Emergency Surgery (concept)

Admit Types:

The concept of emergency surgery is used in two places:

• Admit Type for APACHE II
• T26 & 27 - Emergency Surgery (TISS Item)-39

{{Discuss | We also cover this concept on Surgical Categories Site Definitions.

when to use Emergency Surgery

1. If the patient was admitted from an OR or from Recovery AND
2. your site uses the E1, E2, E3 scheme for surgery documentation:
   • use E1 as emergency surgery for APACHE II Admit Type and for TISS Items 39
3. all other patients admitted from OR or RR, are considered to be elective surgery
4. if your site does not use the E1, E2, E3 scheme in surgery documentation:
   • use your judgment and the General Diagnosis Coding Guidelines to decide if the surgery was emergent or elective
5. If the patient was admitted from anywhere other than Operating Room or Recovery code as Medical in Admit Type for APACHE II

Surgical Categories Site Definitions

These are the current Surgical Category Definitions that exist at each data collection site.

• See: Admit Type for APACHE II
• Table below is simply an assessment of surgical category definitions used by OR's in the Region.

Category	CON	GRA	OAK	VIC	STB	HSC
Date/comment	Feb 3.09	Feb 4.09 _ I spoke with the OR department and they have two categories.It's either emergent or it's elective.	Feb 5.09	Feb 5.09_The definitions for E1-E3 are from the WRHA. The form that are completed are located in the OR desk.	WRHA	WRHA
E1	E1 means a case that must be done immediately and takes precedence over any other activity in the operating room, including booked elective cases. (next available room)	EMERGENT: Their definition of emergent is any case that is not slated. So all bowel perfs that come in through ER would be considered emergent even though the pt is stable and the OR could be done several hours later.	E1- immediate
E2	E2 means a case that must be started within 6 hours of booking. The surgeon booking the case must be available immediately or identify another surgeon who is available immediately. A delay of greater than 6 hours could result in serious negative consequences to the patient. If the length of waiting time is expected to be greater than 6 hours, serious consideration must be given to moving elective cases.		E2 -surgery within 8 hours	binder where the doctors fill out a form when they are booking their surgeries. Actually they are supposed to fill out a form,sometimes they just call it in. The OR desk keeps these form in a box in their dept. and they are never looked at again (their words, not mine). They are not transcribed anywhere on the chart or the OR sheets. (that's what both OR and PARR tell me) I will fax the definitions over. To be honest,I never heard of these definitions before. Norine and I rarely use the emergency surgery part in the apache. elective after they come in to emerg. However after 24 hours, they cannot be bumped and may become an E2 because the longer they wait for the OR, the more complications they may get.
E3	E3 means a case due to the medical condition of the patient, must be started within 24 hours of booking. E3 cases may not be started in the evening if they cannot be completed by 2200 hours. If the length of waiting time is expected to be greater than 24 hours, serious consideration must be given to moving elective cases.		E3-surgery within 48 hours	They are mostly elective.Mostly we get hips and bowel resections and I am told now they are booked as elective after they come in to emerg. However after 24 hours, they cannot be bumped and may become an E2 because the longer they wait for the OR, the more complications they may get.
comments		No. There is no definition of E1 etc. They do not use those codes. Whether the pt was slated (elective) or not slated (emergency surgery) is not necessarily marked on any OR sheet but the info can be gleaned from reading the progress notes. The OR slate will tell for sure if a pt was slated or not but that would mean a call to the OR desk each time a surgical pt from the OR or RR is admited to the ICU.

TOstryzniuk 23:57, 12 February 2009 (CST)