Transfer Ready DtTm field: Difference between revisions
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* "medically stable" written anywhere in the chart | * "medically stable" written anywhere in the chart | ||
* care is stepped down e.g. vital signs decreased, off monitor, IV meds changed to PO meds | * care is stepped down e.g. vital signs decreased, off monitor, IV meds changed to PO meds | ||
* patient | * once patient becomes ACP-C, Medicine or ICU, regardless of whether or not they are still intubated and ventilated <!--(decided at Task Group Meeting on Jan 18, 2016). --> | ||
** {{DA | ACP-C still qualify as transfer-ready would that still be true for a pt in e.g. D5, when there may be no plan to discharge or send to lower level of care? }} | |||
* date and time that the IICU consult is written for patient going to [[HSC_IICU]] | * date and time that the IICU consult is written for patient going to [[HSC_IICU]] | ||
* | * a deconditioned patient may still be medically stable if they can re-condition elsewhere; use your judgment. | ||
* if criteria are otherwise met but need a sitter or some other level of care the the ward can't provide is required then the patient is still considered transfer ready | * if criteria are otherwise met but need a sitter or some other level of care the the ward can't provide is required then the patient is still considered transfer ready | ||
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{{Discuss | who = all | question = would need to be reconciled as part of [[Eliminating distinction between different ward types]]}} | {{Discuss | who = all | question = would need to be reconciled as part of [[Eliminating distinction between different ward types]]}} | ||
=== status changing back and forth === | === status changing back and forth === | ||
Revision as of 20:07, 2018 November 27
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. Bed wasted or avoidable days are being derived from Transfer Ready DtTm and Discharge Date_time (or Dispo Dt_Tm).
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,
- 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 a patient arrives transfer-ready to a lower level of care than your 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 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:
- "medically stable" written anywhere in the chart
- care is stepped down e.g. vital signs decreased, off monitor, IV meds changed to PO meds
- once patient becomes ACP-C, Medicine or ICU, regardless of whether or not they are still intubated and ventilated
|
ACP-C still qualify as transfer-ready would that still be true for a pt in e.g. D5, when there may be no plan to discharge or send to lower level of care? |
- date and time that the IICU consult is written for patient going to HSC_IICU
- a deconditioned patient may still be medically stable if they can re-condition elsewhere; use your judgment.
- if criteria are otherwise met but need a sitter or some other level of care the the ward can't provide is required then the patient is still considered 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
- 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
|
would need to be reconciled as part of Eliminating distinction between different ward types |
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.ENagy 14:12, 2017 October 6 (CDT)E.Nagy
- Template: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? Ttenbergen 08:54, 2018 June 7 (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.ENagy 14:12, 2017 October 6 (CDT)E.Nagy
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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
Data Integrity Checks (automatic list)
| App | Status | |
|---|---|---|
| Check Function Panelling admit transfer same | CCMDB.accdb | retired |
| Query check dispo lower acuity than location | CCMDB.accdb | retired |
| Link suspect transfer ready before arrive date | Centralized data front end.accdb | retired |
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