Registry Patient Type

Medicine

The Patient Type on your registry page can take one of two values:

S for Surgical

• Patients Admitted from OR (operating room) or RR (recovery room) under Medicine service care.

• The medicine database is not tracking Surgical patients under surgeon care who are on a medicine ward
• If there is a surgical patient under surg service in a medicine bed, we exclude from medicine database. This is not a medicine service patient TOstryzniuk 19:15, 6 October 2008 (CDT)

M for Medical

Patients admitted under a medical attending physician for medical reasons.

Critical Care

Note for HSC and STB only

Patients in MICU under MICU attending physician service are that are "cardiac" type patients should always be coded as "M" for medical whether they are stable or not. The only exception is if a patient is a surgical patient, then mark as “S” and in Var 5 put "SM".

S for Surgical

• Patients Admitted from OR (operating room) or RR (recovery room)
• All trauma
• All Burns
• Upper GI Bleeds
• Intracerebral Bleeds
• Patients who undergo a surgery related to primary ICU admit reasonwithin 48 hrs of admission to ICU
• Patients Admitted from a surgical ward
• Pancreatitis in SICU patient

M for Medical

• Cardiac Arrests
• Cardiogenic Shock
• Patients whose Diagnosis does not fall into surgical or cardiac categories
• CCU Patients that are intubated or too sick for CCU (i.e. need inotropes or IABP**)
• Pancreatits in MICU patient (label as S = surgical if patient goes for surgery for this organ in 1st 48 hrs in ICU)

C for Cardiac

• MI
• Rhythm Disturbances
• Unstable Angina
• CHF
• Post angiogram or angiolasty - Stable
• Pacemaker insertions (temporary or permanent)

Discussion

• Which of these codes takes precedence? I.e. an MI who arrests becomes a...
  • Whether the patient is cardiac or medical really depends upon the attending physician. If cardiology is covering, the pt is cardiac whether they have a cardiac arrest, cardiogenic shock or really any diagnosis.LKolesar
    • Is this the case for HSC as well, or only for STB?Ttenbergen 19:49, 6 May 2008 (CDT)
• the ICU PATIENT type guide states the PATIENT TYPE. If you come from the OR to ICU with a bowel resection, and you arrest, you are surgical. TOstryzniuk 19:11, 6 October 2008 (CDT)'

• Clarification about pancreatitis - label "S" even if 1st 48hr surgery is not related?
  • I don't code pancreatitis as surgical unless the attending physician is a surgeon upon admission to the ICU. LKolesar
    • The criteria above are straight from the manual. We'll need to find a definition that is the same for everyone. So, I'll post this for discussion specifically with all HSC and STB ICU DCs, and Julie and Trish. This may be a case of the data being used differently than perceived. Ttenbergen 19:49, 6 May 2008 (CDT)
  • the pancreatitis definition was made by Dr. Gray and Roberts. The reason for this was that MICU took many patients that should have gone to surgery service. There were issues in being able to track those patient that were really surgical population that SICU could not take because they were full.TOstryzniuk 19:11, 6 October 2008 (CDT)

• how about post angio... unstable?
  • Again, if attending is cardiology it is under CCU, if a medical attending, it is under medicine.
    • The criteria above are straight from the manual. We'll need to find a definition that is the same for everyone. So, I'll post this for discussion specifically with all HSC and STB ICU DCs, and Julie and Trish. This may be a case of the data being used differently than perceived. Ttenbergen 19:49, 6 May 2008 (CDT)

• Pacemaker insertions (temporary or permanent) - are ther other than those two? If not, unnecessary to mention.
  • There are pacemaker wires inserted during cardiac surgery also which are epicardial temporary wires, these are not seen in CCU. More precise wording for CCU should be transvenous, transcutaneous and permanent pacemakers, however you can have any of these pacemakers in medical patients as well. LKolesar
    • Are there any pacemakers that would not fall under cardiac? I think we would need a comprehensive list only if there are exceptions. Even then, "all new pacemakers except xxx" should say it all. If we list specifics, then we are vulnerable if we miss any one or if a new one arises. If we stay general and use summary terms where possible, this risk is lower. Ttenbergen 19:49, 6 May 2008 (CDT)

• I don't know if all would be in agreement with me but these categories of patient type do not depend on the diagnosis at all but instead should reflect the service that the patient is admitted under (attending physician) only. LKolesar
  • That is an interesting question, and I guess it depends on the usage of this data. Julie? Ttenbergen 19:49, 6 May 2008 (CDT)
  • It was never the intention to track the physician service. We are currently investigating the need to continue to track Patient type. I will let you know if there is a change. Current guide still stands until further noticeTOstryzniuk 19:11, 6 October 2008 (CDT)