Admit Type for APACHE II

The Admit Type for APACHE II is a way to classify patients surgical status. It is one of the elements used to generate the APACHE score. The possible values are stored in S AP AdmitType.

• Code as: "S" (Surgical) ONLY IF patient admitted directly from operating room (OR) or Recovery Room (RR), otherwise patient coded as "M" (Medical).TOstryzniuk 18:38, 2 February 2009 (CST)

Note: This is not for Registry Patient Type which is part of registry screen.

As with all APACHE items, the assessment is made during the first 24hrs in the ICU. Template:Discussion

Is it really made during the frist 24 hrs? On the flow chart it looks like it is based on admission directly. Is there something that could happen during the first 24 after admission that would change this?Ttenbergen 14:19, 6 May 2009 (CDT)

Data Definition/Clarification

Clarification is for the purpose of uniform application of definition at all data collection sites. There is a discrepancy in the selection of admit type for APACHE for the ICU. Those patients that are "urgent surgery" in particular seem to be an issue. Some collectors are including urgent surgery with the emergency surgery group, others as are including them with the elective surgery group. "Urgent" surgery is to be coded as part of the elective surgery group. To classify a patient, follow this chart:

• Emergency Surgery: when surgery is required immediately and or unexpectedly within a maximum of 5 hours or less from the time surgeon trauma team deems patient needs surgery. Mary Lou will add to this definition as per discussion today. --TOstryzniuk 15:46, 22 December 2009 (CST)

File:Patient Type Flowchart.gif

Template:Discussion

Discussion

The classification has to be consistent for proper scoring. Some collectors had been including urgent surgery under emergency surgery category while others were including it under elective surgery category.

• I know we have talked about this but can you define "immediate" in "immediate surgery essential for pt survival"MWaschuk 14:14, 17 June 2008 (CDT)
  • adverb at once, now, instantly, straight away, directly, promptly, right now, right away, there and then, speedily, rushed without delay, without hesitation, instantaneously, forthwith, pronto (informal) unhesitatingly, this instant, on the nail, this very minute, posthaste, tout de suite (French) before you could say Jack Robinson (informal)now or without waiting; at once; without delay or hesitation; with no time interveningTOstryzniuk 14:42, 17 June 2008 (CDT)
    • I will look into a more helpful definition for this. --Tina 17 June 2008

• • • there is considerable variation in the definition of "urgency" I will look around and see which one we want to adopt and conform to for the purpose of APACHE II.TOstryzniuk 20:55, 15 December 2008 (CST)
      • APACHE II's original definition is as follows (no specific time lines were included in definition):
• Emergency Surg - surgery that is required immediately to prevent life threatening complications.
• Elective Surg -patient can wait for scheduled in for the surgery.(no time lines for the various degrees of urgencies within the elective group).

Current suggestion for urgency time lines for APACHE II patient TYPE

• Emergency Surgery Category - to OR as Emergent or E1 surgical status. (see operating room records)
• Elective Surgery Category - to OR -includes subcategories of elective surgery: urgent, semi urgent and non urgent surgery.
• I will submit this definition to the database committee and see if this is the one we want to adopt for APACHE II. This one is a worldwide definition used by the cardio-thoracic community but it is in variance with other national definitions, however it is simple and clear.TOstryzniuk 21:34, 15 December 2008 (CST)
• I am not sure if the Hospitals in the city have adopted a standard operating definition of emergency surgery. I know they have categories and subcategories of Elective types but I have not found out if they have assigned specific time lines to each group or not?TOstryzniuk 21:41, 15 December 2008 (CST)

Discussion - Non-OP procedures

• I have spoken with Dr. Perry Gray about the issue of the neuro patients who undergo coiling in the angio suite and whether they should be considered as surgery patients in the APACHE scoring. These can be either elective, where they are recovered in PACU, or emergent if they go directly to SICU. He has agreed that, even though these patients do not physically have the procedure done in the OR, they should be considered surgical (elective or emergent) in the APACHE scoring. In addition, Trish has indicated that this would also be considered as an operative day for TISS #96.~~
  • Would we be able to generalize which non-OP procedures can be counted for surgery overall? Ttenbergen 10:45, 20 August 2009 (CDT)
  • Would we be able to generalize how the destination after procedure qualifies as elective/emergent? Ttenbergen 10:45, 20 August 2009 (CDT)
  • The comment about Tiss #96 needs to go to the TISS article; however, again, we should generalize first which non-OP procedures qualify. Ttenbergen 10:45, 20 August 2009 (CDT)

February 2.09

• emailed to ICU collectors:
• 2. We are looking further at the definition of EMERGENCY Surgery. We need the collectors provide us with the following information:
  • a. where in the chart do you find the surgical categories (E1 to E3) at your site?
  • b. what is your sites definition of each of these surgical categories?
• Information required this Friday Feb 6.09.--TOstryzniuk 17:52, 3 February 2009 (CST)
  • Responses recieved:
    • CON:
      • Feb 3.09 (3 categories (E1 to E3 defined-information is found on page 1 of the OR sheet)
      • E1-case must be done immediately & takes precedence over any other activity in the OR, including booked elective cases.
      • E2-case must be started within 6 hours of booking.
    • E3-case due to medical condition of patient must be started within 24 hours of booking. Cannot start in the evening if not completed by 2200hrs. If wait time is to be >24 hrs serious consideration to move elective case.
    • OAK:
      • E1-care immediate
      • E2-case must be started within 8 hours of booking
      • E3-case must be done within 48 hours
    • STB: see WRHA standard guide
    • HSC:
    • VIC:see WRHA standard guide. Form filled out, but not recorded anywhere on chart
    • GRA: Feb 4.09 (2 categories: emergency or elective) Not sure where documented). Their defintion of EMERGENT is any case that is not slated,so all bowel perfs that are stable and surgery can be done several hours later.

• to see information provided to question above go to: Surgical Categories Site Definitions

Dec 9, 2008-More Discussion

•Chronic Health (CH)- is this yes or no or are there different points for each specific type of chronic health problem?

• ►no there are no specific points for each and every CH item. CH is scored as follows:
  • If Elective Surgery is YES & CH is YES, then 2 points.
  • If Elective Surgery NO & CH is YES, then 5 point (elective surgery =NO

means either medical patient (non operative) or emergency surgery.

• • If Elective Surgery is YES & CH is NO, then 0 points
  • if Elective Surgery is NO & CH is NO, then 0 points
• ►Elective surgery or CH in the Master Database are: YES or NO. These two fields had been made into a pick lists by Linda. This was because Medicine wanted to use both APACHE II and SAPS II on Medicine patients. SAPS II and APACHE II scored these same items differently. On the PDA, the collectors select from a specific list for APACHE II for CH, (list of 9 items that belong to one of the 5 APACHE II CH categories)
• ►when CSV file is uploaded to master database, the CH items are converted to a YES or NO. If Elective surgery, converted to YES, if emergency or medical, converted to a NO.

TOstryzniuk 16:07, 9 December 2008 (CST)TOstryzniuk 23:23, 12 February 2009 (CST)