Transfer Delay (Critical Care): Difference between revisions

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m (→‎Admit DtTm or Dispo DtTm < 2020-10-01 00:00: Julie agreed we won't do any substitutions for this so this is done.)
 
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{{Data_element
{{Reporting Indicators
| field_name = Transfer Delay
|description='''Transfer Delay''' is the difference between [[Dispo_DtTm]] and [[#Transfer Ready DtTm in use at different times]] in decimal days.
| element_description =  '''Transfer Delay''' is the difference between [[Dispo_DtTm]] and [[Transfer_Ready_DtTm]] in decimal days.
|created_raw=created
Other terms use to call it are '''Beds Occupied by transferable patients''', '''Wasted Beds''', '''Avoidable Days'''.
|Program=Critical Care
| in_table = Created_Variables_Common table
|indicator_start_date=1999-01-15
| data_type = number
|indicator_name=Transfer_Delay_CC
| datafield_length = single
|program=Critical Care and Medicine
| program_collecting = Med and CC
}}
| created_raw = Created
There is a similar concept in medicine, [[Transfer Delay (Medicine)]].
| data_element_sort_index = 7
| data_element_start_date = 1999-01-15}}


It is stored in the [[Transfer_Delay_CC]] field in [[Created_Variables_CC_2021 table]].


Before Oct 1, 2020, it is calculated by [[Created_Variables_Common_maker query]] and stored in [[Created_Variables_Common table]] in [[CFE]].
== 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 hierarchy| 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 ==
*Transfer Delay is the difference between [[Dispo DtTm]] and first [[Transfer Ready DtTm]].
{{Collapsable| always=see previous definitions| full=
*As agreed in JALT meeting March 22, 2023, transfer delays will be reported based on actual delay times with no more allowances of less than n hours.
*previously, transfer delay calculation followed the national Vital Signs Monitoring program guideline which subtracted 2 hrs from all actual delay time.
*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]]


== Meaning of Transfer Delays (to a lower level of care)==
=== [[Admit DtTm]] or [[Dispo DtTm]] >= 2020-10-01 00:00 ===
*This is especially relevant given the start on October 1, 2020 of the the "patient transfer" project, where within a single hospital, patients who move from location to location at the same level of care (e.g. ICU or ward) have a single database record, but we keep track of [[Boarding Loc]] and [[Service tmp entry]] as they move from place to place.
* Use the ''first'' [[Transfer Ready DtTm tmp entry]], as derived by [[created_FirstTransferReady query]]
*As described in [[Transfer Ready DtTm tmp entry]], collectors make a notation about transfer ready in each separate boarding loc, looking solely at whether or not the patient was recorded as transfer ready from that location (i.e. colletors should not "carry over" knowledge about transfer readiness at prior boarding locs).
*BUT, when calculating "wasted days", Julie will only use the '''FIRST''' transfer ready date/time:
**example 1:  Mr. Jones spent 7 days in MICU and then directly transferred to SICU where he stayed another 7 days.  On MICU day 3 a progress note said he was ready to go to ward, but he didn't.  At no time during his SICU stay did any notes indicate transfer readiness.  Julie will calculate this as 4 wasted MICU days, and 7 wasted SICU days.
**example 2:  Mr. Jones spent 7 days in MICU and then directly transferred to SICU where he stayed another 7 days.  On MICU day 3 a progress note said he was ready to go to ward, but he didn't.  On SICU day 1 a progress note indicates transfer readiness.  Julie will calculate this as 4 wasted MICU days, and 7 wasted SICU days.
**example 3:  Mr. Jones spent 7 days in MICU and then directly transferred to SICU where he stayed another 7 days.  On MICU day 3 a progress note said he was ready to go to ward, but he didn't.  On SICU day 5 a progress note indicates transfer readiness.  Julie will calculate this as 4 wasted MICU days, and 7 wasted SICU days.
**ALL 3 of these examples have the same # of wasted days.


== Definition Details ==
==== Background ====
*'''Transfer Delay Over 2 hours for Critical Care''' (ie subtract 2 hrs from transfer delay)
* For each record, it is possible to have one or more entries of [[Transfer Ready DtTm tmp entry]] corresponding to one or more [[Boarding Loc |boarding locations]].
{{DJ | 1
* We only collect one [[level of care hierarchy | level of care]] per CC record, so we only ever care about the first [[Transfer Ready DtTm tmp entry]] that has a DtTm
* I don't quite understand this. Does it mean that, for whatever report uses this, it only considers the TRDtm+4hrs?
* Any additional [[Transfer Ready DtTm tmp entry]] will be ignored for this calculation
** discussed 2021-09-29, Julie will look up how she does this in SAS. We don't currently use the value from created_variables. [[User:Ttenbergen|Ttenbergen]] 16:20, 2021 September 29 (CDT)
 
}}
==== 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.


== Use ==
== Reporting of Transfer Delays ==
* The purpose is to determine the amount of time the patient is occupying a bed in an ICU or an IICU or a High Observation ward or a regular ward setting when the patient is no longer needing that [[Level of care hierarchy| level of care]] (also refer as wasted bed) from the [[Transfer Ready DtTm]] until the [[Dispo DtTm]].
* Include all cases with transfer ready dttm (who went to same/lower/higher level of care or died).  
=== Which Transfer Ready DtTm To Use? ===
* Refer to the following indicators:
==== Before Oct 1, 2020 ====
#[[Avoidable Days (Critical Care)|Avoidable Days]]
* For each patient in ICU and Medicine ward,  the transfer date and time is taken from the [[Transfer Ready DtTm field]].
#[[Beds occupied by transferrable patients (Critical Care)|Beds occupied by transferrable patients]]
==== Starting Oct 1, 2020 ====
* For each record and each boarding location in ICU and Medicine, the transfer date and time is taken from the [[Transfer Ready DtTm tmp entry]].
* For each record, it is possible to have one or more entries of [[Transfer Ready DtTm]] corresponding to one or more boarding locations.
* if the patient moves to various locations, the '''first''' [[Transfer Ready DtTm]] from a [[Boarding Loc]] the '''same''' [[Level of care hierarchy| level of care]] will be used
** For example, a Med patient stays in  high obs bed and then move to regular ward bed and then another regular ward bed. There are two [[Level of care hierarchy| levels of care]] - one  for high obs and another which is lower, for the regular ward.  At least two [[Transfer Ready DtTm]] intent are expected here - first intent for high obs ready to go to a regular ward and the second intent is from a regular ward to be discharged to another lower [[Level of care hierarchy| level of care]] or home or PCH. Assuming that there are transfer orders both at regular ward 1 and regular ward 2 and both are with same [[Level of care hierarchy| level of care]], the ''first'' [[Transfer Ready DtTm]] time will be used in calculating the wasted bed for that lower [[Level of care hierarchy| level of care]].  There will be another wasted bed to be calculated for the high Obs [[Level of care hierarchy| level of care]] from the [[Transfer Ready DtTm]] to the time the patient left the high obs bed (ie the [[Dispo DtTm]] or the next [[Boarding Loc]] start DtTm.  The sum of the two scenarios will be the total wasted bed for that patient.
** if the Med patient stays in more than one regular wards (or boarding location) or a CC patient stays in more than one ICU location (or boarding ICU location), all locations are considered with the same [[Level of care hierarchy| level of care]], the wasted bed is calculated from  the first [[Transfer Ready DtTm]] until [[Dispo DtTm]].


== IICU and H6 Reporting ==
== IICU and H6 Reporting ==
For the ICU annual and quarter  reports, the transfer ready delay to the IICU and to [[HSC H6]] (LTV)  will be reported separately from the transfer delay to the other Wards and home.  This imply that in addition to the total transfer delay, there will be two more derived delay variables, namely:  
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:  
# to HSC IICU/H6, and  
# to HSC IICU/H6, and  
# to other wards/Home (including nursing home/long term care facility)  
# 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.
The [[Dispo]] location will be used to define the destination. As per Dr. Garland & Dr. Paunovic.
 
== Calculation when transfer time missing ==
The following definitions are used by Julie in reporting from SAS, and by [[centralized_data_front_end.accdb]] to calculate the created_variables query.
 
* if discharge time  < 1000 HR then dummy=0001 HR (12:01 am),
* else if discharge time  >=  1000 HR dummy=1000HR  (10:00 am)
 
This was based on [[Critical Care Vital Sign Monitor]].
 
This is as per approval by [[Dr. Dan Roberts]].


==SAS Program==
*S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\logphi_TR_Jan2023.sas
**  macro %CC_tready
*S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas  (macro %boardtransf)


== Data use ==
== Data use ==
* [[Outcomes Improvement Team Quarterly ICU Report]]
* [[Avoidable Days (Critical Care)]]
* [[Avoidable Days in ICU]]
* [[Beds occupied by transferrable patients (Critical Care)|Beds occupied by transferrable patients]]


{{Data Integrity Check List}}
{{Data Integrity Check List}}


== related fields ==
== related fields ==
* [[Arrive_DtTm]]  
* [[Admit DtTm]]  
* [[Dispo_DtTm]]  
* [[Dispo_DtTm]]  
* [[Transfer Ready DtTm tmp entry]]
* [[Transfer Ready DtTm tmp entry]]
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== Related Articles ==
== Related Articles ==
{{Related Articles}}
{{Related Articles}}
== Legacy ==
{{LegacyContent
|explanation=xxx
|content= 
=== 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.)
}}




Latest revision as of 09:59, 2023 April 20

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.
  • Categories
  • 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

Calculation of Transfer Delay

see previous definitions   
  • As agreed in JALT meeting March 22, 2023, transfer delays will be reported based on actual delay times with no more allowances of less than n hours.
  • previously, transfer delay calculation followed the national Vital Signs Monitoring program guideline which subtracted 2 hrs from all actual delay time.
  • 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

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

Background

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_Jan2023.sas
    • macro %CC_tready
  • S:\MED\MED_CCMED\Julie\SAS_CFE\CFE_macros\prep_Tmp_BoardServiceTransfer.sas (macro %boardtransf)

Data use

Data Integrity Checks (automatic list)

 AppStatus
Query check long transfer delayCCMDB.accdbneeds review

related fields

Related Articles

Related articles:

Legacy

Legacy Content

This page contains Legacy Content.
  • Explanation: xxx
  • Successor: No successor was entered

Click Expand to show legacy content.

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.)
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