Colorado Trauma Registry Colorado Trauma Network Prepared by Health and Safety Data Services July 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! 2DRAFT

3 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” DRAFT4

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 5DRAFT

Discharge Dispositions 6 DRAFT N#National ElementsCDPHE Elements (from Current Data Dictionary 2014) 1Short-term g. hosp. for inpt careACUTE= acute hospital (N1) 2Intermediate Care FacilityICF = intermediate care facility (N2) 3Home under health sev.HH = home under care of home health agency (N3) 4Left against adviseAMA = left against advice (N4) 5ExpiredD = died after admission (NOT in the ED) (N5) 6Home w/ no home servicesHOME = home with no home health services (N6) 7Skilled nursing facilitySNF = skilled nursing (N7) 8Hospice careHOSPICE = hospice care (N8) 9RET. Rehab & Long-term 10Court/lawJAIL = jail, prison, or other detention facility (N10) 11Inpt. rehab or design. unitREHAB = rehabilitation (N11) 12Long-term care hospLTAC = Modified LTAC (see handout) 13Psy. Hosp/ psy unit of hosp.PSYCH = To inpatient psychiatric care…may be another facility or a division of the same facility. (N13) 14Another 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 CMS Ideas from TJC 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? DRAFT7

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” DRAFT9 Download to the State Trauma Registry

Questions for State – Topics for Discussion DRAFT10

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? 11 DRAFT

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.) DRAFT13

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: DRAFT14

Contact us! Health Facilities and EMS Division Colorado Department of Public Health & Environment 4300 Cherry Creek Drive South Denver, CO Phone: (303) Fax: (303) DRAFT