Admit Type for APACHE II

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

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.

Coding Instructions

• If the patient was admitted from an OR or from Recovery then:
  • if your site uses the E1, E2, E3 scheme in surgery documentation:
    • code only E1 as emergency surgery
    • code all other patients admitted from OR or RR as elective
  • if your site does not use the E1, E2, E3 scheme in surgery documentation:
    • use your judgment as an ICU nurse and the General Diagnosis Coding Guidelines to decide if the surgery was emergent or elective
• If the patient was admitted from anywhere other than OR or Recovery
  • code as medical

Relevance

Patients with:

• Chronic disease + emergent surgery or non operative (medical patient) = 5 points
• Chronic disease + elective surgery = 2 points
• No chronic disease = 0 points

Potential Change

May 8.14: it was discovered that below is really not relevant now that we have discovered that ccmdb.mdb "sending" doesn't do it that way.- Tina Tenbergen, Trish Ostryzniuk 19:19, 2014 May 8 (CDT)

Task team meeting: Dr. Allan Garland decided to code as this because it is sufficient to do the scoring, even if it is not as granular as we could be. Template:Potential Change We discussed difficulties related to APACHE ICU admission types. These are in 3 categories: elective surgical, emergent surgical, and nonsurgical (i.e. medical). The single variable in Ed’s program is called “Elective surgical” and is coded Yes/No. So it cannot accurately distinguish the 3 true categories. However, by merging this variable with the pre-ICU location, we can appropriately re-create the correct variable. Thus we’ll make a new variable that will identify the APACHE admission type, coded using “Elective surgical” and the pre-ICU location, as follows:

Elective surgical	Pre-ICU location	APACHE admit type
Yes			any			elective surgical
No			OR or PACU		emergent surgical
No			not OR or PACU	        medical			

We also will consider, “later”, fixing this variable on the laptops to appropriately include all 3 options.