Transfer Ready date and time: Difference between revisions

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m (→‎Medicine Special Case - OM(osteomylitis)requiring the 4-6week IV ABx treatment: format fix, and trying to sort out. Will fwd question to Julie to see how she wants to report on this.)
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* let's code as transfer ready
* let's code as transfer ready
** Good points, a suggestion then is that for patients who are accepted to the CIVP program and are otherwise ready/able to discharge could be considered "CIVP holds" and the transfer ready  date/time  would be the date/time the patient was accepted to the CIVP as the barrier to discharge is systemic in origin (wait for service to be put in place).For patients who are accepted to the CIVP program but are unable to discharge due to patient based problems such as addictions, mental health or other active phsiological problems the transfer ready date/time would be the date/time of physician discharge order.[[User:Ppiche|Pamela Piche]] 07:33, 2015 September 29 (CDT)
** Good points, a suggestion then is that for patients who are accepted to the CIVP program and are otherwise ready/able to discharge could be considered "CIVP holds" and the transfer ready  date/time  would be the date/time the patient was accepted to the CIVP as the barrier to discharge is systemic in origin (wait for service to be put in place).For patients who are accepted to the CIVP program but are unable to discharge due to patient based problems such as addictions, mental health or other active phsiological problems the transfer ready date/time would be the date/time of physician discharge order.[[User:Ppiche|Pamela Piche]] 07:33, 2015 September 29 (CDT)
**Sounds good. I agree with your criteria on which transfer date/time is appropriate to use in calculating bed wasted.  [[User:JMojica|JMojica]] 12:28, 2016 June 22 (CDT)


== Sources ==
== Sources ==

Revision as of 12:28, 2016 June 22

see Transfer time rule for the unrelated rules around patients transferring between wards we collect data on

will be replaced with Transfer Ready DtTm field

The Transfer Ready date and time for critical care is the time a patient is deemed stable enough to be transferred out of the ICU, the one for medicine is the first date during this ward stay that a patient was deemed medically stable and ready to be discharged.

Transfer date/time resource too for data collectors, see: Transfer Tracker.mdb

ICU

The transfer ready date and time is when the pt is deemed stable enough to be transferred out of the ICU.

Required for ICU when

  • a patient is sent to a ward from an ICU
  • a patient is sent to IICU at HSC
  • a patient is ready to go home (ZZ)
  • a patient is ready to go to another hospital OUTSIDE the city
  • See ICU special cases below

Not required for ICU when

  • goes home ICU Var 6 - AMA Against Medical Advice
  • when patient dies in the ICU
  • transfer to one ICU from another ICU in same center or in in city of Winnipeg
  • sent to operating room
  • sent for procedure or test and doesn't return to unit

ICU Special Case - ACP-C

For patients who transfer out of the ICU and are ACP-C use the time that a patient is made ACP-C in the ICU as the transfer ready date and time. See above instructions for patients who die in the unit(transfer ready time isn't required).

ICU Special Case - Condition Deteriorates

If a patient is on the transfer ready list in ICU and his condition deteriorates resulting in the need to remain in the unit, then this patients transfer ready is cancelled and the transfer ready date and time should be deleted. If the patient is put back on the transfer/discharge ready list, enter the new transfer ready date. Not applicable to Medicine ward patient.

This differs from the Medicine instructions.

Medicine

The transfer ready date is the first date during this ward stay that a patient was deemed #medically stable and is ready to be discharged.

Required for Medicine when

  • a patient is sent Home (ZZ)
  • a patient is sent to a long term care facility (NW, DW, RW...)
  • a patient is sent from a Teaching medicine ward to a Non-teaching medicine ward or is changed to "non-teaching" status without changing wards

Not required for Medicine when

  • patient is being transferred to an ICU
  • a patient goes from one medical teaching unit to another in same facility or another facility in the city.
  • goes home Med Var 6 - AMA Against Medical Advice
  • when patient dies on a medicine ward
  • sent to operating room (OR)
  • sent for procedure or test and doesn't come back to the ward

Transfer ready DATE NOT available Medicine only

Go to: "No Transfer Date" in Medicine

Medicine Special Case - Condition Deteriorates

If a patient develops a complication after they were deemed to be medically stable and transfer ready, you do not change their transfer ready date/time. This is unlike the ICU instructions.

Dr Roberts did indicate that he would like the transfer ready to be recorded and unchanged even if the pts condition changes. The original transfer ready date and time are still relevant to the OverstayProject. As per discussions with Roberts for updated guidelines.

Medicine Special Case - Patient arrives transfer-ready

If a pt already has a transfer ready date and time and is moved to another ward, the transfer ready date and time will be the time of admission (1 minute later to keep #CCMDB Consistency Checks happy) to that ward. Needs to be done this way because of the way our statistician reports this data.

Medicine Special Case - OM(osteomylitis)requiring the 4-6week IV ABx treatment

Question: Template:Discussion If a patient has OM(osteomylitis)requiring the 4-6week IV ABx treatment: can they ever be considered medically stable while in hospital? At present a consult is made to Community IV Program and a PICC is inserted-arrangements made and D/C with community management OR Patient is not suitable for CIVP d/t Hx of IV drug abuse/no home to go to/ antibiotic not stable enough to be given from alternate site if home due to its admixture etc so remains in hospital for their IV treatment and is often away on hospital day passes in between doses...

When discharged to home, the order to Discharge patient is their transfer date /transfer Ready time so we enter but they remain on AB IV...

I am unclear about this diagnostic code and Medically Stable determination...we get bad cellulitis/OM pts needing extensive IV AB Tx sent to D5 Non-teaching but not declared med stable D/T infection/s.

How do others feel re: this population? --Llemoine 14:59, 2015 September 23 (CDT)

  • Does noncompliancy or a home care hold or all the reasons above change the fact that the pt is medically stable/ transfer ready would this be more of a discharge issue? (no place to go) The patient is ready to go home and for what ever reaons cant do CIVP Do we look at CIVP as a long term treatment like a foot ulcer? I guess I am saying is does the patient becomes Transfer ready once the acute phase of treatment is over and the pt is medically stable (no wbc elevation/ no temp/ vs stable ect )and treatment is no longer acute but chronic? ps just asking shirley
  • not transfer ready:
    • I've wondered this as well. I would say they are not medically stable for discharge, and therefore in the case where the patient is transferred to a non-teaching ward, would have no transfer ready date. If they can be discharged home with the IV program, then I would assume the transfer ready date is the discharge to home order.Mlagadi 07:49, 2015 September 24 (CDT)
    • This has been my approach as well. Pamela Piche 08:16, 2015 September 24 (CDT)

transfer ready when CIVP becomes only obstacle to discharge:

  • I code the same as Pam and Michelle but know exactly what your talking about Shirley, because if CIVP could be arranged more quickly than the patient would be discharged, so it is a barrier to discharge Lisa Kaita 13:48, 2015 September 28 (CDT)
  • let's code as transfer ready
    • Good points, a suggestion then is that for patients who are accepted to the CIVP program and are otherwise ready/able to discharge could be considered "CIVP holds" and the transfer ready date/time would be the date/time the patient was accepted to the CIVP as the barrier to discharge is systemic in origin (wait for service to be put in place).For patients who are accepted to the CIVP program but are unable to discharge due to patient based problems such as addictions, mental health or other active phsiological problems the transfer ready date/time would be the date/time of physician discharge order.Pamela Piche 07:33, 2015 September 29 (CDT)
    • Sounds good. I agree with your criteria on which transfer date/time is appropriate to use in calculating bed wasted. JMojica 12:28, 2016 June 22 (CDT)

Sources

In order of preference or which ever is source is most reliable at your site

  • Physician Diagnosis Form (green sheet) (available for ICU only)
  • Transfer Ready stamp on physician orders or progress note (Medicine only)
  • STB Electronic Patient Record
  • Physicians’ Orders from patient chart
  • ICU patient Log Book as recorded by unit clerk (from orders)
  • Charge Nurse
  • IPN - Often a physician will write "medically stable" in the IPN but not in the orders.--CMarks 07:51, 2014 March 3 (CST)

Data Use

Used to generate Transfer_Delay, which is used in Overstay and several reports, see also Transfer_Delay#data use.

Date and time formats

see Date and Time Format

Template:CCMDB Data Integrity Checks

CCMDB.mdb Transfer Date validation

If all of

then

  • give an error requiring a comment in notes
  • don't allow final-check if notes are blank

This is checked at registry-check or final check.

NDC_Missing_TransferDate_w_pivot

This query in Centralized data front end.mdb flags patients discharged to "zz" or Like "?w" (ie home or ward) who have a discharge date "Between #2013/Oct/01# And #2013/Dec/31#" (?!) and a transfer date of #3000/Jan/01# (I think this would only catch those imported from Ed, not the newly sent ones).

for incomplete only

Template:Discussion Should this be changed to be like #CCMDB.mdb Transfer Date validation, once that is what we want it to be? Ttenbergen 14:43, 2014 June 23 (CDT)

Date and time formats

see Date and Time Format

Data use

Among other things, the times are used to generate statistics about

See Also

Legacy

This article was spun out from Interrelation between Admit, Discharge and Transfer Ready date and time, see that article for any history missing from here.