Transfer Ready DtTm field
see Transfer time rule for the unrelated rules around patients transferring between wards we collect data on
|Data Element (edit)|
|CCMDB Label:||Transfer Ready DtTm|
|Program:||Med and CC|
The purpose is to determine the avoidable days or bed wasted by patients who are deemed ready to leave the unit or ward and then either move to a lower level of care or leave the hospital. This is used as part of the concept Avoidable Days in ICU.
What is being sought here is the intent to send someone to a lower level of care only. Thus, it doesn’t matter what actually happened after this intent occurs (e.g. patient getting sicker and the transfer intent cancelled).
For each patient,
- enter the first date/time of intent to transfer to lower level in the #Hierarchy of levels of care is documented into the Transfer Ready Date and Time Field; see #status changing back and forth
- if not available because the patient was clearly not transfer ready, leave the date/time empty and enter "not transfer ready" into the "TR info status field"
- if not available but the patient probably was transfer ready and it just wasn't documented, leave the date/time empty and enter "not available" into the "TR info status field"
This entry is about the time of an intent, nothing to do with what actually happened to the patient after.
What is transfer ready?
Any of these criteria, for a patient going to a lower level of care, as per hierarchy below:
- The goal here is to identify the intention of the team to send the patient to a lower level if there was an available bed there.
- Obviously we don't always know the team's intentions, but if they do write them down, then USE THAT INFO.
- Regarding the statement that the patient is "medically stable"
- This phrase could mean that the person is improved enough to go elsewhere, but it does NOT necessarily mean that. For example it could technically indicate that the condition is not changing lately, which may or may NOT mean that they're ready to go elsewhere.
- Thus, by itself that phrase cannot be used alone to suggest the patient is transfer ready
- e.g. Deconditioned patient may be medically stable but intention can be to leave them where they are for now to re-condition
- e.g. Patient is medically stable but still needs a sitter --> another situation in which just being "medically stable" isn't sufficient to tell us if they're transfer ready
- In an ICU setting, you CAN take the following to indirectly indicate transfer ready to a lower level of care when nothing has been written:
- care is stepped down to WARD FREQUENCY (q4hrs or less) of vitals, off ALL forms of life support except possibly intermittent dialysis
- HSC_IICU consult is written
- In a ward setting, you can take the following to indirectly indicate transfer ready to a lower level of care when nothing has been written:
- care is stepped down to change iv meds to po, remove monitoring
- In either ICU or ward setting being made ACP-C can be taken as indirect evidence of being transfer ready.
Hierarchy of levels of care
We require an entry in this field when the transfer is from higher to lower level of care:
- WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU
- Other MB RHA ICU or Other Province ICU
- WRHA IICU
- WRHA HOB ward
- WRHA regular ward
- WRHA lower acuity ward in acute care hospital, whatever flavour of the month word they use for this
- ward outside WRHA
- PCH or home
status changing back and forth
If a patient changes from being transfer ready back to not being transfer ready, collect the first transfer ready dttm.
Data Integrity Checks (SMW)
|Query check ICD10 needs awaiting if TR Dt and Dispo Dt on diff days||CCMDB.accdb||declined|
|Function Dispo Chronological()||CCMDB.accdb||implemented|
|Check if awaiting code is primary dx then Transfer Ready DtTm must be equal to Arrive DtTm||CCMDB.accdb||implemented|
|Function Validate Transfer Ready DtTm||CCMDB.accdb||implemented|
|Function Transfer Ready DtTm vs status||CCMDB.accdb||implemented|
|Query check ICD10 awaiting has Transfer Ready DtTm||CCMDB.accdb||implemented|
|Query check long transfer delay||CCMDB.accdb||needs review|
|Check Function Panelling admit transfer same||CCMDB.accdb||retired|
|Query check dispo lower acuity than location||CCMDB.accdb||retired|
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Similar to the old Transfer Ready date and time, but we eliminated special cases and differences between medicine and critical care. Going forward the entry will be collected even if pt dies or goes to ER etc. It's the intent that counts, not what ended up happening. Resp. field names L_Log.R_TRDate and L_Log.R_TRTime