Admit Procedure: Difference between revisions
Ttenbergen (talk | contribs) m Text replacement - "[[Category: " to "[[Category:" |
|||
| (22 intermediate revisions by 4 users not shown) | |||
| Line 2: | Line 2: | ||
== Collection Instructions == | == Collection Instructions == | ||
* | *An admit procedure is a procedure related to the ''start of the database record'' in question | ||
**(a | **As of October 2020, a single record may span direct transfers between different locations and even between different services. Accordingly, an admit procedure only relates to the very start of that database record. Procedures that do not qualify as an admit procedure will be acquired procedures. | ||
{{Ex | | |||
Admitted to MICU for sepsis --> 2 days later develops an acute abdomen and goes to OR where gets a bowel resection --> goes to PACU --> goes to SICU service and SICU as location. Since the ADMISSION of this continuous episode of ICU care (i.e. MICU-->SICU) was to MICU, and we do not begin a new record with the switch to SICU, this bowel resection is an acquired procedure, not an admit procedure}} | |||
*CODE A PROCEDURE AS [[Px_Type]] '''admit''' IF AT LEAST 1 OF 'A' ''AND'' 1 OF 'B': | |||
*(A) ------------------------------------------------------------------------------------------------------------------------- | |||
**(i) '''directly, causally''' related to the admission (this is a judgement call, see below [[#Causally related]]) ''OR'' | |||
**(ii) directly related to an '''[[Admit Diagnosis]]''' (see below [[#Directly related to the Admit Diagnosis]]) ''OR'' | |||
**(iii) an organ transplant during the current "hospital episode" (i.e. including this and other hospitals) and was '''directly, causally''' related to the current ward/unit admission | |||
*'''AND''' | |||
*(B) ------------------------------------------------------------------------------------------------------------------------- | |||
**(i) Performed '''no more than 48 hrs'''(''[[#Why within 48 hrs?]]'') BEFORE the start of this record, i.e. the [[Admit DtTm]] for the start of the record ''OR'' | |||
**(ii) Irrespective of whether it's within 48 hours (this could be outside of current hospitalization), if the association of that procedure with the admission is abundantly obvious (as per data collector discretion) | |||
=== Recurring procedures === | |||
* If an admit procedure that qualifies is done more than once on two different calendar days, enter it once and set the count to the appropriate number | * If an admit procedure that qualifies is done more than once on two different calendar days, enter it once and set the count to the appropriate number | ||
| Line 45: | Line 52: | ||
**e.g. Patient came to ED with bleeding esophageal varices and in ED got EGD with banding. Here the procedure did not cause the admission, but it was certainly related to the admission diagnosis | **e.g. Patient came to ED with bleeding esophageal varices and in ED got EGD with banding. Here the procedure did not cause the admission, but it was certainly related to the admission diagnosis | ||
**e.g. Patient got an elective CABG for chronic ischemic heart disease/CAD -- the CABG is directly related to the CAD and so should be included as an admit procedure | **e.g. Patient got an elective CABG for chronic ischemic heart disease/CAD -- the CABG is directly related to the CAD and so should be included as an admit procedure | ||
**a more complicated example: Patient with cirrhosis with ascites is admitted with hepatorenal syndrome. While in ED the staff couldn't insert a Foley due to a urethral stricture, so urology came down to ED and did a cystoscopy to dilate the urethra and pass the Foley. Here admit diagnoses include: [[Hepatorenal syndrome]] and the [[Urethra, urethral stricture]], and in this case the therapeutic cystoscopic dilation (coded by components with [[(T) Ureter, Bladder or Urethra]] and [[Dilation]]) is directly related to the stricture, in much the same way that the CABG is directly related to the CAD in the above example. | **a more complicated example: Patient with cirrhosis with ascites is admitted with hepatorenal syndrome. While in ED the staff couldn't insert a [[Foley]] due to a urethral stricture, so urology came down to ED and did a cystoscopy to dilate the urethra and pass the [[Foley]]. Here admit diagnoses include: [[Hepatorenal syndrome]] and the [[Urethra, urethral stricture]], and in this case the therapeutic cystoscopic dilation (coded by components with [[(T) Ureter, Bladder or Urethra]] and [[Dilation]]) is directly related to the stricture, in much the same way that the CABG is directly related to the CAD in the above example. | ||
*Just as above in the section on causally-related procedures, purely diagnostic procedures done prior to admission -- including procedures that merely demonstrated the presence of an admit diagnosis -- should not be coded as an admit procedure. | *Just as above in the section on causally-related procedures, purely diagnostic procedures done prior to admission -- including procedures that merely demonstrated the presence of an admit diagnosis -- should not be coded as an admit procedure. | ||
**Indeed, the only diagnostic-only procedures that would be included as admit procedures are those that caused a complication that then required treatment --- e.g. a central line placement that led to a perforation -- and even here, this would then really come under the item above of "Was directly, causally related to the admission". | **Indeed, the only diagnostic-only procedures that would be included as admit procedures are those that caused a complication that then required treatment --- e.g. a central line placement that led to a perforation -- and even here, this would then really come under the item above of "Was directly, causally related to the admission". | ||
*A few additional notes on this: | *A few additional notes on this: | ||
**Do NOT | **'''Do NOT COUNT or INCLUDE BEFORE admission as a procedure unless they caused a complication''': | ||
** | ***'''transfusions''' (a complication of transfusion would be, for example; transfusion reaction, CHF) | ||
***'''central lines (even vascaths)''', (a complication of line insertion would be, for example; vessel performation) | |||
== Why within 48 hrs? == | == Why within 48 hrs? == | ||
| Line 59: | Line 67: | ||
[[Category: CCI]] | [[Category:CCI]] | ||