Thank you and yes this piece of logic “less than or equal to 2 days starts after end of SCIP major surgery procedure” was changed in the 2015 AU. The logic for version 5 reads- less than or equal to starts after the start of "Occurrence A of Encounter, Performed: ICU Admission or Transfer" AND: Union of:  "Medication, Administered: Diuretics" <= 2 day(s) starts after start of "Occurrence A of Encounter, Performed: ICU Admission or Transfer"  "Medication, Administered: Paralytic Agents" <= 2 day(s) starts after start of "Occurrence A of Encounter, Performed: ICU Admission or Transfer"  "Medication, Administered: IV Positive Inotropic and Vasopressor Agents" <= 2 day(s) starts after start of "Occurrence A of Encounter, Performed: ICU Admission or Transfer"

Initial Question Posted 8/3/2015 ( CQM-1651 ): We are receiving multiple questions around when a patient's ICU location begins prior to the SCIP surgery. Example: Patient is in an ICU location then goes to surgery and then returns back to their ICU location. These statements appear to be looking for the ICU location to start after end of the SCIP procedure. ONCJIRA CQM Response: The logic noted in the ticket is from SCIP 178v4. Please see CQM-1217 . This measure focuses more on the urinary catheter and when it was removed rather than the occurrence of ICU. Maybe these scenarios will help: Scenario 1 (ICU Prior to Procedure) DEN - The patient could be in ICU @ 8am Monday, Major Surgical SCIP procedure performed at 10 AM on Monday at which time the urinary catheter is placed after anesthesia; returns to ICU on Monday, then moved to MedSurg on Tuesday at which time the urinary catheter is removed. NUM - Urinary catheter ended after the SCIP Major Surgical procedure and removed on Tuesday which is less than 2 days. Therefore, the patient would pass the NUM.                                                                                                           Scenario 2 (ICU Post Procedure) DEN - The patient arrives for SCIP Major Surgical Procedure on Monday at 8 am, surgery begins, urinary catheter placed after anesthesia; pt. moved to ICU, then on Tuesday morning @ 7 AM moved to MedSurg at which time the urinary catheter is removed. NUM - Urinary catheter ended after the SCIP Major Surgical procedure and was removed on Monday which is less than 2 days. Therefore the would patient pass the NUM. Follow up Question: We understand the urinary catheter criteria; however we are not experiencing fallouts in that area. The fallouts are occurring with the exclusions for the measure. While it is ideal workflow that the patient be transferred to ICU after they go to surgery, there are numerous patients being admitted to ICU prior to surgery and then returning to ICU after surgery. This flow of the patient is not being adequately captured in the measure due to the AND statement attached to the medication where it evaluates the location “less than or equal to 2 days starts after end of SCIP major surgery procedure”