Transfer Delay (Critical Care)

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

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• SMW:
  • "created" is not in the list (Created, Raw) of allowed values for the "IndicatorCreatedRaw" property.

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• 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

• 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 (also referred to as wasted bed) from the #Transfer Ready DtTm in use at different times until the Dispo DtTm.

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

Calculation for reporting 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 ready time is always present.

Discussed with Julie that we will actually update these in the data rather than do these updates at reporting time. The query below should do it. Pagasa, could you apply it when you get a chance and update here when done? Thanks! Ttenbergen 09:46, 2022 June 29 (CDT)

added: no added date action: no action date

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Not tested yet, but the code to update this would be something like

Update L_Log

SET L_Log.Transfer_Ready_DtTm = [Transfer_Ready_DtTm]+IIf(TimeValue([Dispo_DtTm])<#12/30/1899 10:0:0#,#12/30/1899 12:1:0#,#12/30/1899 10:0:0#)

WHERE (((TimeValue(Nz([Transfer_Ready_DtTm],#12/30/1899 0:1:0#)))=#12/30/1899#));

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

• Use the first Transfer Ready DtTm tmp entry, as derived by created_FirstTransferReady query

Background

• 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 per CC record, so we only ever care about the first Transfer Ready DtTm tmp entry that has a DtTm
• Any additional Transfer Ready DtTm tmp entry will be ignored for this calculation

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

• Reported as count, Mean (average), Sum (Total), and Cumulative counts and percentage
• A - Determine the patients who left alive to a lower level of care in the Dispo field and
  • A1 - Have transfer delays
  • A2 - Have no transfer ready dttm - assign them as zero transfer delay
  • 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 but 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 in the Dispo field .
• C - Determine and report the number of patients with transfer delays who died in the Dispo field before going anywhere.

JALT one of the DC mentioned in the TASK meeting that GRA Med patient with transfer ready dttm and went to GRA ICU should be considered as bed wasted. In the current process, all with transfer ready dttm are included as bed wasted regardless where the patient went or died. but in this new way of reporting, this is not the case. can we discuss again which is the final way? --JMojica 13:28, 2022 June 24 (CDT)

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

Data use

• Transfer Delay
• Avoidable Days (Critical Care)
• Beds occupied by transferrable patients

Data Integrity Checks (automatic list)

	App	Status
Query check long transfer delay	CCMDB.accdb	needs review

related fields

• Admit DtTm
• Dispo_DtTm
• Transfer Ready DtTm tmp entry
• LOS
• Transfer Delay

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.)