>> Welcome to the National Healthcare Safety Network, or NHSN, Quick Learn Series.
These are brief, informative presentations from the Centers for Disease Control and Prevention,
they serve as an educational resource for healthcare facilities,
working to prevent healthcare associated infections, or HAIs.
This Quick Learn will provide an introduction to location mapping
in the patient safety component of NHSN.
Now, by the end of this Quick Learn, the user will be able to discuss the importance
of accurate location mapping in NHSN, define key terms used in mapping locations,
describe the NHSN mapping rules, and outline the steps to define and map a location in NHSN.
This Quick Learn will end with a knowledge check,
which will go over common mapping scenarios and the possible mapping options in these scenarios.
The NHSN location types have been developed
to identify populations within different facilities.
NHSN tries to categorize these patients and incidence of HAIs
and other events in "like populations."
These patients are going to have similar risk of HAIs.
They could have similar devices, similar invasive procedures,
and they may have similar host factors.
NHSN surveillance modules, especially the patient safety component,
utilize the location type as a risk factor.
It is really important to correctly map locations in order
to understand how HAI rates are split by each individual location type.
NHSN pulls the mean rates by location type.
So if a location is incorrectly mapped, it can affect the validity of not only your local data,
in comparison to the national data, but also our national database.
If your facility contributes to your state Health Department's data,
incorrectly mapping a location could impact your state's metrics,
and may require some additional validations on their part.
NHSN promotes the correct location mapping from the first time the location is used.
Mapping your facility's locations and units
within your hospital incorrectly limits the ability
to compare your facility's HAI data to the NHSN data.
It compromises the data validity for identifying trends in HAIs.
This is a decision flow chart to outline the steps for defining mapped locations in NHSN.
We will walk through each step in the flow in slides.
Step one is to review the patient mix.
Step two is to define the acuity level, and step three is to define the type of service.
We will start with step one of mapping a location which is reviewing the patient mix.
Each patient care area in a facility that is monitored
for NHSN is mapped to one room or CDC location.
The specific location code is determined by the type of patient that are cared for in that area,
which is also known as the patient mix.
NHSN recommends the facilities review patient data in that unit
for the last full calendar year to determine the patient mix.
If a full year is not available, then facilities should review the data of at least three months
or any data available for that unit.
Acuity billing data should be reviewed to determine the patient mix
since it is considered the most accurate depiction of the patient's illness and reason
for being admitted to a particular unit.
If this data is not available, the next best option is
to review admissions and transfer diagnosis data.
After reviewing the available data to determine patient mix,
the next step is to determine the acuity level.
The 80% Rule should be applied when determining acuity level
for a unit based on the patient mix data.
If 80% or more of the patients in an area are the same acuity level,
then the user can continue on to step three of the mapping flow chart.
If the unit does not meet the 80% rule for acuity level then virtual locations
or mixed acuity can be considered for mapping the unit.
Virtual locations are used in NHSN when a patient care area is unable to meet the 80% rule
for a location destination, but the facility still wants to report its surveillance data
for each of the major patient types in that unit.
If your facility is capturing patient days and device days electronically,
it is recommended to talk to the IT department
or the electronic health records system administrator to discuss the possibility
of this data to be split to accommodate virtual locations.
Mixed acuity units are intended for locations that are comprised of patients
with varying levels of acuity and do not meet the 80% rule.
If you decide to map a location using the mixed acuity designation,
be aware that NHSN does not plan to publish national pooled mean rates
for this location type at this time.
Finally, mapping locations using the mixed acuity designation could have implications
on data reported for the CMS hospital inpatient quality reporting program.
More information on mixed acuity units can be fond in Chapter 15 of the Patient Safety Manual.
We have reviewed step one, defining and mapping locations in NHSN,
and step two, defining the acuity level.
We will now review step three, which is define the type of service.
In this step, we will review how to define
if the location is a designated specific service type, or if it is a general medical,
surgical, or medical-surgical unit.
If the location is a specific service type, then the 80% Rule should be applied.
If the location is a general medical, surgical, or medical-surgical unit,
then it will be determined by following the 60-40 rule.
If 60% of patients of a unit are either general medical or surgical patients,
then the location should be mapped with the majority of the patient mix.
If the mix of patients does not meet the 60-40 rule,
then the unit should be mapped as a medical-surgical location.
If the unit does not meet either rule, then other mapping options to consider would be
to map a single combined medical-surgical location, or virtual locations.
It is important to note that 100% of patients in this unit should be included
in your surveillance data regardless of the patient type.
Now that we have covered the introduction to location mapping in NHSN,
let's go over some common mapping scenarios encountered by users,
and provide recommendations for mapping based on the information we have learned today.
Here is a simple example of how to apply the 80% Rule
when mapping a new location in the NHSN application.
Let's say you have an intensive care unit, and 85% of patients
in that unit are burn patients, and 15% are trauma patients.
Please pause the video, and take a moment to determine the acuity level
and patient mix, using the information provided.
After reviewing the information, this unit meets the 80% Rule for the acuity level,
because 100% of patients are critical care patients, and it also meets the 80% rule
for specific service, because 85% are burn patients.
This unit should be mapped as a burn critical care unit, and all patients,
regardless of service type should be included in the surveillance efforts for this location.
Scenario 2 is an example where the 80% Rule is not met when mapping a new location in NHSN.
Let's say you have a unit, and 60% are medical ICU patients, and 40% are step-down patients.
The unit does not meet the 80% rule for acuity level, therefore the unit couldn't be mapped
as a medical ICU or a step-down unit alone.
Please pause the video and take a moment to determine the acuity level
and patient mix, using the information provided.
One way of mapping this unit is by using the mixed acuity designation.
As mentioned earlier, using this designation may have implications on data
that your facility reports to CMS, or your state's reporting mandate.
So it is important to take this into consideration
when mapping a location using the mixed acuity designation.
Here is another way you can map the same unit using virtual location.
Let's say your facility would like to follow HAI surveillance for each acuity level separately
by keeping those patients separate.
So, for this particular unit, you would have two locations in NHSN to report.
Please pause the video and take a moment to determine the acuity level and patient mix,
using the information provided, if you were to map this unit as two virtual locations.
If you want to split this area in two virtual locations by acuity level,
the first location could be mapped as a medical critical care unit in NHSN,
because 100% of patients are critical care acuity level in general medical service type.
The second location could be mapped as a step-down unit,
because 100% of patients are step-down acuity level.
In terms of surveillance, you would collect and enter data for each
of these NHSN virtual locations separately, and you would obtain rates,
standardized infection ratios,
and a standardized utilization ratio for each location separately.
We have reached the end of this Quick Learn on Location Mapping.
In addition to the information provided in this Quick Learn, there are many resources available
on the NHSN website for location mapping,
including the location description chapter in the NHSN Manual.
Here are the links to these resources.
If you have any questions regarding the content of this presentation,
please contact us at NHSN@cdc.gov.
Thank you for your attention.