Transfer Ready DtTm field
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,
- 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:
- 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
- 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. Elaine Nagy-- 14:12, 2017 October 6 (CDT)
- 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? Tina Tenbergen-- 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. Elaine Nagy-- 14:12, 2017 October 6 (CDT)
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