[ Inaudible Chattering ]
>> Hello, everybody, it's me again.
>> And me.
>> It is 1 o'clock and we are going to proceed
with the group exercise using SSI data.
So, we're going to give you about 10 minutes or so
to work together with the people at your table to go
through the scenario and answer the questions.
And we'll check back in with you
and if you have any questions, let us know.
There's a few people from the SSI team who are available.
And then in about 10 minutes we'll check in
and start seeing how you guys are doing
with answering your questions.
[ Inaudible Chattering ]
>> All right, I know that you guys aren't quite finished,
but in the interest of time we're going to get started
with answering the questions.
[ Inaudible Chattering ]
So, just to make it easier, we'll just kind of go from table
to table, question 1, 2, 3, 4, 5, 6, 7 and so forth.
[ Inaudible Chattering ]
Okay, so question one, your hospital follows COLO
And BILI procedures in your monthly reporting plan.
What procedures are you required to enter into NHSN?
B? That's correct.
And that's because NHSN only requires you to enter procedures
that included in your monthly reported plan.
And these rational will be up when we put all the slides up,
so I know you're taking pictures and stuff,
but they'll be available to you when we get all the slides
up after the conference is over.
Question two, what does trauma equal in this scenario.
Correct. And that's because there's a blunt force injury
that occurred prior to the procedure
and the procedure was the reason -- or the injury was the reason
for performing the procedure.
Question three, what does emergency equal
in this scenario?
Correct. And just as a caveat, I kind of left out a key piece
of information that you do need to know.
So, I know Vickie talked about this, you select yes
if emergency is defined by your protocol.
So in this scenario our facility uses that E designation
in the ASA score to designate an emergency procedure.
So that's the reason for this particular procedure
that this is an emergency.
Question four, how is a procedure duration reported
for each of the NHSN operative procedures?
[ Inaudible Speakers ]
Okay, I heard a couple of different answers.
The correct answer is C. And this is done
at denominator reporting instruction number 4.
If you have more than one NHSN operative procedure
through the same incision, you're going
to use the entire duration time for each procedure.
[ Inaudible Chattering ]
Question five, and this is based
on the second part of the scenario.
The wound class for that second procedure was reported
as clean contaminated.
Based on the operative procedure details the IP things
that a higher wound class should be entered into NHSN.
What wound class should the IP enter?
Correct, good.
All right, so question six.
Is this procedure primarily closed
for that second procedure?
You guys are good.
Vickie, you did a good job.
Okay, so, yeah, any portion
of the skin incision closed then we call it a primary closure.
On question seven, what criteria would be most appropriate
to apply?
[ Inaudible Speakers ]
You are right.
so, we have organisms are identified
from the organ space level and you would look at IAB,
because it's from the general intraabdominal space.
And for those of you who went further to identify
which IAB criteria was met, it is 3A,
because you had an organism identified
from nonpurulent fluid and you have at least two
of the qualifying symptoms.
Okay, question eight.
You guys are really good,
I'm getting through this pretty fast.
Which procedure is SSI attributed to?
A? all right, good job.
And that's because, as you know, it's kind of hard to tell
which procedure is really attributable to the procedure,
so we're going to refer you to table 4
and your COLO is your highest risk procedure.
And what would you assign PATOS as?
Good job.
All right, question 10, which hospital would report the SSI
to NHSN and what designation would be selected
in the detected field.
>> C.
>> Oh, my gosh, these guys are really good.
I need to take harder questions next year.
Okay, you guys are right, it's the facility
that performed the procedure that's going
to report it, report the SSI.
And we just ask that, you know, we were talking
about good communication at least
between the facilities before.
If you receive a patient and you think they meet SSI criteria,
that you transfer this information back the IP
at the other facility so they can report the SSI
if they need to.
Okay, question 11, the IP notes
that the index operative procedure was performed
in December 2018 and the SSI occurred in January 2019.
Which SSI surveillance protocol should that IP use?
One more time?
>> B.
>> All right.
They listen to you too, Rebecca.
And as Rebecca told you,
that's because the procedure's what carries the risk,
so that's where we're going to put our numerator in is
with that procedure date.
And now for Rebecca's questions.
>> And I have very few.
So, based on the case that we just went through,
what is the procedure to event days in the above case scenario?
>> Well.
>> Sorry, the answer's already there.
Honor system.
who actually -- alright, so, again,
counting the procedure date as day one, the number of days
between the procedure day and the event day is 17.
Okay, now I just now realize
that I did not apply animation to my slides.
So, the answers are all on the slides.
So this is what we're going to do.
I'm going to ask the questions and I know that it's
in your resource manual and you can tell me the answer before I
move onto the next slide.
Which of the missing denominator details listed below will result
in the exclusion of the procedure
from the SSI SIR.
So, there is A, wound class, B, height, C, weight, D, ASA score,
E, procedure duration, F, diabetes, G is all of the above,
regardless of whether it is used in the risk adjustment
of the SIR denominator, or H, any of the above, if it is used
in the risk adjustment of the SIR denominator.
Awesome, H. All right, next question.
Okay, so the rational, let me put that here,
so you guys if you want to take a picture of it,
as Jennifer said, this will be published with the final slide,
so you'll have access to it there.
But procedures with missing data are excluded from the SSI,
SIR if the missing data is used in the risk adjustment
of the SIR denominator.
However, with that said,
you still should make it a conscious effort to report
or enter complete procedures.
You know, that way you know that you have all that information
in your line list when you run it,
otherwise it will still remain in your incomplete alerts,
unless you have addressed it.
Okay? Oh.
All right, the next question, which SSI,
SIR report will the first COLO procedure
and SSI be included in?
So, the first response categories, adult, all SSI data,
B- pediatric, all SSI data, the C- is adult, complex AR
and then D- pediatric complex AR, E- complex 30 days,
SSI data, F- is A and E, G- is none of the above,
H- is all of the above.
I gave you so many options, just, you know.
So, is it -- okay.
We're good.
Awesome. All right.
And the rational, as you all know, it's an adult procedure
and because the event was detected
at a different facility other than when --
where the procedure was originally performed,
it will not be included in the complex AR,
which then leaves the adult and complex 30 day, the same report.
All right, so the fourth question is,
which analysis report can you use to gather details
on this patient's COLO procedure in a table form?
Line listing, frequency table, line listing procedure excluded
from SSI, SIR, search the database, bar or pie chart.
Okay, it's A, and please pardon what you're about to see.
The sign is on the wrong one.
It's A, it's not frequency, it is A. That's correct.
The line listing
of all procedures contains all procedures
and their correspondent detail.
the line listing of procedures is excluded from the SSI,
SIR is a subset of the all SSI procedures
that meet the universal exclusion criteria.
So the answer is A. Okay.
Okay, which analysis report can you use to gather details
on the SSI event resulting from the patient's COLO procedure?
And it's A. And the rationale is also,
line listing gives you the details of the report.
Okay. Which analysis report, next question,
can you use to gather the account --
to get a summary of the number of procedures that are performed
in a summary time period?
You can --
>> That's not the next question.
>> No, no, it's not, it's a question I'm asking to -- .
Because the answer is already on it.
No, I want to know what report can you use to count,
to get a count of your procedures?
Frequency table
Okay, great.
Wanted to confuse you a little bit there.
All right, so the sixth question, trauma equals yes,
COLOs excluded from the complex 30 day SSI,
SIR calculation used in the CMS report?
Yes or no.
Okay. That's correct, it's no.
All right, that is the end of the analysis question,
except there was a bonus question that in the notes
that you didn't have to go through, but I am curious.
Did anybody -- oh, great.
Just that one table?
All right, I have taken notice of that table and I'll go visit
that table in a little bit.
So, that is the end of the questions.
I did include the answers on here
and if you guys do need access to it, we can --
this is going to be printed -- I mean, with the published slides,
so you have the answers
to the bonus questions available to you.
Okay?
All right, so I'm guessing nobody took this path.
No.
Okay. All right, we are out of time.
So, if you have questions or, you know,
want to go over something,
we can talk about that at a break time.
Thank you.
[ Applause ]