Registry Patient Type

• NOTE: The collection of this data elements is scheduled to be dropped. I will let you know when. PDA and ACCESS changes need to be made before this field is allowed to be sent as a blank.TOstryzniuk 18:58, 18 December 2008 (CST)

Medicine

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

Patient TYPE-Medicine Registry

S=Surgical (MED)

●admit from OR & is under Medicine attending physician service's care

●admit from RR & is under Medicine attending physician service's care

NOTE: ►If there is surgical patient that is under a surgical services care who is in a medicine bed we exclude from the database. This is not a medical service patient

M=Medical (MED)

●A patient who is admitted under a medical service 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".

Patient TYPE-ICU

S=Surgical (ICU)

●admit from OR

●admit from RR

●all Trauma (fall, MVA, stabbing, etc)

●all burns

●all upper GI bleeds

●all intracerebral bleeds

●Pt who undergoes a surgery related to primary reason to ICU in the first 48 hrs of admission to ICU

●Pt admitted from SURGICAL WARD

●Pancreatitis admitted to SICU unit

M=Medical (ICU)

●Arrests

●Cardiogenic shock

●CCU patient - intubated

●pts that don't fall into Surgical or Cardiac categories

●Pancreatitis - M-medical (if surgery in 48 hrs then S-surgical)

C=Cardiac (ICU)

●MI

●Rhythm

●Unstable angina / ACS

●CHF

●post angio or plasty (stable

●Pacemaker insertions (temp 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)

Hi Trish,

• • • I saw that you are considering removing the cardiac, medical, surgical labeling of the patients? I collect this for our program manager and director. They are quite interested in how many surgical admissions we have per month and how many of those are ventilated. It would help me to keep collecting this part of the data. (I follow the definitions given to determine this status.) Hope you have a great day, and a wonderful Christmas! Betty

• • • • Thanks Betty. I am glad to hear that you follow the guide!! It is also good to hear how your site is using the data. I would suggest that if your site is interested in this information that you advise your site Director or Manager to discuss with Betty Lou Rock. The reason that we have decided to drop this element is because the information being collected is not consistent and therefore not reliable. Collector are not necessarily following the criteria in the guidelines. The PDA drop down list also allows for the selection of the wrong patient type if not careful. Tina makes a good point in that we are not sure how sites are using this data. Are the current criteria still suitable and do do they meet the needs of how the data is being used? It would be great to have input about patient types from those who use the data (managers, directors). Improving the quality of the data being collected is an ongoing process and I know the collectors are doing the best they can to obtain good data. The decision to drop is not solely based on collection problems but criteria also that may no longer be suitable. Again, feedback from managers and directors who use the information would help guide these decisions also.TOstryzniuk 17:53, 18 December 2008 (CST)

Memo

• • 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)

●Registry Patient Type – we will stop collection. I will let you know when. Need to access the impact on other programs before we withdraw element from collection.TOstryzniuk 17:41, 9 December 2008 (CST)