or Non-ICU service.
    • Example 1 - patients admitted to HSC MICU can be inpatients from STB ICMS or STB Ward or Grace ICU or Grace Ward or non-inpatients from STB ER or Grace ER. All these transfers are counted and attributed to HSC MICU. If need to separate from another site ICU, include only those from STB ICMS and Grace ICU. If from another site non-ICU service, include those from STB ER, STB Ward, Grace ER, Grace Ward. The reasons for transfer can either be medical or bed management reason.
    • Example 2- patients admitted to Grace ICU can inpatients from STB/HSC ICU/Ward or non-inpatient from STB/HSC ER/OR/etc. All transfers can be attributed to Grace ICU and broken from ICU or Non-ICU service. However, the reason for transfer will only be due to bed management.

Data Sources

SAS Program

  • S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\InterfacilityReasonMed.sas - list the diagnosis (old coding and ICD10 codes) that defines a medical reason for transfer
  • S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\InterfacilityInOut.sas

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