I'm concerned about the differening abstraction rules being followed surrounding mortality rates, specifically who is "in or out" of a denominator based on decisions to restrict care (DNR, Comfort Care etc) Will this effect how we look in the SSC comparison reports once they get those are ready to be sent out?
Can someone from the SSC database please address the rule for who should be included/excluded from data collection surrounding the DNR,Comfort Care, limited interventions issue? Wendy Wendy Nieman RN ICU and Medicine Quality Coordinator Quality Benchmarking & External Reporting Practice Improvement Department Phone: 734-712-1151 Fax: 734-712-7099 St. Joseph Mercy Hospital Ann Arbor Michigan 48104 [email protected] This is a confidential professional/peer review and quality improvement document of Saint Joseph Mercy Health Systam and the Trinity Health system of providers. It is protected from disclosure pursuant to the provisions of MCL 333.20175, 333.21513, MCL 333.21515, MCL 333.16222, MCL 331.531, MCL 331.533, MCL 330.1749, MCL 330.1143a, and other state laws as well as the Federal Patient Safety and Quality Improvement Act, 42 U.S.C 299b-21-b-26 and other federal laws. Unauthorized disclosure or duplication is absolutely prohibited. ________________________________________ From: Sepsisgroups [[email protected]] on behalf of Lisa Dumont [[email protected]] Sent: Monday, June 23, 2014 9:15 AM To: '[email protected]' Subject: Re: [Sepsis Groups] Sepsis mortality HI There, When I review mortalities; I exclude the following patients in my denominator. 1. Any patient that is made CMO within 24 hrs of admission 2. Any patient that expires within 24 hrs from admission 3. Any patient where the wishes are not to carry on with "aggressive treatment". I included DNRs as this does not treat and I need to know if we did everything we could for that patient. Regards, Lisa Dumont RN MSN Sepsis Coordinator Southcoast Health New Bedford MA -----Original Message----- From: Sepsisgroups [mailto:[email protected]] On Behalf Of [email protected] Sent: Monday, June 23, 2014 9:05 AM To: [email protected] Subject: Sepsisgroups Digest, Vol 115, Issue 1 Send Sepsisgroups mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org or, via email, send a message with subject or body 'help' to [email protected] You can reach the person managing the list at [email protected] When replying, please edit your Subject line so it is more specific than "Re: Contents of Sepsisgroups digest..." Today's Topics: 1. Re: Sepsis Mortality ([email protected]) 2. Re: Sepsis Mortality (Sam Farrell) 3. Re: Sepsis Mortality (Barnes-Daly, Mary Ann) ---------------------------------------------------------------------- Message: 1 Date: Thu, 19 Jun 2014 13:16:28 -0400 (EDT) From: [email protected] To: [email protected], [email protected] Subject: Re: [Sepsis Groups] Sepsis Mortality Message-ID: <[email protected]> Content-Type: text/plain; charset="utf-8" Please see below: Do you consider do not resuscitate (DNR)? I got what is below from the AHRQ web site....I wonder if it is still current? Date Published: February 28, 2011 Date Updated: June 1, 2012 The AHRQ QI do not currently consider do not resuscitate (DNR) as either a denominator exclusion or covariate in the risk-adjustment. We are however currently evaluating three relatively recent data elements related to hospice, palliative care and DNR. First, the UB-04 data element Point of Origin added a data value of ?F? (Transfer from a Hospice Facility) in January 2010. Second, an ICD-9-CM diagnosis code V49.86 (Do not resuscitate status) was added October 1, 2010. Finally, the UB-04 data element Condition Code has a data value ?P1? for ?a DNR order was written at the time of or within the first 24 hours of the patient?s admission to the hospital and is clearly documented in the patient?s medical record?. The availability of HCUP data for 2010 will allow us to evaluate empirically one or more of these potential data elements alone or in combination as either an exclusion or covariate. As with any other potential patient characteristic, the empirical evaluation will focus on whether the characteristic is a mediator (and therefore a covariate) or moderator (and therefore a stratification or exclusion) of the quality of care. Although there is currently an ICD-9-CM diagnosis code (V66.7) for encounter for palliative care, the AHRQ QI do not incorporate the code in QI calculations because it does not specifically identify hospice care, can be applied at any time during a hospitalization (e.g., several weeks or months after admission), and is not yet reliably reported. See AHA Coding Clinic for ICD-9-CM, 3Q 2008, Volume 25(32):13-14: "This code may be reported for any terminally ill patient who receives palliative care, regardless as to when the decision is made. There is no time limit or minimum for the use of this code assignment." See also AHA Coding Clinic for ICD-9-CM, 1Q 1998, Volume 15(1):11: "Terms such as comfort care, end-of-life care, and hospice care are all synonymous with palliative care. These, or similar terms, need to be written in the record to support the use of code V66.7." In order for us to consider use of the V66.7 code, the coding guidance will need to be clarified or 5th digits must be included. We encourage professional societies with interest in this code to submit proposals to clarify the guidance William E. Haik, M.D.,F.C.C.P.,C.D.I.P. AHIMA Approved ICD-10-CM/PCS Trainer Office: (850) 863-2110 Cell: (850) 803-5854 Fax (850) 864-4438 In a message dated 6/19/2014 8:01:19 A.M. Central Daylight Time, [email protected] writes: When you report sepsis mortality rate (severe sepsis/septic shock), do you use any exclusions in your denominator such as DNR, Comfort care, refuse treatment, etc? Thank You Nenita Francisco, RN, BSN Director of Critical Care & Cardiovascular Unit Methodist Hospital 626 462-2758 This message, together with any attachments, is intended only for the use of the individual or entity to which it is addressed. It may contain information that is confidential and prohibited from disclosure. If you are not the intended recipient, you are hereby notified that any dissemination or copying of this message or any attachments is strictly prohibited. If you have received this message in error, please notify the original sender immediately by telephone or by return e-mail and delete this message, along with any attachments, from your computer. Thank you. ­­ _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140619/d3d34dab/attachment.htm> ------------------------------ Message: 2 Date: Thu, 19 Jun 2014 10:55:18 -0700 From: Sam Farrell <[email protected]> To: "Francisco, Nenita" <[email protected]> Cc: "[email protected]" <[email protected]> Subject: Re: [Sepsis Groups] Sepsis Mortality Message-ID: <CAPZOCFQtnTe=5das_u84argcg3znd+jqkbozy7doyh__3y2...@mail.gmail.com> Content-Type: text/plain; charset="utf-8" I had understood that there were no exclusions from sepsis mortality - regardless of how sensible an exclusion it is. However, it appears that New York State has identified this might not be such a smart idea with reported data: http://open.nysenate.gov/legislation/bill/S6979-2013 It's one thing to get a global epidemiological picture of the impact that sepsis has on our society. When that data is then reported to the public without explanation, then I think we do a disservice to folks who are just trying to make good decisions about their healthcare...and to the hospitals trying to provide that care. The bill sums it up thusly (emphasis mine): Statement in Support: The data collection and reporting requirements within the regulations governing sepsis measures adopted in 2013 are novel both in New York State and throughout the nation (if not internationally). As such, the process for evaluating the data collected to assure completeness and accuracy, as well as the modeling necessary to develop fair and accurate risk-adjusted measures of mortality attributable to sepsis, are also novel and untested. Accordingly, premature release of this data before thorough and careful analysis, may improperly damage hospitals and mislead consumers. This legislation would allow for a pilot phase lasting no more than two years, to complete data collection and analytics* to assure that the information ultimately made public is accurate and meaningful. *The Department would publish this data after validation. Yay, NY State! -- Sam Farrell, RN CCRN Intensivist Program Manager West Coast Critical Care Specialists office: 805.988.7004 fax: 805.988.7101 *wcintensivist.com* <http://wcintensivist.com/> *CONFIDENTIALITY NOTICE : This message and any included attachments are intended only for the addressee and may contain confidential information belonging to the sender that is legally protected. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail. Thank you.* On Wed, Jun 18, 2014 at 12:03 PM, Francisco, Nenita < [email protected]> wrote: > When you report sepsis mortality rate (severe sepsis/septic shock), do > you use any exclusions in your denominator such as DNR, Comfort care, > refuse treatment, etc? > > Thank You > > > > > > Nenita Francisco, RN, BSN > > Director of Critical Care & Cardiovascular Unit > > Methodist Hospital > > 626 462-2758 > > > > This message, together with any attachments, is intended only for the use > of the individual or entity to which it is addressed. It may contain > information that is confidential and prohibited from disclosure. If you are > not the intended recipient, you are hereby notified that any dissemination > or copying of this message or any attachments is strictly prohibited. If > you have received this message in error, please notify the original sender > immediately by telephone or by return e-mail and delete this message, along > with any attachments, from your computer. Thank you. > ?? > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > > -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.sepsisgroups.org/pipermail/sepsisgroups-sepsisgroups.org/attachments/20140619/410f70c7/attachment.htm> ------------------------------ Message: 3 Date: Thu, 19 Jun 2014 08:38:05 -0700 From: "Barnes-Daly, Mary Ann" <[email protected]> To: "'Francisco, Nenita'" <[email protected]>, "'[email protected]'" <[email protected]> Subject: Re: [Sepsis Groups] Sepsis Mortality Message-ID: <62b84847cb93ba4fbe626d1b1d6d6e430137cc6d7...@dcbl105vx.root.sutterhealth.org> Content-Type: text/plain; charset="us-ascii" In mortality we exclude comfort/palliative care. We do not exclude DNR as these pts are not having a cardiac-pulmonary arrest. Thanks, MARY ANN BARNES-DALY RN BSN CCRN DC | Clinical Performance Improvement Consultant Sutter Health - Clinical Integration Department | 2200 River Plaza Drive, Sacramento, CA 95833 Mobile 916.200.5604| Office 916.286.6717 | [email protected]<BLOCKED::mailto:[email protected]> From: Sepsisgroups [mailto:[email protected]] On Behalf Of Francisco, Nenita Sent: Wednesday, June 18, 2014 12:04 PM To: '[email protected]' Subject: [Sepsis Groups] Sepsis Mortality When you report sepsis mortality rate (severe sepsis/septic shock), do you use any exclusions in your denominator such as DNR, Comfort care, refuse treatment, etc? Thank You Nenita Francisco, RN, BSN Director of Critical Care & Cardiovascular Unit Methodist Hospital 626 462-2758 This message, together with any attachments, is intended only for the use of the individual or entity to which it is addressed. It may contain information that is confidential and prohibited from disclosure. If you are not the intended recipient, you are hereby notified that any dissemination or copying of this message or any attachments is strictly prohibited. If you have received this message in error, please notify the original sender immediately by telephone or by return e-mail and delete this message, along with any attachments, from your computer. Thank you. -------------- next part -------------- An HTML attachment was scrubbed... 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