Report Plus Q & A
In the NSO Quarterly Report, a patient's death is reported under which surgery for the predicted and observed 30-day mortality graph?
First CPT eligible and assessed surgery
Veteran consumes three shots of whiskey every evening after work (Monday thru Friday) for the past 20 years. He denies binge episodes. He denies drinking on weekends. Patient does not have a history of delirium tremens or withdrawal. What is the correct response for the ethyl alcohol/ETOH variable?
Yes
Pt undergoing topical chemotherapy for skin cancer within 90 days prior to surgery.
What is do not capture topical chemotherapy.
In the NSO Quarterly Report, a patient undergoes multiple surgeries in a 30 day period and expires. The death is reported under which surgery for the 'unadjusted 30-day mortality graph'?
Last surgery, regardless of CPT eligibility
Postop day four, patient complains of dyspnea. Noted to have rales on exam. Chest x-ray showed new consolidation in left lower lobe. Surgical intensivist notes possible pneumonia. What is the correct response for the postop pneumonia variable?
No
The patient was admitted to the hospital at 9:30 am. The surgeon decides the patient needs surgery as soon as possible. Anesthesia agrees. Patient is added on to the OR schedule to follow surgical specialty cases at the end of the day. The OR case started at 5:00 pm that day. What is the correct response for the surgical priority variable?
Emergency
Is there a specific timeframe determined by NSO in which a surgery request in VistA must be converted to scheduled by the OR scheduler?
VHA Directive 1128, Timely schedule of surgical procedures in the operating room, requires a ‘REQUEST’ for surgery be entered into the electronic health record (VistA). NSO does not have a required timeframe for when conversion from requested to scheduled case occurs. This is a local facility decision. NSO does encourage facilities to review final schedule several days prior to day of surgery to help facilitate filling the OR schedule. The conversion date does not affect the cancellation rate for the facility, as NSO does not include cancellations prior to 48 hours of day of surgery.
Veteran underwent total knee arthroplasty surgery. Patient returned for postop clinic visit on day ten. Upon exam, Nurse Practitioner (NP) notes erythema at incision site and able to express a small amount of purulence. Veteran admits to taking baths despite being instructed to avoid them. NP prescribed antibiotics. What is the correct response for the superficial surgical site infection variable?
Yes
Patient completed all his activities of daily living independently prior to admission to hospital for acute fracture. He was put on bedrest two days before surgery. He continues to feed and dress himself but requires assistance for bathing and toileting. What is the correct response for the functional health status variable?
Partially dependent
Facility has 2 concurrent mandatory cases: ENT-esophagectomy and General surgery -gastrectomy. Are both required to be assessed?
Per VASQIP Operations Manual, ‘mandatory cases may not be excluded for any reason'. Yes, both are required to be assessed.
Veteran underwent left knee arthroplasty. Postop clinic visit, patient demonstrates continued pain and decreased range of motion. Patient is febrile. X-ray demonstrate fluid collection in the prosthetic joint. Patient returns to the Operating Room for washout. Intraoperative findings include presence of pus and intraop cultures returned positive for staphylococcus. What is the level of surgical site infection is this scenario?
Organ/Space pending attending confirmation
Patient had been hospitalized for five weeks preop and underwent a VASQIP eligible surgery. Prior to hospitalization, he lived at home. What is the correct response for the pre-op current residence variable?
Acute care facility
In the NSO Quarterly Report, a patient's death is reported under which surgery for the predicted and observed 30-day mortality graph?
What is the First CPT eligible and assessed surgery?
Remember: Adjusted 1st surgery
Unadjusted Last surgery
Veteran underwent right carotid endarterectomy. New onset left arm weakness was noted in post anesthesia care unit. Per neurologist and radiologist, an ischemic stroke was likely caused by embolism. On postop day four, patient was able to move his left shoulder and squeeze hand, but remains unable to lift left thumb. What is the correct response for the postop stroke/CVA variable?
1) no symptoms
2) symptomatic duration less than 24 hours
3) symptomatic duration of 24-72 hours
4) symptomatic duration >72 hours.
>72 hours
When interviewed by the Emergency Department physician during the patient’s intake exam, patient states that in the last few months he has noticed it is harder to “catch his breath” when carrying his groceries from his car to the house. He has lived in the same two story home for years and will have to move as he can no longer climb the stairs without getting short of breath. Patient has diagnosis of Congestive Heart Failure (CHF). What is the correct response for the preop CHF variable?
CHF with moderate symptoms