Discussion of Complex Clinical Scenarios and Variable Review ACS NSQIP Clinical Support Team

Size: px
Start display at page:

Download "Discussion of Complex Clinical Scenarios and Variable Review ACS NSQIP Clinical Support Team"

Transcription

1 Discussion of Complex Clinical Scenarios and Variable Review CS NSQIP Clinical Support Team

2 SCR Open Q& Calls The CS NSQIP Clinical Team is trialing Open format Q& calls for NSQIP SCRs Participation in calls is optional nswer general clinical questions Continue to send case specific questions to clinical support team 3 weeks a month on Tuesday and Thursday The ugust call schedule is available and will be posted to the CS NSQIP Main Page

3 SCR Open Q& Calls ugust 2014

4 ORGN/SPCE SSI Patient had a lap chole and returned to the ED due to abdominal pain. n abdominal CT was ordered. The results indicated a need for a CT aspiration. The CT impression read Possible interval development of ascites vs. abscess vs. fluid collection. The results from the fluid aspirated had no growth. Would you assign an Organ/Space SSI to this case You would not assign the post-operative occurrence of Organ/Space SSI to this case. You would assign the post-operative occurrence of Organ/Space SSI to this case.

5 ORGN/SPCE SSI Patient had a lap chole and returned to the ED due to abdominal pain. n abdominal CT was ordered. The results indicated a need for a CT aspiration. The CT impression read Possible interval development of ascites vs. abscess vs. fluid collection. The results from the fluid aspirated had no growth. Would you assign an Organ/Space SSI to this case NSWER & RTIONLE You would assign the post-operative occurrence of Organ/Space SSI to this case. There was documentation of a possible abscess on the CT impression in the space that was manipulated during surgery. Please remember modifying words meet criteria to assign the post-operative occurrence.

6 Organ/Space SSI and PTOS You are reviewing a case where the patient arrives to the OR with a perforated bowel. fter a bowel resection and abdominal wash-out, the surgeon chooses to leave the abdominal incision open and place a wound vac directly on the bowel. POD 2 the patient returns to the operating room for an abdominal washout, and wound vac exchange. During the RTOR the doctor notes purulence in the abdominal cavity and the OR nurse assigned a wound class 4 to the case. In regards to the post-operative occurrence of Organ/Space SSI and Organ/Space SSI PTOS, what would you assign to this case C D You would not assign the post-operative occurrence of Organ/Space SSI or Organ/Space SSI PTOS You would assign the post-operative occurrence of Organ/Space SSI but not Organ/Space SSI PTOS You would assign the post-operative occurrence of Organ/Space and Organ/Space SSI PTOS You would only assign Organ/Space SSI PTOS

7 Organ/Space SSI and PTOS You are reviewing a case where the patient arrives to the OR with a perforated bowel. fter a bowel resection and abdominal wash-out, the surgeon chooses to leave the abdominal incision open and place a wound vac directly on the bowel. POD 2 the patient returns to the operating room for an abdominal washout, and wound vac exchange. During the RTOR the doctor notes purulence in the abdominal cavity and the OR nurse assigned a wound class 4 to the case. In regards to the post-operative occurrence of Organ/Space SSI and Organ/Space SSI PTOS, what would you assign to this case NSWER & RTIONLE You would not assign the post-operative occurrence of Organ/Space SSI or Organ/Space SSI PTOS You would not assign an SSI to a wound that was left open. n SSI is only assigned at or below the level of closure. lso, a wound vac is similar to a dressing and not considered a type of surgical wound closure. If you do not assign the postoperative occurrence of Organ/Space SSI, you would not assess for Organ/Space SSI PTOS.

8 Sepsis and Sepsis PTOS Patient arrives in the ER and is worked up for a suspected ruptured appendix. You are unable to find documentation of preoperative vital signs. The patient is taken to the OR for a laparoscopic appendectomy. The doctor s operative dictation confirms the appendix was inflamed and ruptured. In PCU, the patient HR is bpm and RR of ll other vital signs are within normal limits. In regards to the post-operative occurrence of Sepsis and Sepsis PTOS, what would you assign to this case C D You would not assign the post-operative occurrence of Sepsis or Sepsis PTOS You would assign the post-operative occurrence of Sepsis but not Sepsis PTOS You would assign the post-operative occurrence of Sepsis and Sepsis PTOS You would only assign Sepsis PTOS to this case

9 ORGN/SPCE SSI Patient arrives in the ER and is worked up for a suspected ruptured appendix. You are unable to find documentation of preoperative vital signs. The patient is taken to the OR for a laparoscopic appendectomy. The doctor s operative dictation confirms the appendix was inflamed and ruptured. In PCU, the patient HR is bpm and RR of ll other vital signs are within normal limits. In regards to the post-operative occurrence of Sepsis and Sepsis PTOS, what would you assign to this case NSWER & RTIONLE C You would assign the post-operative occurrence of Sepsis and Sepsis PTOS to this case Post-operative Sepsis is assigned as SIRS criteria are met with pulse of 95 bpm and RR of 21 and a ruptured appendix would constitute purulence in the operative site. Sepsis PTOS is assigned as the doctor s operative dictation that the appendix was inflamed and ruptured is highly suggestive or suspicious of sepsis at the time of surgery.

10 UTI and UTI PTOS patient arrives to Same Day Surgery for an elective procedure. The patient tells the Same Day Surgery nurse she has been experiencing painful urination for 2 days. The nurse notifies the surgery resident who orders a pre-operative urine culture. The patient goes to surgery without delay. On POD 1 the urine culture comes back with greater than 100,000 colonies/ml of a single pathogen. There are no other criteria noted post-operatively. In regards to the post-operative occurrence of UTI and UTI PTOS, what would you assign to this case You would not assign the post-operative occurrence of UTI C D You would assign the post-operative occurrence of UTI You would assign the post-operative occurrence of UTI and UTI PTOS to this case You would only assign UTI PTOS to this case

11 UTI and UTI PTOS patient arrives to Same Day Surgery for an elective procedure. The patient tells the Same Day Surgery nurse she has been experiencing painful urination for 2 days. The nurse notifies the surgery resident who orders a pre-operative urine culture. The patient goes to surgery without delay. On POD 1 the urine culture comes back with greater than 100,000 colonies/ml of a single pathogen. There are no other criteria noted post-operatively. In regards to the post-operative occurrence of UTI and UTI PTOS, what would you assign to this case NSWER & RTIONLE You would not assign the post-operative occurrence of UTI The pre-operative symptoms and culture positive urine collection cannot be utilized to assign the post-operative occurrence of UTI. s the post-operative occurrence of UTI is not assigned, PTOS would not be assessed.

12 Pneumonia and Pneumonia PTOS Pre-operatively, the patient s H&P does not report any underlying pulmonary or cardiac disease; however the pre-operative chest CT showed pleural effusion with consolidation. The patient is emergently taken to the OR for necrotic small bowel and perforation and underwent small bowel resection. Post-operatively, the daily post-op CXRs document opacity, effusion and consolidations. On POD 1 a chest tube was placed at the bedside. pleural fluid culture was taken at the time of the chest tube placement and returned positive for E coli. Physician documentation indicates that the E coli pleural fluid is a sympathetic collection from the abdominal process. On POD 1 the patient has leukopenia with WC of 3.8 Would you assign the post-operative occurrence of Pneumonia and Pneumonia PTOS to this case You would not assign the post-operative occurrence of Pneumonia or Pneumonia PTOS C D You would assign the post-operative occurrence of Pneumonia but not Pneumonia PTOS You would assign the post-operative occurrence of Pneumonia and Pneumonia PTOS You would only assign Pneumonia PTOS to this case

13 Pneumonia and Pneumonia PTOS Pre-operatively, the patient s H&P does not report any underlying pulmonary or cardiac disease; however the pre-operative chest CT showed pleural effusion with consolidation. The patient is emergently taken to the OR for necrotic small bowel and perforation and underwent small bowel resection. Post-operatively, the daily post-op CXRs document opacity, effusion and consolidations. On POD 1 a chest tube was placed at the bedside. pleural fluid culture was taken at the time of the chest tube placement and returned positive for E coli. Physician documentation indicates that the E coli pleural fluid is a sympathetic collection from the abdominal process. On POD 1 the patient has leukopenia with WC of 3.8 Would you assign the post-operative occurrence of Pneumonia and Pneumonia PTOS to this case NSWER & RTIONLE C You would assign the post-operative occurrence of Pneumonia and Pneumonia PTOS to this case Radiologic criteria is met with documentation of opacity and consolidations on the daily postoperative CXR. Signs/Symptoms/Lab criteria are met with leukopenia/ WC of 3.8 and the pleural fluid culture which was positive for E coli. Pneumonia PTOS would be assigned as the post-operative occurrence of Pneumonia is assigned and the pre-operative chest CT showed pleural effusion with consolidation, which is highly suggestive or suspicious of Pneumonia.

14 Intraoperative or Postoperative Myocardial Infarction The patient in the case you are reviewing has elevated troponins 10 times your hospitals reference range on POD 2. Cardiology is consulted and the patient is diagnosed with demand ischemia. Would you assign the post-operative occurrence of Intraoperative or Postoperative Myocardial Infarction to this case Yes, you would assign the post-operative occurrence of Intraoperative or Postoperative Myocardial Infarction to this case No, you would not assign the post-operative occurrence of Intraoperative or Postoperative Myocardial Infarction to this case

15 Intraoperative or Postoperative Myocardial Infarction The patient in the case you are reviewing has elevated troponins 10 times your hospitals reference range on POD 2. Cardiology is consulted and the patient is diagnosed with demand ischemia. Would you assign the post-operative occurrence of Intraoperative or Postoperative Myocardial Infarction to this case NSWER & RTIONLE Yes, you would assign the post-operative occurrence of Intraoperative or Postoperative Myocardial Infarction to this case Elevated troponins greater than 3 times the hospital s upper level reference range in the presence of suspected myocardial ischemia. The documentation of troponins and demand ischemia per cardiology meet criteria to assign the variable.

16 Wound Class In general, pathology results are not available until after the patient leaves OR. Can you use results which are not available during the intra-operative period to assign wound class Yes No

17 Wound Class In general, pathology results are not available until after the patient leaves OR. Can you use results which are not available during the intra-operative period to assign wound class NSWER & RTIONLE No Wound classification is assigned at time of the principal operative procedure; therefore post-operative information would not be used for this designation.

18 Case Inclusion patient has a planned breast biopsy and was discharged home on the same day. You included the case in your sampling for cycle 25. The same patient returned to your OR for a planned vascular surgery, which comes up for review in your sampling for cycle 27. Would you include the vascular procedure in your sampling as a new principal operative procedure Yes, you would include the vascular case in your sampling No, you would not include the vascular case in your sampling

19 Case Inclusion patient has a planned breast biopsy and was discharged home on the same day. You included the case in your sampling for cycle 25. The same patient returned to your OR for a planned vascular surgery, which comes up for review in your sampling for cycle 27. Would you include the vascular procedure in your sampling as a new principal operative procedure NSWER & RTIONLE No, you would not include the vascular case in your sampling. You would not assess more than one case per patient in a 30 day period.

20 UTI 75 year old woman had an anterior resection 2 days ago, which you are reviewing. She develops fever, abdominal pain and has not had a bowel movement since surgery. She also has an indwelling urinary catheter. Her heart rate is 95 beats per minute, RR of 26 and her temperature is 38.3 C. CT of the abdomen is negative. urine culture came back positive for 3 organisms all greater than 100,000 colonies/ml. The surgical resident documents the positive urine culture is causative of the fever, elevated heart rate and respirations. Would you assign the post-operative occurrence of UTI to this case Yes, you would assign the post-operative occurrence of UTI to this case No, you would not assign the post-operative occurrence of UTI to this case

21 UTI 75 year old woman had an anterior resection 2 days ago, which you are reviewing. She develops fever, abdominal pain and has not had a bowel movement since surgery. She also has an indwelling urinary catheter. Her heart rate is 95 beats per minute, RR of 26 and her temperature is 38.3 C. CT of the abdomen is negative. urine culture came back positive for 3 organisms all greater than 100,000 colonies/ml. The surgical resident documents the positive urine culture is causative of the fever, elevated heart rate and respirations. Would you assign the post-operative occurrence of UTI to this case NSWER & RTIONLE No, you would not assign the post-operative occurrence of UTI to this case The urine culture does not meet criteria to assign the variable as it is positive for more than 2 species of organisms.

22 Elective Surgery, Patient Coming from Home You have selected an inguinal hernia repair for review. The patient s history shows that the general surgeon scheduled the patient for surgery three weeks ago and ordered him to be admitted the day before surgery to d/c the patient s chronic Coumadin therapy and to start the patient on Heparin. Would you assign the pre-operative variable of Elective Surgery, Patient Coming from Home to this case Yes, you would assign the pre-operative variable of Elective Surgery, Patient Coming from Home to this case No, you would not assign the pre-operative variable of Elective Surgery, Patient Coming from Home to this case

23 Elective Surgery, Patient Coming from Home You have selected an inguinal hernia repair for review. The patient s history shows that the general surgeon scheduled the patient for surgery three weeks ago and ordered him to be admitted the day before surgery to d/c the patient s chronic Coumadin therapy and to start the patient on Heparin. Would you assign the pre-operative variable of Elective Surgery, Patient Coming from Home to this case NSWER & RTIONLE No, you would not assign the pre-operative variable of Elective Surgery, Patient Coming from Home to this case This variable does not apply to patients who are admitted to the hospital for any period of time prior to going to the OR for any reason.

24 Septic Shock and Septic Shock PTOS patient arrives to your ER meeting SIRS criteria. The patient s blood pressure drops and he is placed on a vasopressor. The patient is diagnosed with ischemic bowel and is taken to the OR for an emergency bowel resection. The patient was intubated, prepped, draped and an incision was made. s the surgeon placed the abdominal retractor, the patient arrested. The patient was stabilized, the retractor was removed and only skin was closed. The patient was taken to the ICU for further stabilization prior to a return to the OR for the bowel resection. In the ICU the patient remains intubated, on vasopressors with a HR of 102 and WC s of 20. In regards to the post-operative occurrence of Septic Shock and Septic Shock PTOS, what would you assign to this case C D You would not assign the post-operative occurrence of Septic Shock or Septic Shock PTOS You would assign the post-operative occurrence of Septic Shock but not Septic Shock PTOS You would assign the post-operative occurrence of Septic Shock and Septic Shock PTOS You would only assign Septic Shock PTOS to this case

25 Septic Shock and Septic Shock PTOS patient arrives to your ER meeting SIRS criteria. The patient s blood pressure drops and he is placed on a vasopressor. The patient is diagnosed with ischemic bowel and is taken to the OR for an emergency bowel resection. The patient was intubated, prepped, draped and an incision was made. s the surgeon placed the abdominal retractor, the patient arrested. The patient was stabilized, the retractor was removed and only skin was closed. The patient was taken to the ICU for further stabilization prior to a return to the OR for the bowel resection. In the ICU the patient remains intubated, on vasopressors with a HR of 102 and WC s of 20. In regards to the post-operative occurrence of Septic Shock and Septic Shock PTOS, what would you assign to this case NSWER & RTIONLE C You would assign the post-operative occurrence of Septic Shock and Septic Shock PTOS to this case Post-operative SIRS criteria is met with a HR of 102 and WC s of 20. Sepsis criteria is met with a diagnosis of an ischemic bowel requiring resection, and septic shock criteria is met with the requirement of vasopressors due to hypotension. Septic shock PTOS is assigned as the patient met SIRS criteria and was placed on a vasopressor due to hypotension pre-operatively.

26 Sepsis 75 year old woman had an anterior resection 2 days ago, which you are reviewing. She develops fever, abdominal pain and has not had a bowel movement since surgery. She also has an indwelling urinary catheter. Her heart rate is 95 beats per minute, RR of 26 and her temperature is 38.3 C. CT of the abdomen is negative. urine culture came back positive for 3 organisms all greater than 100,000 colonies/ml. The surgical resident documents the positive urine culture is causative of the fever, elevated heart rate and respirations. Would you assign the post-operative occurrence of Sepsis to this case Yes, you would assign the post-operative occurrence of Sepsis to this case No, you would not assign the post-operative occurrence of Sepsis to this case

27 Sepsis 75 year old woman had an anterior resection 2 days ago, which you are reviewing. She develops fever, abdominal pain and has not had a bowel movement since surgery. She also has an indwelling urinary catheter. Her heart rate is 95 beats per minute, RR of 26 and her temperature is 38.3 C. CT of the abdomen is negative. urine culture came back positive for 3 organisms all greater than 100,000 colonies/ml. The surgical resident documents the positive urine culture is causative of the fever, elevated heart rate and respirations. Would you assign the post-operative occurrence of Sepsis to this case NSWER & RTIONLE Yes, you would assign the post-operative occurrence of Sepsis to this case SIRS criteria are met with the temperature, heart rate, and respiratory rate. The resident s documentation of the positive urine culture being causative of the fever, heart rate and respiratory rate is correlation by a physician that the site is the acute cause of the septic picture.

28 Deep SSI and Deep SSI PTOS patient you are reviewing had lysis of adhesions with no noted intraabdominal infection/contamination. On POD 2 feculent material is noted draining from the incision site. The patient is taken back to the OR where an inadvertent enterotomy from the lysis of adhesions was discovered. In regards to the post-operative occurrence of Deep SSI and Deep SSI PTOS, what would you assign to this case C D You would not assign the post-operative occurrence of Deep SSI or Deep SSI PTOS You would assign the post-operative occurrence of Deep SSI but no Deep SSI PTOS You would assign the post-operative occurrence of Deep SSI and Deep SSI PTOS You would only assign Deep SSI PTOS to this case

29 Deep SSI and Deep SSI PTOS patient you are reviewing had lysis of adhesions with no noted intraabdominal infection/contamination. On POD 2 feculent material is noted draining from the incision site. The patient is taken back to the OR where an inadvertent enterotomy from the lysis of adhesions was discovered. In regards to the post-operative occurrence of Deep SSI and Deep SSI PTOS, what would you assign to this case NSWER & RTIONLE You would assign the post-operative occurrence of Deep SSI but no Deep SSI PTOS You would report an Organ/Space infection that drains through the incision as Deep Incisional SSI. You would not assign Deep Incisional SSI PTOS as the enterotomy, which caused the infection, occurred intra-operatively and was not present when the patient entered the operating room.

30 Case Inclusion patient was scheduled to have an bdominal ortic neurysm repair. Upon entering the OR the patient became hypotensive during anesthesia induction and the surgery was cancelled. Would you include this case in your sampling Yes, you would include this case in your sampling No, you would not include this case in your sampling

31 Case Inclusion patient was scheduled to have an bdominal ortic neurysm repair. Upon entering the OR the patient became hypotensive during anesthesia induction and the surgery was cancelled. Would you include this case in your sampling NSWER & RTIONLE No, you would not include this case in your sampling s the surgery was cancelled before a surgical incision was made, you would not include it in your sampling.

32 Case Inclusion 21yr old female arrives to your ER with 3rd degree burns from the industrial oven at work. The patient is discharged from her initial burn visit. She returns for a skin graft to the burn area. The skin graft case is up for selection on your operative log. Would you exclude this case as a trauma Yes, this case meets NSQIP trauma criteria and would be excluded from sampling No, this case does not meet NSQIP trauma criteria and would be included if all systematic sampling criteria are met

33 Case Inclusion 21yr old female arrives to your ER with 3rd degree burns from the industrial oven at work. The patient is discharged from her initial burn visit. She returns for a skin graft to the burn area. The skin graft case is up for selection on your operative log. Would you exclude this case as a trauma NSWER & RTIONLE No, this case does not meet NSQIP trauma criteria and would be included if all systematic sampling criteria are met s the patient was discharged from the initial burn (trauma) visit, you would include the case if all other NSQIP systematic sampling criteria are met.

34 Septic Shock patient arrives to your ER meeting SIRS criteria. The patient s blood pressure drops and he is placed on a vasopressor. The patient is diagnosed with an ischemic bowel and is taken to the OR for an emergent bowel resection. The patient was intubated, prepped, draped and an incision was made. s the surgeon placed the abdominal retractor, the patient arrested. The patient was stabilized, the retractor was removed and only skin was closed. The patient was taken to the ICU for further stabilization prior to a return to the OR for the bowel resection. In the ICU the patient remains intubated, on vasopressors with a HR of 102 and WC s of 20. Would you assign the pre-operative risk factor of Septic Shock to this case Yes, you would assign the pre-operative risk factor of Septic Shock to this case No, you would not assign the pre-operative risk factor of Septic Shock to this case

35 Septic Shock patient arrives to your ER meeting SIRS criteria. The patient s blood pressure drops and he is placed on a vasopressor. The patient is diagnosed with an ischemic bowel and is taken to the OR for an emergent bowel resection. The patient was intubated, prepped, draped and an incision was made. s the surgeon placed the abdominal retractor, the patient arrested. The patient was stabilized, the retractor was removed and only skin was closed. The patient was taken to the ICU for further stabilization prior to a return to the OR for the bowel resection. In the ICU the patient remains intubated, on vasopressors with a HR of 102 and WC s of 20. Would you assign the preoperative risk factor of Septic Shock to this case NSWER & RTIONLE Yes, you would assign the pre-operative risk factor of Septic Shock to this case Prior to the principal operative procedure, the patient met SIRS criteria, required a bowel resection for ischemic bowel, and was placed on a vasopressor preoperatively due to hypotension (considered organ dysfunction).

36 Ventilator Dependent 35 year old morbidly obese patient arrives to your ER with a small bowel obstruction. The patient is admitted to a floor in your hospital and is placed on the vent with CPP setting at night to maintain his airway. The next day it is determined that medical management is not resolving the bowel obstruction, and the patient is taken to the OR. The patient remains in the hospital for 8 days post-operatively. The patient is on the vent each night for 8 hours. The only setting on the vent is CPP. Would you assign the pre-operative risk factor of Ventilator Dependent to this case Yes, you would assign the pre-operative risk factor of Ventilator Dependent to this case No, you would not assign the pre-operative risk factor of Ventilator Dependent to this case

37 Ventilator Dependent 35 year old morbidly obese patient arrives to your ER with a small bowel obstruction. The patient is admitted to a floor in your hospital and is placed on the vent with CPP setting at night to maintain his airway. The next day it is determined that medical management is not resolving the bowel obstruction, and the patient is taken to the OR. The patient remains in the hospital for 8 days post-operatively. The patient is on the vent each night for 8 hours. The only setting on the vent is CPP. Would you assign the pre-operative risk factor of Ventilator Dependent to this case NSWER & RTIONLE No, you would not assign the pre-operative risk factor of Ventilator Dependent to this case You would not assign the variable when a patient is only on the CPP setting.

38 35 year old morbidly obese patient arrives to your ER with a small bowel obstruction. The patient is admitted to a floor in your hospital and is placed on the vent with CPP setting at night to maintain his airway. The next day it is determined that medical management is not resolving the bowel obstruction, and the patient is taken to the OR. The patient remains in the hospital for 8 days post-operatively. The patient is on the vent each night for 7 nights, 8 hours a night. The vent setting is CPP. On Ventilator > 48 hours and On Ventilator > 48 hours PTOS In regards to the post-operative occurrence of On Ventilator > 48 hours and On Ventilator > 48 hours PTOS, what would you assign to this case You would not assign the post-operative occurrence of On Ventilator > 48 hours or On Ventilator >48 hours PTOS C D You would assign the post-operative occurrence of On Ventilator > 48 hours but not On Ventilator >48 hours PTOS You would assign the post-operative occurrence of On Ventilator > 48 hours and On Ventilator > 48 hours PTOS. You would only assign On Ventilator > 48 hours PTOS to this case.

39 On Ventilator > 48 hours and On Ventilator > 48 hours PTOS 35 year old morbidly obese patient arrives to your ER with a small bowel obstruction. The patient is admitted to a floor in your hospital and is placed on the vent with CPP setting at night to maintain his airway. The next day it is determined that medical management is not resolving the bowel obstruction, and the patient is taken to the OR. The patient remains in the hospital for 8 days post-operatively. The patient is on the vent each night for 7 nights, 8 hours a night. The vent setting is CPP. In regards to the post-operative occurrence of On Ventilator > 48 hours and On Ventilator > 48 hours PTOS, what would you assign to this case NSWER & RTIONLE You would not assign the post-operative occurrence of On Ventilator > 48 hours or On Ventilator > 48 hours PTOS You would not assign the variable when a patient is only on the CPP setting.

40 Wound Disruption patient with a complex recurrent incisional hernia repair requiring mesh and component separation was readmitted with an SSI on POD 20. The incision was noted to be intact. n abdominal CT was ordered which revealed "Open wound on the anterior abdominal wall overlying a large ventral midline hernia sac containing mesenteric fat and non-obstructed bowel. Would you assign the post-operative occurrence of wound disruption to this case Yes, you would assign the post-operative occurrence of wound disruption to this case No, you would not assign the post-operative occurrence of wound disruption to this case

41 Wound Disruption patient with a complex recurrent incisional hernia repair requiring mesh and component separation was readmitted with an SSI on POD 20. The incision was noted to be intact. n abdominal CT was ordered which revealed "Open wound on the anterior abdominal wall overlying a large ventral midline hernia sac containing mesenteric fat and non-obstructed bowel. Would you assign the post-operative occurrence of wound disruption to this case NSWER & RTIONLE Yes, you would assign the post-operative occurrence of wound disruption to this case The open wound on the anterior abdominal wall overlying a large ventral midline hernia sac containing mesenteric fat and non-obstructed bowel would be considered a breakdown of the surgical closure compromising the integrity of the procedure.

42 Organ/Space SSI The patient you are reviewing had a fem-pop bypass. On POD 1, nursing notes the patient is complaining of intense itching at the site of his femoral incision. When the dressing is changed, the patient s incision is noted to be mildly red and the incision site is intact with a moderate amount of serous drainage. On post-op day 2, nursing notes document that the patient is stating the incision is now tender and burning. When the dressing is changed a small amount of purulent drainage is noted. n aseptically obtained culture of the superficial incision is obtained before redressing. The culture does not grow any organisms. Would you assign an Organ/Space SSI to this case You would assign the post-operative occurrence of Organ/Space SSI to this case You would not assign the post-operative occurrence of Organ/Space SSI to this case

43 Organ/Space SSI The patient you are reviewing had a fem-pop bypass. On POD 1, nursing notes the patient is complaining of intense itching at the site of his femoral incision. When the dressing is changed, the patient s incision is noted to be mildly red and the incision site is intact with a moderate amount of serous drainage. On post-op day 2, nursing notes document that the patient is stating the incision is now tender and burning. When the dressing is changed a small amount of purulent drainage is noted. n aseptically obtained culture of the superficial incision is obtained before redressing. The culture does not grow any organisms. Would you assign an Organ/Space SSI to this case NSWER & RTIONLE You would not assign the post-operative occurrence of Organ/Space SSI to this case The purulent drainage from the incision would meet criteria to assign a Superficial Incisional SSI, but there is no information provided that suggests an SSI at the Organ/Space level.

44 Organ/Space SSI patient who had a colon procedure at your site is discharged on POD 7. Twenty-four hours after discharge, the patient returns to your emergency department complaining of voluminous watery diarrhea every 1-2 hours. C Diff DN test returns positive. No other symptoms are noted. The patient is treated with IV fluids and Flagyl. Would you assign an Organ/Space SSI to this case Yes, you would assign the post-operative occurrence of Organ/Space SSI to this case No, you would not assign the post-operative occurrence of Organ/Space SSI to this case

45 Organ/Space SSI patient who had a colon procedure at your site is discharged on POD 7. Twenty-four hours after discharge, the patient returns to your emergency department complaining of voluminous watery diarrhea every 1-2 hours. C Diff DN test returns positive. No other symptoms are noted. The patient is treated with IV fluids and Flagyl. Would you assign an Organ/Space SSI to this case NSWER & RTIONLE You would not assign the post-operative occurrence of Organ/Space SSI to this case positive C Diff DN test alone, with no other specified criteria, would not meet criteria to assign a postoperative SSI.

46 Wound Class You are abstracting a small bowel resection. The doctor documents no inflammation or infection was seen upon entering the abdomen. The OR staff documents the wound class as clean. What wound class would you document in the NSQIP workstation C D Clean Clean/Contaminated Contaminated Dirty/Infected

47 Wound Class You are abstracting a small bowel resection. The doctor documents no inflammation or infection was seen upon entering the abdomen. The OR staff documents the wound class as clean. What wound class would you document in the NSQIP workstation NSWER & RTIONLE Clean/Contaminated This is an operative wound in which the alimentary canal is entered under controlled conditions without unusual contamination.

48 SSI You have abstracted a case where the patient returns to the ED on POD 15, with purulent drainage from the surgical site. The ED doctor diagnoses the patient with an SSI and prescribes antibiotics. On POD 16, the surgeon sees the patient in the office and documents that the incision is clean/dry and intact. Would you assign a post-operative SSI to this case Yes, you would assign a post-operative occurrence of SSI to this case No, you would not assign a post-operative occurrence of SSI to this case

49 SSI You have abstracted a case where the patient returns to the ED on POD 15, with purulent drainage from the surgical site. The ED doctor diagnoses the patient with an SSI and prescribes antibiotics. On, POD 16, the surgeon sees the patient in the office and documents that the incision is clean/dry and intact. Would you assign a post-operative SSI to this case NSWER & RTIONLE Yes, you would assign a post-operative occurrence of SSI to this case. There is a physician diagnosis of an SSI as well as documentation of purulent drainage from the surgical site.

50 Stroke/Cerebral Vascular ccident (CV) There was a repair included in your sampling. The patient expires on POD 25 and the immediate cause of death is listed as a cerebrovascular infarction. Would you assign the post-operative occurrence of Stroke/Cerebral Vascular ccident (CV) to this case Yes, you would assign the post-operative occurrence of Stroke/Cerebral Vascular ccident (CV)to this case No, you would not assign the post-operative occurrence of Stroke/Cerebral Vascular ccident (CV) to this case

51 Stroke/Cerebral Vascular ccident (CV) There was a repair included in your sampling. The patient expires on POD 25 and the immediate cause of death is listed as a cerebrovascular infarction. Would you assign the post-operative occurrence of Stroke/Cerebral Vascular ccident (CV) to this case NSWER & RTIONLE Yes, you would assign the post-operative occurrence of Stroke/Cerebral Vascular ccident (CV) to this case There is a diagnosis of a CV documented in the 30 day post-operative period, therefore it would be assigned.

52 Thank You. We appreciate your participation, dedication, and feedback.

NEW DEFINITION FORMAT AND DIFFICULT VARIABLE DEFINITIONS

NEW DEFINITION FORMAT AND DIFFICULT VARIABLE DEFINITIONS NEW DEFINITION FORMAT AND DIFFICULT VARIABLE DEFINITIONS Bruce L. Hall, MD, PhD, MBA, FACS Clinical Support Physician Lead Paula Farrell, RN, BSN ACS NSQIP Clinical Support Specialist Case Studies &

More information

Pediatric SCR Discussion of Complex Clinical Scenarios NSQIP Annual Meeting July 26, 2015

Pediatric SCR Discussion of Complex Clinical Scenarios NSQIP Annual Meeting July 26, 2015 Pediatric SCR Discussion of Complex Clinical Scenarios NSQIP Annual Meeting July 26, 2015 Scenario 1: Postoperative SSI A 16 year-old patient Principal Operative Procedure: Incision and Drainage for monoarticular

More information

Enhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC. Our Data Experience

Enhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC. Our Data Experience Enhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC Our Data Experience No Disclosures 1/26/2015 2 Purpose To tell our story of how we collect and share our ERACS data 1/26/2015

More information

MBSAQIP Complex Clinical Scenarios & Variable Review

MBSAQIP Complex Clinical Scenarios & Variable Review MBSAQIP Complex Clinical Scenarios & Variable Review Disclosure The following planners, speakers, moderators, and/or panelists of the CME/CEU activity have no relevant financial relationships with commercial

More information

August SCR Educational Call

August SCR Educational Call ugust SCR Educational Call SCR Certification Exam CS NSQIP SCR Certification Exam Policy is posted to the CS NSQIP Main page 2014 Exam- Round 1 starts September 8 Round 1- will be open for 3 weeks Rounds

More information

Pediatric SC/SCR Education Session: Difficult Definitions. NSQIP Annual Meeting July 26, 2014

Pediatric SC/SCR Education Session: Difficult Definitions. NSQIP Annual Meeting July 26, 2014 Pediatric SC/SCR Education Session: Difficult Definitions NSQIP Annual Meeting July 26, 2014 Actual patient Chart Abstraction: The Challenge o Demographics o Risk factors o Events/occurrences Documentation

More information

Adult Surgical Clinical Reviewer: Discussion of Complex Clinical Scenarios and Variable Review

Adult Surgical Clinical Reviewer: Discussion of Complex Clinical Scenarios and Variable Review Adult Surgical Clinical Reviewer: Discussion of Complex Clinical Scenarios and Variable Review Disclosures The following individuals have no actual or potential conflicts of interest in relation to this

More information

SURGICAL SITE INFECTIONS: SURVEILLANCE & PREVENTION

SURGICAL SITE INFECTIONS: SURVEILLANCE & PREVENTION SURGICAL SITE INFECTIONS: SURVEILLANCE & PREVENTION Facts There were an estimated 157,500 surgical site infections associated with inpatient surgeries in 2011. SSIs were the most common healthcare-associated

More information

Demographics. MBSAQIP Case Number: *ACS NSQIP Case Number: *LMRN: *DOB: / / *Gender: Male Female

Demographics. MBSAQIP Case Number: *ACS NSQIP Case Number: *LMRN: *DOB: / / *Gender: Male Female Demographics MBSAQIP Case Number: *IDN: *ACS NSQIP Case Number: Name: *LMRN: *DOB: / / *Gender: Male Female *Race: White Black or African American American Indian or Alaska Native Native Hawaiian/Other

More information

ACS NSQIP Pediatric SCR: Complex Clinical Scenarios and Variable Review

ACS NSQIP Pediatric SCR: Complex Clinical Scenarios and Variable Review ACS NSQIP Pediatric SCR: Complex Clinical Scenarios and Variable Review Disclosures The following planners, speakers, moderators, and/or panelists of the CME/CEU activity have no relevant financial relationships

More information

APIC NHSN Webinar 9/8/2015. Topic Overview. Overall Learning Objectives

APIC NHSN Webinar 9/8/2015. Topic Overview. Overall Learning Objectives APIC NHSN Webinar Janet Brooks, Cindy Gross, Denise Leaptrot, & Eileen Scalise Subject Matter Experts September 9, 2015 National Center for Emerging and Zoonotic Infectious Diseases Place Descriptor Here

More information

Form 1: Demographics

Form 1: Demographics Form 1: Demographics Case Number: *LMRN: *DOB: / / *Gender: Male Female *Race: White Native Hawaiian/Other Pacific Islander Black or African American Asian American Indian or Alaska Native Unknown *Hispanic

More information

Schematic of diagnosing surgical site infections

Schematic of diagnosing surgical site infections Schematic of diagnosing surgical site infections Infection occurred within 30 days after an operation if no implant is in place within one year if an implant is in place eg. hip replacement Do NOT report

More information

World Journal of Colorectal Surgery

World Journal of Colorectal Surgery World Journal of Colorectal Surgery Volume 3, Issue 1 2013 Article 9 ISSUE 1 Perforation Of The Caecum Owing To Benign Rectal Obstruction: A Paradigm Of Damage Control In Emergency Colorectal Surgery DIMITRIOS

More information

General Surgery Service

General Surgery Service General Surgery Service Patient Care Goals and Objectives Stomach/Duodenum and Bariatric assessed for a) Obesity surgery b) Treatment of i) Adenocarcinoma of the stomach ii) GIST iii) Carcinoid 2) Optimize

More information

National Healthcare Safety Network: Central Line-associated Bloodstream Case Studies Teresa C. Horan, MPH

National Healthcare Safety Network: Central Line-associated Bloodstream Case Studies Teresa C. Horan, MPH National Healthcare Safety Network: Central Line-associated Bloodstream Case Studies Teresa C. Horan, MPH National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion

More information

Information for Consent Cholecystectomy (Laparoscopic/Open) 膽囊切除術 ( 腹腔鏡 / 開放性 )

Information for Consent Cholecystectomy (Laparoscopic/Open) 膽囊切除術 ( 腹腔鏡 / 開放性 ) Version 1.0 Page 1 of 3 Information for Consent Cholecystectomy (Laparoscopic/Open) 膽囊切除術 ( 腹腔鏡 / 開放性 ) Introduction Gallbladder is a sac connected to the biliary tree. It serves the function of concentration

More information

CASE SCENARIO EXERCISE

CASE SCENARIO EXERCISE påçííáëü=pìêîéáää~ååé=çñ=eé~äíüå~êé ^ëëçåá~íéç=fåñéåíáçå=mêçöê~ããé CASE SCENARIO EXERCISE CATHETER-ASSOCIATED URINARY TRACT INFECTION SURVEILLANCE SCOTTISH SURVEILLANCE OF HEALTHCARE ASSOCIATED INFECTION

More information

National Emergency Laparotomy Audit. Help Box Text

National Emergency Laparotomy Audit. Help Box Text National Emergency Laparotomy Audit Help Box Text Version Control Version 1.1 06/12/13 1.2 13/12/13 1.3 20/12/13 1.4 20/01/14 1.5 30/01/14 1.6 13/03/14 1.7 07/04/14 1.8 01/12/14 1.9 05/05/15 1.10 02/07/15

More information

General'Surgery'Service'

General'Surgery'Service' General'Surgery'Service' Patient Care Goals and Objectives 1)! Stomach/Duodenum and Bariatric 2)! Interpret the results of clinical evaluations (history, physical examination) performed on patients being

More information

How to Address an Inappropriately high Mortality Rate? Joe Sharma, MD Associate Professor of Surgery NSQIP Surgical Champion

How to Address an Inappropriately high Mortality Rate? Joe Sharma, MD Associate Professor of Surgery NSQIP Surgical Champion How to Address an Inappropriately high Mortality Rate? Joe Sharma, MD Associate Professor of Surgery NSQIP Surgical Champion Disclosure Slide No COI and no disclosures. Hospital Mortality rate : is it

More information

January 2015 Updates. Dec.4, 2014 SCR Education Call

January 2015 Updates. Dec.4, 2014 SCR Education Call January 2015 Updates Dec.4, 2014 SCR Education Call Trauma codes Trauma cases specifically: Any injury with a principal ICD-9 or ICD-10 diagnostic code will be excluded from sampling within the range of:

More information

Categorizing Wound Infections: A Comparison between ACS-NSQIP and an Institutional Surgical Secondary Events Database

Categorizing Wound Infections: A Comparison between ACS-NSQIP and an Institutional Surgical Secondary Events Database : A Comparison between ACS-NSQIP and an Institutional Surgical Secondary Events Database Luke V. Selby MD, Daniel D. Sjoberg MS, Danielle Cassella MA, Mindy Sovel MPH MS, David R. Jones MD, Vivian E. Strong

More information

Hernias Umbilical Hernia When to See a Surgeon? What Are Symptoms of an Umbilical Hernia? How is Repair Performed?

Hernias Umbilical Hernia When to See a Surgeon? What Are Symptoms of an Umbilical Hernia? How is Repair Performed? Hernias Umbilical Hernia An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. Umbilical hernias are common and typically harmless. They

More information

Problem Based Learning. Problem. Based Learning

Problem Based Learning. Problem. Based Learning Problem 2013 Based Learning Problem Based Learning Your teacher presents you with a problem in anesthesia, our learning becomes active in the sense that you discover and work with content that you determine

More information

Management of Bariatric Surgery Patients

Management of Bariatric Surgery Patients % of surgical-related allegations Management of Bariatric Surgery Patients Bariatric surgeries inherently have additional risks due in part to patient co-morbidities and the necessity for patients to be

More information

The Michigan Trauma Quality Improvement Program. Ann Arbor, MI June 7, 2011

The Michigan Trauma Quality Improvement Program. Ann Arbor, MI June 7, 2011 The Michigan Trauma Quality Improvement Program Ann Arbor, MI June 7, 2011 Information Current centers 14 New centers (July 1) Botsford Covenant Spectrum St. Johns Future centers (January 1) 23 Total Information

More information

Proprietary Acute Care Indicators

Proprietary Acute Care Indicators Proprietary Acute Care Indicators Indicator 1a: Device-Associated Infections in the Intensive Care Unit Central Line-Associated Bloodstream Infections in the APICU, CCU, MICU, M/S ICU, & SICU Ventilator-Associated

More information

COMPLICATIONS OF HERNIA REPAIR

COMPLICATIONS OF HERNIA REPAIR COMPLICATIONS OF HERNIA REPAIR Stanley Rogers, MD Associate Clinical Professor of Surgery University of Califronia, San Francisco Paré was respected as a hernia specialist, and was known to have elevated

More information

Surgical Complication, or Not, That Is the Question

Surgical Complication, or Not, That Is the Question Surgical Complication, or Not, That Is the Question Adriane Martin, DO, FACOS, CCDS Vice President Enjoin This is the Full Title of a Session Eads, TN 1 Learning Objectives At the completion of this educational

More information

LAPAROSCOPIC APPENDICECTOMY

LAPAROSCOPIC APPENDICECTOMY LAPAROSCOPIC APPENDICECTOMY WHAT IS THE APPENDIX? The appendix is a small, fingerlike pouch of the intestinal tract located where the small and large join. It has no known use. It is postulated that the

More information

Normal Recovery or Complication: The Risks of Post-Operative Care

Normal Recovery or Complication: The Risks of Post-Operative Care Normal Recovery or Complication: The Risks of Post-Operative Care Darrell Ranum, JD, CPHRM Vice President Patient Safety and Risk Management Department Ohio Hospital Association Convention June 14, 2016

More information

ACS-NSQIP 2015 Julietta Chang MD, Ali Aminian MD, Stacy A Brethauer MD, Philip R Schauer MD Bariatric and Metabolic Institute

ACS-NSQIP 2015 Julietta Chang MD, Ali Aminian MD, Stacy A Brethauer MD, Philip R Schauer MD Bariatric and Metabolic Institute ACS-NSQIP 2015 Julietta Chang MD, Ali Aminian MD, Stacy A Brethauer MD, Philip R Schauer MD Bariatric and Metabolic Institute Disclosures Authors: No disclosures ACS-NSQIP Disclaimer: The American College

More information

Peri-interventional Outcome Study in the Elderly (POSE)

Peri-interventional Outcome Study in the Elderly (POSE) Peri-interventional Outcome Study in the Elderly (POSE) I. Baseline assessment (Visit 1) Age years [80-120] Sex!M!F ASA!I!II!III!IV!V Height cm [120-230] Weight kg [30-250] Referring facility [single best

More information

Infection Control: Surgical Site Infections

Infection Control: Surgical Site Infections Infection Control: Surgical Site Infections Infectious Disease Epidemiology Section Office of Public Health Louisiana Dept of Health & Hospitals 800-256-2748 www.oph.dhh.louisiana.gov Your taxes at work

More information

The ABC s of Chest Trauma

The ABC s of Chest Trauma The ABC s of Chest Trauma J Bradley Pickhardt MD, FACS Providence St Patrick Hospital What s the Problem? 2/3 of trauma patients have chest trauma Responsible for 25% of all trauma deaths Most injuries

More information

I,, hereby authorize Dr. and any associates or assistants the doctor deems appropriate, to perform removal of the adjustable gastric band surgery.

I,, hereby authorize Dr. and any associates or assistants the doctor deems appropriate, to perform removal of the adjustable gastric band surgery. INFORMED CONSENT FOR LAPAROSCOPIC ADJUSTABLE BAND REMOVAL PROCEDURE It is very important to [insert physician, practice name] that you understand and consent to the treatment your doctor is rendering and

More information

Q3 Sex Male Female. Q9b Pre-operative PPOSSUM Morbidity: Mortality:

Q3 Sex Male Female. Q9b Pre-operative PPOSSUM Morbidity: Mortality: Case Report Form Q1 Study ID Q2 Age at admission to study (years) Q3 Sex Male Female Q4 Comorbidities CCF Y/N COPD Y/N CVA Y/N Dementia Y/N Hemiplegia Y/N CKD Y/N Leukaemia Y/N DM(complicated) Y/N Lymphoma

More information

Outcomes of Patients with Preoperative Weight Loss following Colorectal Surgery

Outcomes of Patients with Preoperative Weight Loss following Colorectal Surgery Outcomes of Patients with Preoperative Weight Loss following Colorectal Surgery Zhobin Moghadamyeghaneh MD 1, Michael J. Stamos MD 1 1 Department of Surgery, University of California, Irvine Nothing to

More information

Postoperative Surgical Site Infection after Incisional Hernia Repair: Link to Previous Surgical Site Infection? Zulfiqar Ali, AG Rehan

Postoperative Surgical Site Infection after Incisional Hernia Repair: Link to Previous Surgical Site Infection? Zulfiqar Ali, AG Rehan Original Article Postoperative Surgical Site Infection after Incisional Hernia Repair: Link to Previous Surgical Site Infection? Zulfiqar Ali, AG Rehan ABSTRACT Objective: Aim of the study was to determine

More information

SSI. Ren yu Zhang MD

SSI. Ren yu Zhang MD Ren yu Zhang MD 3 27 2014 1 SSI 16 million operative procedures in 2010. Overall SSI rate 1.9% for 2006 8. Accounts 31% of healthcare associated infection. Leads to further morbidity and mortality. Economic

More information

The Emergency Hernia or The call you don t want at 2:00 a.m.*

The Emergency Hernia or The call you don t want at 2:00 a.m.* or The call you don t want at 2:00 a.m.* *Or even at 8:00 a.m. Michael G. Sarr, MD Professor of Surgery Mayo Clinic South Canada WEST CANADA EAST CANADA Clinical talk Hernias Inguinal Umbilical Incisional

More information

Inadvertent Enterotomy in Minimally Invasive Abdominal Surgery

Inadvertent Enterotomy in Minimally Invasive Abdominal Surgery SCIENTIFIC PAPER Inadvertent Enterotomy in Minimally Invasive Abdominal Surgery Steven J. Binenbaum, MD, Michael A. Goldfarb, MD ABSTRACT Background: Inadvertent enterotomy (IE) in laparoscopic abdominal

More information

Scenario: Error and Apology 1

Scenario: Error and Apology 1 Scenario: Error and Apology 1 Background: 40 year old female with abdominal pain for 2 months presents to the radiology department for a CT of the abdomen and pelvis with IV contrast. The CT technologist

More information

Difficult Abdominal Closure. Mark A. Carlson, MD

Difficult Abdominal Closure. Mark A. Carlson, MD Difficult Abdominal Closure Mark A. Carlson, MD Illustrative case 14 yo boy with delayed diagnosis of appendicitis POD9 Appendectomy 2 wk after onset of symptoms POD4: return to OR for midline laparotomy

More information

Small Bowel and Colon Surgery

Small Bowel and Colon Surgery Small Bowel and Colon Surgery Why Do I Need a Small Bowel Resection? A variety of conditions can damage your small bowel. In severe cases, your doctor may recommend removing part of your small bowel. Conditions

More information

Preoperative Optimization and Surgical Site Infection Reduction

Preoperative Optimization and Surgical Site Infection Reduction Preoperative Optimization and Surgical Site Infection Reduction David Evans, MD Medical Director of Trauma Services Associate Professor Department of Surgery Division of Trauma, Critical Care and Burn

More information

Preoperative Optimization and Surgical Site Infection Reduction

Preoperative Optimization and Surgical Site Infection Reduction Preoperative Optimization and Surgical Site Infection Reduction David Evans, MD Medical Director of Trauma Services Associate Professor Department of Surgery Division of Trauma, Critical Care and Burn

More information

Annex 4. Case definitions of infections

Annex 4. Case definitions of infections Protocol for validation of PPS of HAIs and antimicrobial use in European LTCF TECHNICAL DOCUMENT Annex 4. Case definitions of infections Healthcare-associated infections and antimicrobial use in European

More information

MIST. Minimally invasive Infusion & Suction Therapy Device. Effective treatment for deadly abdominal trauma and sepsis

MIST. Minimally invasive Infusion & Suction Therapy Device. Effective treatment for deadly abdominal trauma and sepsis MIST Minimally invasive Infusion & Suction Therapy Device Effective treatment for deadly abdominal trauma and sepsis Summary Medical device for treating condition that annually kills ~156k intensive care

More information

POSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO

POSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO POSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO MD (ANAESTHESIOLOGY) FINAL EXAMINATION AUGUST 2013 Date : 2 nd August 2013 Time : 1.00 p.m. 4.00 p.m. Answer any three questions. Answer each question

More information

Demographics IDN: DOB: / / Gender: Male Female. Race: White Black or African American American Indian or Alaska Native

Demographics IDN: DOB: / / Gender: Male Female. Race: White Black or African American American Indian or Alaska Native MBSAQIP Case Number: Name: Demographics IDN: LMRN: DOB: / / Gender: Male Female Race: White Black or African American American Indian or Alaska Native Native Hawaiian/Other Pacific Islander Asian Unknown

More information

Surveillance and Epidemiological Investigation

Surveillance and Epidemiological Investigation Surveillance and Epidemiological Investigation Objectives The participant will be able to identify at least 4 types of data used for surveillance of infections. The participant will be able to define outbreak.

More information

Long Term Follow-up. 6 Month 1 Year Annual enter year #: What is the assessment date: / / Unknown. Is the patient alive? Yes No

Long Term Follow-up. 6 Month 1 Year Annual enter year #: What is the assessment date: / / Unknown. Is the patient alive? Yes No Long Term Follow-up 6 Month 1 Year Annual enter year #: What is the assessment date: / / Unknown Is the patient alive? Yes No Was an exam performed by a bariatric physician or PA/NP? Yes No Was the patient

More information

RECOGNISINGSURGICAL SITE INFECTIONS(SSIs) NOVEMBER 2017

RECOGNISINGSURGICAL SITE INFECTIONS(SSIs) NOVEMBER 2017 RECOGNISINGSURGICAL SITE INFECTIONS(SSIs) NOVEMBER 2017 Welcome to this training resource. It has been designed for all healthcare workers involved in coordinating SSI surveillance, SSI surveillance data

More information

SCORES FOR 4 TH QUARTER, RD QUARTER, 2014

SCORES FOR 4 TH QUARTER, RD QUARTER, 2014 SCORES FOR 4 TH QUARTER, 2013 3 RD QUARTER, 2014 PATIENT SATISFACTION SCORES (HCAHPS): 4 STARS OUT OF 5 (ONLY 4 AREA ACUTE CARE HOSPITALS RECEIVED A 4-STAR RATING. NONE ACHIEVED 5-STARS). STRUCTURAL MEASURES:

More information

INFECTION PREVENTION AND CONTROL

INFECTION PREVENTION AND CONTROL INFECTION PREVENTION AND CONTROL Health Care-Associated Infection (HAI) Definitions May 28, 2012 The Capital Health Infection Prevention Control (IPAC) department conducts ongoing surveillance reports

More information

Data Collection Tool. Standard Study Questions: Admission Date: Admission Time: Age: Gender:

Data Collection Tool. Standard Study Questions: Admission Date: Admission Time: Age: Gender: Data Collection Tool Standard Study Questions: Admission Date: Admission Time: Age: Gender: Specifics of Injury: Time of Injury: Mechanism of Injury Blunt vs Penetrating? Injury Severity Score? Injuries:

More information

EMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES

EMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES EMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES Clifford Ko, MD, MS, MSHS, FACS, FASCRS Professor of Surgery UCLA Director, ACS NSQIP, American College of Surgeons EVIDENCE Ban

More information

The Roles and Responsibilities of Nurse Before and After Laparoscopic Urologic Surgery

The Roles and Responsibilities of Nurse Before and After Laparoscopic Urologic Surgery + The Roles and Responsibilities of Nurse Before and After Laparoscopic Urologic Surgery Elif GEZGINCI Gulhane Military Medical Academy School of Nursing Ankara 1 + 2 PREOPERATİVE + Preoperative (Patient

More information

Composite of pneumonia, re-intubation, or death within 30 days of randomisation.

Composite of pneumonia, re-intubation, or death within 30 days of randomisation. Appendix: definitions Clinical outcome measures Primary outcome measure Composite of pneumonia, re-intubation, or death within 30 days of randomisation. Pneumonia Care will be taken to distinguish between

More information

Laparoscopy-Hysteroscopy

Laparoscopy-Hysteroscopy Laparoscopy-Hysteroscopy Patient Information Laparoscopy The laparoscope, a surgical instrument similar to a telescope, is inserted through a small incision (cut) in the belly button during laparoscopy.

More information

Severe and Tertiary Peritonitis

Severe and Tertiary Peritonitis Severe and Tertiary Peritonitis Addison K. May, MD FACS Professor of Surgery and Anesthesiology Division of Trauma and Surgical Critical Care Vanderbilt University Medical Center PS204: The Bad Infections:

More information

AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM - PEDIATRIC Data Collection Worksheet

AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM - PEDIATRIC Data Collection Worksheet AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM - PEDIATRIC Data Collection Worksheet *IDN LMRN Cycle Number Case Number DEMOGRAPHICS PATIENT First Name: MI: Last Name: Street

More information

Dr Yuen Wai-Cheung HA Convention 2011

Dr Yuen Wai-Cheung HA Convention 2011 Dr Yuen Wai-Cheung HA Convention 2011 Outlines Why HA benchmarks hospitals? How to do a successful benchmarking? Using SOMIP as an example How to read and understand SOMIP report? Benchmarking Benchmarking

More information

Table of Contents. Definitions document

Table of Contents. Definitions document Definitions document Table of Contents Definitions of preoperative risk factors... 3 What is the definition of neurosurgery?... 3 What should I do if some important medical co-morbidities are not included

More information

SEP-1 CHALLENGING CASES WITH DR. TOWNSEND

SEP-1 CHALLENGING CASES WITH DR. TOWNSEND UW MEDICINE PATIENTS ARE FIRST SEP-1 CHALLENGING CASES WITH DR. TOWNSEND AMADAE AREVALO RN, MSN, CCRN KATIE MEHRING RN, BSN, CCDS AMANDA SIGALA, RN, BSN, MPH, CPHQ JUNE 12, 2018 OBJECTIVES 1. Summarize

More information

ISF criteria (International sepsis forum consensus conference of infection in the ICU) Secondary peritonitis

ISF criteria (International sepsis forum consensus conference of infection in the ICU) Secondary peritonitis Appendix with supplementary material. This appendix was part of the submitted manuscript and has been peer reviewed. It is posted as supplied by the authors. Supplementary Tables Table S1. Definitions

More information

of Trauma Assembly 28 th Page 1

of Trauma Assembly 28 th Page 1 Eastern Association for the Surgery of Trauma 28 th Annual Scientific Assembly Sunrise Session 12 Disease Grading Systemss in Emergency General Surgery January 16, 2015 Disney s Contemporary Resort Lake

More information

Variable Updates January 2014

Variable Updates January 2014 Variable Updates January 2014 Surgeon National Provider Identifier (NPI) Variable Name: Surgeon NPI Intent of Variable: For sites to have the ability to track each surgeon s surgical cases. Definition:

More information

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process

2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process Quality ID #358: Patient-Centered Surgical Risk Assessment and Communication National Quality Strategy Domain: Person and Caregiver-Centered Experience and Outcomes 2018 OPTIONS FOR INDIVIDUAL MEASURES:

More information

Appendicitis. Diagnosis and Surgery

Appendicitis. Diagnosis and Surgery Appendicitis Diagnosis and Surgery What Is Appendicitis? Your side may hurt so much that you called your doctor. Or maybe you went straight to the hospital emergency room. If the symptoms came on quickly,

More information

UCLA General Surgery Residency Program Rotation Educational Policy Goals and Objectives ROTATION: SURGICAL CRITICAL CARE AND TRANSPLANTATION SURGERY

UCLA General Surgery Residency Program Rotation Educational Policy Goals and Objectives ROTATION: SURGICAL CRITICAL CARE AND TRANSPLANTATION SURGERY UPDATED: August 2009 UCLA General Surgery Residency Program ROTATION: SURGICAL CRITICAL CARE AND TRANSPLANTATION SURGERY ROTATION DIRECTOR: Gerald Lipshutz, M.D. SITE: UCLA Medical Center LEVEL OF TRAINEE:

More information

4/30/2010. Options for abdominal wall reconstruction. Scott L. Hansen, MD

4/30/2010. Options for abdominal wall reconstruction. Scott L. Hansen, MD Components Separation Scott L. Hansen, MD University of California, San Francisco Chief, Plastic and Reconstructive Surgery San Francisco General Hospital Overview Options for abdominal wall reconstruction

More information

Radiology. Undergraduate Radiology Sample Questions

Radiology. Undergraduate Radiology Sample Questions Radiology Undergraduate Radiology Sample Questions April 2012 The following examples are offered of questions that might be used to assess undergraduate radiology. There are 3 different styles: An OSCE

More information

DATA COLLECTION INSTRUMENT:

DATA COLLECTION INSTRUMENT: DATA COLLECTION INSTRUMENT: Study: Prospective randomized comparison of early laparoscopic enterolysis versus trial of non-operative management for high grade small bowel obstruction. Principal Investigators:

More information

2015 General Surgery Survival Guide

2015 General Surgery Survival Guide 2015 General Surgery Survival Guide Chapter 10: Hernia Repair Know What to Look for When Coding Hernia Repair Reporting hernia repair can be tricky. But if you know what to look for then half the work

More information

Presentation at ACS NSQIP National Conference in July Surgical Site Infection Reduction Strategies

Presentation at ACS NSQIP National Conference in July Surgical Site Infection Reduction Strategies Presentation at ACS NSQIP National Conference in July 2015 Surgical Site Infection Reduction Strategies PeaceHealth Sacred Heart Medical Center at RiverBend Level II Trauma Center 379 Beds 15,060 cases

More information

Quality ID #357: Surgical Site Infection (SSI) National Quality Strategy Domain: Effective Clinical Care

Quality ID #357: Surgical Site Infection (SSI) National Quality Strategy Domain: Effective Clinical Care Quality ID #357: Surgical Site Infection (SSI) National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Outcome DESCRIPTION: Percentage

More information

Esophageal Perforation

Esophageal Perforation Esophageal Perforation Dr. Carmine Simone Thoracic Surgeon, Division of General Surgery Head, Division of Critical Care May 15, 2006 Overview Case presentation Radiology Pre-operative management Operative

More information

ANZ Emergency Laparotomy Audit Quality Improvement (ANZELA-QI) Pilot Collaboration between RACS, ANZCA, GSA, NZAGS, ASA, NZSA, ACEM, CICM

ANZ Emergency Laparotomy Audit Quality Improvement (ANZELA-QI) Pilot Collaboration between RACS, ANZCA, GSA, NZAGS, ASA, NZSA, ACEM, CICM ANZ Emergency Laparotomy Audit Quality Improvement (ANZELA-QI) Pilot Collaboration between RACS, ANZCA, GSA, NZAGS, ASA, NZSA, ACEM, CICM DATA COLLECTION FORM Most Australian hospitals contribute data

More information

None of the authors has any disclosures or conflicts of interest to report

None of the authors has any disclosures or conflicts of interest to report None of the authors has any disclosures or conflicts of interest to report The Effect OF PATOS (Present At the Time Of Surgery) On The Calculation of SSI Rates for Appendectomy and Colectomy: Is PATOS

More information

The Abdominal Compartment Syndrome

The Abdominal Compartment Syndrome The Abdominal Compartment Syndrome Andre R. Campbell, MD, FACS, FACP, FCCM Professor of Surgery, UCSF Endowed Chair of Surgical Education San Francisco General Hospital Outline Case presentations Review

More information

34 yo M presented in ER of KCH at 7/06/10 Painful lump lt groin + vomiting Pain started 2 hrs before presentation. PMH known left inguinal hernia PSH

34 yo M presented in ER of KCH at 7/06/10 Painful lump lt groin + vomiting Pain started 2 hrs before presentation. PMH known left inguinal hernia PSH Case Presentation 34 yo M presented in ER of KCH at 7/06/10 Painful lump lt groin + vomiting Pain started 2 hrs before presentation. PMH known left inguinal hernia PSH negative NKDA Case Presentation VS:

More information

Laparoscopic Inguinal Hernia Repair

Laparoscopic Inguinal Hernia Repair 1 Laparoscopic Inguinal Hernia Repair Hernia is a medical condition where a part of the intestine bulges out of the weak abdominal muscles. Inguinal hernia is a type of hernia which occurs in the groin

More information

Historical perspective

Historical perspective Raj Santharam, MD GI Associates, LLC Clinical Assistant Professor of Medicine Medical College of Wisconsin Historical perspective FFS first widespread use in the early 1970 s Expansion of therapeutic techniques

More information

AORTIC GRAFT INFECTION

AORTIC GRAFT INFECTION NURSING CARE Theresa O Keefe NUM Vascular Unit PAH Vascular infections are serious They are associated with high morbidity and mortality The primary cause of surgical wound infections is contamination

More information

CEDR 2018 QCDR Measures for CMS 2018 MIPS Performance Year Reporting

CEDR 2018 QCDR Measures for CMS 2018 MIPS Performance Year Reporting ACEP19 Emergency Department Utilization of CT for Minor Blunt Head Trauma for Aged 18 Years and Older Percentage of visits for aged 18 years and older who presented with a minor blunt head trauma who had

More information

SUB TOPIC 3 : CLINICAL INDICATORS (CLINICAL QUALITY ASSURANCE CQA)

SUB TOPIC 3 : CLINICAL INDICATORS (CLINICAL QUALITY ASSURANCE CQA) SUB TOPIC 3 : CLINICAL INDICATORS (CLINICAL QUALITY ASSURANCE CQA) DEPARTMENT INDICATORS STANDARD ANESTHESIOLOGY Incidence of re-intubation in recovery 0.3% Intraoperative and in recovery CPR Unplanned

More information

Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP) Health Protection Scotland (HPS) SSI Surveillance Protocol 7th Edition

Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP) Health Protection Scotland (HPS) SSI Surveillance Protocol 7th Edition 1 Contents Female reproductive system operations (Abdominal hysterectomy and Caesarean section)... 3 Intra-abdominal infections... 3 Endometritis... 4 Other infections of the female reproductive tract...

More information

Use of an objective measure of time to recovery after cardiac surgery The STET randomised controlled trial

Use of an objective measure of time to recovery after cardiac surgery The STET randomised controlled trial Use of an objective measure of time to recovery after cardiac surgery The STET randomised controlled trial Chris Rogers, Katie Pike, Barney Reeves Gianni Angelini Bristol Heart Institute Aim To compare

More information

Is Readmission a Good Quality Measure for Surgical Care? Examining the Underlying Reasons for Readmissions after Surgery at ACS NSQIP Hospitals

Is Readmission a Good Quality Measure for Surgical Care? Examining the Underlying Reasons for Readmissions after Surgery at ACS NSQIP Hospitals Is Readmission a Good Quality Measure for Surgical Care? Examining the Underlying Reasons for Readmissions after Surgery at ACS NSQIP Hospitals Mila H. Ju, MD, MS Ryan P. Merkow, MD, MS Jeanette W. Chung,

More information

SCIP and NSQIP the Alphabet Soup of Surgical Quality

SCIP and NSQIP the Alphabet Soup of Surgical Quality SCIP and NSQIP the Alphabet Soup of Surgical Quality NSQIP National Conference Christopher C Johnson M.D. Caryn Foster RN, SCR Nicholas Hellenthal M.D., F.A.C.S. 7/26/15 Disclosure None Introduction The

More information

Colorectal non-inflammatory emergencies

Colorectal non-inflammatory emergencies Colorectal non-inflammatory emergencies Prof. Hesham Amer Professor of general surgery, Kasr Alainy hospital, Cairo university Dr. Doaa Mansour Dr. Ahmed Nabil Dr. Ahmed Abdel-Salam Lecturers of general

More information

SECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION

SECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION SECTION 1: INCLUSION, EXCLUSION & RANDOMISATION INFORMATION DEMOGRAPHIC INFORMATION Given name Family name Date of birth Consent date Gender Female Male Date of surgery INCLUSION & EXCLUSION CRITERIA YES

More information

In some cases, a medical evaluation may be needed, to be performed by your primary care physician about 2-4 weeks prior to surgery.

In some cases, a medical evaluation may be needed, to be performed by your primary care physician about 2-4 weeks prior to surgery. Robotic Assisted Laparoscopic Prostatectomy Information Sheet Preoperative Events: You will have a consultation appointment with one of the robotic surgeons. We will try to schedule this within a month

More information

Clinical Radiological Pathological Conference

Clinical Radiological Pathological Conference Clinical Radiological Pathological Conference CASE 1: A 59-year-old female Housekeeper Live in Phuket, Thailand Progressive dyspnea for 1 year Present illness 1 year PTA : She developed dyspnea on exertion

More information

A Diagnostic Dilemma saved by sound

A Diagnostic Dilemma saved by sound A Diagnostic Dilemma saved by sound Dr Syam Ravindranath MBBS DNB, Dr Ash Mukherjee FCEM FACEM We p r e s e n t a d i a g n o s t i c a l l y c h a l l e n g i n g s c e n a r i o in a 59 y e a r old f

More information

SURGICAL SITE INFECTIONS: SURVEILLANCE & PREVENTION

SURGICAL SITE INFECTIONS: SURVEILLANCE & PREVENTION SURGICAL SITE INFECTIONS: SURVEILLANCE & PREVENTION Disclosures: I have No conflicts of interest No commercial support No specific product will be endorsed during this presentation Facts There were an

More information

Michael Minarich, MD General Surgery Resident, PGY4 Cooper University Hospital

Michael Minarich, MD General Surgery Resident, PGY4 Cooper University Hospital BMI as Major Preoperative Risk Factor for Intraabdominal Infection After Distal Pancreatectomy: an Analysis of National Surgical Quality Improvement Program Database Michael Minarich, MD General Surgery

More information