Guideline for coding organ donation after death: Difference between revisions
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* once decided we may need to adjust cross checks, namely | * once decided we may need to adjust cross checks, namely | ||
** [[Query TISS Errors NrTISSDays NE LOS]]; [[Query TISS Errors missing days]]; [[Query TISS Errors TISS date out of admission]] }} | ** [[Query TISS Errors NrTISSDays NE LOS]]; [[Query TISS Errors missing days]]; [[Query TISS Errors TISS date out of admission]] }} | ||
=== Death rate === | |||
{{Discuss | who = Julie | question= | |||
*It’s necessary to avoid double counting the death for patients who transfer after brain death. Do we have a concept of death rate or count? Which reports use it? Do we already have a wiki page for this? If not we should make it and add it to [[:Category:End-of-life related data]] and make sure it records how we will address this scenario. Ttenbergen 16:04, 2019 May 21 (CDT)}} | |||
=== other fields that might be affected === | === other fields that might be affected === | ||
Revision as of 15:04, 21 May 2019
This page explains how we code organ donation after death; it has it's own page because may concepts tie together around this and the information should only live in one place.
| Background |
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We usually encode death in Dispo; for patients with dx Brain death who are moved to a different location for Organ donor (organ/tissue donation by the donor) this means we lose either the info about their death or their new location. We needed a special case compromise to ensure this is dealt with consistently. |
Instructions for coding these patients
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If I understand all this right we will not actually be coding Organ donor (organ/tissue donation by the donor) for these, since that will always happen elsewhere, and pt won't come back to us after, so not our dx. If I understand that right we should probably put a one-liner here to make that clear since it's a bit counter-intuitive. And likely at that page as well. |
- Dispo DtTm: sent from ICU to the operating room or to another ICU (consistent with other Operating room visits
- ie don't code the time of death
Discharge to OR (same or other site)
- Acquired Diagnosis: Brain death
- Dx Date: Date brain death declared
- Dispo: Death - to OR
- Dispo DtTm: DtTm pt leaves to OR
Discharge to another site ICU for harvesting
Sending site
- Acquired Diagnosis: Brain death
- Dx Date: Date brain death declared
- Dispo: Death - to other ICU
- Dispo DtTm: DtTm pt leaves to other ICU
Receiving site
- Admit Diagnosis: Brain death
- Previous Location: the previous ICU
- Dispo: Hopefully "Death - to morgue", or "Death - to morgue" if transplant doesn't work out
- Dispo DtTm:
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We will not have a separate code for cadaver donations. Instead also code the following as appropriate
- After brain death: Brain death
- Donation after Medical Assistance in Dying (MAID) -- where a person who undergoes MAID has made arrangements in advance for organ harvesting after death.
We do not have a special code for:
- Donation after cardiac death (DCD) -- where a donor who is not brain dead is dependent on life support and the family has decided to withdraw care. When the patient's heart stops beating, the organs are then recovered in the operating room.
Some organ donors have a bronchscopy done, but not all do, so don't automatically assume and code it. The only time it is done is if there are considering the lungs. This is according to a Respirologist from STB ICU.
Donation after Cardiac Death (DCD)
- For a braindead donor, or a DCD (donation after cardiac death = almost dead in ICU but decision made to donate by taking patient or OR, removing life support until dead, then harvest organs) it almost always will be an acquired diagnosis. For those the date of that acquired diagnosis should be.... we still need to decide, see: Deceased patients.
How they are treated in linking
- for records which contain the diagnosis of Brain death, Julie will change her algorithm for linking successive records such that no linking will be done:
- in the forward time direction for a record where that diagnosis was NOT an admission diagnosis
- in the backward time direction for a record where that diagnosis was either an admission diagnosis or a comorbid diagnosis
Cross checks that are affected
How reports are affected
LOS
This should live in LOS when it's all settled since it's not unique to organ donors. leaving it here for now just to keep questions together
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confirm these are right |
- Redefine LOS. From now on, for patients who experience Brain death, LOS will include time from admission to Brain death. Time in ICU spent after Brain death being evaluated/optimized for being an organ donor will not be included in LOS.
- Bed occupancy- But, of course, that time will be included in calculations of bed occupancy.
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Death rate
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other fields that might be affected
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- Inter-facility transfers (Critical Care Inter-facility Transfer Report
- Re-admission
- mortality (Mortality and readmission report?)
- transfer delays (Transfer Delay?),
- occupancy Bed occupancy?)
- regular CC (Annual report? If so we should change the name)
- Med reports (I can't even find a link for that) reports. For ICU patient, this rule will only affect the SAS linking check program which can be modified so it will not show up as an error.
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Julie, which reports and what linking will be affected by this, so we can update the related wiki pages? Firstly, Medicine is the only one which report linked admissions during a hospitalization. If a medicine patient happens to go to an ICU, died, an organ donor and move to another ICU , this rule is saying do not consider the second ICU. what will be the LOS of that hospitalization - I presume this rule will exclude the second ICU stay, is that correct? |