Transfer Ready Survey Medicine March 8, 2013

Transfer Ready Date not recorded on chart

Collectors are doing there best to obtain a transfer ready date/time in their units. We are aware thatcompliance from physician is not up there. Can you let us know what you are seeing in your in area. This is a request from the medicine program.

• Are Physicians still documenting transfer ready dates or not?
• Are you guessing from chart based on notes or is CRN stamping charts?
• Are physicians stamping chart or writing tranfer ready date?
• Are there any specific Docs that may be missing updated instructions to do this in your area? Please let me know so we can help them out.
• STB has EPR, but last I spoke to Deb and Elaine the stamping of date on the chart has stopped and it is not being recorded in the EPR. Is this still the case? Is STB collectors also using best guess?

Future Surveys for Transfer Ready Chart documentation on charts or EPR

In the future instead of a observational survey from collectors for their opinions in regards to transfer ready charting compliance, we would setup in our collection program (in TMP study) an audit that we can do for a month or so. Collectors can record if a transfer ready date was documented in the chart or not. It would be like the accounting for compliance that we did for DX green sheets long time ago. An intermittent audit like this would quantify compliance. Example for audit:

1. Collector guess date
2. Not document on chart by physician
3. No time recorded
4. recorded on chart by CRN
5. not applicable (death,.....)

Data Collector observations - Survey Results

Survey Summary_March 8.13. Forwarded to Dr. Dan Roberts, March 8, 2013.-Trish Ostryzniuk 17:14, 2013 March 8 (EDT)

• VIC S4
  • On the whole documentation of transfer ready compliance is about 45-50% according to data collector. Not consistent but slightly better than last call in about this. Don’t know if due to constant turn over with medical students, interns, residents and patient volume. Rare to see the Attending physician documenting in chart that pt is medically stable. They may be saying it to staff in rounds and interns/resident then document?
    • Most consistent: Dr. Bovell, Dr. Vankatesan, Dr. Hiebert. Dr. Semus.
      • The Data Collectors’ observation on this ward is that physician is not committing to charting when a patient is deemed to be medically stable DX charting until the discharge date. Frequently students, intern, resident are charting PENDING blood work or PT, or OT or homecare before they document medically stable. What collector is seeing is that the documentation of transfer ready/medically stable is written on the same day as discharge. Data collector said if she in chart notes that patient was obviously medically stable a day or two before discharge date, and all that Doc is waiting for is a blood result……..she document transfer ready on this date and does not follow stamp date.
      • Collectors thought that may the VIC S4 physicians need more inservice on what Dan Roberts definition or criteria is for “medical stable”? She reminds some that a pending blood test or OT or PT or home care visit does not mean that a pt is not “medically stable” so not transfer ready.
      • The Data collector approaches all new physicians about the transfer ready stamp to reminds them of its existence. Some say they can’t find the stamp, and she lets them know that they can WRITE it in the chart if they can’t find the stamp.
      • When they do stamp the chart they frequently don’t record a “time”. Data collector records a time of NOON because that end time of rounds on this unit or she looks at chart at who charted before and after and guess a time.
• VIC_N5 & S5 & S3
  • Most of the time the stamp is being used by most of the Dr’s.VIC
  • Very occasionally a Dr’s note will say pt is stable & waiting for pt & ot or home care. In this case I will use this as a transfer ready date.
    • Most consistent in documenting patient medical stable and to say they are long term due to placement issues: Dr. Munsamy, Dr. Penner, Dr. Adams, Dr. Cavers, Dr. Thorlakson (sorry if I miss a few names).
• HSC_H4 & D4
  • On H4 the transfer ready stamp is not being used. I am “guessing” the D/C ready date/time on information that I get from OT, Physio and Home Care, eg if pt is waiting for equipment etc. This includes those pt being transferred up to H733 to nonteaching.
  • On D4 the “charge nurse” is stamping the charts with the transfer ready stamp when they are doing rounds with the docs and she does initial the stamp with her initials, there were times that I thought the pt was not ready for D/C, through charting, but I was not there in rounds either.
• HSC_A4
  • Since being implemented, A4's use of the transfer ready stamp has been abysmal.
  • I usually get the transfer ready time from someone charting the patient is medically stable, if and when it is charted but many times it is best guess.
    • Just a thought: I wonder if the physicians are concerned that if such a stamp is used but the patient deteriorates; sometimes to the point of death, that they could be held liable in a court of law? This could then be construed that their judgement is "off" which is not necessarily the case as we all know of cases when (rarely) this has actually occurred to discharge ready stable patients.
• GRA_N3
  • Physicians on N3 have for the most part abandoned the stamp and indicating when the pt is transfer ready. **There a few sporadic periods where the stamp makes a triumphant return however, the date stamped is usually incorrect and may or may not be corrected. I usually take my transfer ready time from where medically stable or the equivalent is indicated in the transfer notes or from the discharge order if all else fails.
• STB E5 & 5B
  • SBGH doc’s no longer seem to be using stamp, because virtually everything is EPR (electronic PT record). Physicians were “supposed to be” putting the transfer ready time in the “planned/actual discharge date” column in the EPR, but I have not seen that being done. It isn’t any one doc that is not complying, it is pretty much all of them. I still do enter a transfer ready date and time if I see something in the IPN that indicates “medically stable”.

• SICU at HSC is very good about transfer ready dates which are either on the green sheets or in the orders.--Jpeterson 08:11, 2014 February 28 (CST)