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Healthcare-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration: Location mapping
ARTICLE IN PRESS American Journal of Infection Control ■■ (2017) ■■-■■
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
j o u r n a l h o m e p a g e : w w w. a j i c j o u r n a l . o r g
Clinical Case Study
Healthcare-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration: Location mapping Marc-Oliver Wright MT(ASCP), MS, CIC, FAPIC a,*, Scott G. Decker MPH b, Katherine Allen-Bridson RN, BSN, MScPH, CIC c, Joan N. Hebden RN, MS, CIC, FAPIC d, Denise Leaptrot MSA, SM/BSMT(ASCP), CIC b a
University of Wisconsin Hospitals and Clinics, Madison, WI CACI, Inc., Atlanta, GA c Division of Healthcare Quality Promotion, National Healthcare Safety Network, Centers for Disease Control and Prevention, Atlanta, GA d Independent Infection Prevention Consultant, Baltimore, MD b
This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) health care-associated infection (HAI) surveillance definitions. This specific case study focuses on appropriately mapping locations within an NHSN-enrolled facility. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions among IPs and encourage accurate determination of HAI events. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers and explanations and rationales. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of NHSN HAI surveillance definitions. © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
This case study is part of a series in the American Journal of Infection Control. These cases represent some of the complex scenarios that infection preventionists may encounter in their use of the National Healthcare Safety Network (NHSN). In 2010, Wright et al. published the objectives of this case study series.1 With each case, a link to an online survey is provided, where you may enter answers to questions and receive immediate feedback in the form of correct answers and explanations. All individual participant answers will remain confidential, although the authors intend to share a summary of the survey responses at a later date. Cases, answers, and explanations were reviewed and approved by the NHSN. We hope that you will take advantage of this offering, and we look forward to your active participation. The online survey may be found at https://www.surveymonkey.com/r/Locations2018. To successfully complete this case study, we strongly recommend that you review/reference the following section of the NHSN Patient Safety Component Manual:
* Address correspondence to Marc-Oliver Wright, MT(ASCP), MS, CIC, FAPIC, University of Wisconsin Hospitals and Clinics, Madison, WI 53792. E-mail addresses: [email protected] (M.-O. Wright).
https://www.cdc.gov/nhsn/PDFs/pscManual/15Locations Descriptions_current.pdf The findings and conclusions of this case study are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC). For each question, please select the most correct answer. 1. Rank the following methods for determining patient acuity (critical care vs non-critical care) from best (1) to worst (5). a. Ask the nurse manager or medical director for consensus to the question, “Are 80% or more of the patients requiring ____ acuity level,” and approve the designation through the infection control committee. b. Retrieve recent patient acuity billing data for 1 year. If 80% or more of the patient days in the unit are billed at the same acuity level (eg, critical care), map the unit to the same acuity level. c. Retrieve recent patient acuity billing data for 1 month. If 80% or more of the patient days in the unit are billed at the same acuity level (eg, critical care), map the unit to the same acuity level.
0196-6553/© 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.ajic.2017.12.012
ARTICLE IN PRESS 2
M.-O. Wright et al. / American Journal of Infection Control ■■ (2017) ■■-■■
d. If the unit is called an intensive care unit (ICU) within the organization, it is a critical care unit. If it is not called an ICU, it is not a critical care unit. e. Review the admission/transfer diagnoses for admission to the unit for 1 year to determine acuity on admission. If 80% or more of the diagnoses indicate the need for critical care, map the unit as a critical care unit. 2. A given unit is 60% adult critical care and 40% adult ward, as determined by 1 year’s worth of admission diagnoses. Of the following, which is not an acceptable choice to designate a location in the NHSN? a. Re-analyze the data using an equally acceptable but alternate measure (such as billing data). If this analysis reveals a single acuity level for ≥80% of the patient population, map to that acuity level. b. Map the unit as adult critical care—60% is a majority. c. Map as a CDC mixed acuity location. d. Split the unit into 2 virtual locations. 3. A given unit comprises 50% cardiac surgical critical care, 20% surgical critical care, 20% oncologic surgical critical care, and 10% medical ward. Of the following, which is not an acceptable mapping choice? a. Surgical critical care with the medical ward patients included b. Two separate virtual locations with (1) surgical critical care for the 90% of critical care patients and (2) medical ward for the 10% of medical non-critical care patients c. Two separate virtual locations for (1) cardiac surgical critical care and (2) surgical critical care comprised of the 40% of surgical critical care patients (20% oncologic surgery and 20% surgical critical care) and 10% medical ward patients. d. Medical/surgical critical care 4. An inpatient location for the level III neonatal critical care unit located on the 3rd floor (label=NICU3), which is currently part
of your reporting plan, is being temporarily relocated to the 4th floor (no existing label) while the 3rd floor location is being remodeled. Construction is expected to last 6 months. The patient type and bed size will remain the same. Which method(s) can you use to continue to report data for this mapped unit in the NHSN? a. Change the existing location “Your Code” to match the new code assigned (eg, NICU4) on the day of the relocation and change back to the original (NICU3) on the day the unit returns to its original physical location 6 months later. b. Create a new location code and location type, NICU4/level III NICU, and inactivate NICU3/level III NICU. When the unit reopens, inactivate NICU4 and reactivate NICU3. c. Either of the above. d. Neither a nor b. 5. Your acute care facility performs FacWideIN reporting for LabID events and owns and operates 2 separate offsite emergency departments (EDs) that admit patients to your acute care facility. Of the following mapping, which is not acceptable? a. Map each ED location separately using the CDC location code “OUT: ACUTE: ED.” b. Map the EDs together as 1 offsite ED using the CDC location code “OUT: ACUTE: ED”. c. Do not map these ED locations to the acute care facility.
Reference 1. MO Wright, JN Hebden, KA Bridson, GC Morrell, T Horan. Healthcare-associated Infections Studies Project: an American Journal of Infection Control and National Healthcare Safety Network Data Quality Collaboration. Am J Infect Control 2010;5: 416-8.
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
j o u r n a l h o m e p a g e : w w w. a j i c j o u r n a l . o r g
Clinical Case Study
Healthcare-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration: Location mapping Marc-Oliver Wright MT(ASCP), MS, CIC, FAPIC a,*, Scott G. Decker MPH b, Katherine Allen-Bridson RN, BSN, MScPH, CIC c, Joan N. Hebden RN, MS, CIC, FAPIC d, Denise Leaptrot MSA, SM/BSMT(ASCP), CIC b a
University of Wisconsin Hospitals and Clinics, Madison, WI CACI, Inc., Atlanta, GA c Division of Healthcare Quality Promotion, National Healthcare Safety Network, Centers for Disease Control and Prevention, Atlanta, GA d Independent Infection Prevention Consultant, Baltimore, MD b
This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) health care-associated infection (HAI) surveillance definitions. This specific case study focuses on appropriately mapping locations within an NHSN-enrolled facility. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions among IPs and encourage accurate determination of HAI events. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers and explanations and rationales. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of NHSN HAI surveillance definitions. © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
This case study is part of a series in the American Journal of Infection Control. These cases represent some of the complex scenarios that infection preventionists may encounter in their use of the National Healthcare Safety Network (NHSN). In 2010, Wright et al. published the objectives of this case study series.1 With each case, a link to an online survey is provided, where you may enter answers to questions and receive immediate feedback in the form of correct answers and explanations. All individual participant answers will remain confidential, although the authors intend to share a summary of the survey responses at a later date. Cases, answers, and explanations were reviewed and approved by the NHSN. We hope that you will take advantage of this offering, and we look forward to your active participation. The online survey may be found at https://www.surveymonkey.com/r/Locations2018. To successfully complete this case study, we strongly recommend that you review/reference the following section of the NHSN Patient Safety Component Manual:
* Address correspondence to Marc-Oliver Wright, MT(ASCP), MS, CIC, FAPIC, University of Wisconsin Hospitals and Clinics, Madison, WI 53792. E-mail addresses: [email protected] (M.-O. Wright).
https://www.cdc.gov/nhsn/PDFs/pscManual/15Locations Descriptions_current.pdf The findings and conclusions of this case study are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC). For each question, please select the most correct answer. 1. Rank the following methods for determining patient acuity (critical care vs non-critical care) from best (1) to worst (5). a. Ask the nurse manager or medical director for consensus to the question, “Are 80% or more of the patients requiring ____ acuity level,” and approve the designation through the infection control committee. b. Retrieve recent patient acuity billing data for 1 year. If 80% or more of the patient days in the unit are billed at the same acuity level (eg, critical care), map the unit to the same acuity level. c. Retrieve recent patient acuity billing data for 1 month. If 80% or more of the patient days in the unit are billed at the same acuity level (eg, critical care), map the unit to the same acuity level.
0196-6553/© 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.ajic.2017.12.012
ARTICLE IN PRESS 2
M.-O. Wright et al. / American Journal of Infection Control ■■ (2017) ■■-■■
d. If the unit is called an intensive care unit (ICU) within the organization, it is a critical care unit. If it is not called an ICU, it is not a critical care unit. e. Review the admission/transfer diagnoses for admission to the unit for 1 year to determine acuity on admission. If 80% or more of the diagnoses indicate the need for critical care, map the unit as a critical care unit. 2. A given unit is 60% adult critical care and 40% adult ward, as determined by 1 year’s worth of admission diagnoses. Of the following, which is not an acceptable choice to designate a location in the NHSN? a. Re-analyze the data using an equally acceptable but alternate measure (such as billing data). If this analysis reveals a single acuity level for ≥80% of the patient population, map to that acuity level. b. Map the unit as adult critical care—60% is a majority. c. Map as a CDC mixed acuity location. d. Split the unit into 2 virtual locations. 3. A given unit comprises 50% cardiac surgical critical care, 20% surgical critical care, 20% oncologic surgical critical care, and 10% medical ward. Of the following, which is not an acceptable mapping choice? a. Surgical critical care with the medical ward patients included b. Two separate virtual locations with (1) surgical critical care for the 90% of critical care patients and (2) medical ward for the 10% of medical non-critical care patients c. Two separate virtual locations for (1) cardiac surgical critical care and (2) surgical critical care comprised of the 40% of surgical critical care patients (20% oncologic surgery and 20% surgical critical care) and 10% medical ward patients. d. Medical/surgical critical care 4. An inpatient location for the level III neonatal critical care unit located on the 3rd floor (label=NICU3), which is currently part
of your reporting plan, is being temporarily relocated to the 4th floor (no existing label) while the 3rd floor location is being remodeled. Construction is expected to last 6 months. The patient type and bed size will remain the same. Which method(s) can you use to continue to report data for this mapped unit in the NHSN? a. Change the existing location “Your Code” to match the new code assigned (eg, NICU4) on the day of the relocation and change back to the original (NICU3) on the day the unit returns to its original physical location 6 months later. b. Create a new location code and location type, NICU4/level III NICU, and inactivate NICU3/level III NICU. When the unit reopens, inactivate NICU4 and reactivate NICU3. c. Either of the above. d. Neither a nor b. 5. Your acute care facility performs FacWideIN reporting for LabID events and owns and operates 2 separate offsite emergency departments (EDs) that admit patients to your acute care facility. Of the following mapping, which is not acceptable? a. Map each ED location separately using the CDC location code “OUT: ACUTE: ED.” b. Map the EDs together as 1 offsite ED using the CDC location code “OUT: ACUTE: ED”. c. Do not map these ED locations to the acute care facility.
Reference 1. MO Wright, JN Hebden, KA Bridson, GC Morrell, T Horan. Healthcare-associated Infections Studies Project: an American Journal of Infection Control and National Healthcare Safety Network Data Quality Collaboration. Am J Infect Control 2010;5: 416-8.