Discharge / Transfer Data Tool : ICU March 2014

Inpatient Goals:
Patients will have discharge times set before 1300 if going to other facility
Patients will have discharge times set befero 1100 if going home
Times will be planned 24 - 48 hours in advance
Patients wtih improved Level of Care will be transferred within 8 hours



A red asterisk (*) indicates required questions.


  1. Primary/Admitting Diagnosis:*


  1. Physician Group tending to patient:*
    Hospitalist
    Family Medicine
    Surgeon
    Cardiologist
    Internal Medicine
    Other


  1. Admission DATE:*


  1. Admission TIME (00:00 format):*


  1. Date and Time Discharge / Transfer Criteria met:*


  1. Date and Time Discharge / Transfer Order Written:*


  1. Actual Discharge / Transfer DATE of the patient:*


  1. Actual Discharge / Transfer TIME of the patient (00:00 format):*


  1. Discharge / Transfer Diagnosis


  1. Discharged or Transferred to:
    Home
    Other Unit
    Deceased
    Other Facility - Hospital
    Other Facility - Nursing Home
    Other Facility - Hospice
    Other Facility - Behavioral Health
    Other Facility - LTAC
    Other


  1. ANSWER FOLLOWING QUESTIONS ONLY IF LOS GOAL/ANTICIPATED DISCHARGE DATE AND TIME WERE NOT MET.

    Patient did not meet LOS Goal or Inpatient Discharge Time because:
    1- Waiting for MD consult
    2- Waiting for consult from other discipline
    3- Waiting for diagnostics
    4- Diagnosis or clinical status
    5- Patient condition change
    6- Transportation issue
    7- Surprise discharge or transfer
    8- Delay in obtaining discharge or transfer orders
    9- Other


  1. Please comment on the reason behind the discharge barrier chosen above:


  1. What, if any, tests, consults, or procedures contributed to the discharge delay? PLEASE INCLUDE THE DATE/TIME ORDERED AND THE DATE/TIME COMPLETED.




Templates provided by QUIA.COM.