>> Welcome to Part 2 of Understanding Your Surgical Site Infections, SSI,
standardized infection ratio as IR using the patient safety components data.
This part of the Quick Learn series is dedicated
to showing you how to troubleshoot your SSI, SIR.
After viewing this video, you will be able
to generate specific line listing analysis reports designed to help the user identify
which procedures are excluded from your SSI, SIR denominator, and the reasons for exclusion,
and determine which events are included in your SSI, SIR numerator.
Please note that this Quick Learn will not discuss introduction to the SSI, SIR.
The SSI, SIR model and numerator inclusion criteria.
The SIR denominator universal exclusion criteria.
And how to generate an SIR report.
Please see the Part 1 of this Quick Learn under the training resources.
In addition, this Quick Learn will not discuss the SIR methodology,
which is detailed in the SIR guide linked here on the screen.
Demonstrating how to troubleshoot your SSI, SIR.
Troubleshooting the SSI, SIR is an important step in understanding your SSI, SIR.
Often, not all procedures that are entered into NHSN are included in the SSI, SIR reports.
Due to inclusion and exclusion criteria, explain in Part 1 of the series.
Next, using a case scenario, we will demonstrate how to determine what procedures
and events are excluded from your SSI, SIR, and the reasons why.
Now, here is our case scenario.
In quarter 2 of 2019, our test facility entered into NHSN 31 in plan in patient COLOs
and 16 in plan in patient HYSTs for adults 18 years and older.
In plan procedures are procedures included are your monthly report and plan.
The facility also entered one event resulting from one
of the COLO procedures from the same time period.
Of the 31 COLOs entered, 19 were included on the complex 30 day SSI,
SIR report, used for CMS reporting.
And of the 16 HYSTs, 10 were included on the same report.
Next, you will learn how to determine the reasons
for the procedure exclusion from this SIR report.
The first step in troubleshooting the SSI, SIR is generating the SIR report.
These steps include data entry, addressing all applicable alerts of missing data,
and generating analysis data sets.
As described in Part 1 of this Quick Learn series, once the Complex 30 day SSI,
SIR report is generated, it presents the data in tables like the screenshots seen here.
The first table on the report contains the SIR data for the specified time period.
The second table titled Incomplete Procedures not Included in the SIR provides a summary
of procedures excluded from the SIR, often due to potential data quality issues.
According to the summary table, the following are excluded;
12 COLO procedures and 6 HYSTs procedures.
To access the line listing procedures excluded from SIR analysis report
in NHSN, follow the following path.
First, select Analysis of left hand navigation bar.
Then select Report and click the Procedure Associated Module folder.
Next, click the SSI subfolder, and click the Line Listing-Procedures Excluded from SIR.
Last step, click on the Modified Report to modify the report.
You can make modifications to your report on the Modify report screen.
These modifications are optional.
In our example, we start by selecting the Time Period tab
and inputting 2019 Q2 as the begin and end dates.
Next, on the Filter tab, we apply filters to limit our report output
to procedure categories COLO and HYST.
Then we select the Display Variable tab to select the variables to include on our report.
On the next slide, I will provide an overview of the display variable tab
and identify the exclusion variables and how they are included on your report.
On the Display Variable tab, you will observe the following three items.
First, if you would like to see the full names of the variables, click the checkbox located
in the top left corner of the screen next to Show descriptive variable names.
You will also get the opportunity to print the list if you desire.
Second, the exclusion criteria variables are included
in the Selected Variable list box by default.
And they are highlighted here for you to view.
Third, the universal exclusion criteria variables are proceeded by excl.
A list of the exclusions and descriptions are available in the quick reference guide
that details how to determine excluded procedures from the SSI, SIR,
and its linked on the resources slide later in this Quick Learn.
An important note here is that the variables excluded underscore SSIs is used to determine
if it's included from the 2006 to 2008 baseline SSI, SIR reports.
This variable is not applicable in any of the 2015 baseline SSI, SIR report,
such as one discussed in this Quick Learn series.
Once you have made all your modifications, then you can click Run.
The Line Listing Procedures Excluded from SIR report output will appear
in a separate HTML window, and will resemble the screenshot on the screen.
For illustration purposes, some of the text in the output are
in bold font to demonstrate teaching points.
The universal exclusion criteria variables are displayed in the columns of the report,
and are proceeded by the letters Excl.
The report output also includes the model exclusion variables proceeded
by the letters excl.
All procedures appearing on this line listing report are excluded from all the SSI, SIR.
Therefore, all the model exclusion variables are set to 1.
The purpose of this report is to demonstrate the reason for exclusion.
If an exclusion or excl variable is set to Y, or yes, then the procedure is universally excluded
from the SSI, SIR report, for the reason indicated.
Please note if all the excl variables are set to N or no and the variable called excluded is set
to Y, then it's because the procedure is linked to a PATOS equals yes event,
resulting in the exclusion of the procedure,
and the event to which it's linked from all the SSI, SIR reports.
Let's review each universal exclusion criteria
for procedures individually using the examples in our line listing output.
In the current slide, the highlighted COLOs are excluded from the SSI,
SIR reports because the procedure duration meets the duration outliers of less
than 5 minutes or greater than the IQR5.
The list of the IQR5 values based on the 2015 national aggregate data is
in the SSI section of the SIR guide.
Another universal exclusion criterion for procedures is the separation
of the inpatient procedures from the outpatient procedures.
Procedures performed in hospital outpatient department or HOPD procedures are excluded
from the SIR reports for the inpatient procedures.
The HOPD procedures are included in a separate SIR report called the All LP SSI Data
SIR report.
These reports are in the same folder as the inpatient SIR reports.
In our examples, the highlighted procedures are excluded from the inpatient SSI, SIR report,
because they are outpatient procedures.
These COLOs are included in the All-Adult OP SSI Data for outpatient procedures
since they meet no other exclusion criteria.
The next exclusion criteria listed here are the exclusion of procedures reported with gender
of other, and those with outlier BMI values.
In our example, the top three HYST procedures highlighted in pale yellow are excluded
from the SSI, SIR reports, because the procedures are performed
in patients whose gender are reported as other.
The procedures highlighted in gold are excluded from the SSI, SIR, because the BMI values
of the patients on whom the procedures are performed meets the BMI outliers of less
than 12 kilograms per meter squared,
or greater than 60 kilograms per meter squared for adults 18 years and older.
The last procedure universal exclusion criterion in our example is the exclusion
of procedures linked to present at time of surgery, or PATOS SSI events.
These procedures will appear on your line listing of procedures excluded from SIR report.
And will show all the excl variables set to N, and the variable called excluded set to Y.
In our example, procedure ID 101295 highlighted in blue is excluded from the SSI, SIR reports,
although all of the excluded variables are set to no.
This is because the procedure is linked to a PATOS equals yes event.
And as previously mentioned in this Quick Learn series,
all PATOS events under the 2015 baseline are excluded from all the SIR reports.
And the procedures to which they are linked are also excluded from the 2015 SSI, SIR reports.
With all of this in mind, if any of the procedures
that meet the universal exclusion criteria is incorrectly entered into the application,
the user can and may make changes to those procedures, save the data,
and update the analysis data sets to reflect the updates.
Now that we have covered how to identify the list of procedures excluded from the SSI,
SIR denominator, and the reasons for exclusion,
let's review how to identify the SSI events included in the SSI, SIR numerator.
Using Line Listing-All SSI Events analysis reports in NHSN, you can generate a list
of SSI events with details about the inclusion and exclusion criteria.
To access the report, first select Analysis on left hand navigation bar and select Reports.
Next, click Procedure-associated Module folder, then click SSI subfolder.
Then click Line Listing-All SSI Events and select Modify report.
On the Modify report screen, select time period tab and input 2019 Q2 as the begin and end date.
Apply a filter to the report to limit output to procode in COLO and HYST.
On the Display Variable tabs, select the variable PATOS
from the Available Variable list to the Selected Variable list.
The exclusion variables are included
in the Selected Variable box by default and are highlighted.
These five SSI event indicators show the inclusion in the SIR numerator.
If the value of the following variables equals 1, then the SSI is included
in the corresponding SIR numerator count.
This applies if the event is not linked to an excluded procedure.
These SSI event indicators demonstrate the exclusion of SSI events
from the SIR numerator by specific model type.
These variables are proceeded by Excl.
The quick reference guide on how to determine SSI event inclusion
in SIR numerator counts is included on the resource slide in this Quick Learn series.
Once you have made modifications, click run.
You can export the report output to Microsoft Office applications
such as Excel or Word document.
The reports output displays the one SSI event that resulted
from a COLO procedure performed in 2019 quarter 2.
According to the details of the event, it's classified as a PATOS equals yes event.
Based on the exclusion criteria discussed above,
the SSI event is excluded from the SIR numerator.
And the procedure to which it's linked is excluded from the SIR denominator.
There are five SSI, SIR event inclusion indicators, one for each of the SSI, SIR models.
In our example, all five SSI, SIR event inclusion indicators are set to 0,
as seen in the highlighted yellow, which means the SSI event is excluded
from all the SSI, SIR report.
The SSI event indicators are highlighted in yellow are used
to determine SSI event inclusion.
If any of the SSI event indicators highlighted in yellow is set to 0,
then the SSI event is not included in the SIR.
For more information about the SSI event indicators, please review the detailed guide
for determining which SSI events are included in your SSI, SIRs.
To troubleshoot the SSI, SIR, which often involves determining reasons
for excluded procedures or SSI events,
users must know the analysis reports to use for the process.
In this Quick Learn, we have learned how to troubleshoot the SSI, SIR using a case scenario
to demonstrate the troubleshooting process.
To summarize, there are universal exclusion criteria apply
to all procedures prior to calculating the SSI, SIR.
A universally excluded procedure is excluded from all the SSI, SIR reports.
The universal exclusion criteria are often due to potential data quality issues
or data outliers determined to result in outlier SIRs, which may not be reflective
of a facility's true performance.
Using various NHSN analysis reports will help users identify procedures meeting any
of these universal exclusion criteria and the reason for exclusion.
Here is a list of analysis resources referenced in this video, which are available
on the NHSN website, including the SIR guide and others.
And these additional SSI analysis resources such as the SSI,
SIR troubleshooting guides, also available on the website.
Here are more SSI analysis resources.
Thank you for your participation and for listening to this Quick Learn.
If you have any additional questions, please contact the NHSN help desk at NHSN@CDC.GOV.