August SCR Educational Call

Transcription

1 ugust SCR Educational Call

2 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 2 and 3 (if needed) will be open for 2 weeks Exam will consist of 2 sections (Multiple Choice and Case Study) ll SCRs must pass with a 90% or better on both portions of the exam

3 imonthly Questions imonthly SCR Review Questions are posted to the SCR Toolbox tab of the CS NSQIP Main page. These questions will cover a number of different clinical scenarios that have been received by Clinical Support and will serve as educational opportunities for all SCRs to review. new pair of questions will be released every other month and will be available for two weeks following release. January 13, 2014 March 3, 2014 May 5, 2014 July 7, 2014 September 8, 2014 November 3, 2014

4 QUESTION: Postoperative Death Within 30 Days You assessed a surgical procedure on a patient who stayed in the hospital for 20 days and was discharged home on hospice. On POD #36 the patient died of multi-system organ failure. Would you assign "Postoperative Death Within 30 Days?" Yes, you would assign Postoperative Death with in 30 days. No, you would not assign Postoperative Death with in 30 days.

5 QUESTION: Postoperative Death Within 30 Days You assessed a surgical procedure on a patient who stayed in the hospital for 20 days and was discharged home on hospice. On POD #36 the patient died of multi-system organ failure. Would you assign "Postoperative Death Within 30 Days?" NSWER No, you would not assign Postoperative Death with in 30 days.

6 QUESTION: Postoperative Death Within 30 Days You assessed a surgical procedure on a patient who stayed in the hospital for 20 days and was discharged home on hospice. On POD #36 the patient died of multi-system organ failure. Would you assign "Postoperative Death Within 30 Days? No, you would not assign Postoperative Death with in 30 days. RTIONLE In order to assign Postoperative Death within 30 days the death must occur on or before POD 30, regardless of cause, in or out of the hospital. s the patient the patient expired after POD 30 this death would not be captured.

7 QUESTION: Postoperative Death greater than 30 Days aby boy Johnson was transferred to your hospital for surgery with a diagnosis of Congenital Diaphragmatic Hernia. The repair was assessed in NSQIP. The patient had a complicated course with multiple post operative complications and is still in acute care after 30 days. On POD #50 the patient expired due to sepsis. Would you assign Postoperative death greater than 30 days if in cute Care to this case? Yes, you would assign Postoperative death greater than 30 days if in cute Care. No, you would not assign Postoperative death greater than 30 days if in cute Care.

8 QUESTION: Postoperative Death Within 30 Days aby boy Johnson was transferred to your hospital for surgery with a diagnosis of Congenital Diaphragmatic Hernia. The repair was assessed in NSQIP. The patient had a complicated course with multiple post operative complications and is still in acute care after 30 days. On POD #50 the patient expired due to sepsis. Would you assign Postoperative death greater than 30 days if in cute Care to this case? Yes, you would assign "Postoperative death greater than 30 days if in cute Care to this case.

9 QUESTION: Postoperative Death Within 30 Days aby boy Johnson was transferred to your hospital for surgery with a diagnosis of Congenital Diaphragmatic Hernia. The repair was assessed in NSQIP. The patient had a complicated course with multiple post operative complications and is still in acute care after 30 days. On POD #50 the patient expired due to sepsis. Would you assign Postoperative death greater than 30 days if in cute Care to this case? Yes, you would assign "Postoperative death greater than 30 days if in cute Care to this case. RTIONLE In order to assign Postoperative Death > 30 Days the death must occur after POD 30 and the patient must never have been discharged from the acute care setting following the principal operative procedure. dditionally, the death must be related to the principal operative procedure or a postoperative occurrence/complications. s the patient was still in the acute care setting after 30 days from the principal operative procedure and the death was related to a complication from the principal operative procedure you would assign "Postoperative death greater than 30 days if in cute Care" to this case.

10 QUESTION: Concurrent Procedure aby boy Smith had a hypospadias repair, which was abstracted as the principal operative procedure and was performed by the Urological surgical team. He also required a Peritoneal dialysis catheter placement which was performed by the General surgery team under the same anesthetic. Which procedure would be assigned as a "Concurrent Procedure?" Hypospadias Repair Peritoneal Dialysis catheter placement

11 QUESTION: Concurrent Procedure aby boy Smith had a hypospadias repair, which was abstracted as the principal operative procedure and was performed by the Urological surgical team. He also required a Peritoneal dialysis catheter placement which was performed by the General surgery team under the same anesthetic. Which procedure would be assigned as a "Concurrent Procedure?" Peritoneal Dialysis catheter placement

12 QUESTION: Concurrent Procedure aby boy Smith had a hypospadias repair, which was abstracted as the principal operative procedure and was performed by the Urological surgical team. He also required a Peritoneal dialysis catheter placement which was performed by the General surgery team under the same anesthetic. Which procedure would be assigned as a "Concurrent Procedure?" Peritoneal Dialysis catheter placement RTIONLE s the Hypospadias repair was the principal operative procedure and the PD catheter placement had a different CPT code and was performed by a different surgical team under the same anesthetic, it would be assigned as a "concurrent procedure"

13 QUESTION: Concurrent Procedure 10 year old girl is scheduled for an umbilical hernia repair and mole excision by General surgery. oth procedures will be performed under the same anesthesia. The umbilical hernia repair is the principal operative procedure abstracted for NSQIP. How would you capture the mole excision? It would be assigned as an "other procedure." C ssign it as an additional principal operative procedure. It would be assigned as a "concurrent case."

14 QUESTION: Concurrent Procedure 10 year old girl is scheduled for an umbilical hernia repair and mole excision by General surgery. oth procedures will be performed under the same anesthesia. The umbilical hernia repair is the principal operative procedure abstracted for NSQIP. How would you capture the mole excision? The mole excision would be assigned as an other procedure.

15 QUESTION: Concurrent Procedure 10 year old girl is scheduled for an umbilical hernia repair and mole excision by General surgery. oth procedures will be performed under the same anesthesia. The umbilical hernia repair is the principal operative procedure abstracted for NSQIP. How would you capture the mole excision? The mole excision would be assigned as an other procedure. RTIONLE s this procedure was performed by the same surgical team and under the same anesthesia it would be assigned as an "other procedure". You would not abstract this case as an additional principal operative procedure because only one case per patient per 30 days can be captured in NSQIP.

16 QUESTION: Organ/Space SSI aby girl Jones had a colectomy which was assessed in NSQIP. She did well and was discharged on POD #5. On POD #15 she went to the ED with a fever and elevated white count (SIRS criteria is met). Patient was admitted and sent for a CT which revealed an anastomotic leak. Would you assign an organ/space SSI to this case? Yes, you would assign an organ/space SSI to this case. No, you would not assign an organ/space SSI to this case.

17 QUESTION: Organ/Space SSI aby girl Jones had a colectomy which was assessed in NSQIP. She did well and was discharged on POD #5. On POD #15 she went to the ED with a fever and elevated white count (SIRS criteria is met). Patient was admitted and sent for a CT which revealed an anastomotic leak. Would you assign an organ/space SSI to this case? Yes, you would assign an organ/space SSI to this case.

18 QUESTION: Organ/Space SSI aby girl Jones had a colectomy which was assessed in NSQIP. She did well and was discharged on POD #5. On POD #15 she went to the ED with a fever and elevated white count (SIRS criteria is met). Patient was admitted and sent for a CT which revealed an anastomotic leak. Would you assign an organ/space SSI to this case? Yes, you would assign an organ/space SSI to this case. RTIONLE s an anastomotic leak occurred within 30 days following the colectomy, an organ/space SSI would be assigned.

19 QUESTION: Postoperative IVH former 23 - week premature infant presents to the OR for a tracheostomy at 35 weeks. prior head ultrasound at 30 weeks is reported as a grade IV intraventricular hemorrhage. repeat head ultrasound is reported at 37 weeks as a grade III intraventricular hemorrhage. Would you assign the postoperative occurrence of Intraventricular Hemorrhage (IVH) Grade for Neonatal Patients to this case? Yes, you would assign Intraventricular Hemorrhage (IVH) Grade for Neonatal Patients to this case. No, you would not assign Intraventricular Hemorrhage (IVH) Grade for Neonatal Patients to this case.

20 QUESTION: Postoperative IVH former 23 - week premature infant presents to the OR for a tracheostomy at 35 weeks. prior head ultrasound at 30 weeks is reported as a grade IV intraventricular hemorrhage. repeat head ultrasound is reported at 37 weeks as a grade III intraventricular hemorrhage. Would you assign the postoperative occurrence of Intraventricular Hemorrhage (IVH) Grade for Neonatal Patients to this case? No, you would not assign Intraventricular Hemorrhage (IVH) Grade for Neonatal Patients to this case.

21 QUESTION: Postoperative IVH former 23 - week premature infant presents to the OR for a tracheostomy at 35 weeks. prior head ultrasound at 30 weeks is reported as a grade IV intraventricular hemorrhage. repeat head ultrasound is reported at 37 weeks as a grade III intraventricular hemorrhage. Would you assign the postoperative occurrence of Intraventricular Hemorrhage (IVH) Grade for Neonatal Patients to this case? No, you would not assign Intraventricular Hemorrhage (IVH) Grade for Neonatal Patients to this case. RTIONLE s the patient's IVH Grade improved after surgery you would not assign this as a post operative occurrence. This post operative occurrence is recorded only for newly developed or worsening of IVH within the 30 day post operative period.

22 QUESTION: Pulmonary Embolism 16 year old boy underwent a left femur ORIF which was abstracted in NSQIP. On POD#2 he became short of breath and complained of chest pain. He was sent for a CT scan which resulted in a diagnosis of a fat pulmonary embolism. Would you assign the post operative occurrence of Pulmonary Embolism to this case? Yes, you would assign Pulmonary Embolism to this case. No, you would not assign Pulmonary Embolism to this case.

23 QUESTION: Pulmonary Embolism 16 year old boy underwent a left femur ORIF which was abstracted in NSQIP. On POD#2 he became short of breath and complained of chest pain. He was sent for a CT scan which resulted in a diagnosis of a fat pulmonary embolism. Would you assign the post operative occurrence of Pulmonary Embolism to this case? No, you would not assign Pulmonary Embolism to this case.

24 QUESTION: Pulmonary Embolism 16 year old boy underwent a left femur ORIF which was abstracted in NSQIP. On POD#2 he became short of breath and complained of chest pain. He was sent for a CT scan which resulted in a diagnosis of a fat pulmonary embolism. Would you assign the post operative occurrence of Pulmonary Embolism to this case? No, you would not assign Pulmonary Embolism to this case. RTIONLE s the patient had a definitive diagnosis of a Fat Pulmonary Embolism and not a blood embolus you would not assign the Post operative occurrence of Pulmonary Embolism.

25 QUESTION: Post operative Cardiac rrest aby oy Moore was born with a cystic lung lesion. He underwent a lobectomy which was an abstracted procedure for NSQIP. On POD #1 he is placed on ECMO. Would you assign the postoperative occurrence of Post operative Cardiac rrest Requiring CPR? Yes, you would assign Post operative Cardiac rrest Requiring CPR to this case. No, you would not assign Post operative Cardiac rrest Requiring CPR to this case.

26 QUESTION: Post operative Cardiac rrest aby oy Moore was born with a cystic lung lesion. He underwent a lobectomy which was an abstracted procedure for NSQIP. On POD #1 he is placed on ECMO. Would you assign the postoperative occurrence of Post operative Cardiac rrest Requiring CPR? Yes, you would assign Post operative Cardiac rrest Requiring CPR to this case.

27 QUESTION: Post operative Cardiac rrest aby oy Moore was born with a cystic lung lesion. He underwent a lobectomy which was an abstracted procedure for NSQIP. On POD #1 he is placed on ECMO. Would you assign the postoperative occurrence of Post operative Cardiac rrest Requiring CPR? Yes, you would assign Post operative Cardiac rrest Requiring CPR to this case. RTIONLE You would assign Post operative Cardiac rrest Requiring CPR because the patient was placed on ECMO on POD #1.

28 QUESTION: Inclusion/Exclusion 10 year old male undergoes a liver transplant on 9/12/13 performed by the transplant surgeon. During this hospital stay he required a G- tube placement. On 10/8/13 he falls on your operative log for placement of a G-tube. Would you assess this gastrostomy as the principal operative procedure, if all systematic sampling criteria are met? Include this case in NSQIP, as all systematic sampling criteria are met. Exclude this case in NSQIP, as any operation performed during the patient s hospital stay for a transplant will be excluded from sampling.

29 QUESTION: Inclusion/Exclusion 10 year old male undergoes a liver transplant on 9/12/13 performed by the transplant surgeon. During this hospital stay he required a G-tube placement. On 10/8/13 he falls on your operative log for placement of a G-tube. Would you assess this gastrostomy as the principal operative procedure, if all systematic sampling criteria are met? Exclude this case in NSQIP, as any operation performed during the patient s hospital stay for a transplant will be excluded from sampling.

30 QUESTION: Inclusion/Exclusion 10 year old male undergoes a liver transplant on 9/12/13 performed by the transplant surgeon. During this hospital stay he required a G- tube placement. On 10/8/13 he falls on your operative log for placement of a G-tube. Would you assess this gastrostomy as the principal operative procedure, if all systematic sampling criteria are met? Exclude this case in NSQIP, as any operation performed during the patient s hospital stay for a transplant will be excluded from sampling. RTIONLE patient who is admitted to the hospital for organ transplant surgery, and has additional surgical procedures performed during the same hospital stay, will be excluded. ny operation performed after the patient has been discharged from the transplant stay will be included.

31 QUESTION: Inclusion/Exclusion patient was in a Rollover MV and has a Post-OPERTIVE DIGNOSIS of Displaced, unstable tibial and fibular fracture, with left foot lisfranc fracture. The principal operative procedure would be IM Nailing Tibia Left (27759) & CRPP 2nd to 5th toes left. Should this case be included for review as the fractures were all in the lower left extremity? Include this case in NSQIP, as all systematic sampling criteria are met. Exclude this case, as it does not meet the trauma inclusion exception of an isolated limb-section fracture, as the patient sustained fractures in 2 limb segments, the lower leg and foot.

32 QUESTION: Inclusion/Exclusion patient was in a Rollover MV and has a Post-OPERTIVE DIGNOSIS of Displaced, unstable tibial and fibular fracture, with left foot lisfranc fracture. The principal operative procedure would be IM Nailing Tibia Left (27759) & CRPP 2nd to 5th toes left. Should this case be included for review as the fractures were all in the lower left extremity? Exclude this case, as it does not meet the trauma inclusion exception of an isolated limb-section fracture, as the patient sustained fractures in 2 limb segments, the lower leg and foot.

33 QUESTION: Inclusion/Exclusion patient was in a Rollover MV and has a Post-OPERTIVE DIGNOSIS of Displaced, unstable tibial and fibular fracture, with left foot lisfranc fracture. The principal operative procedure would be IM Nailing Tibia Left (27759) & CRPP 2nd to 5th toes left. Should this case be included for review as the fractures were all in the lower left extremity? Exclude this case, as it does not meet the trauma inclusion exception of an isolated limb-section fracture, as the patient sustained fractures in 2 limb segments, the lower leg and foot. RTIONLE This case would not meet the trauma inclusion exception of an isolated limbsection fracture, as the patient sustained fractures in 2 limb segments, the lower leg and foot. Therefore, this case would be excluded in your sampling. The intent of the exception is to include one continuous break even if it crosses 2 bones.

34 Questions??