Transfer Ready DtTm tmp entry: Difference between revisions

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|ProjectActive=active
|ProjectActive=active
|ProjectProgram=CC and Med
|ProjectProgram=CC and Med
|ProjectRequestor=internal  
|ProjectRequestor=internal
|ProjectCollectionStartDate=2020-10-15
|ProjectCollectionStartDate=2020-10-15
|Project=Transfer Ready DtTm tmp entry
|Project=Transfer Ready DtTm tmp entry
}}
}}


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.  
== 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 a bed available. 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 and the checkbox is checked.


=== Transfer Ready ===
See [[Level of care hierarchy]] for further information.
For the purpose of this field, Transfer Ready means... {{TT |need to concentrate the details here }}


== Data Collection Instructions ==
==== Specifically for ICU ====
*Use tmp fields:
'''In an ICU''', take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:
** Project: '''Transfer Ready DtTm'''
* Care is stepped down to '''ward frequency''' (q4hrs or less) of vitals AND off '''all''' forms of life support except possibly intermittent dialysis
** Item: '''Transfer Ready DtTm'''  
* [[HSC_IICU]] consult is written
** Transfer Ready Date: Date as defined in [[Transfer Ready DtTm]], under column E.
* patient is made '''[[ACP C|ACP-C]]'''
** Transfer Ready Time: Time as defined in [[Transfer Ready DtTm]], under column M.
* for organ donors, see [[Guideline for coding organ donation after death]]
** checkbox: '''to be checked only if a transfer ready date never became available'''
* if the patient is a '''potential organ donor and then deemed not to be''', the Transfer Ready tmp DtTm will be when that determination is made
** comment (under 'q'): '''only if TR date not available (ie if checkbox checked), enter either "not ready" or "not available" into the comment field.
* for those patients who are declared brain dead, and do '''not become actual or potential organ donors''', use the time of [[Brain death]] as the Transfer Ready DtTm tmp entry, and the time of cardiac death as the [[Dispo DtTm]]


=== initial pre-entered record ===
====Specifically for Medicine ====
A first entry is added automatically to each new patient entered on the laptop.
'''On a medicine ward''', take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:
*For SBGH If there is no discharge order, then the DC summary date/time that the attending signs off can be used, however if the date and time is after the DC time then it may be documented in a nursing or allied health IPN. Also, for SBGH often bed utilization will document when they are waiting on a transfer to an LAU or other facility, or rehab services will document when they are on the central wait list, or long term care (LTC) will document when they are approved for a PCH bed. 
*For HSC if there is no discharge order, then check the IPN notes (nursing, allied health etc), often bed utilization will document when they are waiting on a transfer to an LAU or other facility, or rehab services will document when they are on the central wait list, or long term care (LTC) will document when they are approved for a PCH bed.
* Order is written to change all iv meds to po AND monitor discontinued/vital sign frequency is reduced
* Patient is made '''[[ACP C|ACP-C]]'''
* If a discharge order is written during the preceding day(s) prior to discharge:
** and a specific date and time for discharge is documented in that order, the transfer ready date and time would be the date and time specified in the order. 
** and If the order is to discharge after a specific test or procedure/treatment ie. dialysis or last dose of antibiotics, then the transfer ready date and time would be the time they finish the treatment or procedure.
** and there is no specific date and time documented for discharge or another order for discharge is written, then check the checkbox or use that new discharge order date and time


The first time the patient becomes [[#Transfer Ready]], enter the date and time into this pre-entered record.  
* The discharge medication reconciliation form should NOT be used as transfer ready date and time.


=== additional records if there are additional [[Boarding Loc]]s ===
* '''PT/OT Assessment''': 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.
If, after this initial entry, the patient moves to a physical location (ie new entry in [[Boarding Loc]] that has a different level in the [[Level of care hierarchy]], then:
* exception to this would be for those patients that are waiting for transfer to a rehab ward (Geri, stroke, amp, neuro etc) The date and time they are placed on the wait list for rehab can be used as their transfer ready date and time
* leave the original line as is
* enter a new {{PAGENAME}}, either without a date (for now), or if a new transfer ready date from the new level of care is known by the time you enter this, enter the new date and time


==== pt doesn't become [[#Transfer Ready]] before leaving unit ====
== Data entry instructions ==
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 moves to a unit with a different level of care (either stays in your collection or not) and you are sure a date never became available.
* A "Transfer Ready" line is automatically created for each [[Boarding Loc]] entry.
** Project: '''Transfer Ready DtTm'''
** Item: the only available item is "Transfer Ready DtTm", just like the project entry.
** Date and Time vs checkbox:
***  Collector needs to enter one of the following:
**** '''First''' Date and Time during the stay '''at this [[Boarding Loc]]''' that patient '''became''' transfer ready as per [[#What is Transfer Ready]] above
::OR
:::* checkbox checked if a clear transfer ready date and time are never documented, both must be present to be considered a valid Transfer Ready DtTm


Then either check the box on the new line when you finally complete the patient, or lather rinse repeat.
{{Combined instructions for Transfer Ready DtTm and Boarding Loc}}


We do not need a new record for every move, just for moves to a '''higher or lower''' level in the [[Level of care hierarchy]]. We need this for moves to a higher level as well because once a patient actually moves to a higher level of care, the original determination that they were transfer ready almost certainly is no longer valid.
=== Collection for each Boarding Loc ===
{{Discuss| who = Julie |
We currently only use the first entry per [[Level of care]] to calculate [[Transfer Delay]], but we collect both because:
* How about the original ER entry - that is a high level of care location, but would we expect someone to become transfer ready there and then still move to the ward? Probably not. I'd say no entry for that part, but should see what Julie has to say. Ttenbergen 15:16, 2020 October 16 (CDT)}}
* It gives us the flexibility to report per location if requested
* To make it easier for data collectors. This way, collectors don't have to try and go back and figure out if there was or was not a transfer ready in a prior location. They only need be concerned about the notes and orders from THIS boarding loc.


=== Patient arrives transfer ready ===
== Start DtTm/Legacy ==
If a patient at any [[Boarding Loc]] and is already [[#Transfer Ready]] enter the same date into [[Transfer Ready DtTm field]] as in [[Arrive_DtTm field]].
We used the old [[Transfer Ready DtTm]] field '''for transfer ready dttms''' before 2020-10-15, and use this new entry for dttms after.


=== How will these be matched with [[Boarding Loc]] entries, is additional data needed? ===
The data during the transition period for [[PatientFollow Project]] is inconsistent, so we use all the new and the old in [[Created TransferReady query]].
{{Discuss | who = Julie |
* Should we be entering a date/TM for every entry?  the reason I ask is because if we check off '''B''' and put not transfer ready in column Q,  we often have multiple entries,  How will Julie know which boarding LOC  is associated with each transfer ready entry without a date? [[User:Lkaita|Lisa Kaita]] 10:14, 2020 October 20 (CDT) 
** You could only enter a date if they were transfer ready, so Julie would still not be able to link unready ones. And maybe that's OK, since unready ones wouldn't contribute to wasted beds. But we need to ask Julie. [[User:Ttenbergen|Ttenbergen]] 15:58, 2021 January 21 (CST) }}


== This entry is about '''''intent''''' ==
== Data Use / Purpose ==
Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.


* This is my dilemma with our definition, it is the '''intent''' which I cannot qualify thru the data. if I see an entry in transfer ready date but the physical transfer location is the same or higher level of care, I have to consider  that transfer ready date to be  valid. I rely that the entry is correct. I rather have the definition to be consistent with the level of care (except for  Deaths) so I can quality check the transfer date entry and remove the '''intent'''  as part of the definition. The goal is to measure bed wastage and  when the patient moves to the same or higher level of care, that is not bed wastage to me. --[[User:JMojica|JMojica]] 10:18, 2020 October 16 (CDT)  
Used via [[Created_TransferReady query]] and [[Created_transferDelay table]] to generate [[Transfer Delay]] and [[Avoidable Days (Critical Care)]].
** 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. The only way this makes sense is if it is done by intent. Ttenbergen 15:16, 2020 October 16 (CDT)}}


== Purpose ==
== Background ==
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]].
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.  
 
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 -->
 
== Transition to new way of entering this ==
Use the old [[Transfer Ready DtTm]] field '''for transfer ready dttms''' before 2020-10-15, and use this new entry for dttms after.


{{Data Integrity Check List}}
{{Data Integrity Check List}}


== Data Use ==
== Log ==
Critical care and Medicine programs want to know this to better understand patient flow and bed utilization.
2021-07-08 - [[Change from Awaiting/delayed dx codes to Transfer Ready DtTm]] for data back to 2021-07-01
 
Used to generate [[Transfer_Delay]], see [[Transfer_Delay#data use]].
 
== SAS Program ==


== Background ==
== Legacy ==
== 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.
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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==Related articles ==
==Related articles ==
{{Related Articles}}
{{Related Articles}}


[[Category:Transfer Ready| *]]
[[Category:Transfer Ready| *]]
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[[Category:PatientFollow Project]]
[[Category:PatientFollow Project]]
[[Category:Data Collection Guide]]
[[Category:Data Collection Guide]]
[[Category:Admit/Discharge]]
[[Category:End-of-life related data]]

Latest revision as of 08:29, 2023 December 29

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 a bed available. 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 and the checkbox is checked.

See Level of care hierarchy for further information.

Specifically for ICU

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
  • for organ donors, see Guideline for coding organ donation after death
  • if the patient is a potential organ donor and then deemed not to be, the Transfer Ready tmp DtTm will be when that determination is made
  • for those patients who are declared brain dead, and do not become actual or potential organ donors, use the time of Brain death as the Transfer Ready DtTm tmp entry, and the time of cardiac death as the Dispo DtTm

Specifically for Medicine

On a medicine ward, take the following to indicate transfer ready to a lower level of care even if they have not written that explicitly:

  • For SBGH If there is no discharge order, then the DC summary date/time that the attending signs off can be used, however if the date and time is after the DC time then it may be documented in a nursing or allied health IPN. Also, for SBGH often bed utilization will document when they are waiting on a transfer to an LAU or other facility, or rehab services will document when they are on the central wait list, or long term care (LTC) will document when they are approved for a PCH bed.
  • For HSC if there is no discharge order, then check the IPN notes (nursing, allied health etc), often bed utilization will document when they are waiting on a transfer to an LAU or other facility, or rehab services will document when they are on the central wait list, or long term care (LTC) will document when they are approved for a PCH bed.
  • Order is written to change all iv meds to po AND monitor discontinued/vital sign frequency is reduced
  • Patient is made ACP-C
  • If a discharge order is written during the preceding day(s) prior to discharge:
    • and a specific date and time for discharge is documented in that order, the transfer ready date and time would be the date and time specified in the order.
    • and If the order is to discharge after a specific test or procedure/treatment ie. dialysis or last dose of antibiotics, then the transfer ready date and time would be the time they finish the treatment or procedure.
    • and there is no specific date and time documented for discharge or another order for discharge is written, then check the checkbox or use that new discharge order date and time
  • The discharge medication reconciliation form should NOT be used as transfer ready date and time.
  • PT/OT Assessment: 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.
  • exception to this would be for those patients that are waiting for transfer to a rehab ward (Geri, stroke, amp, neuro etc) The date and time they are placed on the wait list for rehab can be used as their transfer ready date and time

Data entry instructions

  • A "Transfer Ready" line is automatically created for each Boarding Loc entry.
    • Project: Transfer Ready DtTm
    • Item: the only available item is "Transfer Ready DtTm", just like the project entry.
    • Date and Time vs checkbox:
      • Collector needs to enter one of the following:
OR
  • checkbox checked if a clear transfer ready date and time are never documented, both must be present to be considered a valid Transfer Ready DtTm

Combining Transfer Ready DtTm tmp entry and Boarding Loc records

Collection for each Boarding Loc

We currently only use the first entry per Level of care to calculate Transfer Delay, but we collect both because:

  • It gives us the flexibility to report per location if requested
  • To make it easier for data collectors. This way, collectors don't have to try and go back and figure out if there was or was not a transfer ready in a prior location. They only need be concerned about the notes and orders from THIS boarding loc.

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.

The data during the transition period for PatientFollow Project is inconsistent, so we use all the new and the old in Created TransferReady query.

Data Use / Purpose

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

Used via Created_TransferReady query and Created_transferDelay table to generate Transfer Delay and Avoidable Days (Critical Care).

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
Query check ICD10 needs awaiting if TR Dt and Dispo Dt on diff daysCCMDB.accdbdeclined
Query check TISS each dayCCMDB.accdbdeclined
Query check ICD10 awaiting has Transfer Ready DtTmCCMDB.accdbimplemented
Query check transfer DtTm during admissionCCMDB.accdbimplemented
Query check has transfer ready date or checkboxCCMDB.accdbimplemented
Query s tmp check combined Boarding Loc and TransferReadyDtTmCCMDB.accdbimplemented
Query s tmp check Boarding Loc and TransferReadyDtTm pairsCCMDB.accdbimplemented
Query check Transfer DtTm after paired BL and before later BLCCMDB.accdbimplemented
Query Check BL TR combiner nullCCMDB.accdbimplemented
Query check tmp 2 BL TR S same tmCCMDB.accdbimplemented
Query check long transfer delayCCMDB.accdbneeds review
Function Validate Transfer Ready DtTmCCMDB.accdbretired
Function Transfer Ready DtTm vs statusCCMDB.accdbretired
Query check transfer ready tmp for each Boarding LocCCMDB.accdbretired
Query check tmp Transfer Ready not before Boarding LocCCMDB.accdbretired
Query s tmp check combined BL and TRDtTm nonsequentialCCMDB.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.

Related articles

Related articles:
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