I had asked for the rationale related to the updated QNet reply & this is the response received yesterday- Pam
Pamela Anderson, BSN, RN Clinical Data Abstractor Loyola University Health System Center for Clinical Excellence Maguire Center | Bldg 105-3909 | Maywood, IL 60153 (O) 708-216-5544 | (F) 708-216-7867 | (E) [email protected]<mailto:[email protected]> NOTE: The information contained in this message may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you believe you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. Thank you. Loyola University Health System From: IQR Q&A System [mailto:[email protected]] Sent: Thursday, March 31, 2016 3:07 PM To: PAMELA J. ANDERSON Subject: Respiratory Failure as Organ Dysfunction [Incident: 160301-000089] Recently you requested personal assistance from our on-line support center. Below is a summary of your request and our response. If this issue is not resolved to your satisfaction, you may reopen it within the next 1095 days. Thank you for allowing us to be of service to you. To access your question from our support site, click here.<https://cms-ip.custhelp.com/app/account/questions/detail/i_id/282581> Subject Respiratory Failure as Organ Dysfunction Discussion Thread Response Via Email (Mary Cox) 03/31/2016 04:07 PM We have had the same conversations regarding which time. It is the additional note for abstraction that results in this guidance. To use acute respiratory failure as a sign of organ dysfunction there must be: * Documentation of acute respiratory failure AND * Documentation the patient is on mechanical ventilation. It is true that waiting until both are in the record and using the later of the two, cases may be excluded that actually were Severe Sepsis and did receive appropriate interventions. It does not mean that it is inappropriate to treat the patient as a Severe Sepsis case just because the documentation of Acute Respiratory Failure is made hours lager. This does provide a good opportunity for Process Improvement to have physicians consider including a more specific time within the progress note indicating when acute respiratory failure occurred. That would allow you to use that time, and not the progress note open time. Customer By Email (Pamela Anderson) 03/31/2016 03:00 PM Is there a rationale related to the reply below? I forwarded your reply to several sepsis abstractor/coordinator groups I follow with, and we all have the same concern -it seems to me that it is much more accurate to take the time of the actual intubation/application of BiPAP/CPAP since that is when the physical criteria was present, and intervention was required. Often times, especially if a patient is very sick, a note doesn't get written until hours afterwards, sometimes without the specific verbiage/wording of "acute respiratory failure" in the notes for days. I appreciate your help- Pam Pamela Anderson, BSN, RN Clinical Data Abstractor Sepsis Coordinator Loyola University Health System Center for Clinical Excellence 2160 S. First Avenue | Bldg 105-3915 | Maywood, IL 60153 (O) 708-216-5544 | (F) 708-216-7867 | (E) [email protected]<mailto:[email protected]> CONFIDENTIALITY NOTICE** This email communication and any attachments may contain confidential and privileged PHI for the use of the designated recipients named above. Distribution, reproduction or any other use of this transmission by any party other than the intended recipient is prohibited. If you have received this communication in error, please notify the sender immediately. ________________________________ Confidentiality Notice: This e-mail, including any attachments is the property of Trinity Health and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email. Response Via Email (Mary Cox) 03/31/2016 11:45 AM As we have been receiving more questions related to this, we have consulted further with measure steward and need to advise you of the update. To use acute respiratory failure as a sign of organ dysfunction there must be: * Documentation of acute respiratory failure AND * Documentation the patient is on mechanical ventilation. Use the time at which there is documentation supporting both the patient has acute respiratory failure and is on mechanical ventilation. If documented separately use the time the later of the two is documented. In the scenario you have presented, you will not use the actual time of intubation, or the initiation of CiPAP/CPAP. you will use the time the MD/APN documented "acute respiratory failure," even if it is the next day or after. Response Via Email (Noel Albritton) 03/28/2016 11:32 AM Yes! That is correct! Customer By Email (Pamela Anderson) 03/28/2016 11:15 AM Thank you - it does help. Just for my own clarification to make sure I got it right - we are to use the actual time of intubation or the initiation of BiPAP/CPAP for the Organ Dysfunction, as long as somewhere in the chart the MD/APN has documented "Acute Respiratory Failure", even if it's the next day or after. Pam Pamela Anderson, BSN, RN Clinical Data Abstractor Interim Sepsis Coordinator Loyola University Health System Center for Clinical Excellence Maguire Center | Bldg 105-3909 | Maywood, IL 60153 (O) 708-216-5544 | (F) 708-216-7867 | (E) [email protected]<mailto:[email protected]> NOTE: The information contained in this message may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you believe you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. Thank you. Loyola University Health System Confidentiality Notice: This e-mail, including any attachments is the property of Trinity Health and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email. Response Via Email (Noel Albritton) 03/28/2016 10:50 AM Hi Pamela, Thanks for the question. The time of organ dysfunction evidenced by acute respiratory failure/new need for mechanical ventilation is the time ventilation is administered. Therefore, per the documentation you provided organ dysfunction would be met at 06:30. If suspected infection (PNA) and 2 SIRS criteria were documented at 06:00 and organ dysfunction was met at 06:30, Severe Sepsis time would be 06:30. Hope this helps! Auto-Response 03/01/2016 03:10 PM Due to the volume of inquires related to the SEP-1 measure we are experiencing a response lag time. Responses to SEP-1 questions are being answered daily. Please be reminded that Q&As are available in the QualityNet knowledge base tool<https://cms-ip.custhelp.com/app/answers/list/c/576> posted on QualityNet. The Sepsis (SEP-1), Additional Notes for Version 5.0b Abstraction are available on QualityNet https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier3&cid=1228774725171 Be aware, while the Additional Notes for Abstraction were released on 2/10/2016 they are effective with cases discharged starting 10/1/2015. The decision to re-abstract cases abstracted prior to release of the Additional Notes for Version 5.0b is up to the individual facility. Please close your question if it is answered by these resources. We will continue working diligently to reduce response lag time in replying to questions. Customer By Web Form (Pamela Anderson) 03/01/2016 03:10 PM The record indicates the patient was intubated at 06:30. The MD note is timed @ 07:45, and he has documented "intubated for acute respiratory failure related to PNA". SIRS x2 and previous documentation of PNA is present at 06:00. Which time do I use for Severe Sepsis time of presentation?- the time the patient was intubated or the time of the documentation of "acute respiratory failure"? Thank you Question Reference #160301-000089 Escalation Level: 5 Business Days Product Level 1: Measures & Data Element Abstraction Category Level 1: Hospital Inpatient - Sepsis Category Level 2: Severe Sepsis Presentation Date and Time Date Created: 03/01/2016 03:10 PM Last Updated: 03/31/2016 04:07 PM Status: Resolved (IP only) Discharge Period: 10/01/2015 - 06/30/2016 [---001:006647:13684---] Confidentiality Notice: This e-mail, including any attachments is the property of Trinity Health and is intended for the sole use of the intended recipient(s). It may contain information that is privileged and confidential. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please delete this message, and reply to the sender regarding the error in a separate email.
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