Transfer Ready DtTm field: Difference between revisions

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'' see [[Transfer time rule]] for the unrelated rules around patients transferring between wards we collect data on
{{Data element
|field_name=Transfer_Ready_DtTm
|CCMDB_label=Transfer Ready DtTm
|CCMDB_tab=Dispo
|in_table=L_Log table
|data_type=date
|program_collecting=Med and CC
|created_raw=Raw
|data_element_start_date=1999-06-01
|data_element_end_date=2020-10-15
|data_element_sort_index=47
|element_description=Date and time the '''intent to discharge''' a patient to a lower level in the [[Level of care hierarchy]] was documented.
}}
See [[Transfer Ready DtTm tmp entry]]
 
The data in this field will be retained in [[Centralized data.mdb]]'s [[L_Log table]] since it doesn't follow the same pattern as the new entry. The field no longer exists in [[CCMDB data.mdb]].


{{Data_element
| field_name = Transfer_Ready_DtTm
| CCMDB_label = Transfer Ready DtTm
| CCMDB_tab = Dispo
| element_description = Date and time the '''intent to discharge''' a patient to a lower level in the [[#hierarchy of levels of care]] was documented.
| in_table = L_Log table
| data_type = date
| program_collecting = Med and CC
| created_raw = Raw
| data_element_start_date = 2016-07-01
| data_element_sort_index = 47
}}
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). <!-- Clarified at the 11Sept2017 Steering Committee meeting -->
See [[Transfer Ready DtTm tmp entry]] for what this field is about, or see the history of this page for how it has been used at different times before moving to the new field.  


== Collection Instruction ==
== Collection Instruction ==
=== Entering a Transfer Ready DtTm ===
Follow the instructions in [[Transfer Ready DtTm tmp entry]].
{{Collapsable
| always= Before 2020-10-15
| full= 
For each patient,  
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]]
* enter the first date/time of '''intent''' to transfer to lower level in the [[Level of care hierarchy]] is documented into the Transfer Ready Date and Time Field; see [[#status changing back and forth]]
** if a patient '''arrives transfer-ready''' to a [[#Hierarchy of levels of care | lower level]] of care '''than ''your'' ward''' enter the same date into [[Transfer Ready DtTm field]] as in [[Arrive_DtTm field]].
** if a patient '''arrives transfer-ready''' to a [[Level of care hierarchy | lower level]] of care '''than ''the current'' ward''' enter the same date into [[Transfer Ready DtTm field]] as in ''Arrive_DtTm field''.
* 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 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]]'''"  
* 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.
This entry is about the time of an '''intent''', nothing to do with what '''actually happened''' to the patient after.
 
}}
=== What is transfer ready? ===
=== What is transfer ready? ===
Any of these criteria, for a patient going to a '''lower''' level of care, as per hierarchy below:
moved to [[Transfer Ready DtTm tmp entry#Transfer Ready]]
*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|ACP-C]] can be taken as indirect evidence of being transfer ready.


=== Hierarchy of levels of care ===
=== Hierarchy of levels of care ===
We require an entry in this field when the transfer is from higher to lower level of care:
We require an entry in this field when the intent is to transfer from higher to lower level of care. See [[Level of care hierarchy]] for a list.
* WRHA ICU, same level of care includes: MICU, SICU, CICU, ACCU, CCU
* Other MB RHA ICU or Other Province ICU <!--(confirmed by Dr. Allan Garland 2Oct2017)-->
* WRHA IICU
* WRHA HOB ward
* "ward" - the following are all considered the same level of care
** WRHA teaching ward
** WRHA non-teaching ward / EMIP
** residents may set patients to be "non-teaching" because their quota is filled - see [[#pt becoming non-teaching is not a reason to consider transfer ready]] for details
** WRHA sub-acute medicine ward (family medicine service)
** WRHA transitional care ward (family medicine service)
* ward outside WRHA
* PCH or home
 
{{Discuss | who = all | question =  would need to be reconciled as part of [[Eliminating distinction between different ward types]]}}


=== status changing back and forth ===
=== Collection Start Dates ===
If a patient changes from being transfer ready back to not being transfer ready, collect the '''first''' transfer ready dttm.
* Critical Care: all units on board June 1, 1999
 
* Medicine : all wards on board Jan 1, 2005
=== 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.--[[p:CMarks|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.[[p:Elaine Nagy-Retire, Dec 21, 2018 | Elaine Nagy]]-- 14:12, 2017 October 6 (CDT)
*** {{discussion}} 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? [[p:Ttenbergen | Tina Tenbergen]]-- 08:54, 2018 June 7 (CDT)
 
{{Discuss | who = all | question =  would need to be reconciled as part of [[Eliminating distinction between different ward types]]}}
 
== Data Use ==
Used to generate [[Transfer_Delay]], which is used in [[Overstay]] and several reports, see also [[Transfer_Delay#data use]].


== Cross Checks ==
== Cross Checks ==
{{Data Integrity Check List}}
{{Data Integrity Check List}}
== Related Articles ==
{{Related Articles}}


== Legacy ==
== Legacy ==
Line 84: Line 51:
Resp. field names L_Log.R_TRDate and L_Log.R_TRTime
Resp. field names L_Log.R_TRDate and L_Log.R_TRTime


== Related Articles ==
{{Related Articles}}


[[Category: 2016 Time and Place changes]]
[[Category: 2016 Time and Place changes]]
[[Category: Admit/Discharge]]
[[Category: Admit/Discharge]]
[[Category: Transfer Ready]]
[[Category: Transfer Ready]]
[[Category: Data Collection Guide]]
[[Category: Registry Data]]
[[Category: Registry Data]]
[[Category: Transfer Ready| *]]
[[Category:Service/Location check]]

Latest revision as of 16:44, 2023 October 18

 
 
 
 

Legacy Content

This page contains Legacy Content.
  • Explanation: This is a legacy data field, its DataElementEndDate is in the past.
  • Successor: No successor was entered

Click Expand to show legacy content.

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: 1999-06-01
End Date: 2020-10-15
Sort Index: 47

Date and time the intent to discharge a patient to a lower level in the Level of care hierarchy was documented.

  • SMW

Legacy implementation right in the table

  • Cargo


  • Categories
  • Forms


See Transfer Ready DtTm tmp entry

The data in this field will be retained in Centralized data.mdb's L_Log table since it doesn't follow the same pattern as the new entry. The field no longer exists in CCMDB data.mdb.


See Transfer Ready DtTm tmp entry for what this field is about, or see the history of this page for how it has been used at different times before moving to the new field.

Collection Instruction

Entering a Transfer Ready DtTm

Follow the instructions in Transfer Ready DtTm tmp entry.

Before 2020-10-15   

For each patient,

  • enter the first date/time of intent to transfer to lower level in the Level of care hierarchy 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?

moved to Transfer Ready DtTm tmp entry#Transfer Ready

Hierarchy of levels of care

We require an entry in this field when the intent is to transfer from higher to lower level of care. See Level of care hierarchy for a list.

Collection Start Dates

  • Critical Care: all units on board June 1, 1999
  • Medicine : all wards on board Jan 1, 2005

Cross Checks

Data Integrity Checks (automatic list)

 AppStatus
Check Function Panelling admit transfer sameCCMDB.accdbretired
Query check dispo lower acuity than locationCCMDB.accdbretired
Link suspect transfer ready before arrive dateCentralized data front end.accdbretired

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

Related Articles

Related articles:
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