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

Transcription

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

2 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: ICD 9 codes: and ICD 10 codes: S00-T14 and T20-T88. Any suspected abuse/neglect will be excluded with ICD-9 or ICD 10 diagnostic codes within the range of: ICD 9 codes: ICD 10 codes: V00-Y99 *Exception to Trauma criteria: Include cases where there is an isolated limb section facture and included CPT code.

3 Pneumonia Current and Post Operative Radiologic criteria updated to include: New or progressive and persistent infiltrate Consolidation or opacity (e.g. air-space disease, patchy areas of increased density, focal opacification) Cavitation Pneumatoceles, in infants 1 year old OR A diagnosis of pneumonia is rendered by an attending physician based on the findings demonstrated on a chest radiological exam (xray or CT).

4 Pneumonia Current and Post operative Notes: * When other noninfectious conditions are present, serial chest radiographs may be examined to help separate infectious from noninfectious pulmonary processes. To help confirm difficult cases, it may be useful to review subsequent radiographs up to and including 7 days after the initial qualifying radiograph. Pneumonia may have rapid onset and progression, but does not resolve quickly. Radiographic findings of pneumonia persist for several weeks. As a result, rapid radiographic resolution suggests that the patient does not have pneumonia but rather a noninfectious process. Multiple x-rays taken at the same time but from different positions (e.g. posteroanterior, anteroposterior, and lateral) are not considered serial chest radiological exams. Serial chest radiological exams must be taken during distinctly different examination periods.

5 Biliary/Liver/Pancreatic- Esophageal/Gastric/Intestinal Biliary/Liver/Pancreatic Disease Criteria: Patient has a diagnosis of chronic congenital, acquired, or structural liver, biliary, or pancreatic disease resulting in a functional abnormality. Scenarios to Clarify (Do Not Assign Variable): A documented diagnosis of diabetes would not be captured under this variable (Please refer to Diabetes Mellitus Requiring Therapy with Non-Insulin Agents, or Insulin variable) Esophageal/Gastric Disease/Intestinal Criteria: Patient has a diagnosis of congenital, acquired, or structural intestinal tract disorder involving esophagus, stomach, small intestine, or colon, such as gastroschisis, atresias of the esophagus, duodenum, jejunum, and or ileum. Scenarios to Clarify (Do Not Assign Variable): Patients with diagnosed constipation requiring daily medication. Patient taking Proton Pump Inhibitors with no documented diagnosis of GERD Patient with complaints of abdominal pain only. A documented diagnosis of appendicitis

6 Cardiac Risk/ICD Code Cardiac ICD Code For patients that have had a heart transplant: do not assign ICD-9 codes for any diagnoses that were present prior to the transplant. Heart Transplant Recipient is assigned ICD-9 code V42.1 as well as any diagnoses that are present in the transplanted heart. Diagnoses that the patient had before the heart transplant are not assigned. Cardiac Risk Factors New diagnosis codes were added to collect (including heart transplant) Congenital Malformation New diagnoses also added to Collect list/please review the lists and contact us with any questions.

7 Structural CNS Abnormality- Childhood Malignancy Structural CNS Abnormality Any structural CNS abnormality documented in the medical record. This may also be noted in a visual or radiologic exam. The diagnosis of scoliosis is not assigned as a structural CNS abnormality. Childhood Malignancy Intent of Variable: To identify patients with a documented malignancy at any time prior to operation or a malignancy found during the principal operative procedure. The malignancy may be awaiting treatment, under treatment, or treatment may be completed. Scenarios to Clarify (Do Not Assign Variable): Do not assign if there was a suspicious lesion such as a liver nodule or a lymph node and pathology shows no cancer. Patient tumor has been identified as benign

8 Open Wound (with or without infection) An open wound is a breach in the integrity of the skin or separation of skin edges and includes open surgical wounds, with or without cellulitis or purulent exudate. Scenarios to Clarify (Assign Variable): Open drains currently in place and placed during a previous procedure should be considered an open wound (e.g., Penrose drains) Open wounds currently undergoing dressing changes or with negative pressure wound devices (e.g., wound vacs) Any abnormal passageway leading from an internal organ (e.g., intestinal tract) to the surface of the body / skin (e.g., enterocutaneous fistula [ECF]) Decubitus ulcer (Stages 2 4) is considered an open wound. Scenarios to Clarify (Do Not Assign Variable): Osteomyelitis or localized abscesses An ostomy would not be considered an open wound A scabbed over wound with or without drainage Oral sores Perforated tympanic membrane A tracheostomy would not be considered an open wound Gastroschisis, omphalocele, meningomyelocele, and other congenital conditions associated with lack of integrity of overlying tissues are not considered open wounds

9 Previous CPR Within Seven (7) Days Prior to Surgery Criteria: Record patients who had received Initiation of cardiac compressions or patients receiving ECMO (Extracorporeal membrane oxygenation) within 7 days prior to the principal operative procedure as documented in the patient medical record. Scenarios to Clarify (Assign Variable): PEA (pulseless electrical activity) arrests requiring chest compressions Patients in pulseless VT or V-Fib in which defibrillation is performed with or without chest compressions Patients with automatic implantable cardioverter defibrillator (AICD) that fires and the patient has loss of consciousness

10 Intraoperative Cardiac Arrest Requiring CPR Intent of Variable: To identify patient(s) who experienced a cardiac arrest or dysfunction and required the initiation of CPR or ECMO during the intraoperative period. The intraoperative period is defined as the time the patient arrives in the OR (Patient In Room time) to the time the patient is transported out of the OR (Patient Out of Room time). Scenario 1: The patient is started on ECMO (extracorporeal membrane oxygenation) unless this was a planned portion of the principal operative procedure Scenario 2: Cardiac Arrest Requiring CPR must be noted intraoperatively AND one of the following scenarios (A or B, or C ) below: A. The absence of a cardiac rhythm or presence of cardiac rhythm requiring the initiation of chest compressions B. Patients in pulseless ventricular tachycardia (VT) or ventricular fibrillation (V-Fib) in which defibrillation is performed with or without chest compressions C. Patients with automatic implantable cardioverter defibrillator (AICD) that fires and the patient has loss of consciousness

11 Post operative Cardiac Arrest Requiring CPR Intent of Variable: To identify patient(s) who experienced a cardiac arrest or dysfunction and required the initiation of CPR or ECMO during the post-operative period. Scenario 1: The patient is started on ECMO (extracorporeal membrane oxygenation) Scenario 2: Cardiac Arrest Requiring CPR must be noted postoperatively AND one of the following scenarios (A or B, or C ) below: A. The absence of a cardiac rhythm or presence of a cardiac rhythm requiring the initiation of chest compressions B. Patients in pulseless ventricular tachycardia (VT) or ventricular fibrillation (V-Fib) in which defibrillation is performed with or without chest compressions C. Patients with automatic implantable cardioverter defibrillator (AICD) that fires and the patient has loss of consciousness

12 Other/Concurrent Procedures Intent of Variable: To capture additional operative procedures performed by the same surgical team (Other procedure) or performed by a different surgical team (Concurrent), under the same anesthetic, which have CPT codes different from that of the Principal Operative Procedure. In some cases, additional captured CPT codes might be analyzed separately from the principal operative procedure code. This makes it in the best interest of the program to capture all relevant CPT codes. Scenarios to Clarify (Assign Variable): Invasive procedures performed at the time of the principal operative procedure Bronchoscopy Esophagogastroduodenoscopy (EDG) Ureteral Stent placement Scenarios to Clarify (Do Not Assign Variable): Imaging performed during the principal operative procedure, such as x ray or CT scan Anesthesia Procedures Central line placement Sheath Placement Nerve Monitoring Lymph Node Dye Injection Transesophageal Echocardiogram (TEE)

13 Organ/Space SSI Criteria: An infection that occurs within 30 days of the principal operative procedure AND involves any of the anatomy (e.g., organs or spaces), other than the incision, which was opened or manipulated during the operation AND at least ONE of the following: 1. Purulent drainage from a drain that is placed through a stab wound into the organ/space. 2. Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space 3. An abscess or other evidence of infection involving the organ/space that is found on direct examination, during reoperation, or by histopathologic or radiologic examination * 4. Diagnosis of an organ/space SSI by a surgeon or attending physician *If criteria from scenario 3 are met refer to the organ/space algorithm in Appendix J to assist determining if an organ/space SSI should be assigned.

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15 Superficial Wound Disruption/Dehiscence If there has been a report of a separation by a parent or guardian such information can be over-ruled under the following circumstances: If a medical professional physically assesses the patient s wound (in person) within 72hrs of the report, AND the surgeon documents DEFINITIVELY in medical records that the wound is NOT separated The separation could not have healed in the interim between the parent report and the physical assessment. Under such circumstances the surgeon should declare in the record that no event occurred, and this declaration can be considered definitive.

16 Unplanned Intubation/Reintubation With Ventilatory Support Criteria: All endotracheal reintubations in the post operative time period, with the exception of when the patient is being intubated for additional surgical procedures. Scenarios to Clarify (Do Not Assign Variable): Patients who undergo time off the ventilator, remain intubated, fail the trial, and were placed back on the ventilator without extubation would not be assigned Intubations for an unplanned return to the OR would not be assigned Uneventful chronic tracheostomy replacement (planned or unplanned) would not be assigned Intubation/Re-intubation while still in the Operating room for the principal operative procedure would not be assigned as it is for the safe management of the patient

17 Intraventricular Hemorrhage (IVH) Grade for Neonatal Patients Intent of Variable: To identify neonatal patient(s) who developed an intraventricular Hemorrhage (IVH) after surgery. Scenarios to Clarify (Assign Variable): If a pre-term neonate had surgery before an assessment of IVH was performed and following the principal operative procedure, a diagnosis of IVH was found (regardless of reason for assessment performed), this would be assigned as there is no definitive information to show that the Intraventricular hemorrhage was present prior to the principal operative procedure. Scenarios to Clarify (Do Not Assign Variable): Preoperatively the patient had a grade 2 IVH, another ultrasound was performed in the postoperative period with a grade 2 IVH noted. This would not be assigned as a post operative occurrence as this is not a new or worsening IVH grade.

18 Unplanned Reoperation 1. Did the patient have an unplanned return to the OR for a surgical procedure within the 30 day postoperative period? Yes No 2. Was the return to the OR for a postoperative occurrence likely related to the principal operative procedure? Notes: Yes is the default answer unless it is definitively indicated that the unplanned return to the OR is not related to the principal operative procedure. If No is answered, additional information would not be needed and the remaining questions will remain greyed out. If Yes, o Record the ICD code or provide a diagnosis description if ICD code is not documented

19 Variables Removed Variables removed from workstation for Jan cases Elective Surgery Patient Coming from Home Weight Loss Failure to Thrive

20 APPENDECTOMY VARIABLES Appendectomy Appendectomy; for ruptured appendix with abscess or generalized peritonitis Laparoscopy, surgical, appendectomy Unlisted laparoscopy procedure, appendix

21 Appendectomy for Acute Abdominal Pain/Appendicitis Intent of Variable: To identify those children who underwent operation for preoperative diagnosis of acute or perforated appendicitis. Appendectomy performed for acute abdominal pain where a normal appendix was found should be included. Appendectomies performed for chronic abdominal pain (> 7 days duration), as part of another operation (incidental, Ladd procedure for malrotation), or interval appendectomy for perforated appendicitis are excluded. Definition: Appendectomy performed for acute abdominal pain with a diagnosis of appendicitis made 7 days prior to hospitalization for operation. Criteria: Indicate the principal reason for the appendectomy: acute abdominal pain/acute or perforated appendicitis; interval appendectomy >7 days from initial hospital admission for appendicitis; or other for chronic abdominal pain, incidental appendectomy, Ladd procedure, other. Options: Acute abdominal pain/acute or perforated appendicitis Interval appendectomy (>7days from initial hospital admission for appendicitis) Other (Chronic abdominal pain, incidental appendectomy, Ladd procedure, other)

22 Appendectomy for Acute Abdominal Pain/Appendicitis Assign Acute abdominal pain/acute or perforated appendicitis Operation performed for acute abdominal pain ( 7 days from initial diagnosis/hospital admission). Operation performed after multiple serial evaluations over the course of a week even if abdominal pain has fluctuated in character over the time of observation. Operation performed for perforated appendicitis initially treated with percutaneous drainage and intravenous antibiotics with treatment failure and operation within 7 days of initial diagnosis/hospital admission

23 Appendectomy for Acute Abdominal Pain/Appendicitis Assign Interval appendectomy or Other Operation performed earlier than anticipated/planned due to recurrent abdominal pain during interval after non-operative treatment of perforated appendicitis if initial diagnosis/hospital admission was >7 days. This is assigned as Interval appendectomy in this scenario regardless of whether patient was discharged from initial hospitalization or remains hospitalized for perforated appendicitis. (Interval appy) Appendectomy performed as a part of diagnostic laparoscopy for chronic abdominal pain or intestinal malrotation. (Other) Appendectomy performed electively after appendicolith detected on radiographic study in patient without acute abdominal pain. (Other)

24 Preoperative CT Scan at Another Institution Intent of Variable: To identify whether patient underwent preoperative abdominal and/or pelvic CT scan at another institution within 72 hours prior to hospital admission associated with appendectomy. Definition/Criteria: Any preoperative CT scan of the abdomen and/or pelvis obtained at another/referring facility within 72 hours prior to hospital admission associated with appendectomy regardless of ordering physician, stated purpose, findings, impression, or contrast used. Options: Yes No Additional Guidance: Individual hospitals must decide whether CT scans obtained at satellite facilities are considered as an outside/referring institution or a part of your institution. This should be based on considerations such as whether physician staff, medical leadership, and protocols are shared across these facilities. Your site should use a consistent determination

25 Preoperative CT Scan at Your Institution Intent of Variable: To identify whether patient underwent preoperative abdominal and/or pelvic CT scan at your hospital within 72 hours prior to hospital admission associated with appendectomy until time of appendectomy. Definition/Criteria: Any preoperative CT scan of the abdomen and/or pelvis obtained at your hospital within 72 hours prior to hospital admission associated with appendectomy regardless of ordering physician, stated purpose, findings, impression, or contrast used. Options: Yes No Additional Guidance: Individual hospitals must decide whether CT scans obtained at satellite facilities are considered as an outside/referring institution or a part of your institution. This should be based on considerations such as whether physician staff, medical leadership, and protocols are shared across these facilities. Your site should use a consistent determination.

26 Preoperative Ultrasound at Your Institution Intent of Variable: To identify whether patient underwent preoperative abdominal and/or pelvic ultrasound at your hospital within 72 hours prior to hospital admission associated with appendectomy until time of appendectomy. Definition/Criteria: Any preoperative ultrasound of the abdomen and/or pelvis obtained as a formal radiologic study at your hospital within 72 hours prior to hospital admission associated with appendectomy regardless of ordering physician, stated purpose, findings, or impression Options: Yes No Additional Guidance: These studies may be described as limited or complete abdomen, retroperitoneal, right lower quadrant, appendix, and pelvic. This is not intended to be an exhaustive list. Any formal ultrasound obtained to evaluate the appendix or source of right lower quadrant abdominal pain should be included. Individual hospitals must decide whether ultrasounds obtained at satellite facilities are considered as an outside/referring institution or a part of your institution This should be based on considerations such as whether physician staff, medical leadership and protocols are shared across these facilities. Your site should use a consistent determination.

27 Preoperative Ultrasound at Another Institution Intent of Variable: To identify whether patient underwent preoperative abdominal and/or pelvic ultrasound at another institution within 72 hours prior to hospital admission associated with appendectomy. Definition/Criteria: Any preoperative ultrasound of the abdomen and/or pelvis obtained as a formal radiologic study at another/referring facility within 72 hours prior to hospital admission associated with appendectomy regardless of ordering physician, stated purpose, findings, or impression Options: Yes No Additional Guidance: These studies may be described as limited or complete abdomen, retroperitoneal, right lower quadrant, appendix, and pelvic. This is not intended to be an exhaustive list. Any formal ultrasound obtained to evaluate the appendix or source of acute right lower quadrant abdominal pain should be included. Individual hospitals must decide whether ultrasounds obtained at satellite facilities are considered as an outside/referring institution or a part of your institution. This should be based on considerations such as whether physician staff, medical leadership and protocols are shared across these facilities. Your site should use a consistent determination

28 MRI at Another Institution Intent of Variable: To identify whether patient underwent preoperative abdominal and/or pelvic MRI at another institution within 72 hours prior to hospital admission associated with appendectomy. Definition/Criteria: Any preoperative MRI of the abdomen and/or pelvis obtained at another/referring facility within 72 hours prior to hospital admission associated with appendectomy regardless of ordering physician, stated purpose, findings, or impression. Options: Yes No Additional Guidance: Individual hospitals must decide whether CT scans obtained at satellite facilities are considered as an outside/referring institution or a part of your institution. This should be based on considerations such as whether physician staff, medical leadership, and protocols are shared across these facilities. Your site should use a consistent determination.

29 Preoperative MRI at Your Institution Intent of Variable: To identify whether patient underwent preoperative abdominal and/or pelvic MRI at your hospital within 72 hours prior to hospital admission associated with appendectomy until time of appendectomy. Definition/Criteria: Any preoperative MRI of the abdomen and/or pelvis obtained at your hospital within 72 hours prior to hospital admission associated with appendectomy regardless of ordering physician, stated purpose, findings, or impression. Options: Yes No Additional Guidance: Individual hospitals must decide whether CT scans obtained at satellite facilities are considered as an outside/referring institution or a part of your institution. This should be based on considerations such as whether physician staff, medical leadership, and protocols are shared across these facilities. Your site should use a consistent determination.

30 Finding of Complicated Appendicitis Intent of Variable: To identify whether appendicitis was complicated based on the surgeon s observations at operation. These criteria were selected as most likely to be documented and objective. It is recognized that there may be cases of complicated appendicitis that do not have these findings. Definition: Documentation of operative findings noted in the immediate or formal operative report of complicated appendicitis with the observation of a visible hole in appendix, fecalith in peritoneal cavity outside of the appendix, abscess, and/or diffuse fibrinopurulent exudate in peritoneal cavity Criteria: Any of the following operative findings noted in the immediate or formal operative report. Visible hole in appendix Fecalith in peritoneal cavity outside of the appendix Abscess Diffuse fibrinopurulent exudate in peritoneal cavity Options: Yes No

31 Pathologic Diagnosis of Appendix Intent of Variable: To identify whether the diagnosis of appendicitis was confirmed on pathologic examination of appendix. This will allow calculation of a negative appendectomy rate and exclusion of patients without appendicitis from analysis. Definition/Criteria: Record the final diagnosis of appendix by the pathologist as indicated on pathology report. Options: Normal appendix Appendicitis Other appendiceal pathology Not available

32 Percutaneous Drainage or Aspiration of Intraperitoneal Fluid Collection Intent of Variable: To identify whether patient underwent percutaneous or transrectal drainage of abdominal and/or pelvic fluid collection(s) within 30 days following appendectomy. Definition/Criteria: Record any aspiration/drain placement for abdominal and/or pelvic fluid collection performed within 30 days following appendectomy regardless of ordering physician, stated purpose, findings, or impression. Options: Yes No Clarifications: Procedure(s) should be captured regardless of setting Any attempted procedure is counted regardless of whether fluid was obtained Opening abdominal wound (incision) for infection does not qualify Additional operation (e.g. operative drainage of infection via incision) does not qualify

33 PICC-Central Venous Catheter for Appendicitis Intent of Variable: To identify PICC or central venous catheter placement during the hospital admission associated with appendectomy. Definition/Criteria: Record if PICC (percutaneously-inserted central catheter) or other central venous catheter was placed during the same hospitalization as appendectomy. Options: Yes No Additional Guidance: These may have been placed as part of routine management or as treatment of a complication based on local practices. All PICC/central venous catheters are included regardless of reason for placement (poor/limited intravenous access, lab sampling, central monitoring, vasopressor administration, long-term intravenous antibiotics). To ensure data reliability, only catheter placements during the hospitalization for appendectomy are captured. In cases of initial non-operative management of perforated appendicitis and catheter placement, response is YES if the child underwent appendectomy (within 7 days of diagnosis) during the initial admission for perforated appendicitis. If the child had a catheter placed during a prior admission, was discharged, and then subsequently returns for operation after more than 7 days from diagnosis, appendectomy-specific data should not be collected (OPERATION FOR ACUTE APPENDICITIS= NO INTERVAL APPENDECTOMY)

34 Parenteral Nutrition Use After Diagnosis of Appendicitis Intent of Variable: To identify the initiation of total or partial parenteral nutrition (PN) during the hospital admission associated with appendectomy. Definition/Criteria: Record if total or partial parenteral nutrition (PN) initiated during the same hospitalization as appendectomy. Options: Yes No Additional Guidance: To ensure data reliability, only PN initiated during the hospitalization for appendectomy is captured. In cases of initial non-operative management of perforated appendicitis and PN use, response is YES if the child underwent appendectomy (within 7 days of diagnosis) during the initial admission for perforated appendicitis. If the child was discharged, and then subsequently returns for operation after more than 7 days from diagnosis, appendectomy-specific data should not be collected (OPERATION FOR ACUTE APPENDICITIS= NO INTERVAL APPENDECTOMY).

35 Temperature 38.5 C by Any Route on Postoperative Day 3 or 4 Intent of Variable: To identify if a temperature occurred 38.5 C by any route on postoperative day 3 or 4. Definition/Criteria: Record if patient had a temperature greater than or equal to 38.5 C recorded on postoperative day 3 or 4 by any route. Options: Yes No Additional Guidance: Recording of route is not required. Use calendar day to determine postoperative day; each post-operative day starts at 12:00 am and ends at 11:59 pm (POD#1 starts at 12:00am following the end of the case).

36 Postoperative CT Scan at Any Institution Intent of Variable: To identify whether patient underwent postoperative abdominal and/or pelvic CT scan at any facility (your or outside/referring) within 30 days following appendectomy. Definition/Criteria: Any postoperative CT scan of the abdomen and/or pelvis obtained at any facility (your or outside/referring) within 30 days following appendectomy regardless of ordering physician, stated purpose, findings, impression, or contrast used. Options: Yes No Scenarios to Clarify (Assign the Variable): Any indication of CT completion is adequate to answer YES. This includes any reference to study being performed in nursing or physician notes. It is not necessary to know specific study findings or details.

37 Postoperative Ultrasound at Any Institution Intent of Variable: To identify whether patient underwent postoperative abdominal and/or pelvic ultrasound at any facility (your or outside/referring) within 30 days following appendectomy. Definition/Criteria: Any postoperative ultrasound of the abdomen and/or pelvis obtained as a formal radiologic study at any facility (your or outside/referring) within 30 days following appendectomy regardless of ordering physician, stated purpose, findings, or impression. Options: Yes No Additional Guidance: These studies may be described as limited or complete abdomen, retroperitoneal, right lower quadrant, appendix, and pelvic. This is not intended to be an exhaustive list. Any formal ultrasound obtained should be included.

38 Postoperative MRI at Any Institution Intent of Variable: To identify whether patient underwent postoperative abdominal and/or pelvic MRI at any facility (your or outside/referring) within 30 days following appendectomy. Definition/Criteria: Record if a postoperative MRI of the abdomen and/or pelvis obtained at any facility (your or outside/referring) within 30 days following appendectomy regardless of ordering physician, stated purpose, findings, impression, or contrast used. Options: Yes No Scenarios to Clarify (Assign the Variable): Any indication of MRI completion is adequate to answer YES. This includes any reference to study being performed in nursing or physician notes. It is not necessary to know specific study findings or details.

39 Parenteral Antibiotics at Time of Hospital Discharge Intent of Variable: To identify whether patient was prescribed ongoing parenteral antibiotics to be administered following hospital discharge. Definition: A child prescribed outpatient intravenous and/or intramuscular antibiotics at hospital discharge following appendectomy for continued treatment. Criteria: Record if a child was prescribed outpatient intravenous and/or intramuscular antibiotics at hospital discharge following appendectomy for continued treatment regardless of planned outpatient therapy duration. Options: Yes No Additional Guidance: Documentation of receipt of antibiotics is not required. Any duration of planned outpatient therapy is sufficient to meet criteria.

40 Oral Antibiotics at Time of Hospital Discharge Intent of Variable: To identify whether patient was prescribed oral antibiotics to be administered following hospital discharge. Definition: A child prescribed outpatient oral antibiotics at hospital discharge following appendectomy for continued treatment. Criteria: Record if a child was prescribed outpatient oral antibiotics at hospital discharge following appendectomy for continued treatment regardless of planned outpatient therapy duration. Options: Yes No Additional Guidance: Documentation of receipt of antibiotics is not required. Any duration of planned outpatient therapy is sufficient to meet criteria.

41 Postoperative Emergency Department (ED) Visits Intent of Variable: To identify whether a patient was seen in an emergency department within 30 days following appendectomy regardless of visit reason or location. Definition/Criteria: Record if a child had an ED visit within 30 days following appendectomy to either your or outside/referring institution. Options: Yes No Additional Guidance: Visits to Urgent Care Centers which function as emergency departments should be counted. Each institution should determine whether affiliated and nonaffiliated Urgent Care Centers fit this definition

42 Questions??