Transfer Ready DtTm tmp entry

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Projects
Active?: active
Program: CC and Med
Requestor: internal
Collection start: 2020-10-15
Collection end:

Collection instructions

What is Transfer Ready

  • The status of "transfer ready" is about the date/time of an intent to transfer a patient to LOWER level of care in the Level of care hierarchy if there was an available bed there. Whether or not the patient actually moves does not matter, just that at some point there was an intent to move the pt. It also does not matter whether after such a determination the care team changed their minds about such a desired transfer.
  • Obviously we don't always know the team's intentions, but if they do write them down, then use that info.
    • In making this delineation, except as for the exceptions listed immediately below, only consider a clearly written intent that the team now desires the patient to be transferred to such a lower level of care.
      • In particular, when a ward patient is transferred (e.g. home) without any notes stating the team’s intention to do so in advance or even an order to discharge, collectors should not attempt to make educated guesses from the notes of when the patient was probably clinically ready to leave.
  • EXCEPTIONS:
    • In an ICU, take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:
      • care is stepped down to ward frequency (q4hrs or less) of vitals AND off all forms of life support except possibly intermittent dialysis
      • HSC_IICU consult is written
      • patient is made ACP-C
    • In a ward, take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:
      • order is written to change all iv meds to po AND remove monitoring
      • patient is made ACP-C
      • BUT in the absence of some clear indication (a discharge order, or a progress note, or one of the 2 items immediately above), do NOT try to guess at the transfer ready timing. For example, if there is no such order, and no note saying that the patient was ready to leave, but the patient was discharged, in this case assign the transfer ready timing as the actual discharge timing.
  • Special Note regarding Transfer Ready from a ward: Before going home, some ward patients get a home safety evaluation from PT and OT, and if deemed safe for home get a homecare evaluation before going home.
    • The transfer ready date/time in such a situation should be only after the PT/OT evaluation has deemed them safe to go home, i.e. before homecare has seen them. The rationale is that homecare evaluation can occur after discharge, but a hospitalized patient who “fails” their home safety evaluation will end up going to LTC, not home.

Data entry instructions

  • A "Transfer Ready" line is automatically entered for each Boarding Loc entry.
    • Project: Transfer Ready DtTm
    • Item: see #Item
  • Collector needs to enter one of the following:
    • First Date and Time during the stay at this Boarding Loc that patient was transfer ready as per #What is Transfer Ready above
      • i.e. this is the transition to transfer ready, so if they arrived already transfer ready at a Boarding Loc you should not enter the start of that Boarding Loc and instead click the checkbox, or the date of a subsequent new first transfer ready status at this second Boarding Loc
OR
  • checkbox checked that a transfer ready status was never documented for this patient while at this Boarding Loc

Combining Transfer Ready DtTm tmp entry and Boarding Loc records

There needs to be one Transfer Ready DtTm tmp entry for each Boarding Loc and vice versa. To mark which entries belong together, use the same integer number in the "combiner" field in Patient Viewer Tab Cognos ADT2 for both records and in sequential order according to Boarding start_dt and start_tm. The presence of matching records is validated by query s_tmp_check_combined_Boarding_Loc_and_TransferReadyDtTm, and their sequential status by query s_tmp_check_combined_BL_and_TRDtTm_nonsequential.

Patient doesn't become #Transfer Ready before leaving unit

  • If pt never becomes #Transfer Ready, check the checkbox to say so. This is so we can be sure the entry wasn't just forgotten.
  • Don't check this until the patients actually leaves that Boarding Loc (either to a next one or to Dispo) and you are sure a date never became available.

Transfer ready to serveral different lower levels of care

  • If there is clearly written as transfer-ready to a lower level, and then while in the same location he/she is written as transfer-ready to an even lower level of care, only enter the first date and time.

What if the pt ends up transferred to a higher level of care

The original Transfer Ready DtTm tmp entry does not change.

Expand for details why   

It might seem that a patient who was transfer ready but then moves to a higher level of care should be excluded, since they did not actually get transferred to a lower level of care. However, when the patient was deemed transfer ready, additional time in the ward was "wasted time" - if we could have sent them elsewhere we would have. If the patient later crashes, that doesn't make it not-wasted time - they could have crashed anywhere. So the interpretation that a pt moving to a higher level of care after transfer ready is not wasted time is not right. We discussed this repeatedly at task and steering meetings. The only way this makes sense is if it is done by intent.

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Item

As per Change from Awaiting/delayed dx codes to Transfer Ready DtTm

Dropdowns are:

  • for all:
    • LTC/PCH
    • Home
    • WRHA Medicine ward
    • WRHA non-Medicine ward
    • Palliative / hospice
    • ward outside WRHA
  • If they’re in an ICU:
    • ICU outside of WRHA
    • IICU
    • WRHA HOB Medicine Ward
    • WRHA non-Medicine HOB/stepdown

Start DtTm/Legacy

We used the old Transfer Ready DtTm field for transfer ready dttms before 2020-10-15, and use this new entry for dttms after.

Data Use / Purpose

Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.

Used to generate Transfer_Delay and Avoidable Days in ICU.

Background

This isn't so much a project as a change to Transfer Ready DtTm collection to allow us to collect more than one Transfer Ready DtTm per patient-program-stay. See Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry for why we needed to change to this.

Data Integrity Checks (automatic list)

 AppStatus
Check if awaiting code is primary dx then Transfer Ready DtTm must be equal to Arrive DtTmCCMDB.accdbdeclined
Query check TISS each dayCCMDB.accdbdeclined
Query check ICD10 needs awaiting if TR Dt and Dispo Dt on diff daysCCMDB.accdbdeclined
Query check ICD10 awaiting has Transfer Ready DtTmCCMDB.accdbimplemented
Query s tmp check Boarding Loc and TransferReadyDtTm pairsCCMDB.accdbimplemented
Query check tmp Transfer Ready not before Boarding LocCCMDB.accdbimplemented
Query check tmp 2 BL TR S same tmCCMDB.accdbimplemented
Query check transfer DtTm during admissionCCMDB.accdbimplemented
Query s tmp apostrophe in commentCCMDB.accdbimplemented
Query check has transfer ready date or checkboxCCMDB.accdbimplemented
Query s tmp check combined BL and TRDtTm nonsequentialCCMDB.accdbimplemented
Query s tmp check combined Boarding Loc and TransferReadyDtTmCCMDB.accdbimplemented
Query check long transfer delayCCMDB.accdbneeds review
Function Validate Transfer Ready DtTmCCMDB.accdbretired
Query check transfer ready tmp for each Boarding LocCCMDB.accdbretired
Function Transfer Ready DtTm vs statusCCMDB.accdbretired

Log

2021-07-08 - Change from Awaiting/delayed dx codes to Transfer Ready DtTm for data back to 2021-07-01

Legacy

Similar to the old Transfer Ready DtTm field and Transfer Ready date and time, but we eliminated special cases and differences between medicine and critical care.

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