CITNs
Elderly patient with dementia undergoing matrixectomy in clinic for great toe paronychia. Patient had both great toes involved, but wife only consented for Right toe, since the wife stated he is only displaying pain on that foot. They would proceed with conservative management for the other. Resident was asked to provide local toe block while the attending discussed post operative care with wife. Later it was noted that resident injected local lidocaine to Left great toe. The attending noted the discrepency upon returning to room and proceeded with correct toe. Would this be a CITN
Patient had a breast implant removal for non healing breast lesion, with suspicion indolent infection from implant. During surgery, the operative note indicates dense encapulation of implants noted and no sinus identified. Cultures taken and patient placed on IV antibiotics post operatively, pending results of Cultures.
Clean: Clean/Contaminated II
No evidence, pus, inflammation or apparant infection, however component contamination from implants suspected. Do not base on culture results.
If the creatinine is slowly increasing from a preoperative value of 0.57mg/dl to a postop final 5.0mg/dl before trending down, for the postop progressive renal insufficiency variable, which date does the SQN enter into the assessment? Date creatinine level reached 2.58 mg/dl or greater Date of maximum creatine level reached of 5.0 mg/dl
Date creatinine level reached 2.58 mg/dl or greater.
A veteran was diagnosed with acute renal failure (ARF) and ordered dialysis the same day. The central line catheter was put in late that evening and dialysis was initiated early the next day. The SQN should enter the ARF requiring dialysis on the date of the diagnosis even though dialysis did not start until the next day? FALSE TRUE
What is TRUE
True or False: If in a status report, a facility has 50 or more EBNAs, NSO will notify Facility SQN, Facility Chief of Surgery, VLSN, VCSC, VISN CMO and VISN Director.
What is FALSE. VISN Director is not notified and instead, Facility Chief of Staff is notified
While undergoing Nissen, surgeon inadvertently causes rent in distal esophagus requiring repair. Is this a CITN?
What is NOT a CITN. This is risk associated with surgery
Patient undergoes Below knee guillotine amputation for limb threatening ischemia. Wound vac applied and patient scheduled for formal closure in 5 days. What wound class would you assign?
Contaminated: Class III
Open wounds with wound vacs leaving OR are considered contaminated.
Patient seen on postop day 15 after total knee arthroplasty. Exam of the knee demonstrates cellulitis and small amount of fluctuance at incision. The knee remains stiff but gradually improving. Patient is a diabetic. He is prescribed Keflex for 5 days by the surgeon. No cultures, no fever, no labs drawn. What is the correct response for the superficial surgical site infection variable? No Yes
What is NO. Does not meet any definitions.
A veteran experienced preoperative renal failure and was treated with continuous renal replacement therapy (CRRT) but the treatment was stopped 7 days preoperatively. He had his scheduled surgery and then had an exacerbation of renal failure with treatment plan of hemodialysis postoperatively. The veteran refused dialysis. Which is correct response for postoperative acute renal failure requiring dialysis variable? No Yes
Answer NO. nOT A new renal failure since had CRRT pre-op period
65 y o gentleman heavy tobacco use underwent stenting renal arteries. Would you assign PAD?
What is NO. Unable to validate peripheral involvement.
Attending surgeon gets burned from the Bovie, and subsequently changes sterile gloves, proceeding with surgery. No treatment required. Is this a CITN?
No - CITN
OR burn is an An Operating Room where no treatment rendered, is not a CITN
Patient undergoes myringotomy for chronic otitis media. What wound class would you assign?
Dirty/Infected. Wound Class IV
Intraoperative record: Primary Surgeon: Chief resident Dr. A, PGY 5. First Assist: Resident Dr. B., PGY 3. Attending Surgeon: Dr. C. What is the correct response for post graduate surgical year variable? 0 1 2 3 4 5 6 7 8 9 10 11 12
Correct answer: PG 5
Patient was admitted on March 7 for a Left Total Hip Arthroplasty. Admission and course uncomplicated. Patient presented to emergency department on April 10 for dizziness, dehydration, diarrhea x 2 days. Afebrile. Pt re-admitted for observation and hydration. Stool CS collected, later (+) for C.diff, discharged home on Flagyl. Which is the correct response for postoperative clostridium difficile colitis variable? No Yes
Correct answer: NO, >30days
How many status reports are there, prior to final download each Quarter? 2,3,4 or 5?
What are 4.
Patient had a cardiac arrest in same day surgery and died. Is this a CITN?
Yes, patient was in OR suite
Patient underwent elective cholecystectomy. During removal of sac, there was mild amount bile spillage in operative field, otherwise no gangrene or inflammation encountered. What wound class would you assign?
Contaminated: Class III
Patient is admitted for hernia surgery and undergoes a laparoscopic hernia repair. He is administered a regional block for anesthesia. During surgery adhesions are encountered so a general anesthetic is administered. Which is correct response for the principle anesthesia technique? General, Monitored anesthesia care, Spinal Epidural, Regional, Local, No anesthesia
What is General
The Pt. is admitted to the hospital via the emergency room with a diagnosis of abdominal pain and diarrhea. He was tested at an outside facility for C-difficile toxin and was positive (documented in H&P). On admission to our facility he was retested for C-difficile and the toxin was negative. 3 days later his abdominal pain continues, and an open colectomy is performed he is started on ABX post-op. Post-operatively, his abdominal pain re-presents along with watery stools. His WBC spikes to 15,000 and he becomes febrile to 102. A C-difficile toxin is performed and is positive. Which is the correct response for postoperative clostridium difficile colitis variable? No Yes
What is YES. Meets definition
The NSO EBNA are not captured in the status reports until >30 days have lapsed. True/False?
What is False. NSO EBNA are not captured and displayed until 45 days post DOS.
Patient presents to ED with suspected ruptured AAA in extremis. Upon ED and surgeon discussing with family, patient codes and unable to be resuscitated. He eventually dies in ED. Is this a CITN?
No it is not a CITN. Patient died in ED and not during time frame of entering OR suite/pre-op holding.
Patient underwent an uneventful elective vasectomy. What wound class would you assign?
Clean/Contaminated: Class 3II
Patient underwent a transurethral resection of bladder tumor (TURBT) and has an anterior bladder resection. The next day, patient is taken back to surgery for laparoscopic repair of posterior bladder wall blow out. Op note states post diagnosis is repair of iatrogenic bladder perforation. What is the correct response for the wound disruption variable? No Yes
What is NO. Not part of operative myofascial layer.
Patient is a 65 Y/O MALE s/p cervical laminectomy December 8 and admitted to the postop surgical floor. Returned to the OR December 11 for hematoma evacuation. Patient admitted to ICU on ventilator for airway protection. Dec 12 patient agitated and self extubated. MD placed patient on CPAP after self-extubation until Dec 15. What is the correct response for post-op ventilator > 48 hours variable? No Yes
What is NO, since CPAP is not an intubation or ventilator, therefore would not meet definition.
The NSO status reports are visible to the VLSN, facility SQN and VISN VCSC. True/False.
False. Status reports are only visible by VLSN and facility SQN