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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{{Reporting Indicators
{{Reporting Indicators
|description='''Transfer Delay''' is the difference between [[Dispo_DtTm]] and [[#Time patient is ready for transfer]] in decimal days.
|description='''Transfer Delay''' is the difference between [[Dispo_DtTm]] and [[#Transfer Ready DtTm in use at different times]] in decimal days.
|created_raw=created
|created_raw=created
|Program=Critical Care
|Program=Critical Care
|indicator_start_date=1999-01-15
|indicator_start_date=1999-01-15
|indicator_name=Transfer Delay
|indicator_name=Transfer_Delay_CC
|program=Critical Care and Medicine
|program=Critical Care and Medicine
}}
}}
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 ==
== Use ==
* The purpose is to determine the amount of time the patient is occupying a bed in an ICU setting when the patient is no longer needing that [[Level of care hierarchy| level of care]] (also referred to as wasted bed) from the [[Transfer Ready DtTm]] until the [[Dispo DtTm]].
* 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.
}}


== Definition  ==
== Transfer Ready DtTm in use at different times ==
Transfer Delay is the difference between [[Dispo_DtTm]] and  [[#Which Transfer Ready DtTm To Use?]] in decimal days.
===  [[Admit DtTm]] or [[Dispo DtTm]] < 2020-10-01 00:00 ===
* Use the DtTm in [[Transfer Ready DtTm field]]


== Which Transfer Ready DtTm To Use? ==
=== [[Admit DtTm]] or [[Dispo DtTm]] >= 2020-10-01 00:00 ===
=== Before Oct 1, 2020 ===
* Use the ''first'' [[Transfer Ready DtTm tmp entry]], as derived by [[created_FirstTransferReady query]]
* For each patient in ICU and  Medicine ward,  the transfer date and time is taken from the [[Transfer Ready DtTm field]].
* It is calculated by [[Created_Variables_Common_maker query]] and stored in [[Created_Variables_Common table]] in [[CFE]].


=== Starting Oct 1, 2020 ===
==== Background ====
* For each record and each boarding location in ICU , 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 tmp entry]] corresponding to one or more [[Boarding Loc |boarding locations]].
* For each record, it is possible to have one or more entries of [[Transfer Ready DtTm tmp entry]] corresponding to one or more boarding locations.
* 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
* if the patient moves to various locations, the '''first''' [[Transfer Ready DtTm]] from a [[Boarding Loc]] will be used
* Any additional [[Transfer Ready DtTm tmp entry]] will be ignored for this calculation
**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. collectors 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 Location1 and then directly transferred to Location2 where he stayed another 7 days.  On Location1 day 3 a progress note said he was ready to go to ward, but he didn't.  At no time during his Location2 stay did any notes indicate transfer readiness.  Julie will calculate this as 4 wasted Location1 days, and 7 wasted Location2 days.
***example 2:  Mr. Jones spent 7 days in Location1 and then directly transferred to Location2 where he stayed another 7 days.  On Location1 day 3 a progress note said he was ready to go to ward, but he didn't.  On Location2 day 1 a progress note indicates transfer readiness.  Julie will calculate this as 4 wasted Location1 days, and 7 wasted Location2 days.
***example 3:  Mr. Jones spent 7 days in Location1 and then directly transferred to Location2 where he stayed another 7 days.  On Location1 day 3 a progress note said he was ready to go to ward, but he didn't.  On Location2 day 5 a progress note indicates transfer readiness.  Julie will calculate this as 4 wasted Location1 days, and 7 wasted Location2 days.
***ALL 3 of these examples have the same # of wasted days.


==== Why collect per ward in medicine when we only report per admission? ====
==== 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.
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 ==
== Reporting of Transfer Delays ==
*Reported as count, Mean (average), Sum (Total), and Cumulative counts and percentage
* Include all cases with transfer ready dttm  (who went to same/lower/higher level of care or died).  
*A - Determine the patients who left alive to a lower level of care and
* Refer to the following indicators:
** A1 - Have  transfer delays
#[[Avoidable Days (Critical Care)|Avoidable Days]]
** A2 - Have no transfer ready dttm - assign them as zero transfer delay
#[[Beds occupied by transferrable patients (Critical Care)|Beds occupied by transferrable patients]]
** Total True delays = Transfer delays from A1 + zeroes from A2 ;  Total N = A1 + A2; Average True Delays=Total True Delays / Total N
** Total transfer delays > 2 hours  - sum up those patients from A1 by excluding those with transfer delays <= 2 hours  and compute the Average.
** Distribution of true transfer delays - counts, cumulative counts and percentage
***zero
***<= 4 hours
***>4h - 12h
***>12h - 1d
***>1d - 2d
***>2d - 3d
***>3d - 7d
***>10d - 14d
***>10d
 
*B - Determine and report the number of patients with transfer delays who had left alive and went to same level of care.  
*C - Determine and report the number of patients with transfer delays who died before going anywhere.


== IICU and H6 Reporting ==
== IICU and H6 Reporting ==
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# 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 ==
Before Oct 1,2020 -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]].
Starting Oct 1,2020, transfer time is always present.


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

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

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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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