Transfer Ready DtTm field

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see Transfer time rule for the unrelated rules around patients transferring between wards we collect data on


Data Element (edit)
Field Name: Transfer_Ready_DtTm
CCMDB Label: Transfer Ready DtTm
CCMDB tab: Dispo
Table: L_Log table
Data type: date
Length: not stated
Program: Med and CC
Created/Raw: Raw
Start Date: 2016-07-01
End Date: 2300-01-01
Sort Index: 47

Date and time the intent to discharge a patient to a lower level in the #hierarchy of levels of care was documented. See #hierarchy of levels of care for meaning of "lower level of care".

Purpose

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).

Collection Instruction

For each patient,

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
  • "ward" - the following are all considered the same level of care
  • ward outside WRHA
  • PCH or home
Interro-01.gif

would need to be reconciled as part of Eliminating distinction between different ward types

  • SMW


  • Cargo


  • Categories

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.

pt becoming non-teaching is not a reason to consider transfer ready

  • @ HSC we no longer consider patients who are made non-teaching as "transfer ready". This is because residents routinely change patients from "teaching" to "non-teaching" when their quota of patients is filled. The patient moves to non-teaching status under the staff man but are routinely changed back to teaching once discharges occur.--CMarks 13:56, 2017 October 3 (CDT)
    • StB B5 NTU routinely admits Nephrology NT Service patients as well as lateral transfers such as HSC, as identified above, but does not transfer them back to a CTU. Instead the teaching unit Doctors follow the patient on the NT ward they are admitted to. Elaine Nagy-- 14:12, 2017 October 6 (CDT)
      • Interro-01.gif Is this only for HSC? Probably not, right? if not the HSC part above should come out and the direction for this be made generic. Does this really point to a general lack of distinction between teaching and non-teaching? If so, do we need to adjust other processes about this? Tina Tenbergen-- 08:54, 2018 June 7 (CDT)
Interro-01.gif

would need to be reconciled as part of Eliminating distinction between different ward types

  • SMW


  • Cargo


  • Categories

Data Use

Used to generate Transfer_Delay, which is used in Overstay and several reports, see also Transfer_Delay#data use.

Cross Checks

Data Integrity Checks (SMW)

 AppStatus
Function Validate Transfer Ready DtTmCCMDB.mdbimplemented
Function Transfer Ready DtTm vs statusCCMDB.mdbimplemented
Query check ICD10 awaiting has Transfer Ready DtTmCCMDB.mdbimplemented
Query check dispo lower acuity than locationCCMDB.mdbimplemented
Function Dispo Chronological()CCMDB.mdbimplemented
Check if awaiting code is primary dx then Transfer Ready DtTm must be equal to Arrive DtTmCCMDB.mdbimplemented
Query check ICD10 needs awaiting if TR Dt and Dispo Dt on diff daysCCMDB.mdbneeds review
Query check long transfer delayCCMDB.mdbneeds review
Check Function Panelling admit transfer sameCCMDB.mdbretired

Related Articles

Related articles:

Legacy

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