Colorado Trauma Registry Colorado Trauma Network

Prepared by Health and Safety Data ServicesJuly 2014

• Topics• Hospital discharge dispositions (see handouts)

– Difficult to code certain disposition scenarios

• Base reporting timeframe on the state application (admit vs. discharge date)

• Questions to the state – topics for discussion• ICD-10 impact on TR manual – potential topic for

December meeting – looking for help!

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DRAFT 3

Hospital Discharge Dispositions

Hospital Discharge Dispositions

• Error on Example in TR manual (page 49; see handout)“If the patient came from a SNF and returned to the SNF after admission, the hospital discharge disposition should be SNF, not home”

• Aligning with NTDB, Field value = 6, “home” refers to the patient’s current place of residence (e.g., prison, Child Protective Services)

• Correct: patient returned home“If the patient came from a SNF and returned to the SNF after

admission, the hospital discharge disposition should be HOME”

DRAFT 4

Hospital Discharge Dispositions

• Situation: Difficult to code certain health care dc disp. – Is a new code needed for assisted living? – Should assisted living code to intermediate care facility (ICF)? – Should skilled nursing facility (SNF) and nursing home be

combined?– How to code a pt who tx out of acute care but remained in

the hosp? - Modified LTAC• Bottom line:

– Need clarification for appropriate coding

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Discharge Dispositions

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N# National Elements CDPHE Elements (from Current Data Dictionary 2014)

1 Short-term g. hosp. for inpt care ACUTE= acute hospital (N1)

2 Intermediate Care Facility ICF = intermediate care facility (N2)

3 Home under health sev. HH = home under care of home health agency (N3)

4 Left against advise AMA = left against advice (N4)

5 Expired D = died after admission (NOT in the ED) (N5)

6 Home w/ no home services HOME = home with no home health services (N6)

7 Skilled nursing facility SNF = skilled nursing (N7)

8 Hospice care HOSPICE = hospice care (N8)

9 RET. Rehab & Long-term

10 Court/law JAIL = jail, prison, or other detention facility (N10)

11 Inpt. rehab or design. unit REHAB = rehabilitation (N11)

12 Long-term care hosp LTAC = Modified LTAC (see handout)

13 Psy. Hosp/ psy unit of hosp. PSYCH = To inpatient psychiatric care…may be another facility or a division of the same facility. (N13)

14 Another institution not defined elsewhere

DSS = Dep. Soc. Serv. (N14)OTHER = Other (N14)

?N2 or ?N7 or ?N12 or… NHOME= nursing home

?N12 or… ‘Long-stay’ patient scenario ...Modified LTAC (see handout)

?N2 or ?N3 or ?new element or… Assisted living ?

Hospital Discharge Dispositions

• Ideas from CMShttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0801.pdf

• Ideas from TJChttp://manual.jointcommission.org/releases/TJC2012B/DataElem0247.html

• Should assisted living code to ICF?

• Is a new code needed for assisted living?

• Should SNF and nursing home be combined?

• How to code a pt who tx out of acute care but remained in the hospital?

DRAFT 7

DRAFT 8

Download to the State Trauma Registry(Admit vs. Discharge Dates)

– Reporting method on the state trauma application:• Should the data be based on admission or discharge date?• Most items discuss “number of patients admitted…”

– Things to consider• For the state, neither method impacts our data analysis• Colorado Hospital Association (CHA) is based on discharge date • ‘Discharge’ – # of outcomes for the year• NTDB title reads “2014 Admissions”

DRAFT 9

Download to the State Trauma Registry

Questions for State – Topics for Discussion

DRAFT 10

Questions for State

EMS reports/ambulance v. ED documented arrival times can vary up to an hour or more. Currently auto fills to the ambulance arrival time so if it is off, it will extend our ED length of stay. In other cases, the ambulance arrival time is LATER than our ED arrival time, so it will cause an edit. We would like to propose that we use the ED arrival time instead of the arrival time from the ambulance report. Is this the state’s intention that we use strictly the EMS information?

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Questions for State

• Documentation of drug presence– ED staff administer opiods vs. possible

recreational/abuse use pta

DRAFT

12

Question for State

• Are we able to identify the number of patients being discharged to jail?

– Discharge dispositions• JAIL• HOME*

– *NTDB: "home" refers to the patient's current place of residence (e.g., prison, child protective services, etc.)

DRAFT 13

ICD-10 Transition…

Will require a rewrite of some sections of the TR Manual

Perhaps start with Appendix V – ICD9 Codes

– should be the largest section that needs changes

Will need new codes, decision trees, Colorado specific rules, etc.

Hoping to have a draft prepared for the December meeting

Anyone interested in helping with the rewrite, please contact: scott.beckley@state.co.us

DRAFT 14

Contact us!

• Health Facilities and EMS DivisionColorado Department of Public Health & Environment4300 Cherry Creek Drive SouthDenver, CO 80246-1530Phone: (303) 692-2980Fax: (303) 691-7720 www.coems.info

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