- [Sunny] Hello, everyone.
My name is Sunny
and I am an analyst
on NHSN's Acute Care Analytics Team.
This presentation is part of the 2022 NHSN Annual Training,
and will focus on the MDRO/CDI modules,
LabID event reporting.
Specifically, we'll cover topics
such as locations and FacWideIN reporting
in acute care hospitals.
The objectives for this presentation
are to define FacWideIN
and where it is used in the MDRO/CDI patient safety module.
We will identify locations
that are not covered by FacWideIN.
And then understand how LabID events and summary data
are reported under FacWideIN.
And then finally,
we'll walk through an example
of how to identify FacWideIN reporting
through the NHSN analysis reports.
Okay, so let's start with answering the question,
what is FacWideIN
and what does it stand for?
I think this is sometimes a common question
we will get among new NHSN users,
since it is different
from the other NHSN locations you may see.
So, FacWideIN is an abbreviation,
and it's commonly used in NHSN
for the MDRO/CDI module.
And it stands for facility-wide inpatient.
It's a location group identifier
that covers all inpatient locations
physically located in the facility
where denominator data are collected.
So, this would include locations such as ICUs,
wards, step-down units, mixed acuity units,
any of these types of inpatient units
that you map in NHSN
are covered by this FacWideIN location group identifier.
And unlike other NHSN locations,
FacWideIN cannot be mapped
in the locations manager.
So, let's go over where in NHSN
that we see FacWideIN use,
specifically in the context of reporting
for the MDRO/CDI module.
So, firstly, we see FacWideIN
as a selection on the monthly reporting plan.
So, if your facility is following LabID event reporting,
you've likely selected FacWideIN
on your monthly reporting plan
underneath the MDRO module section.
So, we can see here on the screen
that FacWideIN
is selected under the locations dropdown.
This is under the MDRO module.
And then, of course,
in the dropdown to the right of that,
you can choose which specific organism type
your facility would like to follow
for FacWideIN reporting for that month.
We also see FacWideIN
on the summary forms
that collect denominator data.
So, denominator data is collected monthly
for the MDRO/CDI module LabID event reporting.
And for acute care hospitals,
there are multiple lines
of denominator data that is collected
on the FacWideIN summary form.
So, as a quick review,
we can run through the screen.
We can confirm at the top of the summary form
the location code is FacWideIN
or facility-wide inpatient.
And then if we look to the general section,
line one of this FacWideIN summary form
is collecting patient days and admissions
from all of the inpatient units in the facility,
followed by line two and line three
where there are some location exclusions.
So, you may need to subtract patient days
and admission counts from certain units
from the totals in line one
for these next two lines.
And this is only applicable to your facility.
And finally, we see FacWideIN referenced
in the NHSN analysis reports.
If your facility is interested
in rates at the FacWideIN level,
they can be found in the rate tables reports
under each organism folder.
And then of course, SIR is for MRSA,
and CDI LabID are calculated
at the FacWideIN level
for acute care hospitals.
And you can see that indicated
in the SIR report titles
and within the report as well.
So, let's now talk about locations
that are not covered
by the FacWideIN identifier.
So, emergency departments and 24-hour observation units
are considered outpatient locations by NHSN.
And so, these units are not covered by FacWideIN.
This is why,
if you are following FacWideIN LabID event reporting,
ED and 24-hour observation units
need to be added separately
to the MDRO/CDI section
of the monthly reporting plan.
And then, of course,
they have separate summary forms
that need to be completed as well.
And the reason ED and 24-hour observation units
need to be additionally added
when following FacWideIN LabID event reporting
is because the data from these units
are used in risk adjustment
for the SIR calculations.
I do want to touch on CMS certified IRF
and IPF units as well.
These units are somewhat of a special case
when it comes to FacWideIN
because while they are inpatient units,
they do have a separate CMS certification number,
or CCN,
from the acute care hospital.
So, because of this denominator data
from these units are included
in the total facility patient days
and admission counts,
which is line one of the FacWideIN summary form,
however, denominator data for these units
are excluded from lines two and three.
So, if your facility needs or wants
to follow LabID event reporting for these units,
they would be added separately
to the monthly reporting plans,
and would have separate monthly summary forms
to collect unit-specific denominator data.
Just to note,
if your facility has a CMS-certified IRF unit
within your acute care hospital
and are reporting CDI LabID
for the Inpatient Rehabilitation Facility
Quality Reporting Program,
the numerator and denominator data are separate
from the hospital's FacWideIN CDI SIR.
Okay, let's move on to LabID events.
LabID events are reported at the location level.
If any of you have already entered LabID event data
into NHSN,
you know that FacWideIN
is not a selection on the LabID event form.
So, LabID events are reported at the location level
because the SIR numerator algorithms
use locations to determine
which LabID events are counted
in the FacWideIN SIR numerator.
So, for example,
events reported to a CMS-certified IRF and IPF unit
are excluded from the FacWideIN SIR numerator.
I also wanna mention the Report No Events checkbox
in the context of LabID events and locations.
So, each MDRO/CDI summary form at the bottom
has an area where you can indicate no events
for the specific locations,
such as FacWideIN, ED,
or 24-hour observation units.
And so, specifically on the FacWideIN summary form,
if no LabID event was reported
in any inpatient location for that month,
then the Report No Events checkbox
should be checked
for that specific summary form.
And then there are separate checkboxes
for the separate summary forms
for ED and observation locations.
So, please note that
if a facility does not appropriately check
the Report No Events checkbox,
that month's data will be excluded
from the SIR calculations.
And a frequently asked question that we receive
regarding the Report No Events checkbox
is alerts.
So, we can go through the process
of how to handle these alerts
if you ever do come across one.
So, in this example,
the user says that their facility
has reported a CDI event in this month,
but they're confused as to why they have an alert
to check the Report No Events checkbox.
So, the first step in this scenario
would be to check your CDI LabID Line Listing report
for the month,
just so we can review all of the events
that were reported.
So, let's say in this example,
the facility checks their Line Listing report
and they have reported one CDI LabID event for this month,
but it was reported in an outpatient location,
such as the emergency department.
Okay, great.
So, what would this mean?
It means that the alert
to check the Report No Events box
on the FacWideIN summary form is correct
because there were no CDI LabID events reported
in any inpatient location for that month.
However, since the summary forms are separate,
the Report No Events checkbox
would not need to be checked
on the ED summary form for this month
since that one CDI LabID event
was reported in the ED.
Now that we have reviewed how LabID events
and summary data fall under FacWideIN reporting,
let's go through an example
in the NHSN analysis reports.
And as a disclaimer,
all of the data in the reports
on the next few slides
are fictitious and for illustrative purposes only.
So, let's say that you finished entering
all of your FacWideIN CDI lab event reporting data
for the quarter,
and you wanna review how all of the data
is being included in your analysis reports.
So, let's first start with the Line Listing report
in this case.
So, in this CDI line Lister report on the screen,
we can see that this facility reported four CDI events
for the quarter.
When we take a closer look
under the location column,
we can see the units
for which these events were reported in.
So, it looks like two events were reported
in outpatient locations,
ED1 and OBS,
and it looks like the other two events
were reported in inpatient locations.
This would be ICU MED
and I circled those on the screen.
Reminder that FacWideIN isn't listed
under the location column
in this analysis report
because events are reported at the location level.
But we do know that FacWideIN covers all inpatient units,
so, the events reported in the ICU and MED
are included in FacWideIN.
Moving on to the Summary Data Line Listing report,
this report shows us all of our denominator data
that was entered on the summary form
for each month of this quarter.
So, since denominator data is reported
at the FacWideIN level,
we do see FacWideIN under the location column
in this report.
For the quarter,
there are three FacWideIN lines of denominator data
circled on the screen,
one for each month of the quarter.
We can also see there are additional lines of data
for the OBS and the ED location for each month.
And this makes sense
since we know that these units
have separate summary forms for the month.
And finally, the last report we may wanna review
is the CDI SIR report.
Again, in this report,
we can see that FacWideIN
is listed under the location column,
which is correct
since the CDI SIR is only calculated
at the FacWideIN level.
We can also see that all three months of data
for the quarter
are included in this report's calculation.
And that the SIR numerator algorithm determined
that both of those inpatient CDI events
from the line list
are counted in the numerator
of the CDI SIR.
Going across, we can also see that number predicted
was calculated for the quarter
at the FacWideIN level.
And number of CDI patient days
are summed for the three months of the quarter.
And then finally,
the CDI SIR for this quarter is 0.855
for this facility at the FacWideIN level.
So, as we conclude this presentation,
I wanted to point you to some great resources
to help with setting up FacWideIN LabID event reporting,
reporting denominator data for FacWideIN,
and also troubleshooting the LabID event SIRs.
All of these resources are accessible from NHSN's website.
I wanna thank you all for listening
to today's presentation.
I hope this material was helpful.
And if you do have any questions,
please feel free to email them
to nhsn@cdc.gov.
Thank you again. [SK(1]Sunny may have said “as” not “it’s.”