CITN
Does a fire in the hallway of the OR count as a CITN if no patient is in the room?
Yes
A CITN is used to identify patient risks and to improve safety. A fire any where is a potential safety risk
A patient has a focal right gastrocnemius blood clot on dopplers studies Is this a DVT
A gastrocnemius vein thrombosis would not be included in the definition of DVT. Calf veins are not defined as part of the "deep venous system"
Patient had necrotic foot d/t complications from peripheral ischemia r/t 150 pack years of smoking. Surgeon performed below knee amputation where the incision was clean without infection
CLEAN Incision was in a clean area
Please provide information as to how the Surgical Quality Nurse calculated the 10% exclusion rule so as not to go "over the limit".
Recommend tracking the 10% rule exclusions made throughout the fiscal year by looking at your latest Transmission Query Report. This will give an idea of the amount used so far and allow you to project the available number of exclusions for the rest of the FY. The 10% rule will be applied to the 4 quarters in the fiscal year. The NSO highlights the percent of cases that are excluded using the 10% rule in each NSO Quarterly Report if that percent is higher than 10% based on the total number of cases in the previous fiscal year
A non-Veteran has surgery at a VA facility and the CPT code assigned is a VASQIP eligible procedure. Does the SQN assess this case?
No, Non-Veteran care is not included in VASQIP. Exclude using the exclusion rule: inclusion criteria not met. Exception: if the non-Veteran is a live donor to a Veteran recipient, then the live donor non-Veteran becomes a collateral to the Veteran Recipient, and is included in VASQIP for assessment. Must send in Field Comm to alert NSO non veteran surgery
WHO CAN ENTER A CITN?
CHIEF OF SURGERY
SQN
OR NM
C&S + STAPH EPI AND DEEMED A CONTAMINATE BY ID. CAN THIS BE USED FOR SEPSIS?
The initial information included a (+) culture, the case fell within the definition of sepsis. However, once the ID consultant deemed the culture to be a contaminant, the culture should no longer be included in the assessment. Consequently, it did not meet the definition and this was not sepsis
Patient underwent a vasectomy
Clean/contaminated
Incision into reproductory tract = 2
What happens if the facility’s coders have not completed coding surgical cases by the end of the fiscal year?
Surgical cases in the VistA Surgery Package must have a CPT Code assigned by official coding personnel and entered into VistA File 136. If an abbreviated case record is received by the NSO before final coding in File 136 is complete, the NSO cannot determine whether or not the surgical case should be included or excluded in VASQIP. Any surgical case without a principal CPT code will not be included in the NSO Quarterly Report analysis and will not be included in the facility’s denominator of total surgical cases performed. It is critical that surgical cases are officially coded in a timely manner and per policy. Please note: any surgical cases that have not been assigned a CPT Code within the fiscal year will not be included in the facility’s surgical case denominator for that year. Rolling 12-month data will reflect the lower case volume.
A facility has requested to provide a report of VASQIP complications for surgeon privileging.
This is not allowed as VASQIP is 38 U.S.C. 5705 protected as a quality assurance activity. Please see VHA Directive 2008-077,Quality Management( QM) and Patient Safety Activities That Can Generate Confidential Documents
ATTENDING SURGEON GETS BURNED FROM THE BOVIE, IS THIS A CITN?
YES CITN OR Burn – An OR burn is an iatrogenic and unintended tissue (skin, bowel, liver, etc.) injury causing harm to a patient or staff member due to fire, electricity, hot gases, hot liquids, or chemicals occurring in the Operating Room or Post Anesthesia Care Unit during an episode of patient care. Included are burns due to fires, electrocautery, electrical shock, fiberoptic light cables, heating pads, lasers, or prep solutions.
** Note burn is not the same as "zapped" The burn must cause harm"
It was documented that after the UPPP the sleep apnea was corrected and he no longer had to use CPAP. The question was whether or not to answer "yes" or "no" to the sleep apnea question
The answer is "no" as there is clear documentation that the sleep apnea was corrected
Is a rectal-urethral cutaneous fistula considered an open wound?
Yes. An open wound is a wound in which the injured tissues are exposed to air. An urethro-cutaneous fistula connects the urethra with the skin.
How does a SQN update the data sent to NSO for 1-liners, non-VASQIP assessed cases, after a correction has been made to the Intraop Nurse Record (e.g. Timeout checklist answers, counts, times…)?
Per the VASQIP manual: For abbreviated case records in VistA, select the Update 1-liner Case Menu from the Risk Assessment Menu [SROA ONE-LINER UPDATE]. Select patient and case, which opens the “edit” screen. Make changes if applicable. This automatically queues the specific case for transmission. Therefore, if the nurse intraop record is updated, the SQN will need to follow the above process in VistA to retransmit the non-assessed cases data to NSO.
If a patient is scheduled for an elective thoracic aneurysm repair and arrests on the stretcher (due to dissection) just before he is being moved to the OR table and prior to anesthesia induction, does the surgical priority change from elective to emergent?
The patient unexpectedly decompensated prior to initiating the surgery. The fact that the surgery had been scheduled is trumped by the fact that the patient arrested prior to the surgery and interventions were emergently initiated, therefore list the case as emergent
PATIENT DIED ON POD DAY 2 FROM HEMORRHAGE BC THE ARTERIAL GRAFT CAME APART, IS THIS A CITN
NO Death from Hemorrhage within 24 Hours of Leaving OR – The patient died within 24 hours of leaving the Operating Room as a result of complications from bleeding directly related to the procedure
Should a pre-op risk assessment be amended to reflect pre-op conditions that were not discovered until post-op?
No. The preoperative variables are intended to reflect the patient's status as it is known prior to surgery according to the given definitions.
RETURN TO SURGERY FOR HEMATOMA EVACUATION OR DELAYED WOUND CLOSURE
CLEAN
(CLASS IV IF PURULENCE NOTED)
A Veteran is admitted to one facility but is soon transferred to another VA for a urological surgical procedure which is deemed VASQIP eligible by CPT. A week later, he subsequently returns to the original facility and ends up having another urological surgical procedure there as well, which is also deemed VASQIP eligible by CPT. So within the one week he has had surgical procedures at two different VA medical centers. The following week, he develops a UTI and ARF. Which of the facilities, or both, claim the post-operative occurrences?
In terms of eligibility, these are two separate cases and both would be assessed individually by the respective facility. The initial surgery is the 1st eligible surgery for the patient. Therefore, because these two procedures fall into the "multiple cases within 30 days" rule (the same patient), only the first case would be included in the VASQIP analysis. Both facilities claim the post-op occurrences; these will be reflected in each facility's Data Viewer
A patient came to the ED with an incarcerated hernia and is taken to the OR. He is given a MAC and since he relaxed, the hernia was manually reduced and no incisions were made. Should this eligible case be assessed since no incision was made?
If there was no incision, then there was no surgery and the case would not be assessed. This would be considered an aborted case.
THE XRAY IS MARKED FOR THE WRONG PT. BC OF THIS, THE SURGEON OPERATED ON THE WRONG FOOT IS THIS A CITN?
No The definition does not include incorrect procedures performed outside the operating room suite or an incorrect surgery performed in an OR as a direct result of an incorrect or wrong pathology report, lab result, or radiograph.
Patient had an exploratory laparotomy and is POD #1. He is confused and extubated himself in ICU. He was reintubated within 15 minutes. What is the correct response for the Out of OR intubation variable?
YES BRING IT ON LOL
BURN DEBRIDEMENT
CONTAM BURNS ARE ACCIDENTAL
DIRTY IF PURULENT
How can a specialty service have an OE ratio of 3.2 for example, and not be an outlier?
This occurs because of the wide Confidence Interval potentially due to a small sample. This is a statistical term. Please refer to the NSO Quarterly Report Interpretation Document for further guidance on Confidence Intervals. See: NSO Quarterly Report Interpretation Document or Tutorial on Quality
WHO IS THE BEST VLSN IN VISN 4 HISTORY
THANK YOU, THANK YOU VERY MUCH :)