Item 61. Reason for Transfer

Q: Is a discharge for capacity (sort of a "forced" non-acute transfer) considered an "other" for Question 61, or would it be recorded as growth/discharge planning?

A: Please record this infant as “Other”.

Q: What if I have an inborn infant that is ready to be transferred to another hospital. The transport team arrives to pick up the infant, however the symptoms become worse. The transport team treats the infant at the bedside, however the infant doesn’t take to treatment and expires as a result. Technically this infant was not transferred so how would I record the initial position?

A: This infant would be considered inborn and you would record it as an inborn death as the initial disposition on the CPQCC Admission/Discharge form only.

Q: Can you change Medical/Diagnostic Services to Medical/Surgical/ Diagnostic Services?  As opposed to surgical when you aren’t sure if they will have surgery.

A: If the infant is sent with the intention of having surgery even if surgery is not performed the reason is surgery.  If an infant is transferred for additional workup and that workup results in surgery the reason is medical / Diagnostic Services. Adding the word “surgical” to this response name will only be more confusing.  The explanatory note is clear about the intent.

Q: If the baby is transferred from home or a birthing center is it considered an acute transport?

A: Since we’re looking at infant outcomes (via TRIP scores) as a result of interventions during transport by a neonatal Transport Team, our initial response/criteria for inclusion as an acute transport hinges on the same – the infant must have been transported to the facility by an actual Transport Team, regardless where the infant came from.  Just as we wouldn’t consider an infant brought to the ER by the parents a transport, we can’t really evaluate and base quality improvement on the care rendered by a basic 911-ambulance team.

Q: Would a baby who was originally transferred to a different unit of the hospital (not the NICU), then transferred to the NICU, require a CPeTs form?

A: No a CPeTs form is not required. We only need a CPeTs form if the baby was sent directly to the NICU or under NICU service.

Q: There were two babies who we transported out by parents request for a 2nd opinion. One was a preemie inborn that had been here for several months and was still on oxygen. The parents thought we were not progressing with our treatment so they requested to go to another hospital. The second baby was a transport in big baby from a lower level hospital. We determined the baby needed surgery. The parents requested a 2nd opinion to see if surgery was absolutely necessary, so baby transferred to where they wanted to go for the 2nd opinion. In both cases the baby went to CHLA. In both cases we were able and willing to care for the babies and insurance was okay. So my question is whether I should include these two with acute or non-acute transports out?

A: These 2 babies would not be non-acute transports. As per the definition of an acute transport: “An infant with medical problems that require acute resolution for survival who is transferred in order to obtain medical, diagnostic, or surgical therapy that is not provided, or that cannot be provided due to temporary staffing/census issues, or that cannot be provided due to insurance restrictions at the referring hospital”. Since both of babies were transported because of a parent request, not because services were not available due to lower level of care, bed availability, etc.…and in both cases, the services/interventions were available at the referring facility, neither of these babies would qualify as acute transports.

Item 62. Hospital Infant was Transferred to

Item 63. Post-Transfer Disposition

Q: If an infant is still in the hospital where it was transferred to, how should I fill in the disposition variables?

A: If an infant was transferred from your hospital to another hospital and has not been discharged, then answer Items 1-59 and leave Items 60 – 67 blank.

Q: If we have an infant that was transferred to another hospital, how do we track the baby to close out the record?

A: Due to HIPAA we cannot use certain information such as names to track an infant, however there are specific CPQCC variables that can be used such as birth weight, sex, admission date and date of birth. The Data Consistency Report, which is usually release during the time of data finalization, will further assist in finding inconsistencies that may occur between hospitals regarding a transferred infant.

Item 64. Weight at Initial Disposition After Readmission

Item 65. Disposition After Readmission

Item 66. Ultimate Dispostion

Q: Center A transfers an infant to Center B, baby comes back to Center A and they update the appropriate items according to the information from Center B. How does CPQCC credit the correct center for the information that has been updated?

A: CPQCC has two ways to credit each center for certain interventions that take place. We use the OSHPD codes to determine where the baby was born and where it was transferred. We also use location codes for surgeries and certain infections to determine where the infection was acquired or to track which facility performed the surgery.

Q: Should I assign infants that are readmitted to my hospital a new ID number or should they keep their original ID number?

A: New IDs are not assigned when infants are readmitted from another hospital WITHOUT being discharged home. However, reassignment of new IDs MUST be reassigned if an infant is discharged home from your center, AND THEN readmitted back to your center.  For the situation in which an infant is born at your Center, then sent home and then after the home discharge is readmitted back to your center by Day 28 of life, you need to:  1) Fill out a new form and assign a new network ID number, 2) check the baby as Outborn (Item 7a), 3) check the age in days of admission to the NICU (Item 7b), and 4) check your own center as the location of birth (Item 7c).

Q: What if my hospital transfers an infant to a hospital that is not a CPQCC member, and then is readmitted back to my center. Should I still update my form even though the hospital is not a CPQCC hospital?

A: Yes. CPQCC uses the OSHPD codes to determine which hospital the baby is transferred to or from. Therefore, items 23a, 25-27, 29-53 must be updated based on events following the transfer and readmission.

Q: When we transfer a baby to the PICU even though they are discharged from the PICU, but they have not left the center. Do we treat them as if they never left and update all that happened in the PICU?

A: Yes. If you refer the CPQCC Manual of Definitions, on page 34 it states that "If an infant is moved from your NICU to another unit within your Center (Step-Down Unit, Well Baby Nursery, Pediatrics Ward, Intermediate Care Nursery, PICU, etc.), continue collecting data until discharge to home, transport to another hospital, or death."