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| This page ties together the different types of information we collect about deceased patients. Additional info might be in [[Category:End-of-life related data]] but not integrated here yet. | | This page ties together the different types of information we collect about deceased patients. Additional info might be in [[Category:End-of-life related data]] but not integrated here yet. |
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| {{DT | [[Dispo]] needs to be tweaked to
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| * Death - to OR
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| * Death - to other ICU
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| * Death - to morgue
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| {{DA|
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| * What about the tiss score sheet, it extends beyond LOS then in these cases? There are significant interventions done by the nurses after braindeath, hopefully we can complete the tiss to the end of bed occupancy? Just checking.--[[User:LKolesar|LKolesar]] 14:06, 2019 May 2 (CDT)
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| ** AKA [[Query TISS Errors NrTISSDays NE LOS]]; [[Query TISS Errors missing days]]; [[Query TISS Errors TISS date out of admission]] }}
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| == New Rules (as of April 2019) Regarding Brain death and Organ Donation ==
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| *Redefine Length-of-Stay. 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]]. But, of course, that time will be included in calculations of bed occupancy.
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| *Revise list of dispositions to now include THREE types of death disposition:
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| **Death with transfer to morgue
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| **Death with transfer to OR for organ donation
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| **Death with transfer to another ICU
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| *For a patient who develops [[Brain death]] in location A, and then transfers to location B for further evaluation for organ donation
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| **In location A the patient will have an acquired diagnosis of [[Brain death]], and their dispo will be '''Death with transfer to another ICU'''. The [[LOS]] in location A will be time from admit to [[Brain death]]. Any time spent in location A after [[Brain death]] will be counted towards occupancy but not [[LOS]].
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| **In location B the patient will have admit diagnosis of [[Brain death]], and their dispo will be '''Death with transfer to OR for organ donation''' IF they go for donation and '''Death with transfer to morgue''' if not. While all of this time will be included in occupancy, none of it will be included in [[LOS]] (since the person was not alive).
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| **In the unusual situation where the patient goes directly from location A (an ICU) to the OR of another/different hospital for organ harvesting, the dispo for location A will be '''Death with transfer to OR for organ donation'''
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| **Regarding death rates in these records
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| ***It’s necessary to avoid double counting the death in location A and location B.
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| *For a patient who is not yet brain dead in location A and then transfers to location B with expectation of near-future [[Brain death]] or Donation after Cardiac Death (DCD)
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| **In location A the dispo will be transfer to location B. The record in location B will have admit diagnoses of whatever is present. IF that person develops [[Brain death]] in location B, then that will be coded as an acquired diagnosis.
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| **If the patient develops [[Brain death]] in location B, then the [[LOS]] in location B will only be the time from admit to [[Brain death]]. For calculating this patient’s total [[LOS]], it will be the entire time in location A + the time in location B until [[Brain death]].
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| *For a patient who is in one location (e.g. MICU), where he develops [[Brain death]], and then stays in that location to be evaluated/optimized for being an organ donor
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| **[[Brain death]] will be an acquired diagnosis. [[LOS]] will only be the time from admit to [[Brain death]]. Time after [[Brain death]] will be counted towards occupancy but not [[LOS]].
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| **The dispo will be '''Death with transfer to OR''' for organ donation IF they go for donation and '''Death with transfer to morgue''' if not.
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| == General instructions for deceased patients == | | == General instructions for deceased patients == |
| * there might or might not be one of the [[:Category:Diagnosis implying death]] | | *We always know that a patient died by virtue of the [[Dispo field]]. And data collectors record all diagnoses relevant to the admission. Thus beyond those 2 items, we have no specific need to record death as a diagnosis EXCEPT for brain death in which the patient becomes an organ donor. |
| | *There might or might not be one of the [[:Category:Diagnosis implying death]] |
| {{ListICD10Category | categoryName = Diagnosis implying death}} | | {{ListICD10Category | categoryName = Diagnosis implying death}} |
| * the patient might become a [[Organ donor (organ/tissue donation by the donor)]]
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| * if the patient had been sent to a temporary location and was expected to return to the unit after the procedure, then the '''dispo is death'''. If the person was NOT expected to return to the unit after the procedure, then the dispo is transfer to the procedure area, resp the next ward.
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| === NOT organ donor === | | === NOT organ donor === |
| *'''[[Dispo]]''': "Death - to morgue" | | *'''[[Dispo]]''': "Died - to morgue" |
| *'''[[Dispo DtTm]]''': ''' time of death | | *'''[[Dispo DtTm]]''': ''' date and time of death''' - info is found in '''[[Patient Viewer Tab Cognos ADT2]] ''' |
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| === organ donor === | | === organ donor === |
| *'''[[Dispo]]''': "Died - organ donor"
| | See [[Guideline for coding organ donation after death]] |
| ** ie don't code that pt was discharged to the OR or another ICU
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| <!-- as discussed ICU Database Task Group Meeting – April 9, 2019 -->
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| *'''[[Dispo DtTm]]''': '''sent from ICU to the operating room or to another ICU'''
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| ** ie don't code the time of death
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| {{DA |
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| * Is that really what we want? It will give occupancy but miss actual time of death. }}
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| ==== Organ donors moving between sites ==== | | === Death at temporary location === |
| Our data structure allows us either to know that a pt died or that they went to e.g. the OR. What do we want to know more. As of 2019-04-10, we code that they are dead, but not where they went.
| | See [[Visits to temporary locations]] |
| * presumably organ donation always happens in an OR. So, pt would always have [[Dispo]] OR when sent for organ donation. But if that's true, then when do we ever use [[Dispo]] = "Died - organ donor"? The way I read [[Dispo_field#deceased_patients]] we would not code the OR/ICU, but the desire for this cross-check makes me wonder if we are all on the same page about this. Collectors, do you ever code OR/ICU as dispo for a brain dead organ donor? Julie, do you ''expect'' to see them coded as that? (emailed Julie and collectors) Ttenbergen 16:45, 2018 November 24 (CST)
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| ** After our discussion in the office about this, one option to capture both deaths and transfers is to add "Died organ donor - to OR" and "Died organ donor - to ICU" to the [[Dispo_field]] and remove the "Died - organ donor" - are there any other locations need to be added where organ donor goes to? Then the [[Dispo_DtTm]] = date and time left the unit or ward. In this way, the mortality counts can be made without looking at the ICD10 diagnosis; the linking or flow of transfers can be done with correct dispo location; the occupancy will be correct. For these cases, [[Dispo_DtTm]] does not necessarily mean death date. But this is fine since we are working to get the data of death dates from the project 'Data Sharing with WRHA'. We thought of bringing this to Task but I think this option is workable for every one. --[[User:JMojica|JMojica]] 15:22, 2018 November 28 (CST)
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| *** Allan is fine with this. Ttenbergen 10:16, 2018 December 28 (CST)
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| *When there is a braindead patient waiting for transplant we always put dispo to OR once they go there. Putting the time of death as the time of braindeath will not work because we continue to look after the patient for quite a while after the pronouncement of braindeath (even for 1 or 2 days or more). The tiss extends longer and there are interventions that we code after braindeath. If we put died: organ donor for these patients, what time would we put there as the actual time of death?? --[[User:LKolesar|LKolesar]] 05:31, 2018 November 26 (CST)
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| *I have been following the instruction on the [[Organ Donor]] page, so the dispo location is "died - organ donor" and the date/time is when the patient leaves to the OR. For these patients I don't put the actual time of death, but in ICD10 we can put the date for [[Brain death]] and [[Sudden cardiac death (and died)]] --[[User:Jvelasco|Jvelasco]] 08:29, 2018 November 26 (CST)
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| * If we don't need the actual time when all organs stop working (whole body death), then this will work but I would suggest the wording for dispo be only "organ donation" and take out the word "died". The death does not actually happen in the unit but it happens during the harvest of organs in the OR. Putting death as the time to the OR is not accurate as the time of death. The OR probably documents the time of actual death although I am not sure of this. --[[User:LKolesar|LKolesar]] 13:51, 2018 November 28 (CST)
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| * I also use the dispo location "died - organ donor" when pt leaves to OR using that time as time of death. Pts can be in ICU for days after brain death is declared. --[[User:Llovell|Llovell]] 11:03, 2018 November 26 (CST)
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| * We don't often see this at the Grace because they are transferred out to another facility if they are an organ donor, but I do not code the braindeath as the time of disposition, I would code it as a complication and the disposition date and time would be the transfer to another facility [[User:Lkaita|Lisa Kaita]] 10:15, 2018 November 27 (CST)
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| == Data prior to death (even if pt did not die on our ward) == | | == Data prior to death (even if pt did not die on our ward) == |