Deceased patients

This page ties together the different types of information we collect about deceased patients. Additional info might be in but not integrated here yet.

Palliative question

Julie asks: how to add a code for palliative care/ comfort care at discharge and/or change dx palliative service.

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General instructions for deceased patients

• there might or might not be one of the Category:Diagnosis implying death

Diagnosis implying death codes:

Brain death Medical Assistance In Dying

• the patient might become a Organ donor (organ/tissue donation by the donor)
• if the patient had been sent to a temporary location and was expected to return to the unit after the procedure, then the dispo is death. If the person was NOT expected to return to the unit after the procedure, then the dispo is transfer to the procedure area, resp the next ward.

NOT organ donor

• Dispo: "Died - NOT organ donor"
• Dispo DtTm: time of death

organ donor

• Dispo: "Died - organ donor"
  • ie don't code that pt was discharged to the OR or another ICU

Is that really what you want? It will give fact that patient died, but miss new location.

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• Dispo DtTm: sent from ICU to the operating room or to another ICU
  • ie don't code the time of death

Is that really what you want? It will give occupancy but miss actual time of death.

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discussion about organ donor collection

presumably organ donation always happens in an OR. So, pt would always have Dispo OR when sent for organ donation. But if that's true, then when do we ever use Dispo = "Died - organ donor"? The way I read Dispo_field#deceased_patients we would not code the OR/ICU, but the desire for this cross-check makes me wonder if we are all on the same page about this. Collectors, do you ever code OR/ICU as dispo for a brain dead organ donor? Julie, do you expect to see them coded as that? (emailed Julie and collectors) Ttenbergen 16:45, 2018 November 24 (CST)

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• When there is a braindead patient waiting for transplant we always put dispo to OR once they go there. Putting the time of death as the time of braindeath will not work because we continue to look after the patient for quite a while after the pronouncement of braindeath (even for 1 or 2 days or more). The tiss extends longer and there are interventions that we code after braindeath. If we put died: organ donor for these patients, what time would we put there as the actual time of death?? --LKolesar 05:31, 2018 November 26 (CST)
• I have been following the instruction on the Organ Donor page, so the dispo location is "died - organ donor" and the date/time is when the patient leaves to the OR. For these patients I don't put the actual time of death, but in ICD10 we can put the date for Brain death and Sudden cardiac death (and died) --Jvelasco 08:29, 2018 November 26 (CST)
• If we don't need the actual time when all organs stop working (whole body death), then this will work but I would suggest the wording for dispo be only "organ donation" and take out the word "died". The death does not actually happen in the unit but it happens during the harvest of organs in the OR. Putting death as the time to the OR is not accurate as the time of death. The OR probably documents the time of actual death although I am not sure of this. --LKolesar 13:51, 2018 November 28 (CST)

• I also use the dispo location "died - organ donor" when pt leaves to OR using that time as time of death. Pts can be in ICU for days after brain death is declared. --Llovell 11:03, 2018 November 26 (CST)
• We don't often see this at the Grace because they are transferred out to another facility if they are an organ donor, but I do not code the braindeath as the time of disposition, I would code it as a complication and the disposition date and time would be the transfer to another facility Lisa Kaita 10:15, 2018 November 27 (CST)ing death

Data prior to death (even if pt did not die on our ward)

Decisions about end of life care

• ACP C
• (legacy) ACP Status collection in ICU

End of life care

• Comfort Care
• DC Treatment
• Hospice
• Palliative care
• Palliative Service

MAID

• Medical Assistance In Dying (MAID)
• Medical Assistance In Dying (old)

Data about patients who did die

• APACHE physiological variable collection#Patient DIED shortly after arriving in unit
• Dispo DtTm field
• Dispo field

Organ Donation

• Organ Donor
• Organ donor (organ/tissue donation by the donor)

Category:Diagnosis implying death

Diagnosis implying death codes:

Brain death Medical Assistance In Dying

Data Integrity Checks (automatic list)

	App	Status
Query check ICD10 dx implying death must have appropriate dispo	CCMDB.accdb	implemented
Link suspect dead then alive query	Centralized data front end.accdb	implemented
Query NDC dx implying death across encounters	Centralized data front end.accdb	implemented