Transfer Ready date and time

see Transfer time rule for the unrelated rules around patients transferring between wards we collect data on Rewriting in progress.........your patience and help appreciated.

We track Transfer Ready date and time for patients in ICU and Medical wards as part of our Minimal Data Set, i.e. this his high-priority data that needs to be collected ASAP.

All attempts should be made to record the time at which the patient was deemed to be ready for transfer.

Transfer Date and Time

The transfer ready date is the first date during this ward stay that a patient was deemed medically stable and can is ready to be discharged. If the patient status changes again after, the date remains in effect.

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

Transfer Ready date/time

Required for ICU

• when a patient is sent to a ward from an ICU
• when a patient is sent to IICU at HSC
• when a patient is ready to go home (ZZ)
• when DC Treatment AND pt is put on transfer list AND goes to a ward AND dies there, then transfer ready date should be record
  • NOTE: ICU: Further, 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. It the patient is put back on the transfer/discharge ready list, enter the new transfer ready date. Not applicable to Medicine ward patient.

NOT required for ICU

• goes home ICU Var 6 - AMA Against Medical Advice
• when patient dies in the ICU
• transfer to from one ICU to another ICU in same center in other ICU in city.
• sent to operating room (OR)
• Sent for procedure or test, (example: angiogram, CT scan, fluroscopy, bronchoscopy, MUGA scan etc.)
  • Do not record a transfer ready date/time if the unit physician discontinues life-support (withdraws therapy, DC Treatment) on a patient AND pt is put on transfer list BUT dies BEFORE going to a ward. Leave it blank. This field is not for recording the date and time when discontinuation of life support process started

Required for Medicine

• when a patient is sent from a Teaching medicine ward to a Non-teaching medicine ward

Template:Discussion is this to be done when the patient stays on the same Medicine ward?

• when a patient is sent Home (ZZ)
• when a patient is sent to a long term care facility (NW, DW, RW...)
  • NOTE: Medicine patient only: If a patient develops a complication AFTER they were deemed to be medically stable and transfer ready, you do not cancell their transfer ready date/time. 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 dicussions with Roberts for updated guidelines. --LKolesar 15:04, 2012 March 19 (CDT)

NOT required for Medicine

• when patient is being transferred to an ICU
• when a patient goes from one medical teaching unit to another in same facility or another facility in the city.
  • exception: if patient was transfer ready in one medical teaching unit, but in the interim, gets sent to another teaching unit while waiting for longer term care, then transfer ready date can be recorded in first teaching unit, and for the second teaching unit, the transfer ready date/time will be the SAME as admit date/time to the receiving ward. Since the CCMDB.mdb will not allow admit and transfer date as the same time, please make the time 1 min. later to get past this issue.
• goes home Med Var 6 - AMA Against Medical Advice
• when patient dies on a medicine ward
• transfer to an ICU
• sent to operating room (OR)
• Sent for procedure or test, (example: angiogram, CT scan, fluroscopy, bronchoscopy, MUGA scan etc.)

Transfer ready DATE unavailable

When a transfer ready date and time that is REQUIRED, has no date is available and you cannot guess it from a chart, leave it blank and also enter the following in:

• TMP:
• PROJECT: No Transfer Ready Date
• Started date: Feb 29.14 - for all patient still on laptop that REQUIRE (see required for ICU or Med above) a transfer date but collector could not guess from chart notes please enter TMP, Project: No Transfer Date.

Section below need sorting and pruning

questions re, transfer date and dc tx

Pts who become ACP C and expire in hospital 3 days to one month after comfort care is ordered.

• I would like to know where this type of patients fits in. Example: a patient who has co- morbids and is admitted with pneumonia and does not improve or deteriorates. The decision is made to provide comfort care only (ACP C). This patient lives three days to one month in hospital and then dies. Does this patient need a transfer ready date?

• If a unit physician discontinues life-support treatment and a patient does not die immediately and is placed on a transfer/ready list, and then passes away PRIOR TO being transferred out of the ICU unit, then Transfer ready should not be recorded.

• If a patient arrests in the unit and CPR is unsuccessful, the date and time of stopping CPR should not be recorded for Transfer ready.

Instructions for medicine transfer ready dates and times

COPY OF: File:Transfer Ready ChartStamp Memo MEDICINE January 2012.pdf.

• It is important to understand that the transfer ready date and time indicates that the pt no longer needs a medicine bed in the hospital. Because of this definition, not all profiles will have a transfer ready date.
• If a pt moves from one ward to another and still requires hospital medical care, then that profile will not have a transfer ready date. Previously we saw this date as the date ready to leave that particular ward but this has changed based on Dr. Robert's definition.
• Dr Roberts will educate the medical staff about writing in the chart when the pt is medically stable enough for discharge. This is the date and time we will use.
• Another important change for medicine is that this date and time of transfer ready should not be changed even if the pt deteriorates and requires medical care again. Dr. Roberts wants the first day and time when the pt was deemed to be medically stable.
• If a pt already has a transfer ready date and time and is moved to another ward where a new profile is started, the transfer ready date and time will be the time of admission to that ward.

For example, a pt has been in acute care and is medically stable on Oct 15 at 1000. This is your transfer ready data and time. The pt is then transferred to a chronic ward on Oct 30, and a new profile is started. The admit date for the new profile is Oct 30 and you should fill in the transfer ready date as Oct 30 because the pt is still medically stable and continues to wait for discharge. Julie needs them done this way as she links the profiles.--LKolesar 08:59, 10 November 2011 (CST)

• We will re-start collecting transfer ready dates and times starting in November, 2011 even though Dr Roberts' indicators in the chart have not started yet. The data collectors will put in a transfer ready date and time if they have this available information from the current sources. --LKolesar 11:44, 9 November 2011 (CST)

Discussion

• Hi just want to clarify transfer ready times ie. pt was admitted Aug 1/11. Aug 15/11 service states medically stable transfered to S3 for panelling process Aug30/11. Pt discharged to nursing home Nov 10/11 When the pt is transferred to S3 I should be using Aug 15/11 as my admit time not the actual time pt arrived to the ward? Then how do we show the actual time pt arrives to the ward? Thanks
  • • Sorry if the above instructions are not clear enough, I will try to fix them. When a pt is transferred to a ward you still use the usual discharge and admit time. If this same pt already has a transfer ready date and time (when medically ready for discharge) which is Aug 15 in this example, this is already written as the transfer ready date and time in the first profile. If a new profile is started for the pt when transferred, the transfer ready time will be the same as the admit date because they are still waiting for discharge and have been transfer ready for a while already. Julie wants them done this way as she tracks the number of days waiting for discharge once transfer ready and will link this with the first profile. --LKolesar 08:59, 10 November 2011 (CST)
    • Sorry Laura, but I'm even more unclear about what we should be doing for patients transferred to another ward, who already have a transfer ready date and time from the first ward! You say above, "If a new profile is started for the pt when transferred, the transfer ready time will be the same as the admit date because they are still waiting for discharge and have been transfer ready for a while already." Does this mean that the admit date and time for the second move, or transfer is our usual date and time, and that the transfer ready date and time is the same as the admit date and time for the second profile? My understanding was that we use our usual dates and times for the admission to the second ward, but that the transfer ready date and time for the second profile would be the same as it was in the first profile. Am I mistaken about that?DPageNewton 13:01, 11 November 2011 (CST)
    • I know that it would make sense to use the same transfer ready date and time for the second profile but Julie does not want it done this way. She wants us to use the admit date and time of the second profile in this scenario as the transfer ready date and time because she links the two profiles. You can talk to her if you like. I already had this discussion with her. It has to do with the way she extracts data from the profiles.--LKolesar 07:04, 14 November 2011 (CST)
    • Based on the above information, I would suggest that when receiving a pt from another ward that the data collectors check the laptop of the sending ward to ensure they have knowledge of a transfer ready time from the sending ward. --LKolesar 14:36, 14 November 2011 (CST)
      • Is this something that would be useful to add to Transfer Tracker.mdb? Ttenbergen 18:04, 16 November 2011 (CST)
      • Yes, it would be a good item to include in the transfer tracker if this is possible. --LKolesar 16:02, 18 November 2011 (CST)
    • I just want to clarify transfer ready. The pt no longer has medical issues but may still be improving muscle strength and in self care (the pt still needs OT & PT). This pt is considered transfer ready because PT & OT are not considered medical issues. Correct? Judy 08/06/12.
  • The pt is not under-going medical treatment and can be discharged home. Quite often pts are discharged home and come in for occupational and physiotherapy but are not requiring medical intervention.--CMarks 12:01, 2012 June 11 (CDT)

Needs further sorting

• At HSC on the medicine wards, I believe we are not entering a discharge ready time when a patient has been deemed palliative. Am I to assume this is required??? If so let us know, and we will begin to enter the date and time the decision was made for patient to enter palliative care--JHutton 08:59, 17 September 2008 (CDT)
  • The above question is an old one but just to clarify, when a pt becomes palliative, they no longer require an active medical ward bed, so they are transfer ready by the new definition. The date and time for transfer ready is entered when they are deemed palliative. --LKolesar 15:18, 24 January 2012 (CST)
    • Follow up email to Laura & Julie.Trish Ostryzniuk 18:02, 2014 February 26 (CST)
• Now that our definition of palliative is "palliative service" it should be easier to obtain a transfer ready date and time because the date and time of consult to palliative care can be used. --LKolesar 13:38, 2014 February 27 (CST)

Date and time formats

see Date and Time Format

Template:CCMDB Data Integrity Checks

Transfer Date validation

If all of

• transfer ready date /time is blank
• survived,
• var6 is not AMA
• the discharge-to location ends in W, U, Z, X

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.

Transfer Time validation

If there is a transfer date, a transfer time is required also. This is checked at registry-check or final check.

Legacy Information

stamper implementation

• Spring 2012 - A "stamper" is suppose to be used by physicians on Medicine wards to document transfer ready.Trish Ostryzniuk 12:29, 2012 October 25 (EDT)
• January 2013 this data was moved to STB Electronic Patient Record. Chart stamping stopped because physicians were to record this in EPR.

Discussion Leading up to dropping "transfer ready" date collection for Medicine

This is legacy information only.

We did not collect transfer ready date and time for medicine patients from 2010-May-19 until November 2011 for the following reasons. We re-started collection because the data was seen as important enough to collect it even if it is not perfect.

As discussed in the Critical Care Review Group, the transfer ready date information is not very organized or consistent city wide so its value is questionable. Since the data is unreliable, we are are planning to propose to stop collecting this. Does anyone have any thoughts on this?

Dec 9.2008-Transfer Ready date/time

• Transfer ready date/time - will continue to be collected until further notice.

Betty Lou Rock will determine if this will be used or not. She plans to set up a working group to assess if a system could be developed within the Hospital system to make this data more reliable. Data collectors rely on Dr.’s orders, where this information frequently not recorded and they guess at time and sometimes date when a call to the bed desk for a patient who is transfer ready. ICU, because it is a smaller unit, collectors have a better chance of obtaining a fairly good estimate. Some ICU are very good at writing these orders, others are not. On Medicine there is a significant problem in obtaining accurate information because of lack of chart documentation. Currently there is no consistent process in place at each hospital that maintains a record of transfer ready dates/times where data collectors can draw or verify this information from. The next Steering Next Database Committee meeting is in February and Task team will follow up the status of transfer ready date. TOstryzniuk 17:44, 9 December 2008 (CST)

• At the HSC Transfer Ready is being called to admitting dept and recorded on forms. Perry Gray and Dr. Garland set these up. The forms are being faxed to us and entered by Data Processor into Transfer Ready Access database. The Steering Committee must review this information and decide it will still continue. The data coming in this route does not seem very reliable. Poor documentation and not legible.--TOstryzniuk 21:57, 6 November 2009 (CST)
  • For ICU the data collectors will continue to collect transfer/discharge ready.Betty Lou Rock invited Linda Hathout to a ICU QA meeting to explore other ways this information may be collected. Perry Gray has stopped the paper process from the Medical records department at the beginning of this month.--TOstryzniuk 20:11, 19 May 2010 (CDT)